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Flashcards in Pain Deck (117)
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1

Autonomic responses of acute pain

Guarding
Grimacing
Diaphoresis
Increased HR
Increased RR
Increased BP

2

Goals of therapy

Not to be 100% pain free, but to reduce the sensation of pain such that appropriate care or ADLS can be provided or achieve without causing disability or impairment
The expectations of the pt and the practitioner should support goal
Pt-prescriber mismatch- goals should be the same

3

Pain assessment

P-provoking/palliative factors
Q-quality
R-region/radiate
S- severity/intensity
T- temporal/time (onset, duration, frequency)

4

Acetaminophen IV injection formulation

Ofirmev
Expensive
Many restrictions for hospital use
Must inject slowly over 15 mins
Monotherapy in mild to moderate pain
Adjunct therapy in opioids in moderate to severe pain

5

Tramadol side effects

Seizures- contraindicated in patients with a seizure history (may lower threshold)
GI- upset stomach, diarrhea
Physical dependence- physiological withdrawal
Abuse- "psychological dependency" (C1V in TN)

6

Tramadol drug interactions

SSRIs/SNRIs- serotonin syndrome, GI bleeds
Tryptan migraine abortants (serotonin syndrome as well)

7

S/Sx of serotonin syndrome

Agitation or restlessness
Confusion
Rapid HR and htn
Dilated pupils
Loss of muscle coordination or twitching muscles
Diarrhea
HA
Shivering
Goose bumps

8

Severe serotonin syndrome sx

High fever
Seizures
Irregular heartbeat
Unconsciousness

9

Tramadol monitoring

Achievement of goals
S/Sx tolerance
Misuse/abuse

10

General principles of opioid management

Always assess risk of abuse and addiction
All acute principals to pain management apply
Always try to eliminate causes
Try to limit doses and duration
Want to meet goals while minimizing side effects
Utilize adjuvant medications, esp in situations where a combo of issues could be occurring simultaneously (depression, anxiety, etc)

11

Opiates and opioids- MOA

Modify both sensory and affective aspects of pain
Inhibit the transmission of input from the periphery to the spinal cord
Also activates descending inhibitory pathways that modulate transmission to the spinal cord

12

What are the opioid receptors?

Mu
Kappa
Delta

13

Mu receptors

Appears to be the most important in mediating morphine (and other strong opioids) effects
Analgesia, resp depression, sedation, euphoria, miosis, physical dependence, decreased GI motility

14

Chemical classes of opioids

Phenanthrenes
Phenylpiperidine derivatives
Diphenylheptane derivative

15

Phenanthrenes

Morphine
Codeine
Hydromorphone
Oxycodone
Oxymorphone

16

Phenylpiperidine derivatives

Meperidine
Fentanyl

17

Diphenylheptane derivative

Methadone

18

Pure opioid products

Effective for moderate to severe pain
Immediate and ER products available
-Morphine
-Oxycodone
-Hydromorphone
-Oxymorphone
-Fentanyl
-Methadone

19

Absorption of opioids

Most agents are well-absorbed, however some may undergo first-pass metabolism reducing overall bioavailability

20

Common opioid adverse effects

Constipation (80%)
Dry mouth
Nausea (20%)/vomiting (15%)
Sedation
Pruritis (2-10%)

21

Constipation from opioids

Common to all opioids
Opioid effect on CNS, spinal cord, myenteric plexus of gut
Easier to prevent than treat
Tolerance does not develop to constipation
Dietary interventions alone usually not sufficient

22

Nociceptive pain

Usually propagated by mediators or noxious stimulus often localized
-Somatic: bone, joint, muscle, connective tissue
-Visceral: Organ

23

Neuropathic pain

Interruption or damage to the actual impulse transmission pathway often regional or radiating

24

Mediators of nociceptive pain

Prostaglandins
Prostacyclins
Histamine serotonin
Substance P

25

Functional pain

Pain in response to abnormal functioning of the nervous system

26

What is the time span for determining chronic pain?

Persistent pain lasting > 3 mos

27

Time span for acute pain

Comes on quickly, can be moderate to severe in intensity and only lasts a short period (less than 1-2 weeks) of time
-Usually nociceptive in type
-Usually considered a beneficial process warning us of potential harmful situations
-Severe or undertreated acute pain can lead to negative consequences

28

Common types of chronic pain

Back pain
Arthritis
Headaches
Knee pain
Cancer

29

Responses to chronic untreated pain

Anxiety
Hostility
Insomnia
Depression

30

Malignant pain

Usually implies cancer pain
Usually is associated with a terminal condition