Exam III--Pain

Question 1

Describe the physiology of pain

Answer 1

1. Transduction (Tissue damage–> nocioceptive pain). Prostaglandin, histamines, substance P released.
2. Transmission (AP –> spinal cord –> thalamus –> cortex)
3. Perception of pain
4. Modulation (i.e., endogenous opioids/endorphin release) `

Question 2

Mild vs severe pancreatitis

Answer 2

Both: inflammation/enzyme auto-digestion of the pancreas
Mild: edematous, hemmorhagic
Severe: necrotizing–risk for organ failure, sepsis, Turners/cullens spots, tetany (hypocalcemia)

Question 3

Describe the pathophysiology of acute pancreatitis

Answer 3

Trypsinogen, an enzyme produced in the pancreas, is converted to trypsin in the pancreas (should only be in small intestine)

Question 4

What are the common etiologies of pancreatitis?

Answer 4

F sex patients: gallbladder disease
M sex patients: chronic alcoholism
Other risk factors: smoking, high triglycerides (<160M, <135F), GI surgery, infection, drugs

Question 5

Describe the clinical manifestations of pancreatitis (pain, chest, GI)

Answer 5

-Pain: Left upper quadrant, sudden onset, radiating to back, deep/piercing, made worse by eating/vomiting
-Tachycardia, low BP, low grade fever, crackles r/t inflammation
-Hypoactive bowel sounds, tenderness, guarding, Turner’s spots & cullen’s spots if severe

Question 6

Turners vs cullens spots–sign of ________.

Answer 6

sign of pancreatitis
-Turner’s: L hip bruising
-Cullen’s: surrounding belly button

Question 7

Describe psuedocysts and ________ abscess–complications of ________.

Answer 7

Complications of pancreatitis
-psuedocysts: fluid/debris/pus clump in abdomen, leads to N/V, usually resolves on its own but can rupture –> need drainage
-pancreatic abscess: infection, necrosis of a psuedocyst (leukocytosis, abd pain/mass) –> need surgery

Question 8

A patient with suspected pancreatitis asks you what tests will be performed to confirm their diagnosis. How do you respond?

Answer 8

We will start by drawing labs to check for:
-high amylase and lipase
-high liver enzyme labs (ASTs, ALTs)
-low Ca levels
-high blood sugar
-high triglycerides
-high leukocytes
We may also do a CT scan/ultrasound.

Question 9

Signs/symptoms of hypocalcemia include:

Answer 9

-Chvostek’s sign (face squinch)
-Trousseau’s sign (italian hand)
-Tetany
-seizure, confusion

Question 10

How to care for pancreatitis (not drugs)

Answer 10

-Positioning: cannonball, side lie HOB 45, frequent changes
-Correct F/E imbalances
-NPO to allow pancreatic rest

Question 11

Acetazolamide use, MOA

Answer 11

Use: pancreatitis
MOA: carbonic anhydrase inhibitor –> decreased pancreatic secretion

Question 12

Dicyclomine (Benytl) use, MOA, contraindications

Answer 12

use: pancreatitis
MOA: antispasmodic –> decreases vagal stimulation, motility.
Contraindicated in: paralytic ileus

Question 13

Antacid use (in this class), MOA

Answer 13

Use: pancreatitis
MOA: neutralize HCl, decreased production of pancreatic enzymes

Question 14

Omeprazole use, MOA

Answer 14

use: chronic pancreatitis
MOA: PPI, decreases HCl acid secretion –> decreases pancreatic activity

Question 15

What would pancrelipase be used for?

Answer 15

Replacement therapy for pancreatic enzymes after pancreatitis

Question 16

_________ is commonly used for pain relief in pancreatitis

Answer 16

Morphine

Question 17

Name the headache!
-S/S: bilateral pressure, stiff neck, photophobia and phonophobia
-How would you assess?
-What drugs would this pt take?

Answer 17

Tension headache
-Assessment: family history (most important, resistance to head movement
-Drugs: OTC NSAIDs/tylenol, combined w/ caffeine, sedative, muscle relaxant; amitriptyline, topiramate for prevention.

Question 18

Name the headache!
-S/S: unilateral throbbing pain w/ aura, N/V, pt can “feel headache coming on”, lasts 4 hours - 72 hrs
How would you assess?
What drugs would you expect to be prescribed?

Answer 18

Migraine!
-Assessment: ask about precipitating factors (wine, cheese, MSGs, aspertame), genetic/family history, depression, anxiety
-Drugs: OTC NSAID/tylenol, Exedrin, Sumatriptin (SSRI); Gabapentin, Propranolol, other SSRIs, Botox for prevention

Question 19

Name the headache:
-S/S: happens every night at 10pm, unilateral stabbing pain, swollen and teary eye
How would you assess?
What drugs would you expect to be prescribed?

Answer 19

Cluster headache
-Assessment: “allergy” symptoms, CT scan to rule out other issues
-Drugs:
Treat w/ Sumatriptan,
high flow oxygen
Prevent w/ high-dose verapamil

Question 20

Surgical treatments like invasive nerve blocks, deep brain stimulation, and ablative nuerosurgical procedures are used to treat:

Answer 20

cluster headaches

Question 21

Female sex pts are more likely to have ______ headaches, male sex patients are more likely to have ________ headaches

Answer 21

F sex: tension, migraine
M sex: cluster

Question 22

Drugs for cluster headaches

Answer 22

-“-triptans” (SSRIs)
-100% O2 inhalation mask

Preventative (VELP)
-verapamil
-ergotamine tartrate (alpha-ad blocker)
-lithium
-prednisone

Question 23

Drugs for migraines

Answer 23

-NSAIDs, aspirin, caffeine
-“-triptans” (SSRIs)
-Sumatriptan/naproxen
-ergotamine tartrate (alpha-ad blocker)
-dexamethasone (corticosteroid)

Preventative:
-propranolol
-TCA antidepressants (amitriptyline)
-gabapentin
-Ca channel blockers: verapamil, nifedipine

Question 24

Drugs for tension headaches

Answer 24

-NSAIDs, aspirin, caffeine, muscle relaxants
Preventative:
-TCA antidepressant (amitriptyline)
-Anti-seizure drugs: toprimate, divalproex

Question 25

Sumatriptan use, MOA, contraindications

Answer 25

-migraine relief
-SSRI/vasoconstricts
-take when aura appears
-considerations (r/t vasoconstriction): careful w/ heart disease, high cholesterol, stroke history

Question 26

Topiramate use, considerations, side effects

Answer 26

-anti-seizure drug for migraine, tension headache prevention
-needs at least three months to work
-DON’T STOP ABRUPTLY!
-SFX: hypoglycemia, paresthesia, weight loss, cognitive changes (avoid operating heavy machinery)

Question 27

Food (chocolate, cheese, tomatoes, onions, alcohol–red wine, MSGs, aspartame), drugs, stress, poor sleep are triggers for what type of headache?

Answer 27

migraine headache

Question 28

Gabapentin, Topiramate, propranolol, SSRIs, botox are all used to treat ______ headaches

Answer 28

migraine

Question 29

Gallbladder disease increases risk of _________

Answer 29

pancreatitis

Question 30

Pseudoaddiction vs physical dependence vs tolerance

Answer 30

Psuedo: behavior
Physical dependence: withdrawal
Tolerance: need to increase/rotate pain meds