Pain Management Quiz #2 Flashcards Preview

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Flashcards in Pain Management Quiz #2 Deck (70)
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1

What is another name for tract?
-Lissauer
-Module
-Funiculus
-Anterolateral

Funiculus

2

The primary afferent neuron originates in the periphery and terminates in the ____?
-Rexed's laminae I-V
-Tract of Lissauer
-Dorsal root ganglion
-Reticular formation

Rexed's laminae I-V

3

Secondary neurons transmitting pain terminate in the ___?
-Thalamus
-Cerebral cortex
-Pons
-Medulla

thalamus

4

Which funicular modulates pain?
-lateral spinothalmic
-anterolateral system
-ventral spinothalamic
-dorsolateral

dorsolateral

5

Perception of pain occurs once the signal is recognized by the ___?
-medulla
-cerebral cortex
-midbrain
-pons

cerebral cortex

6

Two types of second-order neurons exist. One is nociceptive. The other is ___?
-A delta
-C
-WDR
-A beta

WDR

7

What are the cardiovascular physiologic effects of acute pain(5) and the adverse outcomes related to each effect?

1. increased HR--->dysrhythmias
2. increased PVR--->angina
3. increased ABP--->myocardial ischemia
4. increased myocardial contraction--->myocardial infarction
5. increased myocardial work---->myocardial infarction

8

What are the pulmonary physiologic effects of acute pain(5) and the adverse outcomes related to each effect?

1. decreased VC--->vent/perfusion mismatch
2. decreased TV--->atelectasis
3. decreased TLC--->pneumonia
4. muscle spasms(resp/abdominal)--->hypoventilation
5. decreased ability to cough/deep breath
------->hypoxia/hypercarbia

9

What are the gastrointestinal physiologic effects of acute pain(3) and the adverse outcomes related to each effect?

1. decreased gastric emptying--->nausea/vomiting
2. decreased intestinal motility--->paralytic ileus
3. increased smooth muscle sphincter tone

10

What are the coagulation physiologic effects of acute pain(2) and the adverse outcomes related to each effect?

1. increased platelet aggregation--->thrombosis
2. venostasis--->DVT/PE

11

What are the immunologic physiologic effects of acute pain(1) and the adverse outcomes related to each effect?

1. decreased immune function--->increased risk of infection

12

What are the genitourinary physiologic effects of acute pain(1) and the adverse outcomes related to each effect?

1. increased urinary sphincter tone--->oliguria and urinary retention

13

What are 5 psychological adverse outcomes related to acute pain?

1. fear
2. anxiety
3. depression
4. feelings of helplessness
5. anger

14

What are the 4 most important indicators of acute postoperative pain?

1. the presence of preoperative pain
2. patient fear regarding the outcome of his/her surgery
3. patients who catastrophize pain
4. expected pain postoperatively

15

What are 3 scales used in acute pain assessment?

1. visual analog scale(a psychometric response scale which can be used in questionnaires)
2. numerical rating scale(on a scale of 1-10 where is your pain?)
3. Wong-Baker FACES scale(pediatrics/develop mentally challenged adults)

16

What is preemptive analgesia?

Technique used to treat pre-op pain by providing analgesia. Jury still out if it works
-its high controversial
-Multimodal(peripheral/central mechanisms)***best approach***

17

What are the three types of acute pain analgesics?

1. Nonsteroidal Anti-inflammatory Drugs
2. Opioids
3. Analgesic Adjuncts

18

NSAIDs all possess what three properties?

1. anti-inflammatory
2. antipyretic
3. analgesic properties

19

NSAIDs produce their therapeutic effects by ______ and thereby preventing ____________.

-inhibiting cyclooxygenase(COX)
-conversion of arachidonic acid to prostaglandins

20

In relation to acute pain, what are prostaglandins responsible for?

Prostaglandins(primarily PGE1 and PGE2) are responsible for sensitizing and amplifying peripheral nociceptors to the inflammatory mediators(substance P, bradykinin, and serotonin) which are released when tissue is traumatized.

***prostaglandins lower the pain threshold! We want to prevent formation of prostaglandins***

21

Cyclooxygenase(COX) exists in two isoforms: COX-1 and COX-2

What is COX-1 responsible for?

-responsible for platelet aggregation, gastric mucosal integrity and renal function
-inhibition leads to platelet inhibition, gastric irritation, renal microvasculature constriction.

22

Cyclooxygenase(COX) exists in two isoforms: COX-1 and COX-2

What is COX-2 responsible for?

-inducible enzyme that in the presence of inflammation releases prostaglandins, thereby mediating pain, fever, and carcinogenesis

23

What is the only COX-2 selective NSAID available in the US, and what type of patient is it contraindicated in?

-Celebrex
-contraindicated in known hypersensitivity to sulfonamides or ASA. Caution in asthmatics b/c COX-2 inhibitors can convert arachidonic acid to the precursor of leukotrienes, potentially causing bronchoconstriction

24

What type of NSAID is ketorolac(toradol)?

nonselective COX inhibiter(COX 1 and COX 2)

25

30 mg of ketorolac IM is = to ____ mg of morphine IM?

12 mg IM

26

Ketorolac's use should be limited to?

limit its use <= 5 days

27

What is Ketorolac contraindicated in?

coagulopathies, renal failure, active PUD, GI bleeding, asthma, hypersensitivity to NSAIDs, and surgery that involves a high risk for postop bleeding

28

What is Acetaminophen used for?

-mainly analgesic and antipyretic properties with little anti-inflammatory effects
-excellent drug for multimodal therapy

29

What disease state is Acetaminophen contraindicated in?

contraindicated in those with liver failure

30

What is the onset of action and duration of Acetaminophen?

-onset of action ~ 10 minutes
-duration of action ~ 4-6 hours