Pain Management Flashcards

1
Q

What are the two types of pain?

A

Nociceptive and Neuropathic

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2
Q

________ pain responds best to opiates

A

Nociceptive

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3
Q

Neuropathic pain responds best to _______

A

Neurontin (GABA), Lyrica (GABA), Methadone (NMDA), Anti-seizure meds

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4
Q

Stimulation of nociception occurs when a ___________ (chemical, thermal, mechanical) of nociceptors releases neural chemicals that also stimulate other nociceptors, the signal is transmitted to the _______

A

noxious stimulus

spinal cord

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5
Q

Transmission of nociception occurs when an Action potential moves from site of stimulus to the _______________, then to the_________. From the dorsal horn, _________ are released.

A

dorsal horn of the spinal cord
CNS
neurotransmitters ex) glutamate, substance P, Calcitonin related peptide

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6
Q

Perception of pain is the ___________ of pain. Pain impulses are relayed through the _______ and _____________ transmit pain.

A

Conscious experience
thalamus
higher cortical structures

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7
Q

Modulation is the inhibition of impulses via the _____________

A

brain stem

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8
Q

Neuropathic Pain is sustained by abnormal processing of

A

sensory output

  • Nerve damage, persistent stimulation, autonomic dysfunction
  • Burning, tingling, shocks, hyperalgesia, allodynia
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9
Q

Monitoring Pain:

A
P: palliative and provocative factors 
Q: Quality
R: Radiation
S: Severity
T: Temporal relations
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10
Q

All pain is measured _______

A

subjectively

-No lab tests to “measure” pain
-All subjective
- External and Internal signs and symptoms
¨-Grimacing, guarding, sweating, nausea -Hypertension, tachycardia, tachypnea

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11
Q

Opioid receptors are located throughout the

A

brain, spinal cord, GI tract

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12
Q

The four subtypes of opioid receptors include

A

Delta
Kappa
Mu
Nociceptive

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13
Q

The mu receptors include:

A

Mu1: analgesia, dependence
Mu2: side effects: respiratory depression, euphoria, reduced GI motility, dependence
Mu3: unknown

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14
Q

Mu receptors are found on the presynaptic and postsynaptic clefts. THis is where morphine can work by pumping in _____ and pumping out ________. ________ is key!

A

Calcium in
Potassium Out
Hyperpolarization is key

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15
Q

Most opiates are ______ and work on the ____ receptor

A

agonists

mu

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16
Q

_______ is a natural opiate that has a ________ nucleus

A

Morphine

pheanthrene

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17
Q

_______ forms of opioids have agonist action

A

levo-rotary

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18
Q

Opioids must exist in an _______ state to form strong bonds at the opioid receptor

A

ionized

19
Q

Morphine is most effective when given ______ acute surgical stimulus

A

before

20
Q

Morphines metabolites include

A

M-3 inactive

M-6 active, will build up if not peed out (CKD)

21
Q

Morphine causes a ________ release

A

histamine

22
Q

Fentanyl does not cause a ______ release

A

histamine

23
Q

Morphine use should be cautiously used in

A

head injury patients

24
Q

During cholecysectomy _____ may cause a opioid induced spasm of the sphincter of ______. Tx is ______.

A

morphine
oddi
glucagon 2mg IV

25
Q

Morphine side effects include

A

PONV, biliary colic, delayed gastric emptying, constipation, difficulty voiding

26
Q

Opioids and ________ may cause an exaggerated CNS depression and hyperpyrexia. (especially Demerol)

A

MAO Inhibitors

27
Q

Dilaudid lacks any ___________ , which makes it a good candidate for patients with renal failure.

A

active metabolites

28
Q

Opioids and benzo combinations demonstrate a marked _________ effect, in regards to hypnosis and depression of ventilation

A

synergistic

29
Q

All opioids demonstrate a decrease in plasma concentration with inititation of _______, especially __________.

A

cardiopulmonary bypass

especially fentanyl

30
Q

Sufentanil is a _____ potent form of fentanyl

A

more

31
Q

Alfentanil is a _____ potent form of fentanyl

A

less

32
Q

______ is useful in quick, single, brief stimulus procedures, such as intubation and cardioversion

A

alfentanil

33
Q

Remifentanil requires __________

A

high post operative analgesic requirements

34
Q

Demerol is a

A

synthetic opioid agonist at mu and kappa receptors

35
Q

Decreased renal function can cause an accumulation of __________, the metabolite of Demerol, which can cause toxicities.

A

normeperidine

36
Q

Half life of normeperidine is _____ hours, and ______ hours in patients with renal failure

A

15 hours

>35 hours

37
Q

Normeperidine causes CNS ________, and CNS toxicity leads to ______ and _______ and _______.

A

stimulation
myoclonus and seizures
Demerol induced delirium: confusion and headache

38
Q

Demerol should not be taken for more than

A

48 hours. (600 mg/day max)

39
Q

When Demerol is given with SSRI’s it may cause

A
Serotonin Syndrome
-Autonomic Instability
HTN
Hyperthermia
Hyperreflexia
No true reversal, stop demerol, tx symptoms
40
Q

Advantages of agonist-antagonists include

A

drugs have a ceiling effect

analgesic effect with hopefully less respiratory effect

41
Q

Opioid antagonists demonstrate a high affinity for

A

the opioid receptor and result in displacement of the opioid agonist from the mu receptor

42
Q

Use of Naloxone results in

A

prompt reversal of opioid depression of ventilation and induced analgesia

43
Q

Toradol is a _______

Black box warning:

A

NSAID

5 day max (GI Bleed)

44
Q

IV APAP

A

Reduced Opioid Use

Questionable mechanism