Pain Medications

Question 1

What are some non-pharmacologic methods for pain management?

Answer 1

• massage
• heat or cold
• meditation
• acupuncture
• relaxation therapy

Question 2

What are the 3 opioid receptors?

Answer 2

1. Mu
2. Kappa
3. Delta

Question 3

Where are the opioid receptors found?

Answer 3

Brain, spinal cord and GI tract

Question 4

What are Mu and Kappa receptors associated with?

Answer 4

Analgesia and pain management

Question 5

What feeling is associated with Mu receptors?

Answer 5

Euphoria

Question 6

What receptors are associated with physical dependence?

Answer 6

Mu and delta

Question 7

What is acute pain?

Answer 7

• abrupt onset w brief duration

- source and cause of pain is usually easy to define

Question 8

What is chronic pain?

Answer 8

• lasts longer than 6 months
• often difficult to identify the cause
• can lead to feelings of helplessness and hopelessness
• interferes w ADL’s

Question 9

What are 2 classes of pain?

Answer 9

1. Nociceptive

2. Neuropathic

Question 10

What is nociceptive pain?

Answer 10

Result of an injury to a tissue which usually responds well to pharmacotherapy.

Question 11

What are 2 types of nociceptive pain?

Answer 11

1. somatic

2. visceral

Question 12

What is somatic pain?

Answer 12

Sharp/localized pain in the muscles or joints

Question 13

What is visceral pain?

Answer 13

Dull, throbbing, or aching pain in the organs.

Question 14

What is neuropathic pain?

Answer 14

Result of an injury to a nerve, less responsive to pharmacotherapy. Feels like burning, shooting or numbing pain.

Question 15

What does the P stand for in PQRST?

Answer 15

Provoking factors: events that cause or aggravate pain

Question 16

What does the Q stand for in PQRST?

Answer 16

Quality and quantity; description of pain and rating of intensity

Question 17

What does the R stand for in PQRST?

Answer 17

Region and radiation: origin of pain and whether it spreads from that origin

Question 18

What is referred pain?

Answer 18

Pain that is experienced somewhere distant from the actual source of the pain

Question 19

What does the S stand for in PQRST?

Answer 19

Signs and symptoms: measurable, observable indications of pain including inflammation and subjective factors expressed by the patient (nausea, dizziness)

Question 20

What does the T stand for in PQRST?

Answer 20

Timing: onset, duration, and recurrence

Question 21

What two classes of drugs can be used for pain management?

Answer 21

1. Opioids

2. Non-Opioids

Question 22

What are opioids?

Answer 22

They bind mu and kappa receptors to produce analgesia, indicated for moderate to severe pain.

Question 23

Name 3 natural opioids?

Answer 23

1. morphine
2. codeine
3. oxycodone

Question 24

Name a synthetic opioid:

Answer 24

Fentanyl

Question 25

What's an opioid antagonist?

Answer 25

Naloxone (narcan) - blocks mu and kappa receptors

Question 26

What is methadone?

Answer 26

A mu receptor agonist but does not cause euphoria; used to treat addiction

Question 27

Name 2 non-opioids:

Answer 27

1. NSAIDS | 2. acetaminophen

Question 28

What are 3 examples of NSAID's?

Answer 28

1. ASA 2. celebrex 3. ibuprofen

Question 29

Name two examples of opioid + non-opioid combination:

Answer 29

1. Percocet (oxycodone + acetaminophen) | 2. Percodan (oxycodone + ASA)

Question 30

When should opioids be used?

Answer 30

Moderate to severe pain

Question 31

What are some side effects of opioids?

Answer 31

- sedation, euphoria, relaxation - constipation, nausea, vomiting - urinary retention - orthostatic hypotension, dizziness - respiratory depression - dependence, pruritis

Question 32

What are some of the trade names of morphine?

Answer 32

- Kadian - M-Eslon - MS Contin - MS-IR - Statex

Question 33

What are the uses of morphine?

Answer 33

- acute and sever chronic pain | - relieving acute MI

Question 34

How does morphine work?

Answer 34

It occupies mu and kappa receptors in the brain and dorsal horn of the spinal cord

Question 35

If the resps are lower than ___ then morphine should be withheld?

Answer 35

<12

Question 36

What do opioids do to GI motility?

Answer 36

Reduce motility and promote constipation

Question 37

What does Naloxone do?

Answer 37

It reverses respiratory depression when acute opioid intoxication has occurred by blocking mu and kappa opioid receptors.

Question 38

The use of opioid antagonists such as naloxone may cause:

Answer 38

Withdrawal symptoms

Question 39

What are the side effects of Naloxone?

Answer 39

- tend to be the opposite to effects of opioids - loss of analgesia - increased bp - hyperventilation - tremors - nausea, vomiting - drowsiness

Question 40

How long do withdrawal symptoms last for in a patient who is physically dependent on opioids?

Answer 40

7 days

Question 41

Do psychological or physical withdrawal symptoms last longer?

Answer 41

Psychological, cravings can persist for years after discontinuing the drug

Question 42

What is "methadone maintenance"?

Answer 42

When people who are dependent on opioids take methadone orally to prevent withdrawal symptoms but you don't get the euphoric effects of the drug.

Question 43

How do NSAIDs work?

Answer 43

They reduce the production of prostaglandins at the site of injury by blocking cyclooxygenase (COX) therefore reducing inflammation and pain.

Question 44

What are some of the adverse effects of NSAIDs?

Answer 44

- GI effects (ulceration of mucosa) - dizziness, headache, and rash - anti-clotting properties

Question 45

How does acetaminophen work

Answer 45

Equal efficacy to ASA, blocks COX in central nervous system

Question 46

Name another NSAID?

Answer 46

Aspirin

Question 47

What is aspirin used for?

Answer 47

- mild to moderate pain - inflammation - fever - clot reduction - risk reduction of stroke and MI

Question 48

What are some of the adverse effects of aspirin?

Answer 48

- gastric discomfort and bleeding | - increased clotting time