pain management (final sg)

Question 1

types of pain (2)

Answer 1

➺ acute: sudden onset, subsides with treatment. extremely painful
➺ chronic: persistent and recurring, longer duration ( > 3-6 months), difficult to treat, often no known cause

Question 2

classifications of pain (10)

Answer 2

➺ somatic: skin, muscles, and joints
➺ visceral: internal organs, chest, and stomach
➺ superficial: small cuts, bruises; small area
➺ deep: past the skin into muscle
➺ vascular: within blood vessels
➺ referred: away from site of injury
➺ neuropathic: numbness, tingling; damage to nerves
➺ phantom: sensation of pain where body part has been surgically removed or lost d/t trauma
➺ cancer: “malignant”, from cancer itself or treatment
➺ central: results from CNS damage

Question 3

opioids

Answer 3

synthetic drugs that bind to opiate receptors to relieve pain
➺ indicated to alleviate moderate to severe pain
➺ may also be used for cough suppression (codeine), diarrhea (lamadol), and balanced anesthesia

Question 4

opioid classifications

Answer 4

➺ agonists: cause relief of pain; bind to opioid pain receptors and reduce pain sensation
➺ agonists anti-agonists: also bind to pain receptors, but cause weaker neurological response than an agonist; lower risk of misuse / addiction
➺ antagonists (no analgesic): reverse the affects of these drugs on pain receptors; they bind to pain receptors and exert no response

Question 5

opioid contraindications

Answer 5

➺ allergy
➺ severe asthma
➺ respiratory insufficiency (morbid obesity, sleep apnea, compromised airway, etc.,)
➺ elevated intracranial pressure
➺ paralytic ileus
➺ pregnancy

Question 6

opioid adverse effects

Answer 6

➺ *CNS depression (respiratory)
➺ NV
➺ urinary retention
➺ sweating / flushing
➺ pupil constriction
➺ constipation
➺ itching

Question 7

opioid drug interactions

Answer 7

➺ alcohol
➺ antihistamines
➺ barbituates
➺ benzodiazepines
➺ MAOIs

Question 8

codeine sulfate

Answer 8

➺ mild agonist
➺ has a ceiling effect
➺ often administered with acetaminophen
➺ more commonly used as an ANTITUSSIVE
ADVERSE: Gi disturbance

Question 9

fentanyl

Answer 9

➺ agonist for moderate to severe pain
➺ the patch is most common from chronic, long-term pain management

Question 10

hydromorphine (dilaudid)

Answer 10

➺ extremely potent agonist

Question 11

meperdine

Answer 11

➺ rarely used agonist
➺ NOT recommended for long term use, could result in seizures
➺ caution for elderly / kidney dysfunction
➺ used for migraines and post-op shivering

Question 12

methadone hydrochloride (dolophine)

Answer 12

➺ agonist of choice for detoxification of opioid addicts
➺ prolonged half-life, may lead to OD / death
➺ can cause cardiac dysrhythmias

Question 13

morphine sulfate

Answer 13

➺ drug prototype for all opioids
➺ indicated for severe pain
➺ high potential for abuse

Question 14

oxycodone hydrochloride

Answer 14

➺ structured similarly to morphine
➺ often combined with acetaminophen or aspirin
➺ has immediate or sustained release version

Question 15

naloxone hydrochloride (narcan)

Answer 15

➺ ANTAGONIST; choice for complete or partial reversal of opioid induced respiratory depression
➺ typically used for ODs

Question 16

acetaminophen

Answer 16

➺ NONOPIOID analgesic and antipyretic, little to no antiinflammatory effects
moa: blocks pain impulses peripherally by inhibiting prostaglandin synthesis
➺ max dosgae: 3000 mg/day, 2000 mg/day for older adults / liver disease
➺ do not take if allergic, have liver dysfunction, G6PD deficiency, or with alcohol

Question 17

tramadol hydrochloride

Answer 17

moa: weakens bond to mu opioid receptors and inhibits reuptake of norepinephrine and serotonin
➺ careful use with SSRIs, MAOIs, neuroleptics

Question 18

lidocaine (transdermal)

Answer 18

➺ topical anesthetic
➺ placement should stay in place no longer than 12 hours
➺ may cause skin irritation