Pain

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Author:
sashatom
ID:
35097
Filename:
Pain
Updated:
2010-09-16 02:06:58
Tags:
pain opioids pharmacology
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Pain lecture slides
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  1. What are the three etiologies of pain?
    • Disease related
    • Trauma related
    • Treatment related
  2. What are 10 health consequences of pain?
    • Increased:
    • Stress
    • Metabolic Rate
    • Blood Clotting
    • Water retention
    • Hormone imbalance

    • Decreased:
    • Immune system
    • Healing
    • GI Function
    • Mobility
    • Appetite
    • Sleep
  3. What is positively correlated with high pain scores?
    Post-op pulmonary complication
  4. Why does pain lead to poor wound healing?
    Vasoconstriction
  5. Why does pain lead to deep vein thrombosis?
    Venous stasis from immobility
  6. Why does pain lead to vasoconstriction?
    Sympathetic nervous system activation
  7. What are three types of pain?
    • Somatic
    • Visceral
    • Neuropathic
  8. Which type of pain is well-localized and comes from structural tissues?
    Somatic Pain
  9. Which type of pain is deep and refferred and comes from deep tissues and organs as a result of stretching, distention or ischemia?
    Visceral pain
  10. Which type of pain is shoot, burning or stabbing and comes from the peripheral receptors?
    Neuropathic pain
  11. What two areas modulate pain?
    • Nociceptors
    • Dorsal horns of the spinal cord
  12. When does pain become perceived as a localized sensation?
    When it reaches the sensory cortex
  13. Five factors to consider when assessing pain?
    • P - Q - R - S - T
    • Provokes
    • Quality
    • Radiates
    • Severity
    • Timing
  14. What is the first step of the WHO Analgesic Ladder and what does it treate?
    Nonopioid analgesics, mild to moderate pain
  15. What is the second step of the WHO Analgesic Ladder and what does it treat?
    Opioid analgesic, more severe pain
  16. What is the third step of the WHO Analgesic Ladder and what does it treat?
    morphine, fentanyl, severe pain
  17. What are three categories of non-opioid drugs?
    • Topical
    • Nonsteroidal Anti-Inflammatory Drugs (NSAIDS)
    • Para-aminopheno derivatives (acetaminophen)
  18. What is a common topical nonopioid?
    Capsaicin
  19. What is Capsaicin's mechanism of action?
    Depletes Substance P
  20. What are two kinds of opioid receptors?
    • Mu
    • Kappa
  21. What are six common side effects of opoiod drugs?
    • Sedation
    • Dependency
    • Respiratory Depression
    • Decreased GI motility
    • Euphoria
    • Analgesia
  22. What are the side effects correlated to mu receptors (mu agonists)?
    All of them
  23. What opioid drug side effects correlate to Kappa receptors?
    • Analgesia
    • Sedation
    • Decreased GI motility
  24. Which opioid drug side effects are not connected with kappa receptors?
    • Euphoria
    • Respiratory depression
    • Dependency
  25. What is drug tolerance?
    physiological process of desensitization of receptors requiring increase in dose to get same analgesia effect
  26. What are the seven routes of administration when dealing with opioids?
    • Intravenous
    • Intramuscular
    • Oral
    • Rectal
    • Transdermal
    • Sublingual
    • Buccal
  27. What are the disadvantages of administering opioids orally?
    • Nausea and vomiting
    • Decreased GI function
  28. What are the disadvantages of administering opioids rectally?
    Improper application
  29. What are the disadvantages of the transdermal route of administering opioid drugs?
    • Difficult to titrate
    • Toxicity may continue after removal
    • Expensive
  30. What are the disadvantages of administering opioids sublingually/buccaly?
    • Low bioavailability
    • Taste
    • No fluids after dose for 15 min.
    • inconvenient with large dose
  31. Which opioid is a kappa agonist?
    Pentazocine
  32. Which opioids are mu agonists?
    • Morphine
    • Meperidine (Demerol)
    • Fentanyl
    • Oxycodone
  33. What is given when someone overdoses on opioids?
    Naloxone
  34. Which opioid's dosing is limited by aspirin and acetaminophen?
    Oxycodone
  35. Which opioid when overdosed is lethal?
    Fentanyl
  36. What is a disadvantage of oxycodone?
    • It cannot be crushed
    • Dose limited by ASA and Acetaminophen
  37. Which opioid drug increases intracranial pressure?
    Pentazocine
  38. What is the disadvantage of using meperidine?
    Toxic metabolite inhibits long term use.
  39. What is the name of the drug that blocks mu receptors in the intestines?
    Methylnaltrexone
  40. What is a disadvantage to giving naloxone for opioid overdose?
    It has a shorter half-life than most opioids
  41. What are two types of nonopioid adjuvants?
    • Tricyclic Antidepressants
    • Anticonvulsants
  42. What do tricyclic antidepressants do?
    Block NE and serotonin reuptake which inhibits Substance P release
  43. What do anticonvulsants do to relieve pain?
    Decrease nerve conduction, steroids stabilize mast sells which decreases histamine and swelling
  44. Three things to consider when dosing pain medication...
    • By the ladder
    • By the clock
    • By the least invasive route

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