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What are the three etiologies of pain?
- Disease related
- Trauma related
- Treatment related
What are 10 health consequences of pain?
- Metabolic Rate
- Blood Clotting
- Water retention
- Hormone imbalance
- Immune system
- GI Function
What is positively correlated with high pain scores?
Post-op pulmonary complication
Why does pain lead to poor wound healing?
Why does pain lead to deep vein thrombosis?
Venous stasis from immobility
Why does pain lead to vasoconstriction?
Sympathetic nervous system activation
What are three types of pain?
Which type of pain is well-localized and comes from structural tissues?
Which type of pain is deep and refferred and comes from deep tissues and organs as a result of stretching, distention or ischemia?
Which type of pain is shoot, burning or stabbing and comes from the peripheral receptors?
What two areas modulate pain?
- Dorsal horns of the spinal cord
When does pain become perceived as a localized sensation?
When it reaches the sensory cortex
Five factors to consider when assessing pain?
- P - Q - R - S - T
What is the first step of the WHO Analgesic Ladder and what does it treate?
Nonopioid analgesics, mild to moderate pain
What is the second step of the WHO Analgesic Ladder and what does it treat?
Opioid analgesic, more severe pain
What is the third step of the WHO Analgesic Ladder and what does it treat?
morphine, fentanyl, severe pain
What are three categories of non-opioid drugs?
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDS)
- Para-aminopheno derivatives (acetaminophen)
What is a common topical nonopioid?
What is Capsaicin's mechanism of action?
Depletes Substance P
What are two kinds of opioid receptors?
What are six common side effects of opoiod drugs?
- Respiratory Depression
- Decreased GI motility
What are the side effects correlated to mu receptors (mu agonists)?
All of them
What opioid drug side effects correlate to Kappa receptors?
- Decreased GI motility
Which opioid drug side effects are not connected with kappa receptors?
- Respiratory depression
What is drug tolerance?
physiological process of desensitization of receptors requiring increase in dose to get same analgesia effect
What are the seven routes of administration when dealing with opioids?
What are the disadvantages of administering opioids orally?
- Nausea and vomiting
- Decreased GI function
What are the disadvantages of administering opioids rectally?
What are the disadvantages of the transdermal route of administering opioid drugs?
- Difficult to titrate
- Toxicity may continue after removal
What are the disadvantages of administering opioids sublingually/buccaly?
- Low bioavailability
- No fluids after dose for 15 min.
- inconvenient with large dose
Which opioid is a kappa agonist?
Which opioids are mu agonists?
- Meperidine (Demerol)
What is given when someone overdoses on opioids?
Which opioid's dosing is limited by aspirin and acetaminophen?
Which opioid when overdosed is lethal?
What is a disadvantage of oxycodone?
- It cannot be crushed
- Dose limited by ASA and Acetaminophen
Which opioid drug increases intracranial pressure?
What is the disadvantage of using meperidine?
Toxic metabolite inhibits long term use.
What is the name of the drug that blocks mu receptors in the intestines?
What is a disadvantage to giving naloxone for opioid overdose?
It has a shorter half-life than most opioids
What are two types of nonopioid adjuvants?
- Tricyclic Antidepressants
What do tricyclic antidepressants do?
Block NE and serotonin reuptake which inhibits Substance P release
What do anticonvulsants do to relieve pain?
Decrease nerve conduction, steroids stabilize mast sells which decreases histamine and swelling
Three things to consider when dosing pain medication...
- By the ladder
- By the clock
- By the least invasive route