Exam III--Pain Flashcards
Describe the physiology of pain
- Transduction (Tissue damage–> nocioceptive pain). Prostaglandin, histamines, substance P released.
- Transmission (AP –> spinal cord –> thalamus –> cortex)
- Perception of pain
- Modulation (i.e., endogenous opioids/endorphin release) `
Mild vs severe pancreatitis
Both: inflammation/enzyme auto-digestion of the pancreas
Mild: edematous, hemmorhagic
Severe: necrotizing–risk for organ failure, sepsis, Turners/cullens spots, tetany (hypocalcemia)
Describe the pathophysiology of acute pancreatitis
Trypsinogen, an enzyme produced in the pancreas, is converted to trypsin in the pancreas (should only be in small intestine)
What are the common etiologies of pancreatitis?
F sex patients: gallbladder disease
M sex patients: chronic alcoholism
Other risk factors: smoking, high triglycerides (<160M, <135F), GI surgery, infection, drugs
Describe the clinical manifestations of pancreatitis (pain, chest, GI)
-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
Turners vs cullens spots–sign of ________.
sign of pancreatitis
-Turner’s: L hip bruising
-Cullen’s: surrounding belly button
Describe psuedocysts and ________ abscess–complications of ________.
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
A patient with suspected pancreatitis asks you what tests will be performed to confirm their diagnosis. How do you respond?
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.
Signs/symptoms of hypocalcemia include:
-Chvostek’s sign (face squinch)
-Trousseau’s sign (italian hand)
-Tetany
-seizure, confusion
How to care for pancreatitis (not drugs)
-Positioning: cannonball, side lie HOB 45, frequent changes
-Correct F/E imbalances
-NPO to allow pancreatic rest
Acetazolamide use, MOA
Use: pancreatitis
MOA: carbonic anhydrase inhibitor –> decreased pancreatic secretion
Dicyclomine (Benytl) use, MOA, contraindications
use: pancreatitis
MOA: antispasmodic –> decreases vagal stimulation, motility.
Contraindicated in: paralytic ileus
Antacid use (in this class), MOA
Use: pancreatitis
MOA: neutralize HCl, decreased production of pancreatic enzymes
Omeprazole use, MOA
use: chronic pancreatitis
MOA: PPI, decreases HCl acid secretion –> decreases pancreatic activity
What would pancrelipase be used for?
Replacement therapy for pancreatic enzymes after pancreatitis
_________ is commonly used for pain relief in pancreatitis
Morphine
Name the headache!
-S/S: bilateral pressure, stiff neck, photophobia and phonophobia
-How would you assess?
-What drugs would this pt take?
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.
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?
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
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?
Cluster headache
-Assessment: “allergy” symptoms, CT scan to rule out other issues
-Drugs:
Treat w/ Sumatriptan,
high flow oxygen
Prevent w/ high-dose verapamil
Surgical treatments like invasive nerve blocks, deep brain stimulation, and ablative nuerosurgical procedures are used to treat:
cluster headaches
Female sex pts are more likely to have ______ headaches, male sex patients are more likely to have ________ headaches
F sex: tension, migraine
M sex: cluster
Drugs for cluster headaches
-“-triptans” (SSRIs)
-100% O2 inhalation mask
Preventative (VELP)
-verapamil
-ergotamine tartrate (alpha-ad blocker)
-lithium
-prednisone
Drugs for migraines
-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
Drugs for tension headaches
-NSAIDs, aspirin, caffeine, muscle relaxants
Preventative:
-TCA antidepressant (amitriptyline)
-Anti-seizure drugs: toprimate, divalproex
Sumatriptan use, MOA, contraindications
-migraine relief
-SSRI/vasoconstricts
-take when aura appears
-considerations (r/t vasoconstriction): careful w/ heart disease, high cholesterol, stroke history
Topiramate use, considerations, side effects
-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)
Food (chocolate, cheese, tomatoes, onions, alcohol–red wine, MSGs, aspartame), drugs, stress, poor sleep are triggers for what type of headache?
migraine headache
Gabapentin, Topiramate, propranolol, SSRIs, botox are all used to treat ______ headaches
migraine
Gallbladder disease increases risk of _________
pancreatitis
Pseudoaddiction vs physical dependence vs tolerance
Psuedo: behavior
Physical dependence: withdrawal
Tolerance: need to increase/rotate pain meds
