Lilley Ch 10 (analgesics) Flashcards
Medications that relieve pain without causing loss of consciousness
analgesics
what 5 things influence pain
age culture race spirituality personal experiences
level of stimulus needed to produce the perception of pain
pain threshold
what receptors play significant role in pain sensation
mu opioid receptors
when the number of mu opioid receptors is high, is pain diminished or more painful
diminished
when the number of mu opioid receptors is low, is pain diminished or more painful
more painful
classification of pain: skeletal muscles, ligaments, joints
somatic
classification of pain: organs and smooth muscles
visceral
classification of pain: skin & mucous membranes
superficial
classification of pain: tissues below skin level
deep
classification of pain: vascular or perivascular tissues (thought to account for a large percentage of migraine headaches)
vascular
classification of pain: visceral nerve fibers at the level of spinal cord close to fibers that supply specific subq tissues in the body
referred
classification of pain: damage to peripheral or central nervous system
neuropathic
classification of pain: occurs in a body part that has been removed
phantom
classification of pain: acute, chronic or both. Pressure from tumor mass against nerves, organs or tissues
cancer
classification of pain: tumors, trauma, inflammation, or disease affecting CNS tissues
central
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
how soon should you reassess pain after giving an IV med and PO med
IV: 15 min
PO: 60 min
what substances are released as a result of tissue injury that stimulate the pain process (5)
- bradykinin
- histamine
- potassium
- prostaglandins
- serotonin
what are two endogenous neurotransmitters that the body produces to fight pain
enkephalins
endorphins
neurotransmitter involved in pain responses
Substance P
neurotransmitter released by the pituitary gland to block pain perception by blocking the release of Substance P
endorphins
adjuvant drugs that allow the use of smaller dosages of opioids
synergistic effect
what is PCA
patient controlled analgesia
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
- non-opioid with or without adjuvant
- opioid with or without nonopioid and with or without adjuvant
- 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
