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PathoPharm > Lewis Ch 8 (Pain) > Flashcards

Lewis Ch 8 (Pain) Flashcards

1
Q

complex, multidimensional experience that can cause suffering and decreased quality of life

A

pain

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2
Q

what is the most valid means of assessment with pain

A

self-report, subjective information

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3
Q

what are negative consequences of unrelieved acute pain related to cardiovascular system

A

increased heart rate

increased bp

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4
Q

what are negative consequences of unrelieved acute pain related to endocrine/metabolic system

A

increased cortisol

increased glucose levels

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5
Q

what are negative consequences of unrelieved acute pain related to GI system

A

decreased gastric mobility

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6
Q

what are negative consequences of unrelieved acute pain related to immunologic system

A

decreased immune response

increased risk of infection

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7
Q

what are negative consequences of unrelieved acute pain related to neurological system

A

impaired cognition

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8
Q

(dimension of pain) emotional responses include anger, fear, depression and anxiety; negative emotions impair patient’s quality of life

A

affective

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9
Q

(dimension of pain) observable actions (grimacing, irritability, coping skills) are used to express or control pain

A

behavioral

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10
Q

(dimension of pain) beliefs, attitudes, memories, and meaning attributed to pain influence the ways in which a person responds to pain

A

cognitive

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11
Q

(dimension of pain) genetic, anatomic, and physical determinants of pain influence how painful stimuli are processed, recognized, and described

A

physiologic

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12
Q

(dimension of pain) age and gender influence nociceptive processes and responses to opioids; families and caregivers influence patient’s response to pain through their beliefs, behaviors and support; culture affects pain expression, medication use, pain-related beliefs, and coping methods

A

sociocultural

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13
Q

what are the five dimensions of pain

A 
affective
behavioral
cognitive
physiologic
sociocultural
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14
Q

Physiologic process that communicates tissue damage to the CNS

A

nociception

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15
Q

what are the four processes involved in nociception

A
  1. transduction
  2. transmission
  3. perception
  4. modulation
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16
Q

(1/4 processes in nociception) release of chemical mediators, Conversion of a noxious mechanical, thermal, or chemical stimulus into a chemical signal called an action potential

A

transduction

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17
Q

(1/4 processes in nociception) The process by which pain signals are relayed to the spinal cord and then the brain.

A

transmission

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18
Q

(1/4 processes in nociception) Conscious awareness of pain

A

perception

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19
Q

(1/4 processes in nociception) Activation of descending pathways that exert inhibitory or faciliatory effects on the transmission of pain

A

modulation

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20
Q

what five chemicals are released because of noxious stimuli during transduction

A 
prostaglandins
bradykinin
serotonin
substance P
histamine
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21
Q

two types of classifications of pain according to underlying pathology

A

nociceptive (somatic or visceral)

neuropathic

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22
Q

1/2 types of pain according to underlying pathology

  • damage to somatic or visceral tissue
  • surgical incision, broken bone, arthritis
  • usually responsive to opioid and nonopioid analgesics
A

nociceptive (somatic or visceral)

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23
Q

1/2 types of pain according to underlying pathology

  • damage to peripheral nerves or CNS
  • numbing, hot, burning, shooting, stabbing, or electrical in nature
  • sudden, intense, short lived, or lingering
  • due to trauma, inflammation, or metabolic diseases
  • not well controlled by opioid or nonopioid analgesics
A

neuropathic

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24
Q

type of pain according to duration

  • sudden onset
  • lasts less than three months or time takes to heal
  • mild to severe
  • usually precipitating event or illness can be identified
A

acute pain

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25
Q

type of pain according to duration

  • gradual or sudden onset
  • longer than 3 month duration or normal healing time
  • mild to severe
  • cause may be unknown
A

chronic pain

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26
Q

typical physical and behavioral manifestations of acute pain

A
  • increased heart rate, bp, and resp rate
  • sweating, pallor
  • anxiety, agitation, confusion
  • urine retention
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27
Q

typical physical and behavioral manifestations of chronic pain

A
  • flat affect
  • decreased physical activity
  • fatigue
  • withdrawal from social interaction
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28
Q

two types of somatic pain (nociceptive)

A

superficial

deep

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29
Q

type of somatic pain: Arises from skin, mucous membranes, and subcutaneous tissues

A

superficial

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30
Q

type of somatic pain: Arises from bone, joint, muscle, skin, or connective tissue

A

deep

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31
Q

type of nociceptive pain: Activation of nociceptors in the internal organs and lining of the body cavities; respond to inflammation, stretching, ischemia

A

visceral pain

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32
Q

what are examples of adjuvant analgesics used to treat neuropathic pain

A
  • antidepressants
  • serotonin norepinephrine reuptake inhibitors (SNRI)
  • antiseizure drugs
  • transdermal lidocaine
  • a2-adrenergic agonists
  • NMDA receptor antagonists and a2-adrenergic agonists
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33
Q

The location of pain reported is different from site of injury or inflammation.

A

referred pain

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34
Q

common area referred pain for lungs and diaphragm

A

left side of neck (anterior and posterior)

35
Q

common area referred pain for heart

A

jaw, middle of posterior shoulderblades, left arm

36
Q

common area referred pain for liver

A

right side of neck (anterior and posterior)
sternum
mid-back on right side

37
Q

common area referred pain for gallbladder

A

right shoulder

38
Q

common area referred pain for ovaries

A

posterior and anterior sites lateral to umbilicus

39
Q

common area referred pain for kidneys

A

low back on either side of spine

right lateral thigh

40
Q

common area referred pain for ureters

A

anterior underwear region

41
Q

common area referred pain for bladder

A

posterior inner thighs and buttocks

42
Q

myelinated, rapidly conducting fibers that carry action potential from the nociceptors to spinal cord during transduction

A

A fibers

43
Q

unmyelinated, slowly conducting fibers that carry action potential from the nociceptors to spinal cord during transduction

A

C fibers

44
Q

increased susceptibility to nociceptor activation, ex: sunburn

A

peripheral sensitization

45
Q

Nerves that carry pain impulses from the periphery to the spinal cord

A

primary afferent fibers

46
Q

fibers that conduct pain rapidly and are responsible for the initial, sharp pain that accompanies tissue injury.

A

A fibers

47
Q

fibers that transmit painful stimuli more slowly and produce pain that is typically aching or throbbing.

A

C fibers

48
Q

what are the three segments are involved in nociceptive signal transmission

A

(1) transmission along the peripheral nerve fibers to the spinal cord
(2) dorsal horn processing
3) transmission to the thalamus and cerebral cortex

49
Q

areas on the skin that are innervated primarily by a single spinal cord segment.

A

dermatomes

50
Q

neurons that project to the thalamus

A

second-order neurons

51
Q

Increased sensitivity and hyperexcitability of neurons in the CNS

A

central sensitization

52
Q

pain from a stimulus that is not typically painful

A

allodynia

53
Q

processes that allow neurons in the brain to compensate for injury and adjust their responses to new situations or changes in their environment

A

neuroplasticity

54
Q

type of neuropathic pain: Caused by primary lesion or dysfunction in the CNS
Examples: Poststroke pain, pain associated with multiple sclerosis

A

central pain

55
Q

type of neuropathic pain: Pain felt along the distribution of 1 or many peripheral nerves caused by damage to the nerve
Examples: Diabetic neuropathy, alcohol-nutritional neuropathy, trigeminal neuralgia, postherapeutic neuralgia

A

peripheral neuropathies

56
Q

type of neuropathic pain: Pain resulting from a loss of or altered afferent input
Examples: Phantom limb pain, postmastectomy pain, spinal cord injury pain

A

deafferentation pain

57
Q

type of neuropathic pain: Pain that persists secondary to autonomic nervous system dysfunction
Examples: Phantom limb pain, complex regional pain syndrome

A

sympathetically maintained pain

58
Q

occurs when pain is recognized, defined, and assigned meaning by the person experiencing the pain

A

perception

59
Q

transient, moderate to severe pain that occurs in patients whose baseline persistent pain is otherwise mild to moderate and fairly well controlled

A

breakthrough pain

60
Q

pain that occurs before the expected duration of a specific analgesic

A

end-of-dose failure

61
Q

increasing the dose beyond an upper limit provides no greater analgesia

A

analgesic ceiling

62
Q

what nonopioid analgesic is liver toxic

A

acetaminophen (tylenol)

63
Q

what nonopioid analgesic presents a great risk for GI bleeding

A

aspirin

64
Q

what is the max daily oral dose of tylenol

A

300 mg

65
Q

what are some examples of NSAIDs (5)

A
  • celebrex
  • diclofenac K
  • ibuprofen
  • ketorolac
  • aleve
66
Q

what are two examples of salicylates

A

aspirin

trilisate

67
Q

what salicylate is used more often in low doses as a cardioprotective measure than for its analgesic properties

A

aspirin

68
Q

what are examples of pure opioid agonists(6)

A
  • oxycodone
  • hydrocodone
  • codeine
  • methadone
  • dilaudid
  • levorphanol
69
Q

what two opioids are very likely to cause respiratory depressions

A

morphine

dolophine

70
Q

what class of opioids (physiologic action) are these in:

  • codeine
  • fentanyl
  • hydrocodone with acetaminophen
  • dilaudid
  • levorphanol
  • dolophine
  • morphine
  • oxycodone
  • nucynta
  • oltram
A

agonists

71
Q

what class of opioids (physiologic action) are these in:

  • butorphanol
  • talwin
A

mixed agonist-antagonist

72
Q

what class of opioids (physiologic action) are these in:

  • buprenorphine
  • suboxone
A

partial antagonist

73
Q

what opioid is largely avoided now because of its neurotoxicity and tendency to cause seizures

A

demerol

74
Q

what is the most common side effects of opioids

A

constipation

75
Q

what are the five levels of sedation in the POSS

A

sleep

  1. awake and alert
  2. slightly drowsy
  3. frequently drowsy
  4. somnolent
76
Q

dose adjustment based on assessment of the adequacy of analgesic effect versus the side effects produced

A

analgesic titration

77
Q

dose of 1 analgesic that is equivalent in pain-relieving effects to a given dose of another analgesic

A

equianalgesic drug

78
Q

method that allows the patient to self-administer preset doses of an analgesic within a prescribed time period by activating an infusion pump

A

patient-controlled analgesia (PCA)

79
Q

physical nondrug therapies to treat pain (5)

A
  • heat and cold
  • TENS unit
  • acupuncture
  • massage
  • exercise
80
Q

cognitive nondrug therapies to treat pain (4)

A
  • distraction
  • hypnosis
  • imagery
  • relaxation strategies
81
Q

common examples of barriers to pain management by patient

A
  • fear of addiction
  • fear of tolerance
  • fear of side effects
  • desire to be stoic
82
Q

early responses (12-24 hours) of opioid withdrawal

A
  • anxiety
  • lacrimation
  • sweating
  • shaking, chills
  • dilated pupils
83
Q

late responses (48-72 hours) of opioid withdrawal

A
  • excitation
  • diarrhea
  • restlessness
  • fever
  • nausea and vomiting
  • hypertension
  • tachycardia
  • insomnia

PathoPharm (42 decks)

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