Pain Assessment and Pharmacological Control

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Questions and Answers

What is a reason that remifentanil and sufentanil can only be administered by specific professionals?

They are less potent than other opioids.

They require specialized monitoring due to their potency. (correct)

They can only be used in outpatient settings.

They have longer durations of action than most opioids.

Why may it be necessary to administer repeated doses of naloxone (Narcan)?

Naloxone is less effective in reversing opioid effects over time.

Naloxone has a longer duration of action than most opioids.

Naloxone is an opioid itself and can cause dependence.

Naloxone's effects wear off sooner than those of the opioids. (correct)

What factor should be considered regarding the maximum daily dosage of acetaminophen?

The half-life of acetaminophen determines dosage limits.

Acetaminophen should not exceed 4 g/day. (correct)

Acetaminophen is safe at any dosage in healthy individuals.

Acetaminophen can be taken in unlimited amounts.

Which of the following conditions is NOT increased by the use of NSAIDs?

Muscle growth Signup and view all the answers

For what condition is ketorolac (Toradol) typically used?

Post-operative pain relief Signup and view all the answers

When should a secondary pain assessment be completed after administering IV analgesics?

30 minutes Signup and view all the answers

Which of the following is NOT a side effect of morphine?

Bradycardia Signup and view all the answers

What is the primary indication for administering morphine?

Severe pain Signup and view all the answers

Which medication should be administered for a patient on morphine experiencing respiratory depression?

Naloxone Signup and view all the answers

Fentanyl is how many times stronger than morphine?

50-100x Signup and view all the answers

Which of the following forms is NOT available for fentanyl?

Sublingual tablet Signup and view all the answers

What is a common reason for using hydromorphone over morphine?

Less risk of pruritus and nausea Signup and view all the answers

Which medication is preferred for patients with opioid dependence?

Methadone Signup and view all the answers

What is a significant drawback of Meperidine?

It accumulates toxic metabolites Signup and view all the answers

How does the duration of action of methadone compare to that of morphine?

Longer duration Signup and view all the answers

Study Notes

Pain Assessment

Physiological indicators are not primary indicators of pain, but cues to begin further assessment.
A secondary pain assessment should be completed after:
- IV analgesics: 30 minutes
- Oral analgesics: 1 hour
Two pain assessment tools for ventilated patients:
- Critical Care Pain Observation Tool (CPOT): 0-2
- Behavioral Pain Scale (BPS): 3-12

Pharmacological Control of Pain

Four types of pharmacological control of pain:
- Opioid agonists: Morphine
- Nonopioids: Gabapentin, Tramadol
- Adjuvants: Promethazine (Phenergan)
- Opioid analgesics: Oxycodone (Percocet)
Morphine is available in:
- Oral form
- Injection
Morphine onset is fast, but the duration is longer than fentanyl.
Morphine indications:
- Severe pain
Morphine side effects:
- Respiratory depression
- Pruritus
- Vasodilation
- Sedation
- Nausea/vomiting
Naloxone (Narcan) is given for morphine-induced respiratory depression.
Benadryl is given for morphine-induced pruritus.
Promethazine (Phenergan) is given for morphine-induced nausea/vomiting.

Fentanyl

Fentanyl is 50-100 times stronger than morphine, therefore dosed in mcg.
Fentanyl is available in:
- Injection
- Transdermal patch
- Lozenge
Fentanyl side effects are similar to morphine but can also cause:
- Bradycardia
- Chest wall rigidity if given too rapidly

Hydromorphone

Hydromorphone is more potent than morphine and causes less pruritus, nausea, and vomiting.
Hydromorphone is not indicated for patients with:
- Renal failure
- Hepatic failure

Meperidine (Demerol)

Meperidine is less potent than morphine.
Meperidine's metabolite is CNS toxic.
Meperidine has a shorter duration requiring frequent doses.

Other Pain Management Drugs

Codeine is very effective in stopping coughs.
Methadone is preferred for patients with opioid dependence.
Methadone has a longer duration/half-life than morphine with less sedation.
Remifentanil and sufentanil can only be given by doctors and CRNAs due to their extreme potency.
Repeated doses of Naloxone (Narcan) may be needed because the duration of its effect is shorter than opioids.

Adjuvants

Adjuvants enhance the effect of opioids.

Acetaminophen (Tylenol)

Acetaminophen should not be used in cases of:
- Liver failure
- High alcohol consumption
Acetaminophen dosage should not exceed 4 grams/day.

NSAIDs (Non-steroidal Anti-inflammatory Drugs)

NSAIDS increase the risk of:
- Kidney failure
- Bleeding
- Gastric ulcers

Ketorolac (Toradol)

Ketorolac (Toradol) is typically given for post-operative pain.
It is typically given for a maximum of 5 days.
Ketorolac (Toradol) can increase the risk of bleeding.

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Description

This quiz covers essential aspects of pain assessment and pharmacological control for healthcare professionals. You will learn about key indicators, assessment tools for ventilated patients, and various pharmacological options for pain management, including opioids and their side effects. Test your knowledge on handling severe pain and associated medications like morphine and naloxone.