Analgesia

Question 1

Is pain pathological or physiological?

Answer 1

both

Question 2

What type of pain do we want to get rid of?

Answer 2

Pathological pain

Question 3

What is nociception?

Answer 3

perception of pain

how the sensory nervous system responds to harmful or potentially harmful stimuli

Question 4

What are thye 4 components of loeser’s concept of pain?

Answer 4

Nociception

pain

suffering

pain behaviours

Question 5

What is neuropathic pain?

Answer 5

Pain which is caused by damage or disease affecting the somatosensory nervous sytem

Question 6

Why is pain integral to the process of inflammation?

Answer 6

promotes healing by limits use of affected areas

Question 7

Do we have pain receptors in the body?

Answer 7

No, other receptors which detect other stimuli contribute to the nociception of pain.

When sensory stimuli reaches a certain threshold for a receptor, pain can be felt

Question 8

List some examples of source of pain

Answer 8

Trauma

Inflammation

ischaemia

post-operative pain

neuropathic pain

Question 9

Define acute pain.

Answer 9

Response to traumatic injury, natural or therapeutic process

lasts less than three months duration

Question 10

What type of pain lasts less than three months?

Answer 10

acute pain

Question 11

Define chronic pain

Answer 11

pain lasting more than 3 months duration.

underlying cause potracted or on-going, may not be identifiable.

Question 12

What type pain is on-going and may be poorly localised?

Answer 12

chronic pain

Question 13

List the benefits for treating pain in patients

Answer 13

Humanitarian - rewarding

cost-effectivenss - fewer complications

reduced complications for patient

reduced physiological stressors

Question 14

Why are some surgeons reluctant to pescribe opioids post op?

Answer 14

Opioids can alter physiological process in the following ways

Repress respiration rate -you want to get patient out of bed as soon as possible

lower blood pressure - undesirable after vascular surgery.

Question 15

Why might a surgeon be be reluctant to prescribe opioids after vascular surgery?

Answer 15

Blood pressure is lowered can lead to renal failiure

Question 16

what are the main 2 management options for pain?

Answer 16

Block Transmission (e.g. local anesthetics)

attenuate source of pain (i.e. reduce inflammation, NSAIDs)

remove source of pain (i.e. surgery)

Question 17

What knowledge is key to effective pain management?

Answer 17

pain transmission

modes of action of analgesic drugs

pain assessment

side - effects/ adverse reactions

evaluate medication

Question 18

Give examples of pharmacological pain relief routes

Answer 18

oral/enteral

intra-venous

patient controlled analgesia (PCA)

subarachnoid/ epidural

localised infiltration

nerve block

rectal

subcutaneous

sublingual

Question 19

Why is it not advised to give respiratory patient inhalation anesthetic? what is usually given instead?

Answer 19

Theses types of analgesia may lower respiration rate

can make patient very lethargic

anaesthesia usually given via spinal route

Question 20

Is the half life for inhalation anesthesia usually long or short?

Answer 20

short

Question 21

Why are bariatric patients usually given spinal anesthesia over inhalation anaesthesia?

Answer 21

Bariatric patients usually hold a high amount of adipose tisssue.

gaseous anaethtic goes to their skin.

Since half life of gaseous anaesthesia is short, a high dose needs to be administered to saturate fat before it infiltrates the bloodstream.

this could lead to respiratory arrest due to large amount of medication seeping out of adipose tissue even after administration

Question 22

What is a common sublingual pain relief medication?

Answer 22

GTN

Question 23

What are the two major forms of analgesia?

Answer 23

opioids and non-opioids

Question 24

give examples of common non-opioid medication?

Answer 24

morphine

pethidine

codeine

Question 25

Give examples of common non-opioid medication?

Answer 25

aspirin,paracetamol, diclofenac, ibuprofen

Question 26

what term could describe an opioids agonists or antagonists?

Answer 26

agonist

Question 27

Describe the action of opioids in modulating pain relief

Answer 27

opioid molecules binds toreceptors on preganglionic nerves thus open up K+ channels allowing potassium to flow out of the cell preventing depolarization wave to move through the nerve cell. therefore neurotransmitter cannot be release

Question 28

Why can opiods be described as agonist?

Answer 28

They mimic the action of endogenous ligands (endorphins, ekephalins, dynorphines) to enhance action.

Question 29

Which of the following endogenous ligands neurotransmitters or hormones: enkephalins endorphines dynorphines

Answer 29

horme: endorphine neurotransmitters: enkephaline, dynorphine

Question 30

What is deccusation?

Answer 30

when fibers cross from one side of a structure to the other

Question 31

What term describes when fibers cross from one side of a structure to the other?

Answer 31

deccusation

Question 32

List some of the effects of opioids.

Answer 32

cough centre depression diaphoresis euphoria pupil constriction flushing respiratory, rate and rhythm depression. vasodilation smooth muscle constriction - billiary spasm decreased peristalsis increased bladder tone

Question 33

can an increase in opioids cause receptor upregulation or down regulation?

Answer 33

down regulation

Question 34

When blood pressure drops to low, which organ is most affected?

Answer 34

kidney's

Question 35

What is the most important clinical side-effect which is induced by opioids?

Answer 35

decreased peristalsis

Question 36

What is meant when a drug has a high first pass effect?

Answer 36

it has a high affinity to be metabolised by the liver thus greatly reducing concentration

Question 37

What acute adverse side effects are associated with opioids?

Answer 37

respiratory depression vascular smooth muscle vasodilation: hypotension ->renal impairment->Reduced drug clearance

Question 38

What are the contra-indications for using opioids>?

Answer 38

Head injuries pregnancy/lactation

Question 39

Why is head injury a contra-indication for taking opioids?

Answer 39

risk of brain pressure impairs brain function assessment

Question 40

Why is Pregnancy/;actation a contra-indication for taking opioids?

Answer 40

Passes through placental barrier and can cause respiratory depression and hypotension in the baby

Question 41

Which opioid is an exception for pregnant/lactating women?

Answer 41

pethidine

Question 42

What are the nursing care implications for patients prescribed with opioids?

Answer 42

Properly assess patient prior to administration of drug i.e.: other conditions-disorders present previous meds sensitivity to opioids

Question 43

What nursing care must be implemented on a patient who is on opioids?

Answer 43

monitor vital signs overdose treatment?: Naloxone Monitor for adverse effects

Question 44

What medication treament is administered to patient who may have overdosed on opioids?

Answer 44

Naloxone

Question 45

What consideration should be taken into account prior to administering an opioid to a patient?

Answer 45

depenedence toloerance age pregnancy/lactation? pain assessment