Term
| What are the three types of Pain? |
|
Definition
1. Somatic-muscles, joints, bones
2. Visceral- ex:small intestines, presents as a dull ache
3. Neuropathic- peripheral/central NS, presents as tingling |
|
|
Term
| Due to the subjective nature of pain assessment, what sort of questions would we ask during the pain assessment? |
|
Definition
1. Temporal Pattern
2.Location
3.Intensity
4.Modulating Factors
5.Previous Tx
6. Impact on QOL |
|
|
Term
| What is the goal of the treatment of pain? |
|
Definition
| Symptomatic relief and improve QOL |
|
|
Term
What is COX?
What forms exist?
What do they do? |
|
Definition
Cyclooxygenase: converts arachidonic acid into PG's and related compounds, which are responsible for the pain sensation.
Cox 1: found in all tissues "Housekeeping" enzyme
Cox 2: produced when problems occur causing tissue damage |
|
|
Term
| What are the two COX inhibitors? |
|
Definition
Aspirin (Salicylates)
Tylenol(Acetominophen) |
|
|
Term
Acetominophen (Tylenol)
MOA?
Therapuetic Use?
Dose?
Interactions?
Special notes? |
|
Definition
MOA: inhibits the synthesis of PG's in the CNS to block the pain impulse.
Use: Antipyretic, Analgesic, **DOC for Osteoarthritis**
Dose: 325-1000mg PO 4x day
**Do not exceed 4grams 4000 mg per day**
Interactions:
Alcohol-increased risk of hepatotoxicity
Warfarin-enhance anticoagulant effects
Note: prefered agent for fever or pain in pediatric pts suspect of varicella or flu |
|
|
Term
| Who should avoid using Tylenol(Acetominophen) for pain or fever? |
|
Definition
|
|
Term
Salicylates (Aspirin)
MOA?
Uses?
Dose?
AR?
Interactions?
Special Notes? |
|
Definition
Salicylate(Aspirin)
MOA: Irreversible binding of COX enzyme Uses:Anti-inflammatory,Antipyretic, analgesic. Prevent CV events.
Dose: Low for CV event prevention, High for anti-inflammatory responses
Adverse Reactions: GI events(gastric distress, heartburn, and nausea) most common,chronic use leads to dleaing, ulceration, and perforation.
Interactions: #1 Warfarin, Anti-coagulants, glucocorticoids, alcohol
Notes: Should not be used for fever Tx in children due to Reyes Syndrome, Preg category D |
|
|
Term
| What are the most commmon Non-steroidal Anti-inflammatory Agents? |
|
Definition
| Ibuprofen, Ketorolac, Indomethacin, Naproxen(alleve), Nambumetrone |
|
|
Term
NSAIDs
MOA?
Uses?
AR?
Interactions?
Contraindications?
Notes? |
|
Definition
NSAIDs
MOA: Reversible inhibition of COX, decreasing PG synthesis, pain management
Uses: Anti-inflammatory with less GI upset and reversible platelet effects
AR: GI effects-N/V due to ulceration and bleeding, Renal failure in pts with HD, LD, and renal altertions
Interactions: Antihypertensives
Contraindicators: Preg category D in 3rd trimester, Heart Failure, Kidney Disease, Hx of ulceration
Notes: Should monitor s&s of bleeding, blood counts, renal function, and pain reporting |
|
|
Term
| What drugs can be used with NSAIDs to prevent the GI adverse reactions? |
|
Definition
| Misoprostol and proton-pump inhibitors |
|
|
Term
What is the only COX-2 selective inhibitor available on the market?
Why use? |
|
Definition
Celeboxib(Celebrex)
Use: possible less GI bleeding, little or no plalet effect
More expensive that NSAIDs |
|
|
Term
Opioid Analgesics
What are the four terms used in relation to opioids? |
|
Definition
1. Tolerance
2. Physical Dependence
3. Psychological Dependence
4. Substance Abuse |
|
|
Term
| Where are Endogenous opioids found? |
|
Definition
| CNS and peripheral tissues |
|
|
Term
What are the Pure Opioid Agonists?
MOA?
Abuse Potential? |
|
Definition
Morphine, Oxycodone, Codeine, Fentanyl, and Methadone
MOA: activate receptors, composed of moderately strong to strong agonists
Abuse Potential: High |
|
|
Term
What are the partial agonists?
MOA?
Abuse Potential? |
|
Definition
Buprenorphine and Pentazocine
MOA: Partial agonist or antagonist at receptor sites
Uses:analgesia as monotherapy can cause partial antagonism of pure when used in combination, Cough, diarrhea
Abuse Potential: Low |
|
|
Term
What are the Opioid Antagonists?
MOA? |
|
Definition
Naltrexone and Naloxone
MOA: Prevent activation of receptors
Used: to reverse the adverse effects of pure agonists or partial agonists(Respiratory and CNS depression) |
|
|
Term
| What regimen should pt with chronic opioid use be on? |
|
Definition
| Laxative and stimulant bowel regimen to prevent major adverse reaction of constipation |
|
|
Term
| Codeineis seen in many _________ products and i used in comdination with ________ for Tx of _________. |
|
Definition
|
|
Term
| What pain medication can also cause the following adverse reactions: urinary retention, cough supression, emesis, intracranial pressure, euphoria/dysphoria, sedation and miosis? |
|
Definition
| Codeine products and combination products |
|
|
Term
| What Tx is inappropriate to use opioid analgesics? |
|
Definition
|
|
Term
| What are the durg interactions of Opioids? |
|
Definition
| Interactions: Pure and Partial, CNS depressants, Anticholinergics(atropine,antihistamines, TCAs), Hypotensives, MOA inhibitors |
|
|
Term
| What other centrally acting analgesics can be used to treat pain? |
|
Definition
| TCA's, Carbamezapine, Gabapentin |
|
|
Term
| What pain med is contraindicated in preg, heart failure, kidney disease, and hx of ulceration? |
|
Definition
| NSAIDS-alleve(naproxen, indomethacin,ibuprofen) |
|
|
Term
| What are opioid anatagonists used for? |
|
Definition
|
|
