Pain and Inflammation

Question 1

NSAID action- NONselective

Answer 1

Block COX (cyclooxygenase) 1+2 enzymes which is necessary for the production of prostaglandins, which interferes with prostaglandin synethis at the nociceptor level

Question 2

Which is stronger tylenol or ibuprofin

Answer 2

Ibuprofen

Question 5

What is nociceptive pain

Answer 5

Injury to tissues. Includes:

Somatic= musculoskeletal

Visceral= internal organs

Includes transduction, transmission, perception, and modulation

Question 6

Neuropathic pain

Answer 6

Can affect peripheral or CNS nerves

Burning, tingling, shooting, electric

Causes= infection, ischemia, damage to nerves

Question 7

Transduction

Answer 7

Tissue damage causes nociceptors to release chemical mediators ( prostaglandins, serotonin, histamine)

Question 9

Transmission

Answer 9

Pain impulse is transmitted from the nociceptor to the spinal cord then brain

Question 10

Modulation

Answer 10

Pain is modulated in the brain to either increase or decrease transmission of pain impulse

Inhibitory neurotransmitters block pain transmittion

Excitatory neurotransmitters increase transmission

Question 11

Chronic pain management goals

Answer 11

Restore function

Limit pain

Avoid opioids if possible

Prevent secondary consequences of pain

Learn to live with some amount of pain

Question 12

Nonopioids include

Answer 12

NSAIDS

Acetaminophen

Antigout agents

Question 13

Interfering with prostaglandins effects?

Answer 13

Gastric mucosa

Renal function

Smooth muscle contractions

Normal platelet aggregation

Question 14

Selective NSAID

Answer 14

Inhibits COX 2 activity only

Many cardio side effects

Celecoxib ( Celebrex) only med

Question 15

NSAID side effects

Answer 15

GI irritation(nausea,heart burn, dyspesia), gastric ulcers and bleeding (nonselective nsaid)

Increased bleeding time(nonselective nsaid)

Increased risk of MI or stroke (selective nsaid)

Renal failure

Contraindicated allergy to aspirin

Question 16

Morphine sulfate

Answer 16

Sch 2

PO IM SC IV EPIDURAL INTRATHECAL

Question 17

NSAID uses

Answer 17

Analgesia mild-mod

Anti inflammatory

Antipyretic

Question 18

Tylenol

Answer 18

APAP, paracetamol, acetaminophen

Inhibits prostaglandin synthesis by a dif mechanism

“Cet” suffix= tylenol ingredient in meds

Antipyretic and analgesic
Analgesic effect similar to ASA

Max ceiling dose- 3000-4000 mg/24hr

Hepatoxicity

Question 20

indomethacin

Answer 20

Indocin (NSAID)

mild-mod pain

Common uses= inflammatory conditions such as arthritis, bursitis, tendonitis
IV to promote closure of patent ductus arteriosus

Treat preterm labor

Question 22

What does pain impact

Answer 22

Sleep, mobility, ability to eat, family and relationships

Chronic pain- spiritual crisis; hopelessness

Question 23

NSAID contraindications/ extreme cautions

Answer 23

Active peptic ulcer

CV disease (except aspirin)

Chronic alcohol use

Renal or liver impairment

Do not give concurrently with other NSAIDS

Question 24

celecoxib

Answer 24

Celebrex (COX2 NSAID)

Primarily for anti inflammatory effects (osteoarthritis, rheumatoid arthritis)

Higher risk for CV events

Lower risk for GI effects

Little effect on platelet function

Contr with sulfa allergy

Question 25

Demerol

Answer 25

meperidine

Opioid

Question 26

aspirin

Answer 26

ASA
salicylate/NSAID

Anti inflammatory similar to NSAIDS
Analgesic effect similar to tylenol- mild/mod

Salicylate poisoning = tinnitus, hearing loss— treated with dialysis if severe

Reyes syndrome kids teens with viral illness or fever

Antiplatelet effect greater

Prophylaxis of CV events 81-325 mg daily, rx of acute MI

Question 27

Dietary supplements to treat arthritis pain

Answer 27

Glucosamine and chondroitin

Adv effects largely GI- N/D, gas, heartburn

Caution in
diabetics- need higher insulin doses
Enhances coagulation effects

Question 28

Tylenol #3

Answer 28

codeine with acetaminophen

Question 29

allopurinol

Answer 29

Zyloprim

Xanthine oxidase inhibitor- prevents hyperuricemia by inhibiting the enzyme essential to production of uric acid

Does not relieve acute gout attack

Skin rashes common

Question 30

Aspirin and tylenol

Answer 30

Equal analgesic effects Least potent

Question 31

ibuprofen

Answer 31

Motrin, Advil PO or IV Mild-Mod pain Commonly used for musculoskeletal, dysmenorrhea, arthritis, dental pain ``` Otc= 200mg PO prescription= 300-800mg PO ```

Question 33

Gout

Answer 33

Painful form of arthritis caused by hyperuricemia and deposits of uric acid crystals in joints(usually LE) Rx symptomatically with NSAIDS allopurinol to prevent attacks

Question 36

Opioid agonists effects

Answer 36

``` Analgesia Sedation Euphoria Respiratory depression Miosis Vasodilation Decreased GI peristalsis Stimulates vomiting center Supresses medullary cough center ```

Question 37

Transdermal opioids uses

Answer 37

Severe chronic pain in opioid tolerant patients avoid using heat on patch Gloves to put on Switch sites

Question 38

sublimaze

Answer 38

Fentanyl

Question 39

Percodan

Answer 39

oxycodone with aspirin

Question 40

Ketorolac strength

Answer 40

Same as morphine

Question 41

Fentanyl vs dilaudid

Answer 41

Fentanyl

Question 42

Percocet

Answer 42

oxycodone with acetaminophen

Question 43

Opioids nursing

Answer 43

Rescue before respiratory depression- downward trend in VS OHTN fall risk change positions slowly Premedicate for itching and nausea and constipation Have narcan ready

Question 46

Opioids adv effects

Answer 46

Cns depression= sedation, drowsiness, euphoria, respiratory depression (<10/min) Vasodilation = OHTN, dizzyness N/V, constipation, pruritis Tolerance, dependency

Question 48

NSAID teaching

Answer 48

If upset GI, take with food or milk Avoid alcohol Report S/S of GI bleeding ( dark stools, vomiting blood , anemia) S/S peptic ulcers= pain, nausea Review CV events Dont take 2+ NSAIDS at same time

Question 49

Oxycontin

Answer 49

oxycodone Opiod

Question 51

Codeine

Answer 51

Opioid agonist Cough

Question 52

Perception

Answer 52

Multiple areas in the brain respond to produce pain perception and response

Question 54

hydromorphone

Answer 54

Dilaudid Sch 2 7x more potent than morphine Severe pain

Question 62

Toradol

Answer 62

ketorolac(NSAID) Primarily for analgesic effect Mod-severe acute pain Effects similar to morphine Max use 5 days Coadmin with opiods= additive analgesic effect, less opioid use

Question 64

Goals for acute pain management

Answer 64

To provide relief or control of pain Facilitate recovery from underlying source of pain Minimize impact of pain on recovery activities Reduce physiologic stress from catecholamines