Pain Management

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Author:
capnhue
ID:
133682
Filename:
Pain Management
Updated:
2012-03-02 01:22:59
Tags:
Regis University
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Description:
Pain Management
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  1. Somatic pain
    • well-localized
    • stabbing, throbbing
    • dull, aching
  2. Visceral pain
    • diffuse (poorly-localized)
    • referred (to another organ)
    • deep, squeezinf, pressure
    • gnawing, cramping, itching
  3. Nociceptive pain 4 Steps
    • stimulation
    • transmission
    • perception
    • modulation
  4. Opiod Effects
    • respiratory depression in brainstem
    • depress cough reflex in medulla (antitussive)
    • activation of chemoreceptor trigger zone (CTZ) in medulla - results in nausea and vomiting
    • inhibit ACh in GI causing constipation and Sphincter of Oddi spasm (biliary spasm)
    • promotes histamine release - causing pruritus (itching), urticaria (hives), asthma exacerbation
  5. Mixed agonist-antagonists
    • low efficacy or full antagonist activity at mu opoid receptors
    • agonist activity at kappa opioid receptors
    • nalbuphine
    • butorphanol
    • pentazocine
    • buprenorphine
  6. Adverse Effects of Mixed agonist-antagonist
    • hallucinations
    • psychotic-like reactions
    • dysphoria
  7. Meperidine neurotoxic symptoms
    • CNS excitability
    • tremor and muscle twitching
    • seizures
    • serotonin syndrome
  8. Methadone MOA
    • binding to opioid receptors in CNS
    • antagonism of NMDA receptors
  9. Adverse effects of Naltrexone
    • hepatocellular injury (black box)
    • syncope (cardiovascular)
    • nausea
    • vomiting
    • cramping
  10. Meperidine dose adjustments
    renal dysfunction - not recommendedheptaic dysfunction - dosed decreased
  11. Tramadol renal adjustment
    • CrCl: <30
    • lower dose of IR
    • AVOID: ER tramadol
  12. Meperidine drug-drug interactions
    serotonin syndrome: w/MAOIs, phenelzine (antdepressant)
  13. Morphine elimination
    • eliminated by UGT
    • lamotrigine: inhibitor of UGT
    • CrCl: <50 dose reduction recommended
  14. Treatment of myofascial pain
    • PT
    • ice
    • NSAIDs
    • opioids (if severe pain)
    • uncommon treatments: lidocaine, corticosteroidsbiofeedback therapy, acupuncture
  15. Myofascial pain
    • muscle or muscle groups and adjacent CT affected, resulting in motor dysfunction and spasm
    • low back pain
    • neck pain
  16. treatment for Neuropathic pain
    • nortriptyline (TCA)
    • desipramine (TCA)
    • duloxetine (SNRI)
    • venlafaxine (SNRI)
    • gabapentin (AED)
    • pregabalin (AED)
    • topical lidocaine (lidoderm)
    • second line agents: opioid agonists, tramadol
  17. Treat nausea and vomiting
    • metoclopramide
    • prochlorperazine
    • haoperidol
    • serotonin (5-HT) antagonist
    • *constipation can cause nausea & vomiting
  18. Treat Sedation (an adverse effect)
    • caffine
    • methylphenidate
    • dextroamphetamine
  19. Treat Cognitive Impairment/Delerium (an adverse effect)
    • haloperidol
    • chlorpromazine
    • atypical antipsychotic
  20. opioid induced neuro-toxicity
    • result in accumulation of neurotoxic metabolites
    • causing: confusion & delerium, sedation, myoclonus (myoclonic jerks), hallucinations, vomiting, pinoint pupils, diffuse hyperalgesia
  21. Manage Respiratory Depression
    • hold or discontinue opioid
    • provide tactile stimulus to wake pt
    • administer O2 saturation and prevent hypoxemia
    • dilute naloxone w/NS
    • administer 0.5-1ml by slow IV push every 2mins until pt arouses or respiratory rate improves
  22. Naltrexone adverse effects
    • hepatocellular injury (black box warning)
    • syncope (cardiovascular)
    • GI (nausea, vomiting, cramping)

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