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Sympsoiums yr2 > 27- Pain and anxiety management > Flashcards

27- Pain and anxiety management Flashcards

1
Q

What is pain?

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage

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2
Q

What is nociception?

A

The ability to sense pain (by receptors that translate noxious stimuli to the brain)

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3
Q

What is a condition the means a person is unable to detect pain?

A

Congenital Analgesia

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4
Q

Why is pain important

A

To protect form danger/death

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5
Q

What are the 3 main noxious stimuli?

A
  1. Mechanical noxious stimuli
  2. Thermal noxious stimuli
  3. Chemical noxious stimuli
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6
Q

What are the 3 types of pain fibres?

A

C fibres- non-mylenated

A alpha and A delta - myelnated

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7
Q

Which pain fibres are for dull pain?

A

c fibres

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8
Q

Which fibres are for sharp shooting pain?

A

A alpha and A delta due to their myelnation

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9
Q

When should patient pain be managed?

A

Preoperatively, intraoperatively, postoperatively

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10
Q

Ways of preoperative management

A

ICE (ideas, concerns, expectations)
good planning with patient
pre-op tests/assessment

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11
Q

Ways of intraoperative pain management

A

Local Anaesthesia

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12
Q

What are the 2 main groups of LA

A
  1. Amino-esters

2. Amin-amides

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13
Q

Which LA would you give to pt with liver disease?

A

Amino-esters (they break down in the plasma)

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14
Q

What should you check on a cartridge before you use

A
  • correct medication
  • no damage
  • no bubbles
  • no cloudiness
  • expiration date
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15
Q

What is adrenaline

A

Hormone that helps give more profound anaesthesia by prolonging duration and reducing toxicity

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16
Q

What is felypressin

A

A synthetic octapeptide, not as effective as adrenaline poorer haemorrhage control

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17
Q

What is adrenaline contraindicated with?

A
  • unstable angina
  • hypertension
  • taking monoamine oxidase inhibitors (MAOI)
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18
Q

What different types of LA are there?

A
  • Lidocaine with adrenaline
  • Articaine with adrenaline
  • Prilocaine with felypressin
  • Bupivacaine with adrenaline
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19
Q

Local complications of LA

A
  • Nerve damage
  • Motor nerve paralysis
  • Trismus
  • Intravascular Injection
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20
Q

Systemic complications of LA

A
  • Allergy
  • Infection
  • Toxicity
  • Drug interaction
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21
Q

What does topical anaesthesia contain?

A

20% benzocaine, 2.5-10% Lidocaine

22
Q

Ways of post-operative pain management

A

using analgesia agents: -paractemol, NSAIDs, Opioids

23
Q

What do we want to prevent by carrying out postoperative pain management?

A

1- periferal sensitization

2- central sensitization

24
Q

What will adequate pre/intra/post management do?

A
  • reduce input to spinal cord
  • minimise spinal cord changes
  • prevent cortex reorganisation
  • reduce postoperative pain
  • improve patients experience
25
Q

How does paracetamol work?

A

COX 3 inhibition in the CNS, decreasing prostaglandins thereby increasing the pain threshold

26
Q

What can excessive use of paracetamol cause?

A

liver damage

27
Q

How do NSAIDs work?

A

inhibits non-selective COX1 and COX2, decreasing prostaglandins synthesis, increasing the pain threshold

28
Q

What are the risks associated with NSAIDs?

A

affects COX of other organs : kidneys, stomach, heart complications risk of bleeding stomach ulcers

29
Q

What are opiods mode of action?

A

agonist of opiod receptors

30
Q

weak opiod?

A

codeine

31
Q

moderate opioid?

A

tramadol

32
Q

strong opioid?

A

morphine

33
Q

main risk of opiod?

A

Decreased respiration

34
Q

Dose of paractemol?

A

500mg - 1g every 4-6hrs, maximum 4g a day

35
Q

dose of ibuprofen?

A

400mg every 4-6hrs, maximum 2.4g a day

36
Q

Dose of codeine?

A

30-60mg every 4-6hrs

37
Q

What are some indications of sedation?

A
  • anxiety due to past experiences
  • unpleasant prolonged procedure
  • medical conditions that may be aggravated by stress
  • behavioural conditions
  • special care
38
Q

what is IOSN (Indicator of sedation need) graded on?

A
  • anxiety
  • medical history
  • treatment complexity
39
Q

Main steps in the management of anxiety?

A
  1. behavioural management
  2. inhalation sedation
  3. intravenous sedation
  4. general anaesthetic
40
Q

What is conscious sedation?

A

A technique in which the use of a drug produces a state of depression of the CNS enabling treatment to be carried out, during which verbal contact with the patient is maintained throughout

41
Q

What chemical is used in inhalation sedation?

A

Nitrous oxide and oxygen

42
Q

What is the recovery period for inhalation sedation?

A

10 mins

43
Q

What chemical is used in intravenous sedation?

A

Sedative midazolam given into vein

44
Q

What is the recovery period for intravenous sedation?

A

20-40 minutes

45
Q

What must you not have before intravenous sedation?

A

alcohol or recreational drugs

46
Q

What is the antidote of sedative midazolam?

A

flumazenil

47
Q

Drugs which prolong the effect of sedation

A
  • protease inhibitors
  • nefazodone
  • sertraline
  • grapefruit
  • fluoxetine
  • erythromycin
  • diltiazem
  • clarithromycin
48
Q

Drugs which reduce the effect of sedation

A
  • rifapentine
  • rifabutin
  • phenytoin
49
Q

Drugs which enhance the sedative effect

A
  • antidepressants
  • antiepileptic
  • opioids
  • antipsychotics
  • alcohol
  • some antihitamines
50
Q

What are 3 other types of sedation?

A
  1. oral
  2. intramuscular
  3. rectal
51
Q

What is oral sedation

A

benzodiazepine, easy to administer but difficult to control

Sympsoiums yr2 (27 decks)

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