chapter 8: pain Flashcards by Stephanie Healey

NSAIDS exert their analgesic effects by blocking
__________

cyclooxyrgenase

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2 kinds of primary afferent fibers

A-delta
C fibers

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which type of afferent fiber conduct pain rapidly and are responsible for the initial sharp pain that accompanies tissue injury?

A-delta

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which type of afferent fiber transmits painful stimuli more slowly and pain is typically aching or throbbing?

C fibers

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3 segments involved in nociceptive signal transmission

-transmission along peripheral nerve fibers to spinal cord
-dorsal horn processing
-transmission to thalamus and cerebral cortex

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______ ____ neuron extends the entire distance from the periphery to the dorsal horn with no synapses

1st order

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_______ are areas on the skin that are inneverted primarily by a single spinal cord segment

dermatomes

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neurotransmitters ______ and _________ produce activation of nearby cells

glutamate
substance P

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neurotransmitters ______ and ______ inhibit the activation of nearby cells

GABA
seratonin

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_____ ____ neurons project to the thalamus

2nd order

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_____ ______ is the increased sensitivity and hyper flexibility of the neurons in the CNS

central sensitization

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________ ______ is the increased susceptibility to nociceptor activation

peripheral sensitization

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___ ____ can be caused by peripheral tissue damage or nerve injury

central sensitization

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_____ is pain from a stimulus that is not typically painful

allodynia

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______ is an exaggerated or increased pain response from noxious stimuli

hyperalgesia

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acute, unrelieved pain leads to chronic pain through _____ ________

central sensitization

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__________ are processes that allow neurons in the brain to compensate for injury and adjust their responses to new situations or changes in their environment

neuroplasticity

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perception of pain assumed to occur in ____ _____

cerebral cortex

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modulation of pain signals can occur at the level of the ________, _____ _____, _____ ____, and cerebral cortex

periphery
brain stem
spinal cord

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descending modulatory fibers release chemicals such as: (4)

seratonin
norepinephrine
GABA
endogenous opioids

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what is the treatment for nociceptive pain?

non-opioids and/or opioids

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_____ pain is caused by damage to somatic or visceral tissue

nociceptive

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______ pain caused by damage to peripheral nerves or structure in CNS

neuropathic

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what is the treatment for neuropathic pain?

adjuvant analgesics

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______ pain results from loss of or altered afferent input secondary to either peripheral nerve injury or CNS damage

deafferation

______ pain is caused by CNS lesions or dysfunction

central

______ _____ pain syndrome causes dramatic changes in color and temp if skin over affected limb or body part, accompanied by intense, burning pain, skin sensitivity, sweating and swelling

complex regional pain

complex regional pain syndrome type 1 frequently triggered by ____ injury, _____, or ______ event

tissue injury surgery vascular

complex regional pain syndrome type 2 has all the same features in addition to ______ ______ ______

peripheral nerve lesion

______ ______ products are used to treat breakthrough pain

transmucousal fentanyl

transmucousal fentanyl products are used to treat __________ pain

breakthrough

side effects of pain meds can be managed by: decreasing dose by _____ to ______ % using an administration route that _______ drug concentration

10-15% decreases

older NDAIDS like ibuprofen inhibits both forms of _____ and are ___-____ NSAIDS

COX non-selective

_____ _____ effect is when an NSAID is combined with opioid allowing for lower opioid dose leading to fewer adverse effects

opioid sparing effect

using ____ with an opioid produces an opioid sparing effect

Tylenol

using Tylenol with an opioid produces an ______ _____ effect

opioid sparing

______-___ is found in almost all tissues and is responsible for several protective physiological functions

COX-1

____-__ is produced mainly at sites of tissue injury

COX-2

___-___ mediates inflammation

COX-2

inhibition of ____-___ causes many of the adverse effects of NSAIDS

COX-1

inhibition of ___-__ is associated with the therapeutic anti-inflammatory effects of NSAIDS

COX-2

most commonly administered subclass of opioids is ______ ______ ______

pure opioid antagonists

pure opioid antagonists bind to _____ receptors

pure opioid antagonists are also referred to as ____ ____ opioids

morphine like

when opioids are prescribed for moderate pain, they are usually combined with a ___-______

non-opioid

______ can cause _____ prolongation

methadone QT

_____ is associated with higher incidence of nausea and constipation than other mu antagonist

codeine

_____ plus ______ used as sublingual preparation to treat opioid dependence for easier withdrawal when tapering from opioids

duprenorphine plus nalaxone

opioid induced pruritus can be managed through low dose ____ infusions

naloxone

_____ _____ _____ is a paradoxic response in which pts become more sensitive to certain painful stimuli and report increased pain with opioid use

opioid induced hyperalgesia

opioid induced hyperalgesia is due to ______ changes

neuroplasticity

do not give _______ at same time as NSAID

corticosteroid

corticosteroids have the ability to decrease _____ and ______

edema inflammation

____ antidepressants enhance descending inhibitory system by preventing the cellular reuptake of seratonin and norepinephrine

tryclic

______ _____ anatagonist can interfere with transmission of nociceptive impulses

GABA receptor

GABA receptor antagonists are used to treat (2)

-neuropathic pain -muscle spasms

A2 adrenergic agonists are used to treat(2)

-chronic headaches -neuropathic pain

___% _____ patch used as first line agent for several types of neuropathic pain

5% lidocaine

chronic severe neuropathic pain treated with oral therapy of ________

mexilefine

larger doses needed of oral meds bc of ___ _____ effect

first pass

first pass effect: oral opioids are absorbed from ____ tract into portal of ______ and shunted to the _______

GI circulation liver

transmucousal absorption allows the drug to enter the bloodstream and travel directly to the _____

CNS

pain relief from transmucousal absorption usually occurs ___-____ mins after admin

5-7

____ and ____ commonly used in PCAs

morphine hydrocodone

what are these signs of? -diffuse back pain -pain or paresthesia during bolus injection -unexplained sensory or motor deficits in lower limbs

intraspinal infection

____ ____ _____ most commonly used for chronic back pain secondary to nerve damage

spinal cord stimulation

_____ ______ _____ stimulation delivers electrical currents through electrodes applied to the skin surface over painful region, at trigger points, or over a peripheral nerve

transcutaneous electrical nerve stimulation (TENS)

typical opioid tapering schedule may involve reducing dose by ___-____% each day

20-50

what is the max amount of Tylenol that can be given daily?

4 grams or 4000mg

in opioids overdoses ______ always comes before respiratory depression

sedation

in opioids overdoses sedation always comes before _____ ______

respiratory depression

stop opioid and give nalaxone if RR is below ____or the pt is difficult to arouse

8/min

example of deafferation pain

amputation

______ approach used to treat neuropathic pain

multimodal

______ drugs can be used to treat neuropathic pain

antiseizure

____ pain decreases over time as pt recovers

acute

____ _____ system activated with acute pain

sympathetic nervous

acute pain manifestations include: increased ______ ____ increased ______ ____ increased ___ _____ _______, pallor

hr rr bp diaphoresis

____ pain continues past normal recovery time

chronic

if pt receives PO pain med, evaluate effectiveness in ___-____

30 mins to 1 hr

if pt receives IV pain med, reassess after ___-___ mins

15-30

acetaminophen has the potential to cause _____

hepatotoxicity

acetaminophen has ______ effects

antipyretic

____ don't have an analgesic ceiling

opioids

mixed agonists-antagonists bind as agonists on ______

kappa

______ primarily used in the treatment of chronic pain

methadone

when Tylenol doesnt provide enough pain relief and opioids would provide too much what med is used?

tramadol

_______ most common side effect of opioids

constipation

______-____ pts have a higher risk for respiratory depression

opioid naive

____ used first when discontinuing IV opioid therapy

Percocet

____ route used when pt has high fever and can't tolerate oral Tylenol

rectal

anything over level ____ on opioid induced sedation scale is unacceptable

in level 3 of opioid induced sedation consider administering ____ or an _____ if not contraindicated

acetaminophen NSAIDS