Chapter 7: Drugs To Treat Pain - Nonopioid Analgesics And Anesthetics

Question 1

Define pain:

Answer 1

A subjective, unpleasant, sensory, and emotional experience associated with actual or potential tissue damage or abnormal functioning of nerves

Question 2

What is the biopsychosocial model?

Answer 2

Reflects the development of illness through the complex interaction of biological, psychological, and social factors

Question 3

Define neuropathic pain:

Answer 3

Pain that occurs after damage to the nervous system

Question 4

Define dysfunctional pain.

Answer 4

Pain when there is no damage or inflammation

Question 5

Define dysesthesia.

Answer 5

Shooting, burning pain

Question 6

Define allodynia.

Answer 6

Hurting pain from a light touch

Question 7

Name 5 conditions that can evoke dysfunctional pain.

Answer 7

• fibromyalgia
• irritable bowel syndrome
• tension-type or chronic headache
• temporomandibular joint (TMJ) disease
• complex regional pain syndrome

Question 8

Give an example of a nonopioid analgesic drug.

Answer 8

Acetaminophen

Question 9

What do NSAIDs stand for?

Answer 9

Nonsteroidal anti-inflammatory drugs

Question 10

Give an example of an NSAID.

Answer 10

Ibuprofin

Question 11

Give an example of opioid drugs:

Answer 11

• morphine
• oxycodone

Question 12

Define anesthetics.

Answer 12

Drugs that temporarily affect or eliminate sensation

Question 13

Define analgesics.

Answer 13

Drugs that act in various ways on the peripheral and central nervous systems to achieve relief from pain

Question 14

What are the 3 steps of the WHO analgesic ladder for the oral administration of drugs?

Answer 14

Step 1: nonopioids (acetaminophen, NSAIDs). If pain persists or increases, move to step 2.
Step 2: low-potency opioids (codeine or hydrocodone with APAP). If pain persists or increases, move to step 3.
Step 3: high-potency opioids (morphine) until the patient is free of pain

Question 15

Define adjuvants.

Answer 15

Additional drugs used to calm fears and anxiety

Question 16

Name some common conditions that acetaminophen treats.

Answer 16

• headache
• muscle aches
• arthritis
• backache
• toothaches
• colds
• fevers

Question 17

Define antipyretic.

Answer 17

Drugs that reduce fever

Question 18

Describe the therapeutic effects of acetaminophen.

Answer 18

• antipyretic
• relatively little anti-inflammatory activity
• treatment of headache
• relief of pain in mild arthritis

Question 19

Describe the mechanism of action of acetaminophen.

Answer 19

• Pain relieving aspects are facilitated through inhibiting neurotransmitters in the CNS
• antipyresis produced from inhibition of the hypothalamic heat-regulating centre

Question 20

What is the biggest difference between NSAIDs and acetaminophen?

Answer 20

Acetaminophen is not considered an anti-inflammatory medication

Question 21

Routes of administration for acetaminophen:

Answer 21

• oral
• IR or ER tablet
• rectal
• buccal
• IV

Question 22

Onset of action, peak effect, duration, and half life of acetaminophen:

Answer 22

• onset of action: <1 hr
• peak effect: 1 hr
• duration: 4-6 hr
• half life: 1.5-3 hr

Question 23

What is the recommended max daily dose for acetaminophen? What is the recommended safe dose?

Answer 23

• 4000 mg
• 3250 mg/day

Question 24

What was the first local anesthetic?

Answer 24

Cocaine

Question 25

What is LAST?

Answer 25

- local anesthetic systemic toxicity - a life-threatening adverse event that may occur after the administration of local anesthetic drugs through a variety of routes

Question 26

Describe the typical presentation of LAST.

Answer 26

- perioral numbness - tinnitus - agitation - dysarthria - confusion

Question 27

Describe the mechanism of action of local anesthetics.

Answer 27

Act at the cell membrane to prevent the generation and conduction of nerve impulses

Question 28

Routes of administration for local anesthetics:

Answer 28

- subcutaneously by injection - transdermally by patch - topically in creams, gels, and ointments - ophthalmic drops

Question 29

Indications for lidocaine transdermal patches:

Answer 29

- neuropathic pain - post-herpetic neuralgia - moderate to severe pain secondary to acute, soft-tissue, and connective-tissue injuries

Question 30

Name some precautions for transdermal anesthetics or topical analgesics:

Answer 30

- do not apply to skin that is cut or irritated. - do not apply to swollen skin areas. - avoid using medicine on skin that is raw or blistered. - do not use in patients with sensitivity to aspirin or salicylates - do not apply near eyes or mucous membranes - do not apply over large skin areas - do not apply heat to treated skin areas - use the smallest amount of medication needed - do not cover treated skin areas with a bandage or plastic wrap

Question 31

What form does Salonpas come in and what are the active ingredients in it?

Answer 31

- transdermal patch, gel cream - methyl salicylate, menthol

Question 32

What form does Aspercreme come in and what are the active ingredients in it?

Answer 32

- transdermal patch, cream, topical liquid solution - lidocaine 4%, trolamine salicylate, or menthol 10%

Question 33

What form does IcyHot come in and what are the active ingredients in it?

Answer 33

- cream, balm, gel, spray, topical liquid solution, transdermal patch - methyl salicylate, menthol, camphor, lidocaine 4%

Question 34

What form does Flexall 454 come in and what are the active ingredients in it?

Answer 34

- cream gel - methyl salicylate, menthol, camphor

Question 35

What form does Biofreeze come in and what are the active ingredients in it?

Answer 35

- cream, gel - methyl salicylate, menthol, camphor

Question 36

What form does Salonpas Jet Spray come in and what are the active ingredients in it?

Answer 36

- spray - methyl salicylate, menthol

Question 37

What form does Tiger Balm come in and what are the active ingredients in it?

Answer 37

- counterirritant gel, cream, patch, ointment - capsaicin, camphor, menthol

Question 38

What are topical analgesics?

Answer 38

Medications that numb and reduce the sensation of pain in the area to which they are applied

Question 39

Topical analgesics may be applied to what areas?

Answer 39

- skin - inside the mouth or throat - in the nose - in the eyes

Question 40

What is menthol?

Answer 40

- fast acting, facilitates a reduction in blood flow - tingling sensation when applied to the skin by inhibiting the calcium channel involved in regulating the pain threshold

Question 41

What is capsaicin?

Answer 41

- the active ingredient in chilli peppers that make them hot - used to relieve muscle or joint pain - causes a sensation of heat that activates certain nerve cells - used for temporary relief of muscle or joint pain caused by strains, sprains, arthritis, bruising, or backaches