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pain management
pharm final
| Question | Answer |
|---|---|
| components of CNS | brain and spinal cord |
| components of PNS | connecting CNS to muscles and organs |
| What is the last system to develop in the fetus | nervous system |
| 3 kinds of neurons connecting CNS to body | motor, sensory, interneurons |
| motor neurons aka: | efferent |
| sensory neurons aka: | afferent |
| major division of nervous system | central vs. peripheral |
| efferent neurons | impulses AWAY from CNS to muscles and organs |
| afferent neurons | impulses TOWARD CNS from muscles and organs |
| interneurons | connections within CNS |
| function of nervous system fetus is born with | reflexes |
| basic functional unit to conduct an impulse | neuron |
| cells which protect, support, and nourish neuron | glia |
| receive impulses from the cell | dendrites |
| carry impulses away from the cell | axon |
| space or gap between neurons | synapse |
| located at the end of the nerve brancehs and extend into the synapses located between neurons | vesicles |
| neurons protected by myelin sheath and together form the fiber | nerve fiber |
| fluid filled synapses contain | neurotransmitters |
| role of presynaptic neurons | send info |
| role of postsynaptic neurons | receive info |
| What happens at the vesicles of the neuron | where chemicals are synthesized, stored, and released |
| 5 quick acting neurotransmitters | acetylcholine, dopamine, norepinephrine, serotonin, GABA |
| 2 slow acting neurotransmitters | adrenocorticotropic hormone; antidiuretic hormone |
| sensation that occurs when peripheral tissue injury occurs and pain receptors are activated | pain |
| order of transmission of pain signal | spinal column, medulla oblongata, pons, hypothalamus, thalamus, cerebral cortex |
| What area in the brain is known as the relay station | thalamus |
| Where is the pain sensation perceived | cerebral cortex |
| what is substance P and where is it located | located in nerve cells; serves as mediator in the transmission of painful stimuli |
| 7 locations of pain receptors | skin; underlying soft tissue; muscle fascia; joint surfaces; arterial walls; periosteum; scarce in most internal organs |
| examples of physical tissue damage | heat, cold, pressure, stretch, spasm, ischemia |
| examples of chemical tissue damage | substances released from injured cells and from inflammation |
| one of the strongest pain producing substances but quickly metabolized, associated with acute pain | bradykinin |
| increase pain provoking effects of bradykinin by increasing pain receptor sensitivity | prostaglandin |
| somatic pain | localized sharp, burning, aching, gnawing, throbbing, and cramping; acute or chronic; constant or intermittent |
| visceral pain | abdominal or thoracic organs, deep, dull and aching; cramping intermittent (spasms) |
| neuropathic pain | injury of peripheral pain receptors, shooting, burning, stabbing |
| define acute and give adjectives of acute pain | sharp, lancing, or cutting, sudden onset |
| define chronic and give adjectives of chronic pain | lasting 3 months or more, slow pain, burning, aching or throbbing |
| types of analgesics | opioid analgesics, non-opioid analgesics |
| opioid analgesic relieve what type of pain | moderate to severe |
| Action of opioid analgesics | inhibits transmission of pain impulses to the brain |
| Therapeutic effects of opioid analgesics | reduces pain perception, promotes sedation and reduces emotional upsets |
| what type of drugs are opioid analgesics (schedule) | schedule II - lead to drug abuse ad dependence and increased tolerance |
| routes of opioid analgesics | PO, IM, subcutaneous, IV |
| Where are opioid analgesics metabolized | liver |
| What route of opioid analgesics requires higher doses to obtain the desired therapeutic effects | po |
| analgesic pharmacologic effects | pain relief |
| CNS depression pharamcologic effects | mild, moderate, sever (HR, RR, LOC) |
| GI motility pharmacologic effects | constipation, smooth muscle spasms |
| indiciations for opioid analgesics | acute pain; surgery; invasive procedures; L/D; GI disorders; pulmonary edema; cough (Codeine) |
| why called opioid agonists/ antagonists | agents have agonistic activity at some receptor sites and antagonistic activity at others |
| antagonistic qualities of opioid agonists/ antagonisits | produce withdrawal symptoms in people with opiate dependence, anecdote with overdose; less risk for abuse |
| why are opioid antagonists antidotes | reverse or block analgesia, CNS respiratory depression and other effects |
| Action of opioid antagonists | interfere with opioid binding with the opioid receptor sites (neutralizes) |
| What is the oldest drug of choice to reverse respiratory depression | Naloxone (Narcan) |
| How long does it take Narcan to work | minutes |
| routes of Narcan | IV, IM, subcutaenous |
| Why would you need several doses of Narcan | has short duration |
| what medication causes a depletion of substance P in nerve cells | capsiacin (Zostrix) |
| capsiacin (Zostrix) routes | topical |
| types of pain that can be treated by capsiacin (Zostrix) | osteoarthritis; rheumatoid arthritis, postherpetic neuralgia, herpes zoster, diabetic neuropath, post-surgical pain |
| How should you titrate analgesics | maximal effectiveness and minimal toxicity and avoid dependence |
| desired secondary opioid affects | morphine may reduce pulmonary edema; depress cough reflex |
| undesirable secondary opioid affects | constipation; respiratory depression; orthostatic hypotension; nausea/vomiting |
| What drug reduces excessive pain stimulation and is used when withdrawing from opioids | clonidine |
| 3 types of nonopioid drugs | analgesics, antipyretics, antiinflammatories |
| nonopioid drugs defined | drugs that relieve pain, fever, and inflammation |
| When does pain occur | with tissue injury and inflammation |
| define fever | elevation of temperature |
| what controlls temperature | regulatory center - hypothalamus |
| define inflammation | response to tissue damage |
| nonopioids used a prophylactic to prevent MI/Stroke | acetaminophen and aspirin |
| what nonopioid drugs can cause renal impairment | acetaminophen, aspirin, NSAIDs |
| what nonopioid has a metabolite that destroys liver cells and can cause hepatic impairment | acetaminophen |
| what value does fever have | bodies way of fighting infection |
| how long before surgery should you avoid durgs that impact platelet aggregation | at least 2 weeks before and after |
| you must support adequate fluid intake with all nonopioid analgesics except | acetaminophen |
| another name for acetaminophen | tylenol |
| Why should you give next dose of analgesic before pain is severe | need less drug and achieve greater effectivness |
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