Management of pain and inflammation Part 1

Question 1

pain is treated by ( ) meds

Answer 1

analgesic

Question 2

analgesics include

Answer 2

opiods and nonopiods

Question 3

anti-inflammatory agents include

Answer 3

NSAIDs and glucocorticoids

Question 4

opiods (narcotics) include

Answer 4

morphine and similar agents

Question 5

nonopiods include

Answer 5

NSAIDS and acetaminophen

Question 6

do opiods get rid of pain?

Answer 6

No, they alter pain

Question 7

opiods usually used in what type of pain?

Answer 7

moderate-severe, constant pain

Question 8

are opiods used in acute or chronic pain?

Answer 8

both

Question 9

original opiod source

Answer 9

opium poppies

Question 10

how long have opiods been around?

Answer 10

over 3000 years

Question 11

common opiods

Answer 11

codeine, morphine (grandfather), oxycodine, etc.

Question 12

agonist means

Answer 12

direct effect on tissue

Question 13

stong agonists

Answer 13

morphine, meperidine, fentanyl

Question 14

moderate agonists

Answer 14

codeine, oxycodone

Question 15

antagonists

Answer 15

naloxone, naltrexone

Question 16

binds to tissue and doesn’t do anything but prevents other chemicals from altering tissue

Answer 16

antagonists

Question 17

mixed agonist/antagonist types

Answer 17

butorphanol, nalbuphine, pentazocine

Question 18

opiods primarily on

Answer 18

spinal cord (dorsal gray matter) and brain

Question 19

opiods bind to specific receptors located on

Answer 19

-presynaptic nerve terminals
-postsynaptic neurons
(overall, work all over the place)

Question 20

when opiods bind to presynaptic nerve terminals

Answer 20

decreases release of NT

Question 21

when opiods bind to postsynaptic neurons

Answer 21

decrease excitability of postsynaptic neuron- less likely to create AP

Question 22

opiods can also affect peripheral neurons by

Answer 22

decreasing sensitivity of neurons that initiate pain

Question 23

opiods affect descending (efferent) pain pathway by..

Answer 23

removing inhibition of central anti-pain pathways

Question 24

opioid adverse effects: sedation, mood changed, confusion, neausea/vomiting, constipation

Answer 24

relatively minor

Question 25

opioid adverse effects: orthostatic hypotension, respiratory depression, portential for abuse/addiction

Answer 25

more serious effects

Question 26

need more drug to achieve same effect

Answer 26

tolerance

Question 27

onset of withdrawal if drug suddenly stopped

Answer 27

physical dependence

Question 28

when does tolerence begin?

Answer 28

after 1st dose (but not noticable)

Question 29

when does tolerence of opiods become obvious?

Answer 29

after 2-3 weeks

Question 30

how long does physical symptoms of withdrawal of opiods last after week?

Answer 30

1-2 weeks after opiod use stops

Question 31

opiod withdrawal can begin how long after last dose? peak?

Answer 31

6-10 hours; peak within 2-3 days

Question 32

how long do physical dependence symptoms last?

Answer 32

5 days

Question 33

brachycardia or tachycardia= physical symptoms of dependence?

Answer 33

tachycardia

Question 34

risk of tolerence and dependence minimal if:

Answer 34

• does not have history
• pain is “physiological”
• dosage matches patient’s pain levels

Question 35

PCA

Answer 35

patient-controlled analgesia– patient activates “pump”

Question 36

large oral dose/injected dose every 4 hours:

Answer 36

go beyond appropriate dose

Question 37

PCA may allow better pain control with fewer ( )

Answer 37

side effects

Question 38

opiods may be ineffective or increase pain in certain patients

Answer 38

opioid-induced hyperalgesia

Question 39

possible mechanism of opioid-induced hyperalgesia:

Answer 39

opiods turn on nociceptive pathways that use glutamate instead of turning them off

Question 40

rehab concerns: be alert for

Answer 40

orthostatic hypotension

Question 41

rehab concerns: monitor signs of ( )

Answer 41

respiratory depression