Term
| What are the 4 pain receptors? |
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Definition
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Term
| What is an unpleasant sensory & emotional experience associated with actual or potential tissue damage or described in terms of such damage? |
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Definition
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Term
What type of receptor causes:
respiratory/physical/cns depression
constipation
euphoria
miosis
decrease GI mobility
Hypothermia, Bradycardia
Dependence |
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Definition
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Term
What type of receptor causes:
Spinal analgesia
Sedation
No respiratory depression
Miosis
Diuresis
Less addictive |
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Definition
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Term
What type of receptor causes:
Vasomotor stimulation
Psychotomimetic effects
Miosis |
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Definition
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Term
What type of receptor causes:
Spinal analgesia
Dysphoria, Delusions, Hallucinations
Respiratory & Vasomotor stimulation
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Definition
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Term
| What are the 4 types of Pain? |
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Definition
Acute
Chronic
Malignant
Non-Malignant |
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Term
| This type of pain is sudden, subsides in short period, and is characterized by sharp, localized sensation with identifiable cause? |
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Definition
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Term
| This type of pain is longer than 6 months, malignant, nonmalignant |
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Definition
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Term
| This type of pain is induced by disease and secondary to treatment |
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Definition
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Term
This type of pain is:
nocioceptive
neuropathic
mixed/ undetermined |
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Definition
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Term
Where does Somatic pain arise from?
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Definition
Skin
Joint
Bone
Muscle
Connective Tissue |
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Term
| How is Somatic pain described as? |
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Definition
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Term
T/F
Acute pain is:
desiring pain relief
dependence and tolerance is common
psychological components present
organic component present
influenced by environment & family
insomnia not present
cure is tx goal |
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Definition
False
It is unusual to have dependence and tolerance.
All other statements were true. |
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Term
T/F
Chronic pain:
relief is highly desirable
dependence & tolerance common
pyschological component present
organic component not present
influence by environmental & family
insomnia common
reduction of pain is goa |
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Definition
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Term
| Visceral pain arises from? |
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Definition
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Term
| Visceral pain is described as? |
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Definition
| Referred and well localized |
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Term
| How does modulation of nocioceptive pain occur via endogenous opiates? |
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Definition
1. Stimulation of free nerve ending "nocioreceptors" located in viscera & somatic organs occur.
2. Recepton activation leads to action potentials Transmission to spinal cord.
3. Pt Percieves pain
4. Modulation of pain transmission via endogenous opiates ( Endorphins are released into blood stream by pituitary gland, stimulate mu, kappa, delta receptors thru out CNS which are opiate receptors. |
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Term
| How is neuropathic pain described as? |
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Definition
Shock-like
Burning
Shooting |
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Term
| How does neuropathic pain differ from nocioceptive pain? |
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Definition
| Neuropathic is pain that is sustained by abnormal sensory input from CNS / PNS. |
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Term
| What are some syndromes of neuropathic pain? |
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Definition
Cancer pain
Diabetic neuropathy
Phantom pain
Reflex Sympathetic Dystrophy (RSD)
Chronic pain |
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Term
What are the physiological effects of pain?
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Definition
1.Increased catabolic demands- poor wound healing, weakness, & muscle breakdown.
2.Decreased limb mvmt-increased risk for thromboembolic event.
3.Respiratory effects-shallow breathing, tachypnea, cough suppression leading to atelectasis & pneumonia.
4.Decreased GI motility.
5. Tachycardia & Elevated BP |
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Term
Chronic pain syndromes affect seniors life, how would this show up?
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Definition
Social isolation
Depression
Disability/Decreased functional status |
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Term
| What medication is the safest for chronic aches & pains with no inflammation? |
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Definition
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Term
| What are the Clinician-Aided Barriers for Geriatric Pain management? |
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Definition
Concerns for dependence & tolerance, ER visits conservative tx may not lead to relief.
Overzealous restrictions/Compromises
Decreased visiting hours, tv/radio use, limit use of liability reasons ie. heating pads-thermal injury risk.
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Term
| What are the treatment guidelines for drug therapy? |
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Definition
Continually assess:
Relief of pain
Intensity
Medication side effects
Quality of life |
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Term
| What are the 3 groups of Analgesics? |
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Definition
Non-opiod: Acetaminophen, NSAIDS
Opiods: Mu receptor agonists, mixed agonist/antagonist
Adjuvants: Multipurpose agents for specific types of pain. Not a narcotic, but good for neuropathic pain.
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|
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Term
1. What are non-opiod drugs?
2..What kind of pain are they indicated for? |
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Definition
1. What are non-opiod drugs?
Acetaminophen, NSAIDS, Aspirin
2..What kind of pain are they indicated for?
mild-moderate pain. |
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Term
| What drug is only an injectable NSAID? |
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Definition
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Term
| What are the concerns for NSAID use? |
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Definition
| GI, renal, & vascular problems. |
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Term
What is the normal limit for Acetaminophen daily dose
&
should be limited in these concerns. |
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Definition
4 mg limit per day
alcoholics, hepatotoxicity drugs, cold remedies |
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Term
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Definition
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Term
| Opiods are useful for what type of pain? |
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Definition
|
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Term
| What is the MOA for Non-opiods? |
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Definition
Inhibition of cyclooxygenase, leading to prostaglandin inhibition.
Acetaminophen PG<NSAIDS
PGs confer pain & protection |
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Term
T/F
Opiods have:
no ceiling effect (continue to see higher effects w/ higher doses & see increased tolerance
no maximum daily dose limitation
all are hepatically metabolized |
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Definition
|
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Term
| What are the 3 breakdowns of Opiods? |
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Definition
Morphine-like agents
Morphine, Hydromorphine, Oxycodone, Codeine
Meperidine-like agents
Merperdine, Fentanyl
Methadone-like agents
Methadone, propoxyphene |
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Term
| Which opiods have active metabolites and what are they? |
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Definition
Morphine: M-6-G & M-3-G
Meperidine: Normeperdine
Propoxyphene: Norpropoxyphene |
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Term
| Which opiods do not have active metabolites? |
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Definition
| Methadone, Hydromorphine, Fentanly |
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Term
| Which opiod would you use if the pt had a morphine allergy or derivative? |
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Definition
| Meperidine, Methadone, Fentanyl |
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Term
| What drug are opiods compared to? |
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Definition
|
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Term
| How is morphine formulated? |
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Definition
PO
SL
PR
IV
IM
SC
EPI
IT
Concentrated oral solutions |
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Term
| What s/s is the active metabolite M-6-G associated with? |
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Definition
Itching
Nausea
Sedation
Potent Analgesic substance-Morphine |
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Term
| What s/s is the active metabolite M-3-G associated with? |
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Definition
Effects seen w/ long term accumulation
Myoclonic jerking
Low analgesic potency |
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Term
What drug is this:
shorter duration of action & potency than morphine
lasts 18-24 hrs
no longer preferred for acute & chronic pain |
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Definition
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Term
What does the active metabolite Normeperidine cause?
|
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Definition
CNS stimulation
Seizures
Visual disturbances
Twitching
Anxiety |
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Term
I'm only used if the pt is allergic to Morphine & used sparingly if I am used?
What drug am I? |
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Definition
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Term
Which drug is:
Biphasic elimination
Assoc. w/ opiod abusers & w/d tx
Risk of accumulation toxicity |
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Definition
|
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Term
| What is biphasic elimination? |
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Definition
Alpha-analgesic phase: t1/2 8-12 hours
Beta hours: t1/2 24-36 hrs (protects against w/drawal) |
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Term
| This drug is lipophillic & is well absorbed topically & forms a depot. |
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Definition
| Fentanyl patch ( Duragesic) |
|
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Term
| Peripheral blood flow & subcutaneous fat deposits can alter this drug's absorption? |
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Definition
| Fentanyl patch (Duragesic) |
|
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Term
| This drug has 6-12 hours until it reaches significant systemic levels and 14 or more hours before it platues? |
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Definition
| Fentanly patch (Duragesic) |
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Term
| This drug has a Black box warning by FDA for acute pain & is not for opiod-naive pts. |
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Definition
| Fentanyl patch (Duragesic) |
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Term
| This drug is PO only, used for mild pain, & 50% as potents as Codeine? |
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Definition
| Propoxyphene (Darvan, Darvocet) |
|
|
Term
This drug has a long half life, which makes it a risk for accumulation toxicity
&
can be combined with aspirin & acetaminophen |
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Definition
| Propoxyphene (Darvan, Darvocet) |
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Term
| This drug is a weak analgesic, prodrug, and Schedule II when used as opiod? |
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Definition
|
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Term
| This drug causes urine drug screen to be positive for morphine? |
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Definition
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Term
10% of this drug gets converted to morphine
PO, IM ,SC administered |
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Definition
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Term
| What are the adjuvant agents in neuropathic pain? |
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Definition
Tricyclic antidepressants
Anticonvulsants
Corticosteroids
Alpha 2 agonists |
|
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Term
| What's the MOA & use for TCA |
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Definition
MOA: Block reuptake of serotonin & norepinephrine
Used: Sedation (amitriptyline)
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|
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Term
|
Definition
Decrease neuronal excitability
Gabapentin, Carbamazepine |
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Term
| Use of Corticosteroids & why? |
|
Definition
Excellent for bone pain secondary to metastatic disease
Reduces pressure around nerves |
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Term
Which drug should you watch out for Steroid Psychosis risk?
What is it? |
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Definition
Corticosteroids
Anxiety, Agitation, Euphoria, Insomnia, Mood swings, Personality changes, Serious Depression |
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Term
|
Definition
| Prevent pain transmission to brain via decreased sympathetic outflow. |
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Term
| Non-pharm management of pain? |
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Definition
Stimulation techniques
-TENS unit
not widely used
Psychological intervention
-provide prior procedure instructions to pt
-relaxation, imagery, hypnosis |
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