Table of Contents

A. General

Background Concepts Assessment of Pain

Tx of Pain: Pharmacotherapy Tx of Pain: Procedural

Tx: Psychological, Physical, and Integrative Therapies

B. Clinical States

Taxonomy: Classification of Pain Syndromes
Chronic Widespread Pain Syndromes
Acute Pain, Pain due to Trauma, and Postoperative Pain
Musculoskeletal Pain
Cancer Pain and Cancer-related Pain
Visceral Pain
Headache and Orofacial Pain
Neuropathic Pain
Special Cases

🟣 Pain Awareness Month – Macon, GA

Theme: From Street to Science – Reclaiming Pain Management

📍 Macon, Georgia
🗓️ [Insert Date]
🕐 1:00 PM – 3:30 PM

📅 Event Agenda

1:00 – 1:15 PM – Rep. Mariam Paris
Georgia’s fentanyl crisis, medical cannabis legislation, local health disparities.

1:15 – 1:45 PM – Dr. Terel Newton (Session I)
Fentanyl: street vs. prescription; cannabis: street vs. medical in Georgia; restoring trust in pain medicine.

1:45 – 2:15 PM – Dr. Uma Dhanabalan ("Dr. Uma")
Cannabis as medicine; evidence-based use and safe prescribing; reducing stigma.

2:15 – 2:30 PM – Dr. Alexander
Clinical experience in pain management; real patient cases; integrative strategies to reduce opioid dependence.

2:30 – 2:35 PM – Transition / Break

2:35 – 3:20 PM – Dr. Terel Newton (Keynote)
Trusted leadership in pain management; innovations in interventional, regenerative, AI, and medical cannabis; Macon and Georgia-specific disparities; strategies for caregivers, clinicians, and policymakers.

3:20 – 3:30 PM – Closing Session
Georgia Hemp Association and Rep. Mariam Paris; legislative outlook, community partnerships, and commitment to safer pain care pathways.

🔥 High-Yield (Frequently Tested)

NSAIDs / Aspirin → ↑ GI ulceration & bleeding risk.
Anticoagulants (warfarin, DOACs) → unpredictable INR effects (CYP induction/inhibition + GI bleeding risk).
Opioids / Sedatives → steroids may cause mood, delirium, or psychosis → worsens periop management.
Neuromuscular blockers → steroids can cause prolonged weakness/myopathy, esp. with high-dose or ICU use.
Fluoroquinolones → additive tendon rupture risk.
Vaccines (live attenuated) → contraindicated with immunosuppression.

⚖️ Moderate-Yield (Board-relevant, but tested less often)

CYP3A4 inhibitors (ketoconazole, macrolides, ritonavir, diltiazem, verapamil) → ↑ steroid levels → Cushing’s, adrenal suppression.
CYP3A4 inducers (phenytoin, rifampin, carbamazepine, St. John’s wort) → ↓ steroid effect, adrenal crisis risk if tapered.
Insulin / Oral hypoglycemics → ↓ effectiveness → hyperglycemia.
Diuretics (loop, thiazide) → additive hypokalemia.
Amphotericin B → severe hypokalemia risk.
Calcineurin inhibitors (cyclosporine, tacrolimus) → mutual ↑ toxicity (neuro/nephrotoxicity).
Methotrexate → enhanced efficacy/toxicity; used intentionally in autoimmune disease.

📉 Lower-Yield (But may appear in stem questions)

Protease inhibitors (HIV meds) → severe Cushing’s from CYP3A4 inhibition.
Estrogens / OCPs → ↓ steroid clearance → ↑ exposure.
Anticonvulsants (barbiturates, carbamazepine, phenytoin) → accelerate steroid metabolism.
Digoxin → ↑ risk of arrhythmia due to steroid-induced hypokalemia.
Thalidomide / Lenalidomide → ↑ VTE risk synergistically.

✅ Boards Focus Tip:
They’ll often test in the context of perioperative care:

“Patient on prednisone + warfarin/NSAID scheduled for procedure → what’s the risk?”
“Patient on chronic steroids + rifampin → develops adrenal crisis post-op.”
“Prednisone + fluoroquinolone → Achilles rupture before spinal injection.”

Most Likely to Be Tested:
Warfarin/Anticoagulants - Steroids can alter warfarin metabolism and increase bleeding risk, especially relevant in perioperative management and pain procedures.
NSAIDs - Combined use significantly increases GI bleeding and ulceration risk, a critical safety concern in pain management.
Insulin/Diabetic medications - Steroids cause hyperglycemia requiring dose adjustments, essential knowledge for perioperative care.
ACE inhibitors/Antihypertensives - Steroids can counteract antihypertensive effects and cause sodium retention, important for cardiovascular management.
Neuromuscular blocking agents - Chronic steroid use can prolong paralysis, directly relevant to anesthesia practice.
Moderate Likelihood:
Phenytoin/Anticonvulsants - Mutual induction of metabolism affects seizure control and steroid effectiveness.
Rifampin - Significantly increases steroid metabolism, reducing anti-inflammatory effects.
CYP3A4 inhibitors (ketoconazole, erythromycin) - Increase steroid levels and toxicity risk.
Diuretics - Additive potassium loss leading to severe hypokalemia.
Vaccines (live) - Immunosuppression from steroids contraindicates live vaccines.
Lower Likelihood:
Digoxin - Steroid-induced hypokalemia can increase digoxin toxicity.
Barbiturates - Induce steroid metabolism, reducing effectiveness.
Cholestyramine - Decreases steroid absorption.
Antacids - May reduce steroid absorption when given together.
Least Likely:
Oral contraceptives - May increase steroid levels but rarely clinically significant.
Cyclosporine - Mutual inhibition of metabolism, more relevant in transplant medicine.
The highest-yield interactions for boards focus on perioperative safety, bleeding risk, glucose management, and drug interactions that affect anesthetic management or common pain medicine procedures.

Page updated

Google Sites

Report abuse