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Why is pain management considered one of nurses’ important roles?
To manage the pain of a patient a nurse needs to have good communication and observation skills.
Name some ways pain can be managed?
- Careful selection and administration of drugs
When dealing with mild pain what type of analgesic would be most effective?
Oral as this is effective for mild pain an NSAID (Non steroidal anti-inflammatory)
I am normally administered IM. I am a narcotic. I am an analgesic. I am used against strong pain. The side-effects of me are constipation, euphoria and drowsiness. What drug am I?
What four things need to be considered by a HCP when describing pain?
Where are pain receptors located?
- Dental pulp
- Viscera – Internal organs (renal ureters are extremely sensitive to pain during renal colic
- Periostium – Located in the bone; fibrous threadlike membrane. Extremely painful during osteomyelitis
How many types of pain are there?
I am pain of the skin and subcutaneous tissue. I can be accurately localized. What is my name?
I am pain deep within the body structure, muscles, joints, and tendons. I am more diffused than cutaneous pain. An example of diffused pain is a sprained ankle.
Deep somatic pain
I am pain related to the internal organs and the autonomic nervous system. I am not sensitive to cutting or burning but contractions, ischaemia and distension. I can cause nausea, vomiting, sweating and pallor. I am not localised by nature. I often require diagnostic tests to be found and even exploratory surgery.
I am pain that originates in the mind. There are 3 possible causes to this type of pain. Biomedical medicine has been unable to locate the pathology of the pain. The patient has a disorder that is creating inappropriate pain perception. The patient is malingering it is important not to make a quick judgement on the later.
Functional or psychogenic pain
I am pain that is linked with visceral pain and is perceived to be coming from a site different to point of origin. Ie Myocardial pain is often felt along the left arm. Guarding is normal when the muscles spasm to protect the painful body area.
I am pain that is sudden on onset and often short in duration. I stimulate the autonomic nervous system. My presenting symptoms are tachycardia. Increased LV contractility with subsequent hypertension. Increased SM tension. Pupil dilation. Vasoconstriction of the peripheral causing cold and clammy skin. Decreased GIT motility and salivary function.
I am pain that is continuous or intermittent of long duration. I do not stimulate the autonomic nervous system. I can be linked with depression.
I am pain that is due to dysfunctional peripheral nerves. I am often debilitating and can be linked with a tumour.
I am a pain that occurs along the distribution of the spinal and cranial nerves. I am severe and repetitive. I can be described as lightening like pain.
I am pain that is linked to dental and sinuses. I can be described as stabbing and recurrent.
I am pain that is related to a childhood illness that has presenting symptoms of poxs. Although once the virus has passed I remain in the patient and when the immune system is weakened I reoccur.
Post-herpetic neuralgia (Shingles)
I am pain that is linked to amputation. I am extremely distressing. Most amputees experience it. There are 3 theories, Neuroma; Spinal and Brain theory.
Phantom Limb pain
Do drugs accelerate or decrease a particular function?
What type of drug is a Antacid?
A chemical reaction drug
Why is activated charcoal used after attempted suicides and overdoses?
It acts like a sponge and absorbs toxins and poisons
What is a surfactant?
It is a surface-active agent
Name the two inhibitions and what is their function?
- Competitive inhibition – Dummy substrate slows down the reaction as it fill the enzyme therefore not allowing the enzyme connection to happen.
- Non-competitive – Destroys the enzyme it will never work again.
I am a highly modified protein with carbohydrates & other groups attached, what am I?
Receptor – many cellular functions are controlled by whether or not the cell receptors are being activated
Name the 4-receptor groups?
- Cell membrane - embedded enzymes: activation of a receptor at the cells surface causes the enzyme to catalyse a reaction inside the cell.
- Ligand-gated ion channels -Activation or blockage of the membrane ion channel (na+, ca++), regulates flow of ions.
- G-protein coupled receptor systems - 3 componets; receptor, G-protein and effector (ion channel or enzyme)
- Transcription factors - Located in the nucleus and regulates protein formation, response time for protein synthesis is slow compared with ion channel responses drugs need to be lipid soluble to reach the nucleus (steriods act this way)
Describe an agonist?
An agonist is a drug that activates the receptor therefore mimics the endogenous action of the body’s own chemical
Describe an antagonist?
If a drug is an antagonist it does not activate the receptor. Therefore blocks the action of the body’s own chemical.
Are both agonist and antagonist competitive?
Yes, more drugs means more action
Is there such a things as partial agonist?
Yes, this is a partial chemical fit to the receptor resulting in partial activation of the receptor action.
In the drug catagories in relation can be taken whilst pregnant?
A, C, B1 & B2 the first 4 on the chart the last 3 (B3, D & X) should be avoided whilst pregnant
Name the drug scheduales?
- S2 = Pharmacy, hospital or Dr
- S3 = Pharmacy only but Medical opinion is required
- S4 = Perscription only
- S8 = Controlled drug; Perscription only; special regulations for storage,distribution, possession and supply
I am a drug and I can be natural or synthetic. My action is similar to morphine?
Are morphine and codeine from the opiate family?
If the example of child birth is given, how are the opioid receptors involved. (nb:think pain tolerance)
- Endogenous opioid peptides (endorphines)
- Which are located in the CNS & peripheral tissue act as neurotransmitters
- Activate the opioid receptors
- Decreasing nerve excitability (therefore block pain pathways in CNS)
Name the 3 classes of opioid?
- MU - Action: Analgesia, Respiratory Depression, Sedation, Euphoria, Physical dependence & decreased GI motility (can be used to stop diarrhoea)
- Kappa - Action: Analgesia, Sedation, decreased GI Motility
I am a drug that is classed as inactive; I convert to morphine in the body. I am lipid soluble. I can cross the BBB better than morphine. I create a opioid rush and I have the potential for abuse. What am I?
I have controlled release. I treat moderate to severe pain. What drug am I?
The liver converts me to morphine. I have a higher efficacy when combined with asprin or paracetamol. I can reduce cough supressent or anti diarrhoeal activity. What drug am I?
I am a partial opioid against the MU receptor and an antagonist at the Kappa receptors. My action reduces respiritary depression & abuse potential. What drug am I?
I am a competitive antagonist at the opiod receptiors. I can be administered by most routes but not oral due to a high first pass. What drug am I?
I am administered orally. I am used in alcohol addictions. I can not be used if the pt has a liver disorder. What am I?
Explain tapering dose?
I am a method of reducing medication. A high dose over 3 week may produce dependence but tapering over 3 days will reduce addiction tendency.