Drugs for the Control of Pain

Question 1

pain is multi-dimensional and incorporates:

Answer 1

• the physical stimulus
• the physical state of the patient
• emotional state of the patient
• patients past experience with pain
• patients belief about the implications of being in pain

Question 2

define pain

Answer 2

• pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage

Question 3

what age group is the numeric rating scale used for?

Answer 3

• clients older than 8 years old

Question 4

what are the ratios for the numeric rating scale?

Answer 4

• mild pain: <4
• moderate pain: between 4-6
• severe pain: between 7-10

Question 5

what are the 4 classifications of pain?

Answer 5

• nociceptor pain
• neuropathic pain
• acute pain
• chronic pain

Question 6

what is involved with nociceptor pain?

Answer 6

• associated with tissue injury and activation of receptor nerve endings that transmit pain signals to the CNS
• somatic pain: sharp, localized pain
• visceral pain: generalized, dull, throbbing, aching pain

Question 7

what is involved with neuropathic pain?

Answer 7

• caused by damage from a lesion or disease of the somatosensory nervous system
• associated with direct nerve injury; surgery or diabetic neuropathy
• burning, shooting, numbness

Question 8

what is involved with acute pain?

Answer 8

• intense pain occurring over a defined period of time

Question 9

what is involved with chronic pain?

Answer 9

• pain that persists longer than 6 months, interferes with daily activities

Question 10

what is the multi-modal therapy of analgesic drugs? what is an example?

Answer 10

• the use of drugs from several different drug classes offers better analgesia than single modal therapy because you can use less of each
• Tylenol 3: contains acetaminophen, codeine, and caffeine

Question 11

what is the mechanism of action for NSAIDS (non-opioid analgesics) ?

Answer 11

• administered to relieve mild to moderate pain, inflammation and fever
• inhibits the inflammatory response to tissue injury
• inhibits the activity of cyclooxygenase

Question 12

what is the mechanism of action for endogenous opioids?

Answer 12

• modulate the transmission of pain to the brain and spinal cord

Question 13

opioid receptor activation on postsynaptic and presynaptic receptors

Answer 13

• postsynaptic: opens potassium channels, causing membrane hyper polarization, inhibiting neuronal activity
• presynaptic: closes calcium channels, inhibiting the release of excitatory neurotransmitters

Question 14

what receptors do opioids exert their analgesic effects on?

Answer 14

• mu and kappa receptors in the brain and spinal cord

- used in treatment of moderate to severe acute pain

Question 15

what are some clinical uses of opioids?

Answer 15

• severe diarrhea

- acute pain (in combination with an NSAID)

Question 16

what are examples of opioids antagonists?

Answer 16

• naloxone and buprenorphine

Question 17

what are some symptoms of opioid withdrawal?

Answer 17

-rhinorrhea, lacrimation, chills, gooseflesh , muscle aches, diarreah

Question 18

Canadian guideline for opioids for chronic non-cancer pain

Answer 18

• non-opioid and non-pharmacological therapy prior to a trial of opioids
• stabilizing any psychiatric disorder before opioids

Question 19

buprenorphine + naloxone

Answer 19

• administered sublingually but naloxone does not get absorbed this way, so it will not be absorbed if used correctly
• if pt’s try to snort or crush it to get a high, the naloxone will be administered and it will counteract the drug

Question 20

what are some adverse effects of opioids?

Answer 20

• constipation
• nausea and vomiting
• itchiness
• sedation
• resp depression
• delirium

Question 21

what is the mechanism of action for serotonin agonists

Answer 21

• endogenous pain suppression pathways release the neurotransmitter serotonin
• triptans bind to serotonin receptors and are effective in treatment for migraine headaches by vasoconstriction on intracranial vessels and inhibits release of substance P

Question 22

what is the mechanism of action for GABA receptor agents

Answer 22

• endogenous pain suppression pathways release the neurotransmitter GABA
• benzodiazepines act on GABA receptors and intensify the effects of GABBA
• used to augment analgesia

Question 23

how are steroids used for pain management?

Answer 23

bone pain and nerve compression

Question 24

what can anticonvulsant and anti epileptic drugs be used for?

Answer 24

• neuropathic pain