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95 Cards in this Set

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Matching:
1. throbbing, well localized pain
2. pain from nerve injury
3. pain arising from muscle
4. pain arising from liver
5. exaggerated painful response to non noxious stimuli
6. chronic pain
7. pain that presents as if it's coming from somewhere else
8. pain from burn
9. acute pain
10. chronic pain not assoc'd w/ malignant dz

a. nociceptive
b. somatic
c. visceral
d. neuropathic/fxl pain
a & b 1. throbbing, well localized pain
d 2. pain from nerve injury
a & b 3. pain arising from muscle
a & c 4. pain arising from liver
d 5. exaggerated painful response to non noxious stimuli
d 6. chronic pain
a & c 7. pain that presents as if it's coming from somewhere else
a 8. pain from burn
a. 9. acute pain
a &/or d 10. chronic pain not assoc'd w/ malignant dz

a. nociceptive
b. somatic
c. visceral
d. neuropathic/fxl pain
T/F managing pain up front prevents chronic pain & avoids pain anxiety syndrome
true
which of the following is NOT true of chronic non malignant pain?

a. persists months to yrs
b. pain from ongoing nociceptor stimulation
c. pain is often the result of normal activation of nociceptors
d. pain may not have an IDable cause
e. pain may come from abnormal activity of sensitized Rcs in inflamed tissue
f. ppl experience dep, sleep distrubance, fatigue, dec phys fxing, & anxiety due to pain
c. pain is often NOT the result of normal activation of nociceptors

rest T:
a. persists months to yrs
b. pain from ongoing nociceptor stimulation
d. pain may not have an IDable cause
e. pain may come from abnormal activity of sensitized Rcs in inflamed tissue
f. ppl experience dep, sleep distrubance, fatigue, dec phys fxing, & anxiety due to pain
T/F chronic malignant pain TX is intended to relieve suffering rather than TXing the disease
true: make cancer PT comfortable
T/F Acute pain is often associated with other problems ie. depression, anxiety
false: chronic non malignant pain is assoc'd w/ problems NOT acute pain
where are impulses from nociceptors interpreted by the body as pain? (where is pain perceived)

a. dorsal root ganglia
b. cerebral cortex
c. dorsal horn
d. hypothalamus
b. cerebral cortex

a. dorsal root ganglia -- location of nociceptors
c. dorsal horn -- transmission location
d. hypothalamus -- fake answer
Myelinated A fibers transmit (sharp/dull) impulses.

Unmyelinated C fibers transmit (sharp/dull) impulses
Myelinated A fibers transmit SHARP impulses.

Unmyelinated C fibers transmit DULL impulses (that are stronger)
T/F By blocking substance P on afferent fibers the body is able to lessen the pain you feel.
true: modulation mech
T/F You should always be a little skeptical of the PT, esp when dealing with pain.
false: believe the PT!
What is the PQRSTU method of pain assessment?
P -- precipitation & palliating. What causes/relieves the pain?
Q -- quality
Shooting, aching, gnawing, or throbbing?
R -- region & radiation
where is the pain? where does it spread?
S -- severity
what is the intensity on the pain intensity scale?
T -- temporal
constant/intermittent? freq?
U - you
how is the pain affecting your life?
matching pain intensity scales:

1. simple description
2. 0 - 10 numeric
3. visual analog scale
4. faces

a. children
b. most commonly used
c. PT can point to their pain
d. other pain scale appropriate for other PTs
d 1. simple description
b 2. 0 - 10 numeric
c 3. visual analog scale
a 4. faces

a. children
b. most commonly used
c. PT can point to their pain
d. other pain scale appropriate for other PTs
pain goal for everyone is:

a. pain free
b. 1-3
c. 4-6
pain goal for everyone is:

b. 1-3

c. pain 4-6 w/ activity may be acceptable based on the situation
at each level of pain if that TX isn't working

a) inc dose to MAX
b) add another therapy
c) change therapy
d) all the above are appropriate
d) all the above are appropriate

at each level of pain if that TX isn't working

a) inc dose to MAX
b) add another therapy
c) change therapy
T/F By using multimodal analgesia the doses of each analgesic can be lower than if the analgesic was dosed alone.
true: synergistic/additive effect allows for lower doses of each, which is good bc it has less SE
T/F Local anesthetics & anti inflamms work well @ peripheral areas
true
T/F Acetaminophen is an NSAID that is effective at reducing inflammation
false: APAP NOT NSAID or anti-inflamm agent
APAP is NOT indicated for:

a. mild
b. moderate pain
c. severe pain
d. non visceral pain
e. all the above
c. severe pain

APAP is NOT indicated for severe pain. It is indicated for mild - mod pain; non visceral pain, & bone pain
which of the following is a likely SE of APAP?

a. impaired uric acid execretion
b. impaired prothombin synthesis
c. severe cross reactivity w/ ASA
d. hepatic complications
d. hepatic complications

all of the rest are NSAID SEs:
a. impaired uric acid execretion
b. impaired prothombin synthesis
c. severe cross reactivity w/ ASA
What is the max amt of APAP/day you'd want to take to min liver damage?
4g
what should you always counsel PTs about in terms of APAP?

a. other names of APAP
b. limit daily dose to <4g
c. beware of other combo prods that contain APAP
d. all of the above
d. all of the above

always counsel PTs about

a. other names of APAP
b. limit daily dose to <4g
c. beware of other combo prods that contain APAP
doses > __g (#) QD have been assoc'd w/ inc in INR w/ PTs taking ____
doses >2.275g QD have been assoc'd w/ inc in INR w/ PTs taking WARFARIN
T/F IV APAP (paracetamol) is clinically MUCH better than PO bc of the increased BA
false: still questionable
T/F NSAIDs are 1st line for nociceptive & neuropathic pain.
false: NSAIDs are only 1st line for nociceptive pain
NSAIDs MOA:
inhibit COX enz that catalyzes PG synthesis from arachidonic acid
NSAIDs are indicated for:

a. inflammatory pain
b. neuropathic pain
c. bone pain
d. a & c
e. b & c
d. a & c

NSAIDs are indicated for:
inflammatory pain & bone pain

b. neuropathic pain efficacy not estab'd
T/F The higher the NSAID dose the greater the effect.
false: ceiling effect on ALL NSAIDs = up to a certain dose, adding more won't have any more effect
Matching:

1. gastro protective PGs
2. induced by inflamm mediators, TNF, & PG
3. effects on vascular endothelial cells & platelets
4. anti thrombotic effect
5. prothrombic effect

a. COX-1
b. COX-2
a 1. gastro protective PGs
b 2. induced by inflamm mediators, TNF, & PG
a 3. effects on vascular endothelial cells & platelets
b 4. anti thrombotic effect
a 5. prothrombic effect

a. COX-1
b. COX-2
Which is associated with CV risk?

a. COX-1 inhibitor
b. COX-2 inhibitor
b. COX-2 inhibitor --> COX-1 unopposed --> prothombic --> TXA2 --> CV risk & HTN
ketorolac should be used w/ caution after __ (#) days
5 days
T/F IV NSAIDs INCREASE opioid reqs & the incidence of AE compared to opioids alone
false: IV NSAIDs DECREASE opioid reqs & the incidence of AE compared to opioids alone
Which of the following is an opioid antagonist?

a. meperidine
b. morphine
c. naloxone
d. buprenorphine
c. naloxone = opioid antag
Name narcotic class:

morphine, hydromorphone, oxymorphone, oxycodone

a. strong agonists
b. weak agonists
c. synthetic strong agonists
d. mixed agonists-antags
a. strong agonists

morphine, hydromorphone, oxymorphone, oxycodone
Name narcotic class:

codeine, hydrocodone, tramadol

a. strong agonists
b. weak agonists
c. synthetic strong agonists
d. mixed agonists-antags
b. weak agonists

codeine, hydrocodone, tramadol
Name the narcotic class:

meperidine, fentanyl, methadone

a. strong agonists
b. weak agonists
c. synthetic strong agonists
d. mixed agonists-antag
c. synthetic strong agonists

meperidine, fentanyl, methadone
Name the narcotic class:

pentazocine, butorphanol, nalbuphine, buprenorphine

a. strong agonists
b. weak agonists
c. synthetic strong agonists
d. mixed agonists-antag
d. mixed agonists-antag

pentazocine, butorphanol, nalbuphine, buprenorphine
Which of the following are more selective for the analgesic Rc & may result in dec SE?

a. strong agonists
b. weak agonists
c. synthetic strong agonists
d. mixed agonists-antag
d. mixed agonists-antag

more selective for the analgesic Rc & may result in dec SE
1. full agonists occupy (mu / kappa / both) Rc(s)
2. partial agonists occupy part of (mu / kappa / both) Rc(s) --> less analgesia than full agonists
3. mixed agonist-antag act as agonist @ (mu/kappa) Rc & block activity at (mu/kappa) Rc
1. full agonists occupy BOTH mu & kappa Rcs
2. partial agonists occupy part of MU Rc --> less analgesia than full agonists
3. mixed agonist-antag act as agonist @ KAPPA Rc & block activity at MU Rc
Which of the following opioid AEs do you not build tolerance to?

a. constipation
b. impaired judgment/psychomotor fxs
d. sedation
d. resp dep
e. you don't build tolerance for any of these AEs
a. constipation

no tolerance --> TX by inc fluid intake & stimulant laxatives QD
T/F opioid naive PTs are at lower risk for AE than opioid experienced PTs
false: naive PTs @ HIGHER risk for AE than experienced PTs
APAP tolerance develops after ~
1. resp depression:
2. sedation:
3. impaired judgment/psychomotor fxs:
APAP Tolerance develops after ~
1. resp depression: 5-7 days
2. sedation: 5 days
3. impaired judgment/psychomotor fxs: 4-7 days
how do you prevent constipation assoc'd w/ opioid use?
1. inc fluid intake
2. stimulant laxatives QD
all of the following help to reduce addictive behavior EXCEPT:

a. freq clinic visits
b. contracts
c. drug & alcohol abstinence pgm
d. urine testing
e. family support
f. high supply of narcotics
g. choosing a less abused agent
f. high supply of narcotics --> LOW supply of narcotics dec addictve behavior


dec addictive behavior by: freq clinic visits, contracts, drug & alcohol abstinence pgm, urine testing, family support, choosing a less abused agent, psy/social involvement, monitor pain & actions
which opioid is considered the gold standard for pain therapy?

a. naloxone
b. oxycodone
c. morphine
d. codeine
c. morphine

gold standard for pain therapy, bc most studied not bc it's the most effective
T/F morphine has a ceiling effect like NSAIDs
false: no ceiling effect for morphine
morphine needs to be used w/ caution in:

a. PTs w/ liver disease
b. renal failure
c. cirrhosis
d. all the above
d. all the above
morphine needs to be used w/ caution in:
a. PTs w/ liver disease
b. renal failure
c. cirrhosis
hydromorphone needs to be used w/ caution in:

a. PTs w/ liver disease
b. renal failure
c. cirrhosis
d. all the above
b. renal failure

hydromorphone needs to be used w/ caution in:
Which of the following is NOT true about oxycodone

a. no dose ceiling
b. must use caution in severe liver disease PTs
c. must use caution in renal failure PTs
d. is OK for PTs that are breast feeding
e. oxycodone is ONLY available PO
d. is OK for PTs that are breast feeding --> oxycodone is NOT rec'd during breast feeding
Meperidine (demerol) is safe for

a. PCA use @ high dose escalation
b. renal insufficiency PTs
c. hepatic insufficiency PTs
d. none of the above
d. none of the above

Meperidine (demerol) is NOT safe. Too many SE including convulsions, neurotoxicity, renal & hepatic insufficiency bc normeperidine (metabolite) accumulates.
What is the dose limit of codeine?
180mg/day
T/F codeine must be activated by the kidney to morphine before it has any analgesic activity
false: must be activated by liver (CYP2D6) for analgesic activity
which of the following is NOT a CYP2D6 inhibitor?

a. ibuprofen
b. paroxetine
c. ritonavir
d. amiodarone
e. fluoxetine
a. ibuprofen

paroxetine, ritonavir, amiodarone, & fluoxetine are all CYP2D6 inhibitors
Tramadol is better at TXing (nociceptive/neuropathic) pain.
Tramadol is better at TXing NEUROPATHIC pain
T/F Codeine is not rec'd for renal failure PTs
true
tramadol is C/I for PTs w/ a Hx of

a. renal failure
b. liver failure
c. seizures &/or taking drugs that lower seizure threshold
d. all the above
c. seizures &/or taking drugs that lower seizure threshold

tramadol is C/I for PTs w/ a Hx of
It is not rec'd to take tramadol w/ SSRIs, TCAs, other opiate agonists & MAOIs due to the possibility of ______ _____.
It is not rec'd to take tramadol w/ SSRIs, TCAs, other opiate agonists & MAOIs due to the possibility of 5HT SYNDROME.
fentanyl patches are dosed in __/hr.

a. mcg
b. mg
c. g
fentanyl patches are dosed in MCG/hr
(fentanyl/morphine) is more potent than (fentanyl/morphine)
FENTANYL is more potent than MORPHINE
Which of the following is not true ab fentanyl:

a. highly PRO bound
b. change patch q 2-3days depending on pain
c. available as PO, IV, TD patch
d. safe for hepatic & renal dysfx
c. available as PO, IV, TD patch

fentanyl NOT available as PO
Which of the following is/are safe to use if a PT has hepatic & renal insufficiency?

a. morphine
b. oxycodone
c. meperidine
d. codeine
e. fentanyl
f. hydromorphone
g. tramadol
e. fentanyl (C/I pain mgmt & life threatening resp dep) & g. tramadol (C/I seizures or SSRIs, TCAs, opiate agonists, MAOIs)

a. morphine --> C/I liver dz & renal failure
b. oxycodone --> C/I severe liver dz, renal failure, breast feeding
c. meperidine --> C/I renal & hepatic insuff
d. codeine --> C/I renal & hepatic insuff
f. hydromorphone --> C/I renal failure
what is the morphine equivalent of a fentanyl patch TDF (transdermal fentanyl)?
TDF = 50% PO morphine/day ie. 25mcg/hr fentancyl = 50mg/d PO morphine
T/F there is no real diff in analgesia b/t the full mu agonists
true
T/F greater potency means the agent works better bc you have a high analgesic effect
false: greater potency DOESN'T mean agent works better. Just means use less of drug to obtain same equal analgesic effect
matching:
1. no ceiling effect
2. true ceiling
3. fxl dose ceiling

a. codeine
b. morphine
c. buprenorphine
b 1. no ceiling effect -- all mu agonists
c 2. true ceiling -- mixed agonist-antag opioids
a 3. fxl dose ceiling -- limited by SE

full agonists: morphine, hydromorphone, oxycodone, oxymorphone
mixed agonist-antag: pentazocine, butorphanol, nalbuphine, buprenorphine

a. codeine
b. morphine
c. buprenorphine
True opioid allergies are rare, if they do happen you should switch medicinal chemical classes if allergic rxn occurs.
Which of the following is appropriate?

a) morphine --> codeine
b) morphine --> hydrocodone
c)methadone --> levomethadyl
d) oxycodone --> fentanyl
d) oxycodone --> fentanyl

phenanthrenes: morphine, codeine, hydrocodone, hydromorphone, oxycodone, oxymorphone

phenylpiperidine: meperidine, fentanyl

phenylheptanones/diphenylheptanes: methadone, levomethadyl
Name the medicinal chemical class of the following opioids:

morphine, codeine, hydrocodone, hydromorphone, oxycodone, oxymorphone

a. phenanthrenes
b. phenylpiperidine
c. phenylheptanones/ diphenylheptanes
a. phenanthrenes

morphine, codeine, hydrocodone, hydromorphone, oxycodone, oxymorphone
Name the medicinal chemical class of the following opioids:

methadone, levomethadyl

a. phenanthrenes
b. phenylpiperidine
c. phenylheptanones/ diphenylheptanes
c. phenylheptanones/ diphenylheptanes

methadone, levomethadyl
Name the medicinal chemical class of the following opioids:

meperidine, fentanyl

a. phenanthrenes
b. phenylpiperidine
c. phenylheptanones/ diphenylheptanes
b. phenylpiperidine

meperidine, fentanyl
(IV/IM) is preferred over (IV/IM) if PO is not viable option for acute pain
IV is preferred over IM if PO is not viable option for acute pain.
IM for acute pain is NOT rec'd bc

a. painful
b. wide rngs in rate of absorption
c. peak lag effect
d. all the above
d. all the above

a. painful --> don't want to cause more pain if TXing for pain
b. wide rngs in rate of absorption
c. peak lag effect --> 60-90 min want relief ASAP
matching for PCA dosing:

1. loading dose
2. bolus dose
3. lock out interval
4. dose limit
5. continuous infusion

a. ~1-2mg/hr
b. 1st dose
c. time in b/t bolus doses
d. per hr
e. PT gives themself
b 1. loading dose
e 2. bolus dose
c 3. lock out interval
d 4. dose limit
a 5. continuous infusion

a. ~1-2mg/hr
b. 1st dose
c. time in b/t bolus doses
d. per hr
e. PT gives themself
the loading dose is usually (bigger/smaller) than the bolus dose
the loading dose is usually BIGGER than the bolus dose bc you want to get closer to steady state up front
Goal pain scores <(#) @ rest & <(#) w/ activity
Goal pain scores < 3 @ rest & <5 w/ activity
if analgesia inadequate inc dose by #%
if analgesia inadequate inc dose by 25%
Which of the following is NOT an appropriate agent for PCA?

a. morphine
b. hydrocodone
c. oxycodone
d. hydromorphone
e. all the above are appropriate
b. hydrocodone & codeine
NOT appropriate agents for PCA
T/F If PT can be switched to PO analgesia from IV, they should be.
true
1. When switching from IV --> PO analgesia what is the time frame of PCA overlap?
2. In that window, should you give PO analgesia while still on PCA?
1. 4-6 hrs
2.YES, so PT isn't in pain during switch
T/F If a PT is experiencing pain around the clock, it is not appropriate to give pain meds around the clock for relief.
False: if PT is in pain around the clock, dose around the clock for pain relief
which of the following does NOT describe neuropathic pain?

a. shooting
b. throbbing
c. numbness
d. stinging pain
e. burning
f. all the above
b. throbbing describes acute/nociceptive pain

shooting, numbness, burning, stinging, needles = neuropathic pain
chronic non malignant pain can be caused by ____ pain

a. nociceptive
b. neuropathic
c. psychogenic
d. all the above
d. all the above

chronic non malignant pain can be caused by ____ pain

a. nociceptive
b. neuropathic
c. psychogenic
Matching:

1. carbamazepine
2. tramadol
3. TCA
4. SSNRI
5. gabapentin
6. citalopram
7. lidocaine patch

a. 1st line neuropathic agent
b. 2nd line neuropathic agent
c. 3rd line neuropathic agent
c 1. carbamazepine
b 2. tramadol
a 3. TCA
a 4. SSNRI
a 5. gabapentin
c 6. citalopram
a 7. lidocaine patch

a. 1st line neuropathic agent
b. 2nd line neuropathic agent
c. 3rd line neuropathic agent
T/F Mgmt of neuropathic pain has very STRICT guidelines uniformly followed by all practitioners.
false: guidelines aren't held together well, mainly based on each Dr's individual experiences w/ particular drugs
correct sequence of neuropathic pain:

a. assess pain & ID cause of NP
b. Add 2nd line agent bc 1st line agent has failed
c. TX cause of NP
d. Add 1st line agent for Sxmatic relief
e. Reassess pain (avg pain 4/10)
f. Add 2nd 1st line agent
g. Reassess pain 2nd time (2/10)
h. Continue TX
i. Refer to specialist
a --> c--> d --> e --> f or b--> g --> h


a. assess pain & ID cause of NP
b. Add 2nd line agent bc 1st line agent has failed
c. TX cause of NP
d. Add 1st line agent for Sxmatic relief
e. Reassess pain (avg pain 4/10)
f. Add 2nd 1st line agent
g. Reassess pain 2nd time (2/10)
h. Continue TX
i. Refer to specialist --> don't need to bc pain is under cntrl 2 < 3
T/F: TCAs (if F, why)

1. secondary amines have least amt of SE
2. 2nd line agent
3. safe for children & adolescents
4. causes orthostatic hypotension in elderly
5. qAM
T 1. secondary amines have least amt of SE
F 2. 2nd line agent --> 1st line
F 3. safe for children & adolescents --> black box warning bc suicidal ideation
T 4. causes orthostatic hypotension in elderly
F 5. qAM --> qPM causes sleepiness
T/F: SSNRI (if F, why)

1. duloxetine & venlafaxine TX DM peripheral neuropathy
2. SE: nausea
3. duloxetine should not be used in PTs w/ CVD
4. venlafaxine should not be used in PTs w/ CVD
5. placebo is equally as effective as low doses of venlafaxine
6. 1st line agent
T 1. duloxetine & venlafaxine TX DM peripheral neuropathy --> venlafaxine at high doses will TX
T 2. SE: nausea
F 3. duloxetine should not be used in PTs w/ CVD --> safe from CV SE
T 4. venlafaxine should not be used in PTs w/ CVD
T 5. placebo is equally as effective as low doses of venlafaxine
T 6. 1st line agent
T/F: Ca Channel 2 ligands (if F, why)

1. 3rd line agent
2. C/I bc increased suicide risk
3. gabapentin TID
4. dose related nausea & constipation
5. pregabalin QD
F 1. 3rd line agent --> 1st line
F 2. C/I bc increased suicide risk --> no link to inc suicide risk
T 3. gabapentin TID
F 4. dose related nausea & constipation --> dose related dizziness & sedation
F 5. pregabalin QD --> BID - TID
T/F: topical lidocaine (if F, why)

1. available as patch & gel
2. 2nd line agent
3. can change up to 5x/day
4. Tx central & localized neuropathic pain
5. Txs allodynia
T 1. available as patch & gel
F 2. 2nd line agent --> 1st line
F 3. can change up to 5x/day --> max 3x/day
F 4. Tx central & localized neuropathic pain --> ONLY localized
T 5. Txs allodynia
Which of the following can not TX post herpetic neuralgia?

a. lidocaine gel 5%
b. nortriptyline
c. venlafaxine
d. duloxetine
e. all the above can
c. venlafaxine

can not TX post herpetic neuralgia


lidocaine gel 5%, nortriptyline, & duloxetine TX post herpetic neuralgia
T/F: opioids (if F, why)

1. 1st line agent
2. low potential for misuse, but high potential for abuse & addiction
3. useful for episodic exacerbations
4. as good of an agent as TCA bc equal SE & equal analgesia
F 1. 1st line agent --> 2nd line
F 2. low potential for misuse, but high potential for abuse & addiction --> high potential for misuse, abuse, & addiction
T 3. useful for episodic exacerbations
F 4. as good of an agent as TCA bc equal SE & equal analgesia --> equal analgesia BUT opioids SE >> than TCA
when giving analgesia, the goal is to "control the pain".

T/F Beckham has an avg pain of 8/10, we need to give him enough analgesia to drop his pain to 1-3.
F when giving analgesia, the goal is to "control the pain". Initial drop in 2-4 of pain rating, if he was at an 8, we need to give him enough analgesia to reach 4-6 NOT complete relief.
T/F: narcotics (if F, why)

1. no max dose
2. morphine is the most effective narcotic
3. IV more potent than PO
4. IM more potent than PO
5. ALL narcotics can be titrated QD
T 1. no max dose
F 2. morphine is the most effective narcotic --> all narcotics equally effective if equivalent doses
T 3. IV more potent than PO
F 4. IM more potent than PO --> NEVER give IM
F 5. ALL narcotics can be titrated QD --> all except fentanyl patch & methadone
which of the following would NOT be an appropriate reason to change opioids?

a. too expensive
b. PT not experiencing relief from analgesic
c. develop hives, rash, SOB
d. PT thinks morphine is only for drug users
e. all are acceptable reasons to change
e. all are acceptable reasons to change

a. too expensive --> cost & formulary issues
b. PT not experiencing relief from analgesic --> lack of therapeutic response
c. develop hives, rash, SOB --> AE
d. PT thinks morphine is only for drug users --> PT/family stigma
T/F: break thru pain (if F, why)

1. inc total daily dose if experiencing incidental break thru pain
2. inc frequency of dosing if experiencing end of dose break thru pain
3. give 25-50% of total daily dose as immediate release PO PRN q1-4 PRN break thru pain
4. give 1/4 of 10% of total daily dose IV q15 min PRN break thru pain
5. must be very specific when ordering narcotics & write purpose (fever vs pain)
F 1. inc total daily dose if experiencing incidental break thru pain --> TX INCIDENTAL & SPONTANEOUS break thru pain w/ IMMEDIATE release narcotics
T 2. inc frequency of dosing if experiencing end of dose break thru pain --> inc dose &/or freq
F 3. give 25-50% of total daily dose as immediate release PO PRN q1-4 PRN break thru pain --> 10-15%
T 4. give 1/4 of 10% of total daily dose IV q15 min PRN break thru pain
T 5. must be very specific when ordering narcotics & write purpose (fever vs pain)
T/F: titration (if F, why)

1. titrate 10-15% moderate pain
2. titrate 25-50% severe pain
3. titrating 100% for severe pain is appropriate
4. Break thru pain meds should be given IN ADDITION to long acting meds
F 1. titrate 10-15% moderate pain --> 25-50%
F 2. titrate 25-50% severe pain --> 50-100%
T 3. titrating 100% for severe pain is appropriate
T 4. Break thru pain meds should be given IN ADDITION to long acting meds
when switching to a diff opioid, you may experience incomplete cross tolerance. how much do you decrease/increase the dose by?
dec by 25-50% for incomplete cross tolerance
Which case would you have to factor in incomplete cross tolerance?

a. Oxycodone IR --> CR
b. morphine PO --> IV
c. oxy PO --> morphine PO
d. oxy CR --> TDF
No a. Oxycodone IR --> CR same agent
No b. morphine PO --> IV same agent
Yes c. oxy PO --> morphine PO bc changing agents
No d. oxy CR --> TDF bc TDF & methadone don't calc incomp X tolerance