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Pharmacology 1 > Analgesics > Flashcards

Analgesics Flashcards

1
Q

What is Pain?

  • Pain is a ______(1)______ experience with _____(2)______ tissue damage.
  • Pain is _______(3)______.
  • Pain is an _______(4)______ sensory and emotional experience.
  • Pain is ________(5)_______ with different _____(6)___ and pain tolerances
A
  1. highly subjective
  2. actual or potential
  3. difficult to define
  4. unpleasant
  5. individualized
  6. thresholds
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2
Q

Classification of pain

What type of pain is this?

  • Sudden onset and short in duration
A

Acute pain

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3
Q

Classification of pain

Are we good at treating acute pain?

A

Yes- we have a lot of meds to treat acute pain

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4
Q

Classification of pain

What are some examples of acute pain?

A
  • MI
  • appendicitis
  • kidney stones
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5
Q

Classification of pain

What type of pain is this?

  • Persistant or recurring; (comes in cycles)
A

Chronic pain

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6
Q

Classification of pain

Are we good at treating chronic pain?

A

No- chronic pain is difficult to treat

we can get it under control but it never goes away

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7
Q

Classification of pain

Characteristics of chronic pain

A
  • long duration
  • cyclic
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8
Q

Classification of pain

Examples of chronic pain

A
  • RA- rheumatid arthitis
  • cancer pain
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9
Q

Classification of pain

What type of pain

  • originates from muscles, ligaments, and joints
A

Somatic pain

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10
Q

Classification of pain

Charactertitics of somatic pain

A
  • localized
  • constant
  • described as “aching/throbbing”
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11
Q

Classification of pain

What medicatin does somatic pain best repond to?

A

NSAIDS (treats inflammation)

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12
Q

Classification of pain

Examples of somatic pain

A
  • strains
  • sprains
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13
Q

Classification of pain

What type of pain:

  • originates from organs (deep pain)
A

Deep (visceral) pain

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14
Q

Classification of pain

Characteristics of deep (visceral) pain

A
  • often described as “dull/aching” and/or as “referred”
  • hard to pin down exactly where it is
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15
Q
A
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16
Q

Classification of pain

Examples of deep (visceral) pain

A
  • deep pelvic pain
  • intestional pain
  • transplant organ rejection
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17
Q

Classification of pain

What type of pain is this?

  • Pain in a missing body part (amuputation)
A

Phantom pain

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18
Q

Classification of pain

How is phantom pain described as?

A
  • burning
  • itching
  • tingling
  • stabbing
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19
Q

Classification of pain

What type of pain is this?

  • Origin in one place but felt in another
A

Referred pain

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20
Q

Classification of pain

Examples of referred pain

A
  • MI
  • appendicitus
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21
Q

Classification of pain

What type of pain is this?

  • Caused by peripheral nerve injury not stimulation
A

Neuropathic pain

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22
Q

Classification of pain

What is neuropathic pain described as?

A
  • shooting
  • burning
  • tingling
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23
Q

Classification of pain

Examples of neuropathic pain

A
  • carpel tunnel syndrome
  • pinched nerve
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24
Q

Theory of pain transmission and relief

A

Gate Control Theory

(Melzack and Wall)

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25
Q

Shortcomings of the Gate Control Theory:

  • This ____(1)______ is not a _______(2)________.
  • It doens’t always ______(3)______ what is happening.
A
  1. theory
  2. physiological principle
  3. explain
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26
Q

Gate Control Theory

Step 1:

  • Tissue injury → release of _____(1)_____, _____(2)____, _____(3)____, ______(4)______, and _____(5)_____.
    • Treatment may work by blocking one or more of these substances

“bananas have potassium, phosphorus, and sugar.”

A
  1. Bradykinin
  2. Histamine
  3. Potassium
  4. Prostglandins
  5. Serotonin
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27
Q

Gate Control Theory

Step 2:

  • Sensory _____(1)_____ travel to _____(2)_____ where the “___(3)___” are located.
A
  1. nerve impulses
  2. spinal cord
  3. gates
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28
Q

Gate Control Theory

Step 3:

  • If impulses cannot get through the “gate” then pain does not get to the ____(1)_____ to be _____(2)_____.
A
  1. brain
  2. recognized
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29
Q

Gate Control Theory

Step 4:

  • A “___(1)____” pain may not open the ____(2)____.
    • Ex: when you sit at first its not painful, but 2 hours later its painful
A
  1. pain
  2. gate
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30
Q

Gate Control Theory

Step 5:

  • Large nerve fibers (____(1)____) tend to keep the gate ____(2)___.
    • To kill pain, ______(3)______ large nerves, with massage, bite, acupuncture, and pressure
A
  1. A fibers
  2. closed
  3. stimulate
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31
Q

Gate Control Theory

Step 6:

  • Small nerve fibers (____(1)___) tend to ____(2)_____ the gate
A
  1. C fibers
  2. open
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32
Q

Gate Control Theory

Step 7:

  • The brain can alson ___(1)_____ the gate and _____(2)_____ pain perceived
A
  1. control
  2. decrease
33
Q

What are the body’s natural pain killers and can inhibit pain impulses (close the gate)

example of runner’s high

A
  1. Endorphins
  2. Enkephalins
34
Q

Assessment of Pain

What type of assessment is this?

  • Ask the patient to describe their pain in their own words
    • We chart it
  • Rate it on a scale of 1-10
    • Ex: 5/10
A

Subjective pain

35
Q

Assessment for Pain

Objective signals patient is in pain:

CHIRPS

“Can’t dance with tense toes”

A
  1. Complains
  2. Hypertension (increase BP)
  3. Insomnia
  4. Restlessness
  5. Pallor
  6. Sweating
  7. Can’t concentrate
  8. Difficulty walking/ more slowly, etc.
  9. Withdrawal
  10. Tense muscles
  11. Tachycardia (increase heart rate)
    12.
36
Q

Opioid Analgesics

Characteristics

A
  • very strong pain relievers
  • originally derived from opium
  • now many or synthetic
37
Q

Assessment of Pain

Should you belive what the patient tells you about their pain?

A

Yes

38
Q

Opioid Analgesics

Mechanisms of Action

  • _____(1)______ and ______(2)_____ the pain receptors
  • Also causes _____(3)______ and _______(4)______.
  • Releases _______(5)______ (causing drop in BP & itchy skin)
A
  1. Binds to receptors
  2. blocks
  3. sedation
    1. “chill pill”
  4. euphoria
    1. “happy juice”
  5. histamine
39
Q

Opioid Analgesics

Major CNS S/E

A
  • Sedation
  • Disorientation
  • Lightheadedness
  • Cough suppression (codeine)
40
Q

Opioid Analgesics

Major CV S/E

A
  • orthostatic hypotension
  • flushing
41
Q

Opioid Analgesics

Major Respiratory S/E

think Morphine

A
  • respiratory depression
    • may lead to death
42
Q

Opioid Analgesics

What are the three major S/E of opioids?

A
  1. Constipation
  2. Respiratory depression
  3. Urinary retention
43
Q

Opioid Analgesics

Major GI S/E

A
  • N/V
  • constipation (Lomotil)
44
Q

Opioid Analgesics

Major GU S/E

A
  • urinary retention
45
Q

Opioid Analgesics

Major Skin S/E

A
  • itching
  • rash
  • redness along vein or place of injection
  • facial flushing
46
Q

Opioid Analgesics

Major Psych S/E

A
  • Addiction
    • Compulsive craving and need for the euphoria
47
Q

Toxicity/ Overdose

Respiratory Depression

A
  • Life threatening side efffect of opioids
  • Treat with nacrotic antagonist (Naloxone/Narcum)
    • ​May take several does
48
Q

Toxicity/ Overdose

Physical Dependence/ Physical Tolerance

A
  • Long-term use causes opioid medication to be less effective
  • Physical dependence/ physical tolerance is not the same as addition
    • Often is associated with cancer treatments
49
Q

Toxicity/ Overdose

What is Naxolone/Narcan used for?

Why?

A

To treat severe respiratory depression caused by an opioid

B/c its a narcotic antagonist

50
Q

Toxicity/ Overdose

Hallucinations

A
  • some very disturbing (change the drug)
    • Bugs crawling
  • some very pleasant
51
Q

Toxicity/ Overdose

Do not mix narcotics with ____(1)____, _____(2)___, ____(3)____, and _____(4)____.

B/c of of those are _____(5)_____.

A
  1. many medications
  2. alcohol
  3. psych meds
  4. sleeping pills
  5. “downers”
52
Q

Morphine

A
  1. The Gold Standard powerful pain reliever
  2. Highest addictive potential
  3. Causes respiratory depression and constipation
  4. Routes: PO, IM, IV, patch, rectally
53
Q

Codeine

A
  1. Moderately effective pain reliever
  2. Addictive
  3. Mostly for moderate pain and cough suppression
  4. Routes: PO, rectal, IM, IV
54
Q

Meperidine/ Demerol

(me-per-i-dine)/ (dem-er-ol)

A
  • Synthetic narcotic
  • Highly addictive
  • Does not usually cause respiratory depression
  • Not good for the elderly or those with renal failure
  • Going out of favor d/t so many complications
  • Route: IV, PO, IM
55
Q

Assessment before administration of pain medications (narcotics)

  • Assess ___(1)___- find out about it, would something ____(2)____work?
  • Scale of ____(3)___
  • Assess _____(4)____! before administration
    • Don’t give if respiratory rate is <__(5)__ per minute
  • Safety- These meds decrease ____(6)___- NO _____(7)___!
  • Don’t crush if ___(8)___form!
  • Assess ____(9)___use and other drugs.
A
  1. pain
  2. less strong
  3. 0-10
  4. respiratory rate
  5. 12
  6. alertness
  7. drive
  8. “extended release”
  9. alcohol
56
Q

Administration Guidelines:

  • Assess for ___(1)____, ____(2)___ and ____(3)____ afterwards
  • Oral narcotics generally tolerated with ____(4)___
  • There are _____(5)____- special counting and _____(6)___ procedure
  • Raise ___(7)___ afterward- patient not out of bed d/t disorientation
  • Have ____(8)____ available
  • Narcotics work better if taken ___(9)___ the pain becomes too bad.
    • Keep the gates ___(10)___
  • Most institutions’ “___(11)__” is for pain to be a “___(12)__” or less
A
  1. respiratory depression
  2. constipation
  3. urinary retention
  4. food
  5. controlled substances
  6. documentation
  7. siderails
  8. Naloxone/Narcan
  9. before
  10. closed
  11. goals
  12. 3
57
Q

Codeine examples

A
  1. Tylenol 3
  2. Percocet (with Tylenol)
  3. Percodan (with aspirin)
  4. Vicodin
58
Q

Naloxone

(Narcan)

A
  • Narcotic antagonist
  • Use to reverse narcotic induced respiratory depression or overdose
  • Route: IV (only in hospital) and spray (in the community)
59
Q

Controlled Substances

  • ____(1)____ are controlled substances.
  • Kept in a ____(2)____
  • Must be ____(3)_____ at the beginning and ending of each ____(4)____ (or when a medication giving staff member goes home)
  • Counted by _____(5)____ and they ____(6)_____ to verify the count is correct
  • Any ___(7)___ or part of a dose that was ____(8)___ from the locked cabinet that cannot be given to the patient must be ____(9)____.
    • Another __(11)__ (besides the one wasting the med) must sign that they witnessed the medication being ____(12)___.
A
  1. Narcotics
  2. locked drawer/cabinet
  3. counted
  4. shift
  5. 2 RNs
  6. sign
  7. dose
  8. removed
  9. wasted
  10. RN
  11. wasted
60
Q

Substance Abuse

Who does it affect?

A

Affects all ages, races, sexes, and socioeconomic groups

61
Q

Substance abuse

Psychological Dependence

  • ____(1)____ for the ____(2)____ is extremely strong.
  • Without the ___(3)____, ___(4)___ and _____(5)____ develop
  • Does the body really ____(6)___ it to survive? ____(7)___
  • “___________(8)______ are common
A
  1. “need”
  2. euphoria/ pleasant feeling
  3. drug
  4. cravings
  5. physical systems
  6. NEED
  7. no
  8. Drug Seeking Behavior
62
Q

Substance Abuse

Physiological Dependence

  • Characterized by _____(1)______ on a _____(2)___
  • If substance is ____(3)_____, _____(4)_____ will develop
  • Increasing ______(5)____ to medications- need _______(6)__________
A
  1. physiological
  2. reliance
  3. stopped
  4. withdrawal symptoms
  5. tolerance
  6. more and more to get effect
63
Q

Substance Abuse

Withdrawal Peak

A
  • Typically 1-3 days after stopping
64
Q

Substance Abuse

Withdrawal Duration

A
  • Typically 5-7 days
65
Q

Commonly Abused Drugs

Opioids

Examples of:

A
  • Codeine
  • Morphine
  • Meperidine
  • heroin
  • oxycodone
66
Q

Commonly Abused Drugs

Opioids

Action (why they take it)

A

Euphoria

Drowsiness

67
Q

Commonly Abused Drugs

Opioids

S/S of Withdrawal

A
  • drug seeking
  • dilated pupils
  • sweating
  • insomnia
  • HTN
  • tachycardia
  • runny nose
  • teary eyes
68
Q

Commonly Abused Drugs

Stimulants

Examples

A
  • Amphetamine
  • cocaine/crack
  • ecstasy
  • speed
  • methamphetamines
  • Ritalin
69
Q

Commonly Abused Drugs

Stimulants

Actions (why they take it)

A
  • wakefullness
  • increased mood
  • decreased fatigue
  • increased self confidence
  • increased concentration
  • performance enhancing
70
Q

Commonly Abused Drugs

Stimulants

S/S of Withdrawal

A
  • depression & social withdrawal
  • suicidal thoughts/behavior
  • sleep all the time
71
Q

Commonly Abused Drugs

Depressants

Examples

A
  • Barbiturates-
    • “roofies” (sleeping pills)
72
Q

Commonly Abused Drugs

Depressants

Action (why they take it)

A
  • decreased anxiety
  • drowsiness (often mixed with alcohol)
73
Q

Commonly Abused Drugs

Depressants

S/S of Withdrawal

A
  • agitation
  • delirium
  • sweating
  • muscular weakness
  • hyperactivity
  • hallucinations
  • suicudal thoughts
  • convulsions
74
Q

Commonly Abused Drugs

Alcohol

Action (why they take it)

A
  • “Feel loose” drowsy
  • hyperactive (varies)
  • decreased inhibitions
75
Q

Commonly Abused Drugs

Alcohol

S/S of Withdrawal

A
  • HTN
  • tachycardia
  • insomnia
  • tremors
  • agitatin
  • fever
76
Q

Commonly Abused Drugs

Nicotine

Examples

A
  • cigarettes
  • cigars
  • smokeless tobacco
77
Q

Commonly Abused Drugs

Nicotine

Action (why they take it)

A
  • calms nerves
  • helps relax
    • but actually excites the nerves
78
Q

Commonly Abused Drugs

Nicotine

S/S of Withdrawal

A
  • craving
  • irritability
  • restlessness

Pharmacology 1 (15 decks)

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