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pain mgmt ch 6
pharm - opioid analgesics and pain management ch 6
| Question | Answer |
|---|---|
| most common symptom prompting people to seek health care | pain |
| pain usually indicates | tissue damage |
| Purpose of opioid (narcotic) analgesics | to relieve moderate to severe pain |
| Why does pain occur? | tissue damage activates free nerve endings of peripheral nerves. (pain receptors/nociceptors) |
| Nociceptors locations | abundant in arterial walls, joint surfaces, muscle fascia, periosteum, skin and soft tissues. Scarce in most internal organs. |
| Causes of tissue damage | physical (heat/cold, presure, spasm, ischemia) or chemical (pain producing substances released into extracellular fluid around nerve fibers) |
| How does a person feel pain? | signal from nociceptors in peripheral tissues transmits to spinal cord then to hypothalamus and cerebral cortex. Signal carried to spinal cord by 2 nerve cells (A-delta fibers and C fibers) to thalamus for perception of pain. |
| Difference between A delta and c fibers | A delta = acute pain - fast, sharp, well-localized pain signals. C fibers = chronic pain - slow, poorly localized, dull , burning pain. |
| pain is classified according to... | origin in body structures (somatic, visceral, neuropathic), duration (acute, chronic) or cause (cancer) |
| acute pain | may be caused by injury, trauma, spasm, disease processes and treatment or diagnostic procedures that damage body tissues. sharp/cutting. pain proportional to amt of tissue damage warning system to get attention to get person to stop it. |
| chronic pain | lasts 3+ months demands attention less urgently, possibly no visable signs, often w/ emotional stress, inc. irritability, depression, social withdrawal, loss of libido, disturbed sleep. etc. can be anywhere not necessarily related to tissue damage. |
| cancer pain | characteristics of both acute and chronic pain. may be constant or intermittent. often assoc. with tumor spread into pain sensitive tissues and resulting tissue destruction. progresses as disease advances. acute pain often with procedures or treatment. |
| somatic pain | from stimulation of nociceptors in skin, bone, muscle and soft tissue. localized, sharp, burning, throbbing, cramping. intermittent or constant, acute or chronic. sprains are acute somatic. arthritis chronic somatic. inc. bp, pulse, respiration, tension |
| visceral pain | diffuse, not well localized. results when nociceptors stimulated in abdominal or thoracic organs and their surrounding tissues. deep, dull aching or cramping. maybe referred. dec. bp, pulse, nausea/vomit, weak, loc |
| neuropathic pain | caused by lesions or physiologic changes that injure peripheral pain receptors, nerves or cns. excessive excitability in damaged area or tissues, nerve cells discharge more easily. may be spontaneous or from normally nonpainful stimulus. severe, stabbing. |
| standard analgesics are less effective on what type of pain? | neuropathic pain. antidepressants and anticonvulsants are often used w/ analgesics. |
| Endogenous analgesia system | cns system for relieving pain by suppressing transmission of pain signals from peripheral nerves. activated by nerve signals or morphine-like drugs. |
| most effective regimen for pain management | combination of drugs that act by different mechanisms |
| nonopioids are used mainly for | chronic neuropathic pain or bone pain. |
| NSAIDs | nonsteroidal anti-inflammatory drugs. act by reducing production of prostaglandins, which reduces inflammatory chemicals that cause, inc or maintain pain signals. useful in treating pain w/ inflammation. mod to severe. adverse - gi bleed (give prilosec?) |
| acetaminophen acts by | effecting parts of brain that receive pain signals and is safest analgesics for mild pain or as supplement to more intense pain. useful in nonspecific musculoskeletal pain or pain of osteoarthritis. max daily dose is 400 mg, avoided/red. in renal issues. |
| Antiepileptic drugs (aed) | treat neuropathic pain, dec irritability of overexcited nerve cells that occur in epilepsy and neuropathic pain. nerve cells less likely to discharge spontaneously or from stimuli. |
| antidepressants and pain | tricyclic antidepressants used for nuropathic pain. inhibit reuptake of norepinephrine and serotonin in nerve synapses, inhibiting pain signals. older adults more adverse effects. |
| biphosphonates | used to prevent/treat osteoporosis, can relieve pain related to metastiatic bone cancer and multiple myeloma |
| corticosteroids | reduce inflammation, irritability and spontaneous discharge in injured nerves and tissues. treat neuropathic, visceral and bone pain. in caner - pain assoc. w/ brain metastases and spinal cord compression. |
| local anesthetics | various forms of lidocaine to prevent or relieve pain. |
| because of potentially fatal adverse effects and risks of drug abuse and dependence, all opioid analgesics have... | black box warnings |
| What drugs have highest risk of fatal overdoses because of respiratory depression and highest potential for abuse | fentanyl, hydromorphone, methadone, morphine, oxycodone and oxymorphone |
| how do opioids relieve pain? | binding to opioid receptors in brain, spinal cord nad peripheral tissues. |
| major types of opioid receptors | mu, kappa and delta |
| most opioid effects are attributed to activation of what receptors? | mu receptors |
| what occurs with activation of kappa receptors? | analgesia, sedation and decreased GI motility |
| opioid effects | analgesia, cns depression, respiratory depression, sedation, euphoria, decreased gi motility, physical dependence |
| Delta receptors are important in ____ but may not bind with ___ | endogenous analgesia system - opioid drugs |
| contraindications to opioid use | people with respiratory depression, chronic lung disease, liver or kidney disease, prostatic hypertrophy, increased intracranial pressure or hypersensitivity reactions to opioids and related drugs. |
| what are the two main subgroups of opioid analgesics? | agonists and agonists/antagonists. |
| opioid agonists | morphine, codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, oxycodone, oxymorphone, propoxyphene, tramadol |
| opioid agonists/antagonists | butorphanol, nalbuphine |
| opioid antagonist | antidote reverses analgesia and cns and respiratory depression caused by opioid agonists. naloxone (narcan) |
| common herbal/dietary supplement for pain relief | capsaicin from cayenne chili pepper - applied topically to skin. mostly for arthritis type pain. |
| for most acute and chronic pain analgesics are more effective if given... | on regular schedule around the clock. |
Created by:
FSclafani
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