Surgery Dr Q: Chapter 7

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  1. Essential part of every patient evaluation
    Pain assessment
  2. Detection by the nervous system of the potential for or the actual occurrence of tissue injury
    Nociception
  3. Protective sensation of pain that occurs when there is no or minimal tissue injury
    Physiologic pain
  4. Pain the occurs after the tissues injury
    Pathologic pain
  5. Nociception consist of 4 main steps
    • Transduction
    • Transmission
    • Modulation
    • Perception
  6. Transformation of thermal, chemical or mechanical stimuli into electrical signals called action potentials
    Transduction
  7. Sensory impulses conducted to the spinal cord
    Transmission
  8. Sensory nerve impulses are amplified or suppressed by other neurons
    Modulation
  9. Impulses transmitted to the brain where they are processes an recognized
    Perception
  10. Drugs effective in transduction phase
    • NSAIDs
    • Opioids
    • Local anesthetics
    • Corticosteroids
  11. Drugs effective in transmission phase
    • Local anesthetics 
    • Alpha2- agonists
  12. Drugs effective in modulation phase
    • Local anesthetics
    • NSAIDs
    • Opioids
    • Alpha2-agonists
    • Ketamine
    • Anticonvulsants
  13. Drugs effective in the perception phase
    • Opioids
    • Sedatives
    • General anesthetics
  14. Multimodal therapy
    Using several analgesic drugs, each with different mechanisms of action
  15. Multimodal therapy, in regards to drug doses, results in...
    Lower doses of drugs which increases safety
  16. 5 freedoms that help to asses quality of life
    • Freedom from... 
    • Hunger and thirst
    • Discomfort
    • Disease
    • Injury
    • Pain
  17. Pain related physiological changes in the cardiovascular system
    • Hypertension
    • Tachycardia
    • Tachyarrhythmia
    • Peripheral vasoconstriction
  18. Pain related physiological changes in the respiratory system
    • Tachypnea
    • Shallow breathing
    • Exaggerated abdominal component
    • Panting
    • Open-mouth breathing
  19. Pain related physiological changes with the eyes
    Mydriasis
  20. Painful medical conditions
    • Arthritis
    • Cancer
    • Cystitis
    • Pancreatitis
    • Peritonitis
    • Pleuritic
  21. Painful surgical conditions
    • Spinal
    • Fracture repair
    • Hip replacement
    • Joint
    • Ear
    • Dental extractions
    • Sinus
    • Trauma
    • Eye
    • Pyometra
  22. Preemptive analgesia
    Administering analgesics before surgery decreases analgesic requirements and minimizes CNS sensation
  23. Examples of opioids strongest to weakest
    • Fentanyl
    • Oxymorphone
    • Hydromorphone
    • Methadone
    • Morphine
    • Meperidine
    • Buprenorphrine
    • Butorphanol 
    • Nalbuphine
  24. Examples of Alpha-2 agonists
    • Xylazine
    • Dexmedetomidine 
    • Detomidine
    • Ramifidine
  25. Examples of NSAIDs, COX-1
    • Aspirin
    • Acetaminophen
    • Flunixin meglumine
    • Ketoprofen
    • Ketorolac
    • Phenylbutazone
    • Piroxicam
  26. Examples of NSAIDs, COX-2
    • Carprofen
    • Meloxicam
    • Etodolac
    • Deracoxib
    • Tepoxalin
    • Firocoxib
  27. Examples of other analgesics
    • Ketamine
    • Amantadine
    • Dextromethorphan
    • Amitriptyline
    • Tramadol
    • Gabapentin
  28. Idiopathic pain defined as
    Pain of unknown cause
  29. An ovariohysterectomy, which involves surgically incising the skin and abdominal wall and excising the uterus and ovaries has which components of pain
    Somatic and visceral
  30. Where in the pain pathway does secondary sensitization of "windup" occur
    Spinal cord
  31. Example of multimodal analgesic therapy
    Dexmedetomidine, morphine and ketamine
  32. Example of an analgesic plan that targets three different pain receptor mechanisms
    Morphine IM, Ketamine CRI and Lidocaine nerve block
  33. Does treating pain improve wound healing?
    Yes
  34. Potential side effect of opioid administration in cats and dogs
    Vomiting, dysphoria, respiratory depression
  35. Method of action of NSAIDs
    Inhibit prostaglandin synthesis
  36. Potential side effects of NSAIDs
    Liver damage, kidney damage, GI ulcers
  37. What to asses when indicating pain assessment scale
    • Interaction level
    • General appearance
    • Posture
    • Cardiovascular
  38. Muscoskeletal pain
    Somatic pain
  39. Pain from the organs
    Visceral pain
  40. Nerve injury pain
    Neuropathic pain
  41. If patient is feeling mild pain then only  __ location may need to be targeted
    1
  42. With moderate pain may need to target ___ locations
    2
  43. With severe pain may need to target ___ locations
    3
  44. Locations that may need to be targeted in regards to pain
    Peripheral nerves/tissues, spinal cord and brain
  45. Occurs when stressors like pain affect physiology and behavior
    Distress
  46. Consequences of pain
    • Catabolic state and wasting
    • Suppressed immune system
    • Inflammation and delayed wound healing
    • Stress
  47. State of increased sensitivity near a site of tissue injury in which stimulation with a normally non-noxious stimulus is painful
    Primary Hyperalgesia
  48. A state caused by constant nociceptive input from the periphery, in which neurons in the spinal cord become hyperexcitable and sensitive to low-intensity stimuli that would not normally elicit a pain response
    CNS hypersensitivity AKA windup
  49. Project or describe animals as having human emotions/behavior
    Anthropomorphize
  50. Behavior changes animals make when in pain
    • Facial expressions (glazed/squinted eyes)
    • Bruxism
    • Lack of grooming
    • Disinterest
    • Aggression
  51. Pain treatment used before, during and after surgical procedure
    Perioperative analgesia
  52. Opioids provide analgesia through which opioid receptors found where
    • Spinal cord
    • Brain
    • Synovial membranes of joints
  53. C-II Opioids
    • Morphine
    • Oxymorphone
    • Fentanyl
  54. Morphine causes..
    Excitement in horses/cats, vomiting, histamine release if given IV rapidly
  55. Fentanyl
    Strongest opioid, used commonly as a CRI, transdermal use as well
  56. Butorphanol
    • Good for cough suppressant, cranial GI pain and visceral pain
    • C-IV
  57. Buprenorphrine
    • Opioid that has the longest duration
    • C-III
  58. Adverse effects of opioids
    • Dysphoria 
    • Respiratory depression
    • Excitability (cats)
    • Excessive panting
    • Vomiting
  59. NSAID effects
    • Skeletal pain
    • Newer ones have somatic and visceral pain control
    • 30-60 mins onset of action
    • Some are antipyretic
  60. COX-1 controls
    Homeostasis
  61. COX-2 controls
    Inflammation
  62. Central acting NSAID
    • Acetaminophen
    • Ketorolac
  63. Central and peripheral acting NSAID
    • Ketoprofen
    • Meloxicam
  64. Advantages of NSAID
    • Not a controlled substance
    • No  cardio/resp effect
    • No CNS depression
  65. Conditions in which NSAID's shouldnt be used
    • Renal disease
    • Liver disease
    • GI ulcers
    • Hypotension
    • Blood clotting disorders
  66. Strongest anti-inflammatory drugs
    Corticosteroids
  67. Tramadol
    • Non opiate
    • Centrally  acting oral pain medicine
    • Inhibition of norepinephrine and serotonin reuptake
    • Now a controlled substance
    • Only in oral form
  68. Good nursing care indicates
    • Clean/dry bedding
    • Allowing defecation/urination 
    • Comfortable/quiet environment
    • Regular pain assessment
    • Petting/comforting patient
  69. Non drug therapies
    • Cold/heat therapy
    • Acupuncture/electro stimulation
    • Therapy laser
    • Physical therapy
  70. Two drugs that block NMDA receptors and stimulate "windup"
    • Methadone
    • Ketamine
  71. Opiate absorbed mucosally in cats
    Buprenorphrine
  72. Ideally NSAID's are __ sparing and ___ selective
    • COX-1
    • COX-2
  73. ___ ___ is most important thing an anesthetist can do to prevent complications
    Patient preparation
Author:
Kristenw
ID:
315802
Card Set:
Surgery Dr Q: Chapter 7
Updated:
2016-02-28 22:22:45
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Surgery
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Surgery Dr Q: Chapter 7
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