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Define Pain
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3 types of Pain
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Pain overview
Pain; Opiods, Non opiods, NSAIDs , Acetaminophen
| Question | Answer |
|---|---|
| Define Pain | an unpleasant sensory & emotional experience associated w/actual or potential tissue damage, or described in terms of such damagephysical, emotional-QOL,grumpy,work |
| 3 types of Pain | nociceptive(tissue); visceral, somatic, neuopathic pain |
| Describe Visceral pain areas,treatment med group | originates in smooth muscle & organsnephrolithiasis, cholecystitis,pancreatitisResponds to opiods |
| Describe Somatic pain areas, treatment med groups | skeletal muscle,ligaments,jointsosteoarthritis,RAResponds to NSAIDS, Acetaminophen, Opiods |
| Describe neuropathic Pain areas, treatment med groups | Nerves; peripheral nerve injury, Diabetic neuropathy, chemotherapy induced MSResponds to adjuvant meds;TCA's or Anticonvulsants |
| 2 types of Responses to pain | Acute vs Adaptive |
| Describe Adaptive Rspnse to pain -s/s | physiological- no changes in VS's or skinBehavioral- no pain rpted,sleeps well, no facial grimaces, diverts attn, phys inactivity/immob. |
| Describe Acute Response to pain - s/s | Phys; increased BP,HR,R, dilated pupils,perspirationBehavioral- focus/rpts pain,cries,moans, rubs pain area,increased muscle tension, frowns/grimaces |
| describe problems w/unalleviated pain | pt disatisfaction, longer recovery,delayed healing, decreased ability to work,enjoy leisure, anxiety, depression |
| What are Pain managemnt Goals (4) | Pain reduction, improved functioning,improved QOL, SMART-specific,measurable,achievable,realistic, time-based |
| What is SMART? | specific,measurable,achievable,realistic, time-based |
| Describe pain severity levels in terms of 3 groups and treatment per group. hint-pain:1-10 | Mild 1-3 Non-Opiod;tylenol,NSAIDS, NON-PHarmMod 4-6 Non-Opiod + Mod Opiod;darvocetSevere 7-10 Strong Opiod;Morphine |
| What are Edogenous Opiod Peptides | naturally occuring; enkephalins, endorphins, dynorphins- in CNS and Peripheral tissue |
| Name the 3 Opiod R's and functions | Mu (OP3) big, analgesia,Resp dep,euphoria, sedaton, phys dependanceKappa (OP2) -Analgesia, psychomometric effectDelta (OP1) |
| Name 3 groups/classification of Opiod Drugs | Pure Opiod Agonists-morphine, codiene, etc-act pos on mu and kappa R'sAgonist-Antagonist Opiods-pentazocine,etc antagonist-Mu, agonist Kappa except Buprenorphine-partial agonist mu, antag kappaPure Agonists-antagonizes both MU and Kappa-used w/overdos |
| Pure Agonist s/a- Respiratory, route/onset, caution groups | Resp depr-can cause death, add effects w/other CNS dep(ie etoh); do not give w/resp <12,IV-7min,IM-30min,SC-90min, Epidural hrscaution-elderly neonates,resp diseases |
| Pure Agonist S/A- GI | Constipation-few days onset, increase fluids,exercise, give docusate(stool soft)may need add-stim lax(sienna,bisacodyl) or Osmotic lax(mag citrate,MOM) |
| Pure Agonist S/A - BP | Orthostatic Hypotension- dilates peripheral arteriols and veins, instruct pts to change positions slowly |
| Pure Agonist S/A- GU | Urinary retention,urgency,decreased prod., additive effects w/ BPHypertropy, other meds w/anticholinergic properties |
| Pure Agonists S/A- Cough | Cough suppression, decreases spont cough reflex, may lead to accumulation of secretions in airway |
| Pure Agonists S/A- Biliary | biliary colic, may increase pain in biliary colic patients,Demerol causes less, morphine bad-high(pain in gallbladder) |
| Pure Agonists S/A- Emisis | moving makes worse, greatest w/initial dose, uncommon w/ recombent pt, 15-40% mobile pts |
| Pure Agonists S/A - Cranium | Increases ICP, decreases resp=increased CO2dilates cerebral vasc., demoral favored |
| Pure Agonists S/A - Eyes | Miosis, pinpoint pupils, so keep lights dim |
| Pure Agonists S/A- CNS | Euphoria / dysphoria uncommon in pts w/pain, but may occur in absence of painSedation -minimized s/smller dose shorter halflife - give small doses of stimulant like methylphenidate in am and afternoon to help |
| Pure Agonists S/A - Uterus | uterin contraction suppression, along w/neonatal resp depress, not used in Labor &del. |
| Pure Agonists S/A - Tolerance | larger dose needed to produce same rspnseusually resp dep, euphoria, sedation decrease over time, constipation no tolerance ever or miosis. can have some cross tolerance to other CNS dep like etoh |
| Pure Agonists S/A - Phys Dependance,s/s | Abstinence syndrome if abrupt discontinue.Intens & duration depend on halflife and duration of use. initial s/s- yawning,rhinorrhea, sweats,followed by anorexia, irritable, tremor, goosefleshpeak, viol sneezes, n/v, week, cramps,m.spasm,diarhea |
| Pure Agonists S/A - Toxicity s/s | classic triad-coma,resp dep,pinpoint pupilsdeath usually -resp depr.trtmt opiod antagonist, narcan(naloxone), nalmofene(longer halflife)given IM,IV,SC; naltrexone longest halflife given IM, POwatch reversal of analgesia and w/drawel |
| Pure Agonists s/A -Equinalgesic Doses | uses tables published for diff opiods, convert to eq and start smaller. Oral increased -first path, Morphine -IV |
| Strong Opiod Agonists used for? meds | mod-severe pain,more effective fo constant dull pain then sharp intermt pain. Admin around clock-short halflife,give immd rlse drugs PRN for breakthrough pain. assess BP,P,R, reasses post 1hr |
| administering Morphine how, to prevent what | slow admin, IV over 5min to prevent severe hypotension, cardiac, and resp arrest |
| Administering Fentanyl methods | strong opiod, high potency, transdermal-onset of action over 24hrs, fold used patches-biohazard |
| Name 4 strong opiods agonists | morphine, fentanyl, meperidine (demoral), methadone |
| administering Meperidine (demerol)-interactions, s/a's | less n/v then morphine, used for B-induced rigors. Toxic metab during renal dysf, increases siezures. interacts w/MAOI's--leads to seratonin syndorom-death.less depress fetal R & uterus contractions, intcts w/triptan(migraine)-treat gallbladder,tremors |
| pt has morphine allergy, meds used instead? | demerol, fentanyl,methadone, propoxyphene |
| Name 4 mod to strong opiods | codeine, hydrocodone, propoxyphene(darvocet) &Oxycodone (percocet) |
| Codeine use, s/a's? | mod-strong opiod.antitussive, s/a-dose limited, synergistic w/non opiod analgesics |
| Hydrocodone use | analgesia sim to codeine,(mod-strong),antitussive, synergistic w/ non opiods |
| Propoxyphene (darvocet) use | mod-strong opiod, analgesic similar to ASA, synergistic w/ non-opiods, toxic metab -increased siezures w/build up. |
| Agonist -Antagonist Opiod med, use, r/t pure agonists | tramadol, antag mu(op3), agonist kappa(op2)less pot for abuse, less resp dep,less poweful, psychomimetric via increased kappa -anxiety halluc.,can precip withdrawel when only 1 R (like morphine)-so give stadol |
| What are the protocols for CII prescriptions? | strong opiods r controlled, need new Rx each time,no refils, doc must sign Rx, no faxes or callins-except hospice or LTC |
| NSAIDs work by affecting what pathways/severity of pain treated | cox inhibitors, Cox-1, Cox-2; mild/mod -mostly joint pain, HA and muscle pain. No tolerance. |
| Cox-1 functions | stomach-decreased acid, increased bicarb,mucous, and blood flow(healing)Neonate- patent ductus arteriosis, kidney-maint of Renal BF. Blood-promotes platlet aggreg |
| Cox-2 functions | Tissue injury- promotes infl and pain sensationBrain-mediate fever & perception of painkidney- maint BF, sometimes used for neoplasms(colon, prostate cancers) |
| NSAID- A/E - GI | stomach upset, heartburn,nausea 10-16%direct irritation, take w/full glass h2o. EC,ER buffered doses dont help |
| NSAID-A/E - Ulcers | 2-4%, decreased protective bariers, platelet agg. Increased risk=age,prior ulcer, severe illness/disabiliy, coagupathy. prophylaxix -misopresto, AntiUlcer drugs H2RA(pepsid),PPI(prilosec) |
| NSAID- A/E - Renal | both cox1,-2. maint BF, cause acute reversible renal impairmt. increased BP, Na&H2O-edema,increased cardiovasc eventsBleeding -platelets dont exp cox-2,interacts w/etoh, preg-risk anemia,hemorrage, decreased contractions |
| Aspirin moa, uses,interactions, s/a | non-selective cox inhibition, Irreversible pltlet inhib, clot prevention (stroke,MI prevention).interact w/ibuprofin-take aspirin 1st, Salicylism, Reyes Syndrome |
| what is Salicylism seen w/aspirin | tinnitus, sweating, Ha, dizzy, acid/base disturb., discontinue until no s/s, restart w/lower dose |
| what is Reyes Syndrome? | ASA + children who had chicknpox or influenza=increased risk. dont use ASA in kids. |
| Non-Selective NSAIDS used for | greater cox inhib in uterus-superior to ASA or APAP for dysmenorhea, reversible, cross hypersensitivity w/ASA & other NSAIDS, no protect for MI,contraind in post op CABG. opthalmic & topical preps avail. |
| Cox-2 Inhibitors - med, use, S/A | less GI risk, escept if takin ASA, renal dysf,contains sulfa-allergy?,no inhib of pltlt aggreg., premature closure of Art.ductus, risk for CV,may be prothrombotic, costly! |
| Acetaminophen (APAP) - use,strength, interactions, S/A, recovery trtmt? | mild-mod pain, anti-pyrotic,not anti-inflam.Interact w/etoh in liver, Warfarin slight inhib., max dose 4000mg->irreversible liver necrosis. pain control/fever.s/s -early:N/V,diarhea, sweat,abd pain. Late-liver fail,coma,death. trtmt acetylcystene w/pop |
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1311292139