EXAM 3: pain & comfort + meds Flashcards
Describe the concept of pain
-Unpleasant sensory and emotional experience associated w/ actual and potential tissue damage
-Pain = when person reacts to stimulus by removing tigger causing stimulation
-Many factors influence a persons reaction to pain (anxiety, culture, past experience)
-Pain distress more heavily influenced by how someone reacts to the pain rather than intensity.
Describe the neurological transmission of pain and sensory impulses.
-First order - Detect sensation.
-Second order - Spinal cord transmits signals to thalamus.
-Third order - Thalamus relays info to cerebral cortex.
-Anterolateral pathway (2) - transmits info on pain to the brain.
-Primary somatosensory (3) - identifies the sensation.
Differentiate the role of A-delta fibers, C-fibers, and the periaqueductal gray region and their associated neurotransmitters in the transmission of painful
stimuli.
-A delta fibers - impulses travel quickly (fast pain); Large myelinated fibers. Releases glutamate (NT) - plays crucial role in initial transmission of pain signals from site of injury to SP.
-C fibers - Slow impulses; Small non-myelinated. Releases G & Substance P - Amplifies pain signals & contributes to perceptions of pain intensity.
-Periaqueductal gray region - Analgesic center; Opioid receptors releases endogenous opioids - ENDORPHINS!!!
Contrast types of pain and alterations of pain sensitivity.
-Paresthesias - spontaneous, unpleasant sensation.
-Anesthesia - reduced or loss of sensation with or w/o consciousness.
-Analgesia - relief of pain without loss of consciousness.
-Allodynia - pain after non-noxious stimulus.
-Neuralgia - severe, brief, often repetitive attacks or lightening-like or throbbing pain. Occurs along dist. of spinal or cranial nerve
Discuss the pathophysiology of neurogenic inflammation.
-Neurogenic inflammation is a distinct type of inflammation initiated by nerve activity, rather than solely by tissue damage or infection.
-It plays a significant role in various inflammatory conditions, including migraine, asthma, inflammatory bowel disease, and arthritis.
-Inflammatory mediators from nerve fibers lead to various physiological changes at the site of inflammation.
Migraines
-More common in women - associated with periods/hormones.
-Severe, throbbing headaches on one side of the head.
-With or w/o aura.
-NV, sensitive to light, visual disturbances.
-Blurriness, flickering lights, spots, paresthesia.
-Temporary loss of vision, numbness.
Cluster Headaches
-Occur in clusters (w/ long periods free from headaches).
-Involve sharp, steady eye pain, sweating, flushing, tearing, congestion.
-more common in men
Tension Headaches
-Occur in times of stress.
-Dull band of pain around the entire head.
Describe the therapeutic actions, indications, pharmacokinetics, contraindications, most common adverse reactions, and important drug-drug interactions associated with drugs used for the treatment of pain.
Opioids
-Morphine
-Other Narcotics - Oxycodone, Hydrocodone, Methadone, Fetnanyl, Hydromophone.
-Bind to opioid receptors to induce analgesia
NSAIDs
-Non-selective (Cox 1 & Cox 2)
-Ibuprofen, Naproxen, Aspirin
-Selective (?): Mostly
-Acetaminophen
Opioid agonists: morphine
-Produce analgesia (pain relief), sedation, and a sense of well-being
-Relief for severe acute/chronic pain
-IV, IM, or rectal (rapid)
-Adverse effects - respiratory dysfunction, shock, ORTHO HYPO, NV, cardiac arrest
Opioid inverse agonists: naloxone
-Binds to opioid receptors to block/reverse the effects of opioids
-IV, IM, SC (quick onset 2-3 minutes)
-Adverse effects: N&V, sweating, tachycardia, hypo or hypertension, pulmonary edema
-Can also cause acute withdrawal syndrome
Opioid agonist-antagonists: butorphanol
-An opioid reversal drug.
-Can help reduce dependence & overdose due to the ceiling effect.
-Agonize one type of receptor, but antagonize others
Ergot derivatives: ergotamine
-blocks the receptors in the brain that cause constriction of cranial vessels
-uses: abortion; prevention, HEADACHES
-Adverse effects: preg, lactation, CAD, HTN, hypoperfusion
Triptans: sumatriptan
-bind to serotonin receptors that cause vasoconstriction of blood vessels
-treats acute migraines & cluster headaches
-rapidly absorbed from numerous sites
-don’t mix with ergot drugs
-Adverse effects: Preg, CAD, lactation
Acetaminophen
-Mostly selective (Cox-2)
-Less GI upset/manifestations
