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Chronic pain is...
pain not associated with cancer or other medical conditions that persists for more than 3 to 6 months
pain lasting more than 1 month beyond the course of an acute illness or injury
or pain recurring at intervals of months or years.
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What enzyme converts Archaidonic acid to prostaglandins?
Cyclooxygenase
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Which COX is responsible for stomach lining, stomach mucus production?
Cox 1
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Which cox in the blood, thromboxane promotes platelet aggregation and vasoconstriction
In lungs prostaglandins have anti-inflammatory effect and anti asthmatic?
COX 1
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Which COX is ramped up during injury, increase vasodialation and vascular permeability which causes swelling?
COX 2
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Which cox increases production of osteoblasts? and pain?
Cox 2
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Which has a prostacycline that inhibits platelet aggregation, allowing the body to keep clot formation isolated to area of injury?
Cox 2
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Which cox is ramped up in response to pathogens and have prostaglandins that work on the hypothalamus to increase body temperature by peripheral vasoconstriction. activated by pathogen
cox 3
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what are released from the cells in response to chemical stimuli or trauma?
prostaglandins
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What are some selective cox 2 inhibitors?
Naproxen, meloxicam, celecoxib
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NSAIDS decrease COX by __________
competitive inhibition
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NSAIDS can be used as a sole agent or in conjunction with...
Narcotics, muscle relaxants, acetaminophen
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how do NSAIDS cause a decrease in renal perfusion?
inhibits prostaglandins ability to vasodialate blood vessels
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Prostaglandins help maintain the ______of the glomerulus
lumen of the afferent
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Fast acting NSAIDS should be limited to...
5 days
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Why arent NSAIDS indicated during fractures?
May inhibit osteoblasts
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How do NSAIDS work with blood thinners
Potentiate the effects
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What are some names for motrin?
Advil, Nuprin Midol
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What are indications for motrin?
Mild to moderate pain
fever
inflammatory diease
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What are contraindications to ibuprofen?
- HX of allergy to aspirin or other NSAIDS
- penetrating trauma
- Head injury or ICP
- Bronchiospasm
- Angioedema
- Pain control before surgery
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Naproxens indications?
- Mild to moderate pain
- Inflammatory diease
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contraindications
liver functions test for long term use!
HX of allergy to aspirin or other NSAIDSpenetrating traumaHead injury or ICPBronchiospasmAngioedemaPain control before surgery
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Meloxicam indications
Inflammatory Disease
mild to moderate pain
once a day dosing Cox 2 inhibitor
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Contraindications for Mobic?
- HX of allergy to aspirin or other NSAIDS
- penetrating trauma
- Head injury or ICP
- Bronchiospasm
- Angioedema
- Pain control before surgery
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Celexobid or celebrex Category? and benefit?
Cox 2 inhibitor
once a day dosing
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Ketorlac or toridol indications
Primary benefits?
- moderately acute severe pain not requiring opiods
- Injectable
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Time for IV bolus?
How long should ketorolac be given for?
15 seconds
5 days
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Aspirin indications
Inflammation
- fever
- mild to moderate pain
- Thromboembolytic disorders
- Reduce risk of TIA MI or unstable angina
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common NSAID Contraindications
- HX of allergy to aspirin or other NSAIDS
- penetrating trauma
- Head injury or ICP
- BronchiospasmAngioedema
- Pain control before surgery
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Contraindications for ASA
- bleeding/gi disorders
- Patients under 19
- Asthma
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How long does permanent platelet inhibition last for Acetl Sylic acid
7-10 days
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Aspirin side effects
- GI symptoms and bleeding
- Stomach PN
- Nausea vomiting
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How to Identify Reyes syndrome.
A hallmark is a red rash on the palms and soles with in 3 weeks of a viral illness (chicken pox, mono, or URI) accompanied by nausea and vomiting, fever, and other flu-like symptoms.
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Other names for Tylenol
Acetaminophen, APAP, paracetmol
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Contraindications for tylenol?
- Hepatitis, renal disorders
- Anemia, cardiac, pulm, renal disease
- alcoholics due to high risk of hepatoxicity
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Where is APAP metabolized and how many MG causes hepatoxicity?
Liver, 7500mg
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Early signs of Paracetamol toxicity are...
Diaphoresis, anorexia, nausea and fatigue
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What is the antidote for tylenol poisoning?
How fast should it be given?
N-acytlecystine or Mucomist
Within 24 hours
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Indications for NARCS
- Moderate to severe acute/chronic pain
- Anesthesia
- coughing
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How do opiods work?
Inhibits cAMP, not allowing calcium channels to open and slows transmission
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This type of opiod receptor has an effect of
analgesia
respiratory depression
miosis
euphoria
Reduced GI motility
physical dependence
MU
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Kappa opiod receptors do what?
- Analgesia
- Sedation
- Miosis
- Dysphoria
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What kind of effects does the delta receptor have?
- analgesia
- antidepression
- physical dependence
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What opiod receptor causes these effects?
Anxiety
Depression
Tolerance to Mu
Nociception
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Why is a closed head injury contraindicated with opioid?
Respiratory depression can cause the brain to sense high CO2 levels and release more blood increasing ICP
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Other names for morphine?
MS contin, Roxanol, Duramorph
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What are some narcotic contraindications?
- Respiratory depression
- Hypotension
- head injury/ICP
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What type of patients are at risk to overdose of MS Contin?
Circulatory impairment (Burn or shock) due to slower absorption
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What are some CV effects morphine has?
- peripheral arterial dialation
- decreases systemic resistance of afterload in the heart
- decreases myocardial oxygen demand
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What is meperidine?
Demerol a synthetic opiod
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What are some uses for meperidine?
- Moderate to severe pain,
- anasthesia adjunct for preoperative sedation
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what are some other names for fentanyl?
Actiq, duragesic
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What are some indications for fentanyl
Synthetic and highly potent for acute or chronic severe pain
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SOCM recommendation for a fentanyl lollipop is
800 mcg
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Oxycodone combined with APA is?
with ASA is?
Percocet, tylox
Percodan
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The 12 hour sustained release tablet of oxycodone is?
Oxycontin (no ASA or APAP)
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Tramadol does what with serotonin?
Increases the release and decreases the reuptake of nE, mitigating opiod side effects
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What are some indications of hydrocodone and codeine?
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Hydrocodone 5mg + APAP 500mg are known as?
Lortab or vicodin
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Codeine 30mg and 300mg APAP are?
Tylenol 3
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Hydrocodone 5mg and guaifenesin 100mg/5ml is?
Kwelcof, codiclear
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What are signs of opiod toxicity?
- Respiratory depression
- Unconsciousness, coma, decreases LOC
- Miosis
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Why does tolerance occur?
Liver gets used to it and builds up enzyme which metabolizes the drug faster
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a compulsive, drug seeking behavior, it is not when a person develops tolerance to opioid’s analgesic effects is
addiction
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after giving an opiod there may be wheezing due to a histamine reaction, how can an operator differentiate between anaphylaxis?
listen to the lungs for wheezing and check blood pressure, as well as signs of urticaria.
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people with renal disease require what kind of opiod dose?
lower
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Minimum BP for opiod?
100 mmhg
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what are some agonist/antagonist opiods?
Butorphanol (Stadol) and Nalbuphine (Nubain)
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how does nubain decrease euphoria and resp depression and maintain analgesia?
Nubain does this by competitively antagonizing the opioid off the mu receptor site while providing analgesia on the kappa receptor site.
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What is a common compettitive opiod antagonist?
Naloxone, narcan
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Narcan is included in oral narcotics to prevent the crushing of the pill and IV abuse, whats this called
(aversion technology)
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Dosage for narcan?
.4-2mg IV repeat 2-3 min PRN
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How long does narcan last?
20-40 min
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Narcan dose for children?
0.01 mg/kg IV/SQ/IM q2-3 min
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