lect 3: chapter 27 Flashcards
what is the 5th vital sign?
pain
pain is undertreated in older adults, especially elders of color and cognitively impaired adults
true
conditions associated with neuropathic pain
diabetes
PVD
herpes zoster
stroke
conditions associated with musculoskeletal pain
arthritis
degenerative spinal conditions
examples of nonopioid analgesics
acetaminophen
NSAIDs (ibuprofen and naproxen)
what is considered the initial treatment for mild to moderate pain?
acetaminophen
what are the contraindications for acetaminophen?
hepatic compromise
alcoholism
malnutrition
dehydration
acetaminophen is most effective for osteoarthritis and back pain
true
what is the max dose for acetaminophen?
400mg in 24 hours
acetaminophen can increase the risk of bleeding when taken with warfarin
true
older adults with these conditions should not take NSAIDs
HTN
impaired renal function
HF
NSAIDs cannot be taken with which medications?
diuretics
ACE inhibitors
(additional kidney damage)
warfarin/ aspirin (increased bleeding)
NSAIDs are highly useful for which conditions?
persistent pain of inflammatory nature (rheumatoid arthritis)
acute inflammatory pain (muscle strain)
naproxen is safer than ibuprofen due to less GI complications
true
patients with heart disease cannot take naproxen
true
(NSAIDs are COX 1 and 2 inhibitors; it increases likelihood for MI and stroke)
what are COX-2 inhibitors?
these are gastroprotective agents that are packed alongside NSAIDs (Celebrex)
COX 2 inhibits platelet aggregation, therefore precipitates for increased GI bleeding
NSAIDs by themselves (traditional) make GI bleeding more likely, but with COX-2 inhibitor that is less likely
COX-2 inhibitors need to be administered with this type of medication for those with higher risk of GI bleeding
PPI (Misoprostol)
what is a major concern with topical pain relief?
rashes
what makes opioids different from NSAIDs regarding side effects?
they are more predictable
what is the only instance that would require patients to use opioids?
non-opioids were deemed ineffective
common side effects of opioids
sedation
respiratory depression
nausea
constipation
impaired cognition
which opioid is contraindicated in older adults?
demerol
(this has a strong effect that older adults are not physiologically suited for)
there is low-risk of drug abuse when opioids are treated for pain
true
how is the effect of opioids different in older adults?
higher peak and longer duration of action
bowel regimen for opioid use
stool softener, mild laxatives, and adequate fluid intake
what are adjuvant pain medications?
intended for another purpose but are useful for pain management
types of adjuvant pain medications
herbs
antidepressants
anticonvulsants (Gabapentin)
SSRIs are more effective in treating pain than most antidepressants
true
older adults need a drug with shorter half lives due to
slower metabolism
what are pain clinics?
facilities that provide specialized, and comprehensive multidisciplinary approach to pain management
types of pain centers
1) syndrome-oriented
2) modality-oriented
3) comprehensive
syndrome-oriented centers
focus on specific chronic problems (HA and arthritis pain)
modality-oriented centers
focus on treatment techniques (relaxation or acupuncture)
comprehensive centers
are associated with medical centers
includes thorough assessment of the person
utilize multidisciplinary teams
where is aspirin better absorbed?
stomach
where is morphine better absorbed?
intestine
serotonin syndrome
neuromuscular hyperactivity
