Management of pain and inflammation Part 1 Flashcards

1
Q

pain is treated by ( ) meds

A

analgesic

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2
Q

analgesics include

A

opiods and nonopiods

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3
Q

anti-inflammatory agents include

A

NSAIDs and glucocorticoids

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4
Q

opiods (narcotics) include

A

morphine and similar agents

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5
Q

nonopiods include

A

NSAIDS and acetaminophen

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6
Q

do opiods get rid of pain?

A

No, they alter pain

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7
Q

opiods usually used in what type of pain?

A

moderate-severe, constant pain

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8
Q

are opiods used in acute or chronic pain?

A

both

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9
Q

original opiod source

A

opium poppies

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10
Q

how long have opiods been around?

A

over 3000 years

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11
Q

common opiods

A

codeine, morphine (grandfather), oxycodine, etc.

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12
Q

agonist means

A

direct effect on tissue

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13
Q

stong agonists

A

morphine, meperidine, fentanyl

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14
Q

moderate agonists

A

codeine, oxycodone

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15
Q

antagonists

A

naloxone, naltrexone

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16
Q

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

A

antagonists

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17
Q

mixed agonist/antagonist types

A

butorphanol, nalbuphine, pentazocine

18
Q

opiods primarily on

A

spinal cord (dorsal gray matter) and brain

19
Q

opiods bind to specific receptors located on

A

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

20
Q

when opiods bind to presynaptic nerve terminals

A

decreases release of NT

21
Q

when opiods bind to postsynaptic neurons

A

decrease excitability of postsynaptic neuron- less likely to create AP

22
Q

opiods can also affect peripheral neurons by

A

decreasing sensitivity of neurons that initiate pain

23
Q

opiods affect descending (efferent) pain pathway by..

A

removing inhibition of central anti-pain pathways

24
Q

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

A

relatively minor

25
opioid adverse effects: orthostatic hypotension, respiratory depression, portential for abuse/addiction
more serious effects
26
need more drug to achieve same effect
tolerance
27
onset of withdrawal if drug suddenly stopped
physical dependence
28
when does tolerence begin?
after 1st dose (but not noticable)
29
when does tolerence of opiods become obvious?
after 2-3 weeks
30
how long does physical symptoms of withdrawal of opiods last after week?
1-2 weeks after opiod use stops
31
opiod withdrawal can begin how long after last dose? peak?
6-10 hours; peak within 2-3 days
32
how long do physical dependence symptoms last?
5 days
33
brachycardia or tachycardia= physical symptoms of dependence?
tachycardia
34
risk of tolerence and dependence minimal if:
- does not have history - pain is "physiological" - dosage matches patient's pain levels
35
PCA
patient-controlled analgesia-- patient activates "pump"
36
large oral dose/injected dose every 4 hours:
go beyond appropriate dose
37
PCA may allow better pain control with fewer ( )
side effects
38
opiods may be ineffective or increase pain in certain patients
opioid-induced hyperalgesia
39
possible mechanism of opioid-induced hyperalgesia:
opiods turn on nociceptive pathways that use glutamate instead of turning them off
40
rehab concerns: be alert for
orthostatic hypotension
41
rehab concerns: monitor signs of ( )
respiratory depression