false; have to assess short-acting usage before XR regimen
It is permissible to start a patient on a long-acting opioid. T/F?
immediate release (IR) for breakthrough pain; 10-15% of TDD
What must be prescribed alongside a Long-acting Opioid?
What is the dose?
nonpharmacological; nonopioid
_________ and _______ therapies are preferred over opioids.
start with IR formulations; prescribe lowest effective dose
What should we do when starting a patient on Opioids? (2)
stimulants/amphetamines; caffeine, modafinil, methylphenidate
Which drugs are used for augmenting the action of opioids? (3)
chronic; breakthrough pain
When treating cancer pain, the treatment must address ______ & _______.
combination of: long-acting/short-acting opioids, NSAIDs, acetaminophen
What pain medications do we use for Cancer pain? (3)
neuropathic
Which type of pain has a poor response to analgesics?
increases over time; more likely to have hyperalgesia/allodynia
What are the characteristics of neuropathic pain? (2)
TCAs, SNRIs, gabapentinoids, topicals
What are the 1st line treatment options for Neuropathic pain? (4)
tramadol, combination of 1st line therapies
What are the 2nd line treatment options for Neuropathic pain? (2)
SSRIs, anticonvulsants, NMDA antagonists
What are the 3rd line treatment options for Neuropathic pain? (3)
opioids
What is the 5th line option for Neuropathic pain?
neuromodulation
What is the 4th line option for Neuropathic pain?
topicals
Which medication should we AVOID in diabetic neuropathy?
Gabapentinoid + TCA or + SNRI
What is the combination therapy for Neuropathic pain? (2)
elderly
Which patients with neuropathic pain should we AVOID using combination therapy?
middle-aged women
Fibromyalgia is most common in _________.
Fibromyalgia
-widespread somatic pain and deep tissue tenderness caused by
sensitization of neural pain pathways; "pain all over"
pure mu-opioid receptor agonists, acetaminophen, NSAIDs
Which medications do we NOT use in Fibromyalgia? (3)
codeine, fentanyl, oxycodone
Which medications are Pure Mu-Opioid receptor agonists? (3)
milnacipran, gabapentin, pregabalin, tramadol
Which medications do we use for Fibromyalgia? (4)
Senna +/- docusate
What is the first option when treating Opioid-Induced Constipation?
inappropriate
Docusate is _________ as a monotherapy for constipation.
add one or 2 additional agents; lactulose, MOM
If the patient hasn't had a BM for 48 hours, what do we do/ what can we add?
impaction
No bowel movements for 72 hours may indicate the patient has _______.
mineral oil, magnesium citrate, enema
What are the treatment options for a patient with constipation >=72 hours with no impaction? (3)
glycerin suppository, oil retention enema
What are the treatment options for a patient with constipation >=72 hours WITH impaction? (2)
normal BM
Bulk-forming laxatives should be avoided until the patient has _________.
1 spray into 1 nostril; if desired response not achieved after 2-3 min; give second dose (new device) into alternate nostril; additional doses every 2-3 min until ER arrives
Opioid Reversal for Intranasal administration?
if desired response not achieved, dose should be repeated every 2-3 min; may need continuous infusion
Opioid Reversal for IV/IM/SQ administration?
after 10mg
Which IV/IM/SQ dose may indicate that the patient is NOT suffering from an
opioid overdose?
Auto-Injector (Evzio)
Which Naloxone device is no longer available?
decrease dose by 30%
How do we switch from one opioid to another?
5-10 MME; 20-30 MME
What is the lowest, starting single dose?
What is the maximum daily dosage?
> 50 MME/day
At what dose do patients begin increasing the risk of AE's in Opioids?