Lilley Ch 10 (analgesics) Flashcards by McKenna Michael

Medications that relieve pain without causing loss of consciousness

analgesics

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what 5 things influence pain

age
culture
race
spirituality 
personal experiences

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level of stimulus needed to produce the perception of pain

pain threshold

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what receptors play significant role in pain sensation

mu opioid receptors

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when the number of mu opioid receptors is high, is pain diminished or more painful

diminished

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when the number of mu opioid receptors is low, is pain diminished or more painful

more painful

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classification of pain: skeletal muscles, ligaments, joints

somatic

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classification of pain: organs and smooth muscles

visceral

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classification of pain: skin & mucous membranes

superficial

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classification of pain: tissues below skin level

deep

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classification of pain: vascular or perivascular tissues (thought to account for a large percentage of migraine headaches)

vascular

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classification of pain: visceral nerve fibers at the level of spinal cord close to fibers that supply specific subq tissues in the body

referred

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classification of pain: damage to peripheral or central nervous system

neuropathic

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classification of pain: occurs in a body part that has been removed

phantom

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classification of pain: acute, chronic or both. Pressure from tumor mass against nerves, organs or tissues

cancer

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classification of pain: tumors, trauma, inflammation, or disease affecting CNS tissues

central

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describe the gate theory of pain transmission

small c fibers contribute to nociception, opening the gate for pain to reach the brain
large a fibers inhibit nociception and close the gate

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how soon should you reassess pain after giving an IV med and PO med

IV: 15 min
PO: 60 min

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what substances are released as a result of tissue injury that stimulate the pain process (5)

bradykinin
histamine
potassium
prostaglandins
serotonin

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what are two endogenous neurotransmitters that the body produces to fight pain

enkephalins

endorphins

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neurotransmitter involved in pain responses

Substance P

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neurotransmitter released by the pituitary gland to block pain perception by blocking the release of Substance P

endorphins

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adjuvant drugs that allow the use of smaller dosages of opioids

synergistic effect

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what is PCA

patient controlled analgesia

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4 examples of adjuvant drugs that assist primary drugs in relieving pain

NSAIDs antidepressants corticosteroids anticonvulsants

what are the 3 categories on the 3 step ladder by WHO

1. non-opioid with or without adjuvant 2. opioid with or without nonopioid and with or without adjuvant 3. stronger opioid with or without nonopioid and with or without adjuvant

what are two mild agonists of opioids

hydrocodone | codeine

what are six strong agonists of opioids

``` morphine hydromorphone oxycodone fentanyl methodone mereperidine (no longer used) ```

common side effects (2) of opioids and what to treat with

nausea: antiemetics constipation: stool softener or laxative

which class of opioid analgesic is associated with with analgesic ceiling effects

agonist-antagonist

what is the reversal agent (antidote) for opioid overdose

narcan

what is an important contraindication for opioid use

severe asthma

what are four adverse effects of opioid use

- release of histamine - CNS depression (respiratory depression) - nausea and vomiting - urinary retention

A common physiologic result of chronic opioid treatment; Result: larger dose is required to maintain the same level of analgesia

opioid tolerance

Physiologic adaptation of the body to the presence of an opioid

physical dependence

A pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief

psychologic dependence

what are five things that can cause interactions with opioid analgesics

- alcohol - antihistamines - barbiturates - benzodiazepines - monoamine oxidase inhibitors

opioid: schedule 2, ceiling effect, for chronic long-term pain management, opioid agonist

codeine

opioid: schedule 2, for chronic long-term pain management, *don't give fast, available in a patch

fentanyl

opioid: schedule 2, 7x more powerful than morphine, exalgo: extended release and less abuse potential

dilaudid

opioid: schedule 2, no longer used because associated with toxic levels and seizures

mereperidine

opioid: schedule 2, opioid of choice for detox, long half-life (can cause unintentional overdose and death)

dolophine

opioid: schedule 2, prototype for all opioid drugs, high abuse potential, embeda: newest product

morphine

opioid: schedule 2, combined with acetaminophen = percocet, combined with aspirin = percodan

oxycodone

oxycodone + acetaminophen =

percocet

oxycodone + aspirin =

percodan

hydrocodone + acetaminophen =

vicodin / norco

4 examples of agonist-antagonist opioids (schedule 4, low risk of misuse/addiction)

buprenex stadol nubain talwin

opioid antagonist: Drug of choice for the complete or partial reversal of opioid-induced respiratory depression

narcan

opioid antagonist used for alcohol and opioid addiction

naltrexone

nonopioid analgesic: relieves pain and fever, blocks PG synthesis, liver toxic

acetaminophen (tylenol)

max recommended daily dose for healthy adult for tylenol

3000 mg

max recommended daily dose for adult with alcohol abuse for tylenol

2000 mg

antidote for tylenol toxicity

mucomist (acetylcysteine)

nonopioid analgesic: weak bond opioid receptor, not.a controlled substance

tramadol

topical anesthetic: transdermal, max time for application: 12 hours

lidocaine patch

if respiration rate is less than __ breaths per minute, you should withhold opioids

10-12 breaths per minute

herbal product with antiinflammatory properties, used to treat migraine headaches, menstrual cramps, inflammation, and fever

feverfew

culture that believes in the power of healers who rely strongly on the religious faith of people and often use prayer and the laying on of hands for relief of pain.

african american

culture that believes in prayer, the wearing of amulets, and the use of herbs and spices to maintain health and wellness. Specific herbs are used in teas and therapies, often including religious practices, massage, and cleansings.

hispanic american

culture that utilizes acupuncture, herbal remedies, yin and yang balancing, cold treatment, and moxibustion as ways to treat pain

chinese

culture(s) that are often reluctant to express their pain because they believe that the pain is God’s will or is punishment for past sins

asian/pacific islanders

culture that utilizes massage, the application of heat, sweat baths, herbal remedies, and being in harmony with nature as treatments for pain

native american

culture in which patients are expected to express their pain openly and anticipate immediate relief, preferably through injections or intravenous drugs.

arab