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Analgesics
Ch. 11 Pharm
| Question | Answer |
|---|---|
| what do analgesics do | relieve pain w/o causing loss of consciousness |
| name some analgesics | painkillers, opioids, NSAIDs |
| Pain is: | pt oriented, tissue damage, personal |
| what are nociceptors | sensory nerve fibers that cause pain and transmit from body to spinal cord and brain |
| What are the four processes of nociception | 1. stimuli- transduction to cord 2. transmission- to brain 3. perception of pain 4. modulation- neurotransmitters block pain impulse |
| what is a pain threshold | level of stimulus needed to produce the perception of pain, physiologic response of nervous system. "Tough cat, eat pain for brfst" |
| what is pain tolerance | amt of pain can endure w/o interfering with normal fx, subjective response, psychologic |
| Classifications of pain in terms of onset and duration | Acute- sudden, subsides Chronic- persistent, recurring, lasts 3-6mos |
| Pain classifications on source | somatic- origin skeletal muscles, ligaments, joints |
| Visceral pain | origin organs, smooth muscles, superficial |
| superficial pain | skin, mucous membranes |
| deep pain | tissues below skin level |
| vascular pain | vascular/perivascular tissues, migraines |
| referred pain | choecystitis, referred to back and scapular areas; heart attack |
| neuropathic pain | nerve, CNS |
| phantom pain | in area of body that's been removed, amputation |
| Cancer pain | acute/chronic/both, from tumor pressure on nerves,organ, tissues |
| central pain | tumor, trauma, disease affecting CNS tissues |
| which part of spinal cord is the "gate" located | dorsal horn |
| What two fibers operate in the gate theory | A(abstain) lg, fast fibers- close gate, limit perception of pain, C(carries)- sm, slow fibers- open gate to pain perception |
| what are the endogenous neurotransmitters that are our painkillers | enkephalins, endorphins, bind to opioiod receptors, close gate |
| What is the gate theory | impulses from damaged tissues are sensed in the brain are opened or closed by a "gate" |
| What are some of the substances released with tissue injury to start the pain process | bradykinin, histamine, K, prostaglandins, serotonin Massage also closes gate |
| What is PCA by proxy | someone else pushes PCA pump |
| what is opioid tolerance | how much drug is needed to make comfortable |
| what is breakthrough pain | pain b/n doses of pain meds |
| What do adjuvant drugs do with opioids | assist primary drugs in relieving pain NSAIDs, antidepressants, anticonvulsants, corticosteroids |
| one common use of adjuvant is neuropathic pain, give two examples | Amitriptyline(antidepressant) Gabapentin or pregabalin (anticonvulsants) |
| What are three classifications of opioids | aganists, partial agonists, antagonist |
| Which two drugs are associated with the opioid ceiling effect | pentazocine, nalbuphine b/c drug reaches max effect and higher dose does not x effect |
| What does an agonist do | bind to opioid pain receptor in brain and causes analgesic response |
| what does a partial agonist do | binds to pain receptor but causes weaker response |
| what are the 5 types of opioid receptors | Mu, kappa, sigma, delta, epsilon, with mu, kappa, delta most responsive and mu most important for morphine sulphate |
| know 8 common opioids | codeine sulfate, meperidine HCI(Demerol), methadone HCI(Dolophine), morphine sulfate, propoxyphene HCI, hydromorphone, oxycodone(percoset), fentanyl---set= Tylenol |
| Opioids main use | alleviate moderate to severe pain, with adjuvants |
| what other uses for opioids | cough suppressant, diarrhea, balanced anesthesia |
| what are contraindications of opioids | resp depression, drug allergy Use caution if incr cranial press., obese, sleep apnea, paralytic ileus |
| adverse effects of analgesics | euphoria, CNS depression, N/V, constipation, urinary retention, diaphoresis/flushing, miosis, itching |
| what is opioid tolerance | need lgr dose to maintain same level, not addiction |
| Opioid psychological dependence is | compulsive drug use other than for pain, continued craving |
| what is used for opioid overdose | naloxone(Narcan), naltrexone(Revia) Given when resp depression occurs with opioid |
| What are nonopioid analgesics | acetominophen, mild to moderate pain, analgesic and antipyretic effect, no anti-inflammatory effects |
| Mechanism of action for nonopioids | similar to salicylates(aspirin) |
| what is antidote for overdose | acetylcysteine regimen |
| what is maximum daily dose of nonopioids | 4000 mg/day, 2000 mg for elderly |
| what are herbal analgesics | Feverfew, from marigold, antiinflammatory |
| With opioid analgesics, what if decline in pt | withhold and call Dr if resp is <10-12, watch for hypotension |
Created by:
palmerag
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