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Oms > management of post op pain > Flashcards

management of post op pain Flashcards

1
Q

post op pain is due to

A

inflammation

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2
Q

what is the purpose of inflammation

A

contains and isolates injury
destroy invading microorganisms
inactivate toxins
healing and repair

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3
Q

5 cardinal signs of inflammation

A 
calor (heat)
rubor (redness)
dolor (pain)
tumor (swelling)
functio laesa
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4
Q

what happens to arachidonic acid

A

Broken down by 5-lipoxygenase to form leukotriene

Broken down by cyclooxygenase to form prostaglandins, prostacyclins, thromboxane

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5
Q

effect/function of prostaglandin

A 
vasodilation (inflammation)
fever
increase vascular permeability (edema)
pain
maintain renal blood flow
gastric mucin production
bronchial constriction
decreased blood flow
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6
Q

what is pain transduction

A

from peripheral nervous system to central nervous system

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7
Q

what blocks pain transduction

A

local anaesthesia
capsaicin
NSAIDS
SSRI

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8
Q

what is pain transmission

A

from central nervous system to thalamus

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9
Q

what blocks pain transmission

A

LA, opioids, a2 agonists

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10
Q

what is pain modulation

A

limitation of flow of pain information

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11
Q

what drugs can modulate pain

A

SSRI
SNRI
TCA

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12
Q

which pain pathways can opioids affect

A

pain transmission and pain perception

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13
Q

which pain pathways can LA affect

A

pain transduction and pain transmission

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14
Q

extent of post op pain affected by what factors

A
  1. patient factors (pain is sbujective, compliance with post op instructions, individual pharmacokinetics)
  2. operator factors eg competence
  3. surgical factors eg degree of difficulty, amount of bone required to remove, presence of inflammation during procedure (reduce LA effectiveness)
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15
Q

pain VAS score grading

A

mild 1-3
moderate 4-6
severe 7-10

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16
Q

articaine duration of action

A

1 hour

17
Q

bupivacaine duration of action

A

4-8 hours

18
Q

mepivacaine duration of action

A

2-3 hours

19
Q

How long does it take to start feeling the effect of oral analgesics

A

30min

20
Q

mode of action of acetaminophen/paracetamol

A

prostaglandin cox inhibitor
no antiinflamamtory effect
effective anti pyretic

21
Q

why should tylenol not be given with anarex

A

result in OD as both contain paracetamol

22
Q

maximum dose of paracetamol

A

15g can cause hepatic toxicity (diarrhea, vomiting, abdominal pain)

23
Q

mode of action of NSAIDS

A

inhibit cyclooxygenase, inhibiting synthesis of prostaglandins via endoperoxide pathway (cascade inhibited)

24
Q

adverse effect of nsaids

A

dyspepsia
gastric mucosal bleeding
increased bleeding
anaphylactoid reactions

25
Q

contraindications to NSAIDS

A
  • third trimester pregnancy due to premature closure of ductus arteriosus
  • aspirin induced asthma
  • gastric ulcers, gastrointestinal inflammatory disease, acute gastritis
  • significant renal disease
  • anti coagulants
  • anti neoplastic doses of methatrexate
  • alcohol
26
Q

use of ibuprofen for post op pain

A

may combine with narcotics for severe pain
mild to moderate pain
400mg every 4-6 hourly
non selective cox inhibitor

27
Q

what analgesic can you give for a patient in severe pain

A

ketorolac – pain control cpmparable to morphine

6hrly dose, max dose 120mg

28
Q

arcoxia mechanism

A

cox 2 selective inhibitor

29
Q

Arcoxia given for

A

Acute pain ie last less than 8 days

30
Q

Arcoxia should not be given to patients

A

with risk of thrombotic events
who are pregnant or nursing
who are taking ace inhibitors/ace receptor antagonists as raise bp and cause acute renal failure, peripheral edema

31
Q

celecoxib cannot be given to patients with

A

sulfonamide allergy

32
Q

what are the opioud receptors

A

mu, kappa, delta

33
Q

which pain pathway does opioid inhibit

A

pain transmission ie cns to thalamus/higher centres

34
Q

mu receptors result in

A

analgesia and respiratory depression

35
Q

side effects of opioids

A 
antitussive (cough suppressant)
sedation 
nausea
constipation 
mood alteration (euphoria/dysphoria)
miosis (except meperidine)
physical dependence 
respiratory depression (mu)
36
Q

contraindications for use of opioids

A

concurrent alcohol use
inflammatory bowel disease
chronic respiratory disease (mu)
long term use in late pregnancy (neonatal withdrawal syndrome)

if allergy to opioids –> can use synthetic opioid meperidine, or pentazocine

37
Q

what type of drug is tramadol

A

opioid

38
Q

name 3 opioids

A

tramadol, codeine, fentanyl, morphone, oxycodone

Oms (24 decks)

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