Pain Management

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Neuropathic pain is abnormal signal processes in the CNS and can be peripheral and

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Examples of peripheral neuropathic pain include (select all that apply):

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A example of central neuropathic pain is fibromyalgia.

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Opioid therapy is not a line treatment for neuropathic pain.

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An example of nociceptive pain is tissue .

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There are two types of nociceptive pain, which includes muscle, skin and bones and which includes organs.

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Acute pain is defined as (select all that apply):

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Chronic pain (select all that apply):

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T or F. The WHO analgesic ladder recommends non-opioids in the treatment of mild pain.

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The WHO analgesic ladder recommends the use of opioids along with non-opioid and adjuvant treatments in treating to pain.

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The 1st line treatment for mild to pain is Acetaminophen and NSAIDS.

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T or F. Use the max dose of acetiminophen or NSAIDS before proceeding to analgesics.

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T or F. Acetaminophen generally has a favorable side effect profile.

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Two considerations in using NSAIDS are patients with a history of CV disease and bleeding.

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Acetaminophen is best for patients with non-inflammatory like Osteoarthritis and chronic low back pain.

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T or F. Acetaminophen does not alter platelet functioning.

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Acetaminophen is known to be hepatoxic and can impact function.

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There is caution in using acetaminophen in patients with a history of ETOH abuse and hepatic dysfunction.

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Acetaminophen interacts with warfarin/coumadin and prolongs .

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Acetaminophen is the drug of choice as an analgesic and antypyretic in (select all that apply):

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NSAIDS have and analgesic properties.

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Prescription examples of NSAIDS like Naprosyn has a more onset and Meloxicam has a duration of action.

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T or F. NSAIDS are effective treatment for acute and chronic pain and inflammatory conditions.

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GI concerns with the of NSAIDS includes dyspepsia, ulceration and bleeding.

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T or F. Selective COX 2 inhibitors have less GI Risk.

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Safety concerns and considerations with NSAID with CV disease or thrombotic events include (select all that apply):

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In patients with or at risk for CV disease, NSAIDS should be , or, if benefits outweigh risks, use at the effective dose, for the duration necessary.

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T or F. NSAIDS should be avoided in older adults and in pregnancy.

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NSAIDS monitoring should include (select all that apply):

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In some psych patients, NSAIDS may lithium levels.

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NSAIDS should also be avoided in patients with a history of (select all that apply):

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T or F. NSAIDS may cause or worsen renal impairment.

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Indomethacin (Indocin) is an NSAID that is used in the treatment of acute and specific types of headaches.

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T or F. The MOA for Indomethacin is a potent inhibitory effect on renal prostaglandin synthesis.

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Indomethacin has more frequent side effects and has a higher risk of renal and CV toxicities.

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T or F. Sulindac (Clinoril) is an NSAID which cause more frequent hepatic inflammation, can contribute to the formation of renal calculi and the prescribing of this drug should be limited to specialists.

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Ketorolac is used for moderate pain, comes in tablets or injection and carries a BBW for short term use, less than days in adults.

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Contraindications and cautions in the use of Ketorolac include (select all that apply):

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T or F. Oral Ketorolac is not indicated in pediatrics.

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Topical NSAIDS have a risk for systemic effects.

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T or F. Diclofenac (Voltaren) gel is helpful in the relief of OA pain.

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Flector, an NSAID patch is helpful in pain due to minor strains, sprains and contusions.

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The MOA of topical lidocaine for pain is blocking the initiation and conduction of impulses.

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T or F. Topical lidocaine is best for neuropathic, local and OA pain.

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Adverse effects of topical lidocaine include local irritation.

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T or F. There is a low risk for systemic side effects if topical lidocaine is used properly.

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The following is true of steroid therapy for pain (select all that apply):

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A taper is required if steroids like Prednisone or Medrol dose pack are used for more than weeks.

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T or F. Cortisone can be given as an IM injection and has a short-acting duration of 2-3 days.

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Triamcinolone(Kenalog) Methylprednisolone (Depo-Medrol) have an intermediate potency and duration.

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Dexamethasone/Decadron has a potency and long-acting duration up to about days.

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T or F. Steroid injections in joints for pain, must be done by a trained provider.

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Major side effects associated with the use of systemic glucocorticoids is often -dependent and more likely to occur with -term use.

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Systemic glucocorticoids can cause elevated pressure, mood disorders, psychosis, insomnia, and impact blood sugar by causing hyerglycemia.

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Additional major side effects associated with the use of systemic glucocorticoids includes (select all that apply):

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Muscle relaxants used for pain are to be used short-term for less than weeks, and should be avoided in patients older than years.

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The main adverse effect of muscle relaxants for pain is .

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T or F. Antispasmodic skeletal muscle relaxants are indicated in the treatment of acute cervical or lumbar pain.

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Cyclobenzaprine (Flexeril) is not and can be dosed up to times a day if needed.

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T or F. Tizanidine (Zanaflex) is an Alpha 2 adrenergic agonist.

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Carisoprodol (Soma) is a substance that can cause respiratory and physical and psycholgic .

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Treatment options for chronic pain include (select all that apply):

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Treatment of chronic pain should be a multidisciplinary effort, using multiple approaches and collaborative care models to improve pain management and patient .

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should not be the sole focus of treatment, but should be used when according to evidence-ased recommendations to meet treatment goals and in conjunction with other treatment modalities.

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T or F. Adjuvants for chronic pain include anticonvulsants and antidepressants; they enhance analgesia and manage other symptoms associated with pain like depression and anxiety.

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Gabapentin (Neurontin) and pregablin (Lyrica) have proven efficacy versus placebo in several neuropathic conditions.

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Adverse effects of anticonvulsants like gabapentin and pregabalin for pain include and sedation.

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T or F. When using anticonvulsants as an adjuvant in pain management, start it with a low dose with gradual increases until pain relief.

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Pregabalin is controlled , reported to cause and is a Schedule .

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T or F. There are some reports of misuse with gabapentin.

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Venlafaxine (Effexor) and Duloxetine (Cymbalta) are that may provide relief separate from their anti-depressant effect.

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T or F. The analgesic effects of SNRI's appear to occure early and at lower doses.

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SNRI's are helpful treating pain from neuropathy, fibromyalgia and chronic musculoskeletal pain.

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T or F. SNRI's would have to be tapered gradually to avoid withdrawal symptoms.

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like amitriptyline (Elavil) are associated with multiple side-effects and do not carry a indication for management.

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In patients with chronic kidney disease and the elderly avoid and COX 2 inhibitors like Celebrex.

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T or F. Avoid NSAIDS with peptic ulcer disease and glucocorticoid use.

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In patients with cardiovascular disease or risk, use the lowest effective dose of NSAIDS; in patients who require treatment consider .

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Opioids are indicated for moderate to pain, are controlled drugs and powerful analgesics.

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T or F. When combined with acetaminophen and ibuprofen, opioids provide better pain control than if they are used alone.

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Opioids are receptor agonists.

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Mu1 correlate to supraspinal analgesia, bradycardia and sedation.

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Mu2 correlate to respiratory depression, euphoria and physical dependence

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Delta correlate to spinal analgesia and respiratory depression.

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Kappa correlate to spinal analgesia, respiratory depression and sedation.

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Higher potency opioids like morphine, hydromorphone and fentanyl are reserved for pain.

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Literature suggests opioids should only be used on a chronic basis in patients (select all that apply):

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Tramadol (Ultram) is a centrally acting weak of opioid receptors which also inhibits the reuptake of norepinephrine and causes release.

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T or F. Ultram is a Schedule IV controlled substance and has a higher risk for drug interaction due to hepatic metabolism due to CYP-450.

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Adverse effects of tramadol (Ultram) include (select all that apply):

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Tramadol (Ultram) should be avoided in patients with a history of or substance abuse and is not FDA approved for use.

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T or F. Tramadol (Ultram) would need to be tapered if discontinuing after prolonged use.

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Current evidence supports the role of opioid therapy in more severe forms of pain and in pain.

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There is limited evidence for effectiveness of -term opioid therapy for pain relief and improved functional outcomes.

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T or F. Opioid administration in chronic non-cancer pain remains controversial.

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Adverse effects of opioids include sedation and the highest risk for respiratory depression is in opioid patients.

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There is a higher risk for depression in the elderly, COPD and severe asthma.

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Additional adverse effects of opioids includes (select all that apply):

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Opioid overdose increases with increased dosing.

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The most common opioids involved in overdose deaths include (select all that appy):

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Benzodiazepines and opioids should be co-prescribed.

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T or F. Between 1999-2003, adults ages 25-54 had the highest overdose rates.

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Opioid naive patients have the risk for overdose death in the first two weeks of treatment and are defined as patients who have not received opioids for one week or longer at doses defined by the FDA for tolerance.

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According to the FDA, patients who are opioid-tolerant have been taking opioids for a 1 or longer in the following doses: at least 60mg of oral morphine QD, 25 mcg of transdermal fentanyl per hour, 30 mg oral oxycodone QD, 8 mg hydromorphone QD, 25 mg of oxymorphone QD or an equianalgesic dose of another opioid.

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Equianlagesic dosing is defined as the dose in state providing the same analgesic response also know as morphine equivalent dosing.

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T or F. Morphine is the gold standard for comparison of all pain relieving meds and serves as a reference point for analgesic potency.

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T or F. Morphine 30mg PO is equivalent to hydromorphone 7.5 mg PO.

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There is substantial interpatient variability in relative potency of different opioid .

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When changing from one opioid to another, it is preferable to consider initially underestimating requirements and provide rescue medication as needed to potentially fatal overdose.

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T or F. The elderly are more susceptible to the adverse effects of opioids and the NP should consider starting at 1/2 the typical starting dose.

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Opioids should not be prescribed in .

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Neonatal abstinence syndrome presents as irritability, hyperactivity, abnormal sleep patterns, high pitched , tremor, vomiting, diarrhea and failure to gain weight.

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T or F. Pregnant women who are dependent on opioids should be referred to a specialist who will likely place them on methadone or buprenorphine.

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Dependence is the emergence of withdrawal symptoms when the drug is abruptly discontinued or the dose is rapidly decreased, and usually occurs after taking the drug for month or longer.

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T or F. Dependence is a component of addiction, but not all patients with dependence are addicts.

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Opioid withdrawal signs and symptoms include (select all that apply)

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T or F. Additional symptoms of opioid withdrawal include tremors, dysphoria, anxiety, mood volatility, abdominal cramping, bone pains and diffuse muscle aches, as well as strong drug cravings.

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Tolerance is defined as increasing amounts of opioid required to produce an equivalent level of efficacy.

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T or F. Tolerance typically does not develop in patient with cancer who are treated for pain.

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Addiction is characterized as a psychological and behavioral syndrome, with extreme behavior patterns that are associated with procuring and consuming the .

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Features of opioid addiction include (select all that apply):

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Maladaptive behavior associated with addiction include (select all that apply):

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Prescription drug is using the prescribed drug outside of the intent for which it was prescribed and includes using to "get high". having multiple prescribers or non-prescribed sources for the medication, and concurrent use of alcohol, illicit substances or non-prescribed opioid controlled medications.

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Risk factors associated with increased risk for opioid misuse include (select all that apply):

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Aberrant behaviors associated with addiction include (select all that apply):

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The DSM-5 definition of Opioid Use Disorder is a problematic pattern of opioid use leading to clinically significant impairment of distress, as manifested by at least specific behaviors in a month period: larger amounts/longer period; persistent desire for opioid; spending excessive time to obtain, use or recover from the effects of opioids.

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Assisted Treatment or MAT, may be used to treat opioid use disorder and includes naltrexone (mild d./o). buprenorphine and methadone (moderate to severe) and naloxone (mild, moderate, severe)

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Indications for tapering in chronic opioid therapy include (select all that apply):

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When tapering opioids, it is recommended to reduce the dose by % each week.

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T or F. Clonidine can be used to treat the diarrhea and muscle pain associated with opiate withdrawal and Zolpidem or Doxepin for sleep issues.

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Methadone is a long-acting synthetic opioid with dual-mechanism on the Mu and NMDA receptor, and is a Schedule controlled substance.

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The following is true of methadone (select all that apply):

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Buprenorphine is a opioid, used for severe pain (just an FYI, our doctors at my hospital say it is illegal to prescribe it for pain) and opioid dependence and is considered a partial Mu-opioid and is a Schedule controlled substance.

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T or F. Buprenorphine can only be prescribed by specially trained MD's and NP.

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T or F. Buprenorphine combined with the antagonist naloxone is called Suboxone.

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T or F. There are critical opioid interactions with CNS depressants and alcohol.

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T or F. Many drugs can inhibit or induce the metabolism of opioids and raise or lower serum opioid levels, leading to increase risk for respiratory depression or sedation, or cause the development of withdrawal symptoms.

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The following drugs may induce the metabolism of opioids (select all that apply)

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T or F. Naloxone (Narcan) competitively binds to opioid receptors without producing analgesic response.

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Pain medications that are scheduled include (select all that apply):

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Schedule drugs have no currently accepted medical use in the US and have a high potential for abuse.

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Schedule drugs have a high potential for abuse, which may lead to severe psychological or physical dependence, can only be prescribed with a max day quantity, no refills, no orders (hard copy of the Rx required).

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Schedule drugs have a potential for abuse less than substances in Schedules I/II, and abuse may lead to moderate or low physical depedence or high psychological dependene, can prescibe a max month supply and verbal orders are allowed.

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Schedule drugs have a low potential for abuse relative to the substances in Schedule III, can have a max 6 month supply, verbal orders are and includes several benzodiazipines like Xanax, Kolnopin and Valium.

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Schedule drugs have a low potential for abuse relative to substances listed in Schedule IV and consist primarily of preparations containing limited quantities of certain narcotics, like cough preparations with codeine.

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The five A' s framework for follow-up of patients prescribed chronic opioids includes (select all that apply):

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T or F. Urine Drug Testing can be used to determine if the patient is taking the controlled substance as prescribed and/or if the patient is taking other drugs that may interfere with safe prescribing of controlled drugs.

Test sobre Pain Management, creado por Maggie Throckmorton el 04/12/2017.

Pain Management

Neuropathic pain is abnormal signal processes in the CNS and can be peripheral and

Examples of peripheral neuropathic pain include (select all that apply):

A example of central neuropathic pain is fibromyalgia.

Opioid therapy is not a line treatment for neuropathic pain.

An example of nociceptive pain is tissue .

There are two types of nociceptive pain, which includes muscle, skin and bones and which includes organs.

Acute pain is defined as (select all that apply):

Chronic pain (select all that apply):

T or F. The WHO analgesic ladder recommends non-opioids in the treatment of mild pain.

The WHO analgesic ladder recommends the use of opioids along with non-opioid and adjuvant treatments in treating to pain.

The 1st line treatment for mild to pain is Acetaminophen and NSAIDS.

T or F. Use the max dose of acetiminophen or NSAIDS before proceeding to analgesics.

T or F. Acetaminophen generally has a favorable side effect profile.

Two considerations in using NSAIDS are patients with a history of CV disease and bleeding.

Acetaminophen is best for patients with non-inflammatory like Osteoarthritis and chronic low back pain.

T or F. Acetaminophen does not alter platelet functioning.

Acetaminophen is known to be hepatoxic and can impact function.

There is caution in using acetaminophen in patients with a history of ETOH abuse and hepatic dysfunction.

Acetaminophen interacts with warfarin/coumadin and prolongs .

Acetaminophen is the drug of choice as an analgesic and antypyretic in (select all that apply):