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
- highly subjective
- actual or potential
- difficult to define
- unpleasant
- individualized
- thresholds
2
Q
Classification of pain
What type of pain is this?
- Sudden onset and short in duration
A
Acute pain
3
Q
Classification of pain
Are we good at treating acute pain?
A
Yes- we have a lot of meds to treat acute pain
4
Q
Classification of pain
What are some examples of acute pain?
A
- MI
- appendicitis
- kidney stones
5
Q
Classification of pain
What type of pain is this?
- Persistant or recurring; (comes in cycles)
A
Chronic pain
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
7
Q
Classification of pain
Characteristics of chronic pain
A
- long duration
- cyclic
8
Q
Classification of pain
Examples of chronic pain
A
- RA- rheumatid arthitis
- cancer pain
9
Q
Classification of pain
What type of pain
- originates from muscles, ligaments, and joints
A
Somatic pain
10
Q
Classification of pain
Charactertitics of somatic pain
A
- localized
- constant
- described as “aching/throbbing”
11
Q
Classification of pain
What medicatin does somatic pain best repond to?
A
NSAIDS (treats inflammation)
12
Q
Classification of pain
Examples of somatic pain
A
- strains
- sprains
13
Q
Classification of pain
What type of pain:
- originates from organs (deep pain)
A
Deep (visceral) pain
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
15
Q
A
16
Q
Classification of pain
Examples of deep (visceral) pain
A
- deep pelvic pain
- intestional pain
- transplant organ rejection
17
Q
Classification of pain
What type of pain is this?
- Pain in a missing body part (amuputation)
A
Phantom pain
18
Q
Classification of pain
How is phantom pain described as?
A
- burning
- itching
- tingling
- stabbing
19
Q
Classification of pain
What type of pain is this?
- Origin in one place but felt in another
A
Referred pain
20
Q
Classification of pain
Examples of referred pain
A
- MI
- appendicitus
21
Q
Classification of pain
What type of pain is this?
- Caused by peripheral nerve injury not stimulation
A
Neuropathic pain
22
Q
Classification of pain
What is neuropathic pain described as?
A
- shooting
- burning
- tingling
23
Q
Classification of pain
Examples of neuropathic pain
A
- carpel tunnel syndrome
- pinched nerve
24
Q
Theory of pain transmission and relief
A
Gate Control Theory
(Melzack and Wall)
25
Shortcomings of the Gate Control Theory:
* This \_\_\_\_(1)\_\_\_\_\_\_ is not a \_\_\_\_\_\_\_(2)\_\_\_\_\_\_\_\_.
* It doens't always \_\_\_\_\_\_(3)\_\_\_\_\_\_ what is happening.
1. theory
2. physiological principle
3. explain
26
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."
1. Brady**kinin**
2. Histamine
3. Potassium
4. Prost**glandins**
5. Sero**tonin**
27
Gate Control Theory
Step 2:
* Sensory \_\_\_\_\_(1)\_\_\_\_\_ travel to \_\_\_\_\_(2)\_\_\_\_\_ where the "\_\_\_(3)\_\_\_" are located.
1. nerve impulses
2. spinal cord
3. gates
28
Gate Control Theory
Step 3:
* If impulses cannot get through the "gate" then pain does not get to the \_\_\_\_(1)\_\_\_\_\_ to be \_\_\_\_\_(2)\_\_\_\_\_.
1. brain
2. recognized
29
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
1. pain
2. gate
30
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
1. A fibers
2. closed
3. stimulate
31
Gate Control Theory
Step 6:
* Small nerve fibers (\_\_\_\_(1)\_\_\_) tend to \_\_\_\_(2)\_\_\_\_\_ the gate
1. C fibers
2. open
32
Gate Control Theory
Step 7:
* The brain can alson \_\_\_(1)\_\_\_\_\_ the gate and \_\_\_\_\_(2)\_\_\_\_\_ pain perceived
1. control
2. decrease
33
What are the body's natural pain killers and can inhibit pain impulses (close the gate)
example of runner's high
1. En**dorph**ins
2. En**kephal**ins
34
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
Subjective pain
35
Assessment for Pain
Objective signals patient is in pain:
CHIRPS
"Can't dance with tense toes"
1. **C**omplains
2. **H**ypertension (increase BP)
3. **I**nsomnia
4. **R**estlessness
5. **P**allor
6. **S**weating
7. **C**an't concentrate
8. **D**ifficulty walking/ more slowly, etc.
9. **W**ithdrawal
10. **T**ense muscles
11. **T**achycardia (increase heart rate)
12.
36
Opioid Analgesics
Characteristics
* very strong pain relievers
* originally derived from **opium**
* now many or **synthetic**
37
Assessment of Pain
Should you belive what the patient tells you about their pain?
Yes
38
Opioid Analgesics
Mechanisms of Action
* \_\_\_\_\_(1)\_\_\_\_\_\_ and \_\_\_\_\_\_(2)\_\_\_\_\_ the pain receptors
* Also causes \_\_\_\_\_(3)\_\_\_\_\_\_ and \_\_\_\_\_\_\_(4)\_\_\_\_\_\_.
* Releases \_\_\_\_\_\_\_(5)\_\_\_\_\_\_ (causing drop in BP & itchy skin)
1. Binds to receptors
2. blocks
3. sedation
1. "chill pill"
4. euphoria
1. "happy juice"
5. histamine
39
Opioid Analgesics
Major CNS S/E
* Sedation
* Disorientation
* Lightheadedness
* Cough suppression (codeine)
40
Opioid Analgesics
Major CV S/E
* orthostatic hypotension
* flushing
41
Opioid Analgesics
Major Respiratory S/E
think Morphine
* **respiratory depression**
* may lead to death
42
Opioid Analgesics
What are the three major S/E of opioids?
1. Constipation
2. Respiratory depression
3. Urinary retention
43
Opioid Analgesics
Major GI S/E
* N/V
* constipation **(Lomotil)**
44
Opioid Analgesics
Major GU S/E
* urinary retention
45
Opioid Analgesics
Major Skin S/E
* itching
* rash
* redness along vein or place of injection
* facial flushing
46
Opioid Analgesics
Major Psych S/E
* Addiction
* Compulsive craving and need for the euphoria
47
Toxicity/ Overdose
Respiratory Depression
* Life threatening side efffect of opioids
* Treat with **nacrotic antagonist (Naloxone/Narcum)**
* ****May take several does
48
Toxicity/ Overdose
Physical Dependence/ Physical Tolerance
* 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
Toxicity/ Overdose
What is Naxolone/Narcan used for?
Why?
To treat severe respiratory depression caused by an opioid
B/c its a **narcotic antagonist**
50
Toxicity/ Overdose
Hallucinations
* some very disturbing (change the drug)
* Bugs crawling
* some very pleasant
51
Toxicity/ Overdose
Do not mix narcotics with \_\_\_\_(1)\_\_\_\_, \_\_\_\_\_(2)\_\_\_, \_\_\_\_(3)\_\_\_\_, and \_\_\_\_\_(4)\_\_\_\_.
B/c of of those are \_\_\_\_\_(5)\_\_\_\_\_.
1. many medications
2. alcohol
3. psych meds
4. sleeping pills
5. "downers"
52
Morphine
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
Codeine
1. **Moderately** effective pain reliever
2. **Addictive**
3. Mostly for **moderate pain** and **cough suppression**
4. Routes: PO, rectal, IM, IV
54
Meperidine/ Demerol
(me-per-i-dine)/ (dem-er-ol)
* **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
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.
1. pain
2. less strong
3. 0-10
4. respiratory rate
5. 12
6. alertness
7. drive
8. "extended release"
9. alcohol
56
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
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
Codeine examples
1. Tylenol 3
2. Percocet (with Tylenol)
3. Percodan (with aspirin)
4. Vicodin
58
Naloxone
(Narcan)
* **Narcotic antagonist**
* Use to **reverse** narcotic induced respiratory depression or **overdose**
* Route: **IV** (only in hospital) and **spray** (in the community)
59
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)\_\_\_.
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
Substance Abuse
Who does it affect?
Affects all ages, races, sexes, and socioeconomic groups
61
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
1. "need"
2. euphoria/ pleasant feeling
3. drug
4. cravings
5. physical systems
6. NEED
7. no
8. Drug Seeking Behavior
62
Substance Abuse
Physiological Dependence
* Characterized by \_\_\_\_\_(1)\_\_\_\_\_\_ on a \_\_\_\_\_(2)\_\_\_
* If substance is \_\_\_\_(3)\_\_\_\_\_, \_\_\_\_\_(4)\_\_\_\_\_ will develop
* Increasing \_\_\_\_\_\_(5)\_\_\_\_ to medications- need \_\_\_\_\_\_\_(6)\_\_\_\_\_\_\_\_\_\_
1. physiological
2. reliance
3. stopped
4. withdrawal symptoms
5. tolerance
6. more and more to get effect
63
Substance Abuse
Withdrawal Peak
* Typically **1-3** **days** after stopping
64
Substance Abuse
Withdrawal Duration
* Typically **5-7 days**
65
Commonly Abused Drugs
Opioids
Examples of:
* Codeine
* Morphine
* Meperidine
* heroin
* oxycodone
66
Commonly Abused Drugs
Opioids
Action (why they take it)
Euphoria
Drowsiness
67
Commonly Abused Drugs
Opioids
S/S of Withdrawal
* drug seeking
* dilated pupils
* sweating
* insomnia
* HTN
* tachycardia
* runny nose
* teary eyes
68
Commonly Abused Drugs
Stimulants
Examples
* Amphetamine
* cocaine/crack
* ecstasy
* speed
* methamphetamines
* Ritalin
69
Commonly Abused Drugs
Stimulants
Actions (why they take it)
* wakefullness
* increased mood
* decreased fatigue
* increased self confidence
* increased concentration
* performance enhancing
70
Commonly Abused Drugs
Stimulants
S/S of Withdrawal
* depression & social withdrawal
* suicidal thoughts/behavior
* sleep all the time
71
Commonly Abused Drugs
Depressants
Examples
* Barbiturates-
* "roofies" (sleeping pills)
72
Commonly Abused Drugs
Depressants
Action (why they take it)
* decreased anxiety
* drowsiness (often mixed with alcohol)
73
Commonly Abused Drugs
Depressants
S/S of Withdrawal
* agitation
* delirium
* sweating
* muscular weakness
* hyperactivity
* hallucinations
* suicudal thoughts
* convulsions
74
Commonly Abused Drugs
Alcohol
Action (why they take it)
* "Feel loose" drowsy
* hyperactive (varies)
* decreased inhibitions
75
Commonly Abused Drugs
Alcohol
S/S of Withdrawal
* HTN
* tachycardia
* insomnia
* tremors
* agitatin
* fever
76
Commonly Abused Drugs
Nicotine
Examples
* cigarettes
* cigars
* smokeless tobacco
77
Commonly Abused Drugs
Nicotine
Action (why they take it)
* calms nerves
* helps relax
* but actually excites the nerves
78
Commonly Abused Drugs
Nicotine
S/S of Withdrawal
* craving
* irritability
* restlessness
