What do health care practitioners ask when assessing pain?
Location and severity with validation of the pain assessment scale
What are the components of pain?
pyschological and physiological
Why is pain threshold higher in some people?
because of conditioning, ethnic background, sensitivity, or physiological factors (endorphin release)
What is the purpose of endorphins?
they block the transmission of pain
endorphins are ______ analgesics produced within the body as a reaction to severe pain or intense exercise
endogenous
A term most commonly used to describe endorphins
runner's high
endorphin release may be responsible for a _____ effect
placebo
relief from pain as the result of suggestion without the administration of an analgesic is an example of a _____
placebo effect
what can analgesics be classified as?
opioid, nonopioid, and adjuvant
_____ are classified as full or pure agonists, partial agonists, or mixed agonist antagonist depending on the specific receptors they bind to and their activity at the receptor
opioids
______ are commonly used because their action is similiar to that of opium in altering the perception of pain, and they do not have a ceiling to their analgesic effects
full agonists
this is referred to medication level at which there is no enhanced analgesia
no ceiling
what drug is considered a weak opiate agonist and is not currently classified as a controlled substance on the federal level?
tramadol(ultram)
physical adaptation of the body that have withdrawal symptoms after abrupt drug discontinuation is:
dependance
when a larger dose is needed to achieve the same analgesic effect
tolerance
is opioids used for extended periods?
No. They are used mostly to relieve chronic pain
how can opioids become a more effective pain medication?
by combining nonopioids and adjuvants
what does around the clock dosing do?
prevent pain from developing
drugs that enhance an analgesic effect are called:
adjuvant analgesics
(they can reduce the needed dosage of opioids)
side effects of opioids
(BURN FBCHHSS)
Blurred Vision
Urinary Retention
Respiratory depression
Nausea, vomiting, constipation
Flushing, rash, pruritus
Bradycardia
Confusion, euphoria, restlessness
Headache
Hypotension
SedationSexual dysfunction
Opioid contraindications
A CHAP DOG COC
Abrupt discontinuation
COPD
Head Injury
Addiction prone, suicidal, alcoholic
Pregnancy, lactation
Driving or operating machinery
Opiate agonist hypersensitivty
GI, Hepatic, Renal, thyroid disease
Cardiac disease
Older adults
CNS depression
Interactions of opioids with all CNS depressants
AAAAMPS
Alcohol
Antihist
Antiemetics
Antiarrythmics
Muscle relaxants
Psychotropcs
Sedatives/hypnotics
An opioid that can be administered parenterally before the start of anesthesia
fentanyl
patients with kidney disease should not use this because it may cause seizures
meperidine (sounds like My poor kidney)
these are used to manage moderate to severe pain due to their long duration of effect and potency
morphine and hydromorphone (what i got at the docs)
____ is a centrally acting synthetic analog of codeine that has dual action, and produces analgesia by weak inhibition of norepinephrine and serotonin reuptake
tramadol
(think TRAMPS have a potential for abuse and resp. depression)
Used in the treatment of opioid dependance
naltroxene (pure opioid antagonist)
buprenorphine (partial opioid antagonist)
used in the treatment of opioid overdose in the OR, delivery room, and nursery for opiate induced respiratory depression
Narcan (naloxone)
(think narCAN help overdose)
true or false
Nonopioids are usually found OTC
true
_______ are given for purposes of relieving mild to moderate pain, fever, and anti-inflammatory conditions
nonpioids
nonopioids may also be used as a ______ in severe or acute or chronic pain requiring opioids
coanalgesic
_______ are most commonly used for their analgesic and antipyretic properties as well as anti inflammatory action
Salicylates (asprin)
_____ a nonopioid that has analgesic and antipyretic properties but very little effect on inflammation
acetaminophen
_____ & ______ actions are associated primarily with preventing the formation of prostaglandins and the subsequent inflammatory response prostaglandins help to reduce
salicylate analgesic and antiinflammatory
Side effects of salicylate and other NSAIDS
(PACT BRHD)
Poisoning
Anaphylaxis
Coma
Tinnitus (with overdose)
Bleeding/Bruising
Renal insufficeincy
Hepatic dysfunction
Drowsiness
salicylate contraindication
(BAG V CLAP)
Bleeding disorders
Asthma
GI disorders
Vitamin K deficiency
Children younger than 15 bc of reyes syndrome
Lactation
Allergy to ASA
Pregnancy
_____ should be discontinued 5-7 days before elective pre/postoperative surgery
salicylates/NSAIDS
_____ is used extensively in the treatment of mild to moderate pain and fever and has little effect on inflammation
acetaminophen (tylenol)
Acetaminophen side effects
Severe liver toxicity
Renal insufficiency
Rash
Blood dyscrasias
cautions with acetaminophen
alcohol
pregnancy/breastfeeding
•Enhance analgesic effect with opioids and
nonopioids
•Produce Analgesia alone, or reduce the side effects of analgesics
adjuvant analgesics
2 classes of analgesia
–Anticonvulsants
–Antidepressants
available topically in a patch and may be especially effective to treat nerve pain and other localized pain while avoiding adverse effects or oral or parenteral routes
lidocaine (lidoderm)
(dental nerve pain)
a local anesthetic used for postherpatic neuralgia
lidocaine
antidepressants used for fibromyalgia
Duloxetine (cymbalta)
Venlafaxine (effexor)
•Treatment of nerve pain
–“Burning pain”
–Herpes, arthritis, cancer,
migraine, diabetes, insomnia, and depression.
•Increases available norepinephrine and
serotonin – block pain transmission.
Tricyclic Antidpressant
___ & _____ block pain transmission
norepinephrine & serotonin
Side effects r tricyclic antidepressants
(DUST HOD )
Dry mouth
Urinary retention
Sedation
Tachyarrrythmias
Heart Block
Ortho Hypotention
Delirium
Inhibit reuptake of both serotonin and norepinephrine
