Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical - Winter > 8 - Pain 1 > Flashcards

8 - Pain 1 Flashcards

1
Q

What is pain?

A

Unpleasant sensory and emotional experience associated w/ actual or potential tissue damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What causes nociceptive pain?

A

Activation of pain pathways by ongoing tissue damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the subcategories of nociceptive pain?

A
  • Somatic

- Visceral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is somatic pain?

A
  • Pain arising in tissues of the body

- Sharp, sometimes burning, aching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are examples of somatic pain?

A
  • Osteomyelitis
  • Osteoarthritis
  • Bone fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is visceral pain?

A
  • Pain arising in organs of a body cavity

- Deep, aching, cramping, poorly localized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are examples of visceral pain?

A
  • Endometriosis (pelvis)
  • Crohn’s disease (abdomen)
  • Angina (thorax)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Can visceral pain be managed w/ OTC products?

A

No, so require referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What causes neuropathic pain?

A
  • Direct nerve damage

- Abnormal processing of a pain signal in CNS pain pathways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is neuropathic pain generally described as?

A

Burning, tingling, shock-like, or shooting pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some examples of neuropathic pain?

A
  • Diabetic neuropathy
  • Post-herpetic neuralgia
  • MS
  • Phantom limb pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is hyperalgesia?

A

When a stimulus that would normally cause discomfort causes significant pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is allodynia?

A

Pain due to stimulus that doesn’t normally evoke pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is phantom pain?

A

Pain in a limb that is no longer there

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the difference between acute, sub-acute, and chronic pain?

A
  • Acute lasts 2-4 weeks
  • Sub-acute lasts 4-12 weeks
  • Chronic lasts longer than 12 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is break-through pain?

A
  • A temporary increase in pain greater than moderate intensity that occurs on a baseline pain of moderate intensity or less
  • Ex: px after surgery that is on an analgesic has a dressing change
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is incident pain?

A

Type of breakthrough pain that is made worse by movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What tools can be used to assess pain?

A
  • Numerical rating scale (appropriate for adults)
  • Visual analogue scale (horizontal line w/ left side meaning no pain and right side meaning worst pain)
  • Wong-Baker FACES pain rating scale (appropriate for children and px that don’t speak english)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the most accurate evidence of pain/intensity?

A

Px description and self-reporting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the 4 main pieces essential to pain information gathering?

A
  • Severity of pain
  • Location of pain
  • Onset and how long pain lasts
  • Quality of pain (description– dull ache, sharp pain, tingling or burning)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is OTC pain medication effective at treating?

A
  • Mild to moderate somatic pain from skin, muscles, and joints
  • Dysmenorrhea
  • Headache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Are OTC pain meds effective in tx neuropathic pain?

A

For some px

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the types of OTC pain meds?

A
  • NSAIDs (ibuprofen, ASA, naproxen)
  • Non-anti-inflammatory analgesics (acetaminophen)
  • Opioids (codeine 8 mg)
  • Other (caffeine, muscle relaxants, topical counter-irritants)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How does acetaminophen prevent pain?

A
  • Central inhibition of prostaglandins

- Peripherally blocks generation of pain impulses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is acetaminophen a first line therapy for?

A
  • Mild to moderate pain (low back pain, osteoarthritis, some headaches)
  • Fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the duration of acetaminophen?

A

4-6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When does acetaminophen produce a ceiling effect?

A

Over 1000 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What can contribute to acetaminophen toxicity?

A
  • Overdose

- Disease and lifestyle issues (hepatitis, cirrhosis, chronic alcohol use, binge drinking)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the minimum toxic single dose of acetaminophen in a healthy adult and in children?

A
  • 7.5-10 g in adults
  • 150 or more mg/kg in children
  • Over an 8 hour period
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the sx of acetaminophen overdose?

A
  • Early sx = N/V, drowsiness, confusion, sweating
  • Biochemical evidence of liver damage after 24-48 hours
  • Hepatic damage may not be apparent for 4-6 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Why can alcoholism lower the threshold for acetaminophen liver damage?

A
  • Possible induction of enzymes
  • Hepatic dysfunction
  • Decreased stores of glutathione
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Severe liver damage may occur in adults who drink ___ alcoholic drinks/day while taking acetaminophen

A

3 or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the pharmacological properties of NSAIDs?

A
  • Analgesic
  • Anti-platelet
  • Anti-pyretic
  • Anti-inflammatory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Is ASA a first line analgesic?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the mechanism of ASA?

A

Works primarily in periphery (anti-inflammatory)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the same and different btwn acetaminophen and ASA?

A
  • Equally effective

- ASA has higher side effects (gastric irritation, nausea)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the dosing of ASA?

A
  • 325-650 mg q4-6h

- Max 4g/ 24 h

38
Q

What are some adverse effects of ASA?

A
  • Abdominal pain w/ cramps
  • Heartburn
  • Dyspepsia
  • GI irritation
39
Q

What are the contraindications for ASA?

A
  • Under 18 y/o
  • Active GI lesions
  • History of recurrent GI lesions
  • Bleeding disorders
  • Hypersensitivity
  • Px relying on vasodilatory renal prostaglandins for renal function
40
Q

What types of pain is ibuprofen indicated for?

A
  • Minor pain
  • Headache
  • Common cold
  • Toothache
  • Fever
  • Dysmenorrhea
41
Q

How long does the analgesic effect of ibuprofen last?

A

6-8 hours

42
Q

Can ibuprofen be given to a px w/ an ASA allergy?

A

No

43
Q

Can naproxen be given to a px w/ an ASA allergy?

A

No

44
Q

Mucosal damage through NSAID use is primarily a consequence of _____

A

COX-1 inhibition

45
Q

Which px are at high risk of GI intolerability of NSAIDs?

A
  • Peptic ulcer disease
  • GI bleeds or perforation
  • Concomitant alcohol
46
Q

NSAIDs should always be taken w/ ____

A

Food

47
Q

How can ASA cause damage to GI mucosa?

A
  • Local irritant effect from drug contacting gastric mucosa

- Systemic effect from prostaglandin inhibition

48
Q

What are some risk factors for upper GI bleeding?

A
  • 60 y/o or older
  • Concomitant use of alcohol
  • Concomitant use of other NSAIDs, anticoagulants, antiplatelets, bisphosphonates, SSRIs, or systemic corticosteroids
  • History of uncomplicated or bleeding peptic ulcer
  • Rheumatoid arthritis
49
Q

What affects do enteric coated forms of ASA have on the GI?

A
  • Reduce risk of mucosal lesions and local irritation

- Don’t reduce risk of major GI bleeding

50
Q

What are signs of GI bleeding?

A
  • Black, tarry stool
  • Blood in vomit
  • Blood in stool
51
Q

What are prostaglandins important for?

A

Maintenance of renal blood flow and tubular transport of electrolytes

52
Q

When does prostaglandin release increase?

A

In response to increased levels of angiotensin 2 and norepinephrine

53
Q

What is an important drug-drug interaction w/ NSAIDs?

A

Anti-hypertensive agents (ACE inhibitors, diuretics, beta blockers)

54
Q

Which px are at risk of renal failure when using NSAIDs?

A
  • Volume depletion states (dehydrated)
  • Severe congestive heart failure
  • Hepatic cirrhosis
  • Creatinine clearance less than 30 mL/min
55
Q

What is ASA-induced asthma?

A

Onset of asthma 30 mins to 3 hours post ingestion of ASA

56
Q

Which px is ASA-induced asthma common in?

A

Asthmatics w/ concomitant allergic rhinitis or nasal polyps

57
Q

What is the proposed mechanism for ASA-induced asthma?

A

Decreased prostaglandins causes increased leukotrienes

58
Q

Can acetaminophen be given to px w/ ASA allergy?

A

Yes, but no more than 1g/day

59
Q

What is white willow bark?

A

Natural health product similar to ASA

60
Q

Can a COX-2 selective inhibitor (ex: celebrex) be used in px w/ ASA allergy?

A

Doesn’t affect levels of prostaglandins, so shouldn’t be a problem, but monitor closely

61
Q

Which NSAIDs inhibit platelet aggregation?

A

ASA and ibuprofen

62
Q

How long before surgery should ASA be discontinued? Why?

A

1 week to decrease risk of bleeding during and after surgery

63
Q

How long before surgery should naproxen and ibuprofen be discontinued?

A
  • Ibuprofen = 24 h

- Naproxen and other NSAIDs besides ASA = 3 days to err on side of caution

64
Q

What is an important drug-drug interaction w/in the NSAID class?

A
  • Regular use of ibuprofen 400 mg may interfere w/ cardioprotective effect of low dose ASA when taken at the same time
  • Ibuprofen also has effect on naproxen
65
Q

What should be done if ibuprofen must be taken w/ low dose ASA?

A

Take ibuprofen at least 2 hours after ASA/naproxen

66
Q

What can happen if warfarin and ASA are taken together?

A

Increased INR and bleeding risk

67
Q

What can happen if warfarin and ibuprofen/naproxen are taken together?

A
  • No effect on INR

- GI irritation, so increased risk of bleeding

68
Q

When is acetaminophen considered a first line therapy?

A
  • ASA-sensitive asthma
  • Gastritis or PUD
  • Increased risk of bleeding
  • Px w/ renal dysfunction
  • CV or hypertensive px
  • Multiple concurrent drug therapy
  • Pregnant or breastfeeding (esp. 3rd trimester)
69
Q

What is the active analgesic metabolite of codeine?

A

Morphine

70
Q

How is codeine use preferred?

A

Short term, as adjunctive therapy

71
Q

When should a px be referred who is taking codeine?

A

If no benefit for moderate pain in 2-3 days

72
Q

What effect does caffeine have as an analgesic?

A

Enhances analgesic effects of ASA and acetaminophen

73
Q

What is the recommended tx for pain that is 1-4 (mild to moderate)?

A
  • Acetaminophen, ASA, ibuprofen, or naproxen at OTC doses

- Monitor according to type of pain and agent selected

74
Q

What is the recommended tx for pain that is 4-8 (moderate to severe)?

A
  • Consider addition of codeine combination or alternative (2-3 days)
  • May need to switch to T3 or tramadol (weak opioids)
75
Q

What is the recommended tx for pain that is 8-10 (severe)?

A
  • Refer depending on acute/chronic situation, px history, and red flags
  • Likely requires stronger opioids
76
Q

What are some general red flags for pain?

A
  • Escalating
  • Unresponsive to appropriate therapy
  • Severe
  • Px is pregnant
  • Px uses concurrent therapies or has other illnesses
77
Q

Why shouldn’t medications be mixed in a bottle of milk or formula?

A

If child doesn’t finish the entire bottle then you don’t how much medication they received

78
Q

What is thought to occur after a migraine is triggered?

A
  • Dilation of intracranial and extracerebral blood vessels
  • Activation of trigeminal sensory nerves
  • Leads to pain signals in brain
79
Q

An aura is thought to be due to ____

A

Neuronal dysfunction

80
Q

How long do auras typically last? How long after an aura will a migraine occur?

A
  • Typically last less than 1 hour

- Migraines occur w/in 60 mins of aura ending

81
Q

What is the potential pathophys of tension headaches?

A

Thought to occur due to mental stress and tension

82
Q

What is the location for a tension headache, migraine headache, and cluster headache?

A
  • Tension = bilateral
  • Migraine = mainly unilateral, can spread to bilateral
  • Cluster = only unilateral
83
Q

What is considered a chronic tension headache?

A

Headaches on 15 or more days per month

84
Q

Which products most often cause medication-overuse headaches?

A
  • Caffeine and/or opioids

- Acetaminophen or ASA

85
Q

What are the sx of medication-overuse headaches?

A

Mimic tension headaches

86
Q

What is the tx for medication-overuse headaches?

A
  • Discontinue implicated drugs
  • Relieve withdrawal sx
  • Tx recurrent headaches w/ appropriate Rx migraine therapies (so would refer)
87
Q

What are red flags for headaches?

A
  • Severe or abrupt onset
  • Age of onset over 40 y/o
  • Recent head trauma
  • Medication-overuse
  • Progressive severity and/or increased frequency
  • Neurological signs or symptoms (stiff neck, fever, reduced consciousness)
  • Systemic sx
  • Nocturnal occurrence
  • Onset w/ exercise or exertion
  • Chronic tension headaches
88
Q

What are some non-pharms for migraine headaches?

A
  • Cryotherapy
  • Relaxation techniques (quiet, dark room, sleep)
  • Massage, acupuncture
  • Stress management
  • Exercise (helps some, worsens others)
  • Avoid triggers
89
Q

When are OTCs used for migraines headaches?

A

Px w/ mild to moderate migraine pain

90
Q

When is Rx therapy required for migraine headaches?

A
  • OTC doesn’t work

- Tx being used more than 15 days per month

91
Q

What are the Rx options for migraines?

A
  • Acute tx w/ triptans (sumatriptan, zolmitriptan)

- Prevention (propranolol, amitriptyline)

92
Q

What should be monitored w/ headaches?

A
  • Relief of pain w/in 2 hours after taking medication

- If additional sx present, relief of those sx should also occur in that time

Clinical - Winter (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions