control of pain + anxiety Flashcards
what is allodynia
pain from non-painful stimuli
what is hyperalgesia
exaggerated response to noxious stimuli
2 effects of paracetamol
antipyretic
analgesia
risk of paracetamol
liver toxicity in compromised pts
risks of NSIADs
gastric ulceration
bleeding
pts when NSAIDs are contraindicated
elderly previous hypersensitivity pregnancy/breastfeeding history of gastrointestinal bleed/ulcer renal impairment hepatic impairment coagulation defects cardiac impairment asthmatics - increased risk of hypersensitivity
drug prescribed alongside NSAIDs to offer gastrointestinal protection
proton pump inhibitors - ols
drugs developed to have same affects as NSAIDs without side effects
selective COX-2 inhibitors
why do NSAIDs cause side effects
not selective - COX1 also inhibited
side effects of opioids
nausea/vomiting
respiratory depression
example of a weak opioid
codeine or dihydrocodeine
example of a strong opioid
morphine
why may it be important to give systemic analgesia before LA worn off?
reduce risk of sensitisation
where are amino-ester LAs metabolised?
in plasma by pseudocholinesterase
where are amino-amide LAs metabolised?
in liver
3 general complications of LA
psychogenic
toxic
allergy
allergy most likely with what type of LA?
esters
3 local complications of LA
soft tissue trauma
nerve trauma - paraesthesisa
intravascular injection - haematoma, systemic effects
complications of IDB
injection in medial pterygoid - trismus
deep injection in parotid gland - facial nerve = facial muscle paralysis temporary
electric shock = needle touches IAN
medical indications for conscious sedation
mild angina, hypertension, asthma
spasticity, MS, parkinsons
epilepsy
why BDZ sedation CI in severe respiratory disease?
sensitive to respiratory depression
medical CI to conscious sedation
allergy systemic disease resp disease pregnancy liver/kidney disese muscle disease - respiratory depression obesity - airway control psychiatric disorders drug interactions
mechanism of action of benzodiazepines
act on GABA receptions - inhibitory action
undesirable effects of BDZs
respiratory depression
elimination problems
hyperactivity in elderly - receptors change with age
