Chapter 7: Pain Management

Question 1

Transduction of pain

Answer 1

Excitatory chemical neurotransmitters cause AP synapsing in dorsal horn of spinal cord

Question 2

Transmission of pain

Answer 2

Neurotransmitters in dorsal horn depolarize the second order neurons causing transmission of information to the brain

Question 3

Perception of pain

Answer 3

End result of pain transmission

Question 4

modulation of pain

Answer 4

Main central inhibitory neurotransmitters include serotonin and norepinephrine–fight pain by increasing concentration in spinal cord and brainstem

Question 5

Drugs recommended for mild to moderate pain

Answer 5

Acetaminophen and NSAIDs

Question 6

Drugs recommended for moderate pain

Answer 6

Combo opioids, Ketorlac, Tramadol

Question 7

Drugs recommended for severe pain

Answer 7

Opioids

-Morphine is gold standard

Question 8

pure mu opioid agonists

Answer 8

Oxycodone, morphine, hydromorphone, oxymorphone, fentanyl

Question 9

DOC for minor, noninflammatory pain

Answer 9

Acetaminophen

Question 10

Drugs for chronic noncancer pain

Answer 10

NSAIDs and salicylates for chronic inflammatory conditions

Low dose opioids may be considered

Question 11

Drugs for chronic cancer pain

Answer 11

Needs to be individualized

Opioids are mainstay in addition of nonopioids and coanalgesics

Question 12

Acetaminophen

Answer 12

Prostaglandin inhibiton in CNS as COX-3 inhibitor
No anti-inflammatory, platelet or GI effects
Can cause fatal liver necrosis in toxic amounts >4000mg

Question 13

NSAIDs

Answer 13

Anti inflammatory, antipyretic, analgesic
Block COX1 and COX2
Can cause GI side effects by blocking COX1

Question 14

Opioids that are not excreted in active metabolites by kidneys

Answer 14

Fentanyl and methadone–DOC in renal failure

Question 15

opioid DOC in liver failure

Answer 15

Fentanyl

Question 16

Effects of opioids

Answer 16

Analgesia, respiratory depression, sedation, confusion, N/V, pruritus, miosis, constipation, urinary retention

Question 17

Morphine

Answer 17

Undergoes significant first pass metabolism; crosses bbb, placenta and excreted in maternal milk
Binds to mu receptors in CNS
Prophylactic bowel regimens recommended

Question 18

Codeine currently used as

Answer 18

Anti tussive primarily

Question 19

Fentanyl

Answer 19

Alternative to morphine

Long acting transdermal patch available

Question 20

Tramadol

Answer 20

Centrally acting, weak mu receptor agonist; inhibits NE and serotonin reuptake
Used for moderate to severe pain and neuropathic pain
Metabolized by CYP450 system

Question 21

Methadone

Answer 21

Usually sued for treating opioid substance abuse
Mu receptor agonist and NMDA receptor antagonist
Metabolized by CYP450 system

Question 22

Naloxone

Answer 22

Pure opioid antagonist used in opioid induced respiratory depression

Question 23

Which form of laxative should not be used with opioids

Answer 23

Bulk forming laxatives–could cause bowel obstruction

Question 24

Methylnaltrexone

Answer 24

Can treat opioid constipation as it binds to mu in the gut only and antagonizes

Question 25

Withdrawal symptoms of opioid use

Answer 25

Tremors, sweating, fever, flu like symptoms, increased RR, persipiration, lacrimation, mydriasis, hot and cold flashes, anorexia

Question 26

Benefits of coanalgesics seen in

Answer 26

Chronic pain, neuropathic pain, post op pain

Question 27

Examples of coanalgesics

Answer 27

Antidepressants, anticonvulsants, sodium channel blockers, antispasmodics and antispastic agents