Flashcards in Mod 1 Deck (130)
In the immediate postoperative period what is the first-line route of administration of analgesic delivery?
What can be applied directly over the injection site prior to painful needle sticks?
Local anesthetic such as EMLA and L.M.A.X. ( lidocaine 4%)
What is the difference between tropical and transdermal drug delivery?
Transdermal requires drug absorption into the systemic circulation and tropical agents produce effects on the tissue immediately
How are intranspinal analgesic delivered?
By inserting a needle into the subarachnoid space or epidural space and injecting the analgesic agent or treading a catheter through a needle and taping it in place
When are temporary epidural catheters for acute pain management removed?
After 2-4 days
What is the most common opioids administered intraspinally?
And are combined with a local anesthetic, most often ropivacaine (Naropin) or bupivavaine (marcaine)
What is the difference between opioid tolerant and opioid naïve?
Opioid naive: patients who are not chronically receiving opioid analgesics on a daily basis; and
Opioid tolerant: patients who are chronically receiving opioid analgesics on a daily basis.
What is authorized advent controlled analgesia?
When a patient is unable to use the PCA equipment a nurse or capable family member is authorized to manage the pain using the PCA
What is considered one of the safest and best tolerated analgesic agents?
What is the most serious complication when taken acetaminophen?
Hepatotoxicity ( liver damage)
What is the primary underlying mechanism of NSAID (aspirin, IBUPROFEN and naproxen)?
Gastric ulceration and reduction in the GI productive prostaglandins
Administer small does for short time
What are the unwanted side effects of opioids?
Constipation, nausea, sedation and respiratory depression
What is the goal of titration?
Is to use the smallest does that provides satisfactory pain relief with the fewest adverse effects
What is the first sign of withdrawal?
What is the recommended approach for treatment of pain in all types of pain and all age groups?
What is a normal response that occurs with repeated administration of an opioid for 2 or more weeks
Sensitivity to pain is known as what?
OHI is a result of what?
Changes in the central and peripheral nervous system that produces increased transmission of nociceptive signals
What is the opioid is the standard to which all other opioids are compared?
Morphine is a hydrophilic drug which accounts for what?
It's slow onset and long duration
What does hydrophilic mean?
Readily absorbed in aqueous solution
Fentanyl (sublimaze) is lipophilic opioid and as such it has what kind of onset and duration?
A fast onset and short duration
How often should a fentanyl duragesic be changed?
48 to 72 hours
What do you need to be careful of when it comes to a fentanyl transdermal patch?
The application of heat because it speeds up absorption of the transdermal fentanyl which can lead to life threatening respiratory depression
What medication has been removed or severely restricted on hospital formularies for the treatment of pain in efforts to improve patient safety?
What are the most common adverse effects of opioids?
Constipation, nausea, vomiting, pruritus and sedation
Respiratory depression is less common but most feared
In postop patients ileus can become a major complication
What is given to reverse significant opioid induced respiratory depression?
When giving narcan for respiratory depression what should you do?
It should be diluted and titration led very slowly to prevent severe pain, hypertension, tachycardia, ventricular dysthymias, pulmonary edema and cardiac arrest
0.4 mg of naloxone and 10 mls of NS administer 0.5 ml over 2 min