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BSNC 3000 > Module 3 - Post op Pain > Flashcards

Module 3 - Post op Pain Flashcards

1
Q

Pain description

A

unpleasant sensory/emotional experience assoc with actual or potential tissue damage

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2
Q

Pain transmission stages

A

Transduction
Transmission
Perception
Modulation

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3
Q

Transduction

A

somatic & visceral receptors are stimulated by external stimuli –> convert stimulus into an electrochemical signal

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4
Q

Transmission

A

a-delta & c-fibers generate action potentials that are transmitted towards the CNS

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5
Q

Perception

A

cortex, limbic system, hypothalamus, reticular system involved in processing & sensation of pain

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6
Q

Modulation

A

descending pathway

release of neurotransmitters at the dorsal horn to modulate pain sensation

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7
Q

Complications of pain

A

PSR
shallow breathing, atelectasis, pneumonia
chronic pain
sleep disturbance
decreased appetite
impaired mobility & ADLs –> increased risk of pressure ulcers, DVT, PE

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8
Q

Acute pain

A

<3-6 months
resolves with healing/removal of stimuli
protective purpose
activates SNS

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9
Q

Chronic pain

A

> 3-6 months
pain lasts longer than recovery period
pathological
no SNS activation. psychosocial damages

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10
Q

Types of pain

A

nociceptive

neuropathic

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11
Q

Chemical mediators causing pain

A

prostaglandins
kinins
intracellular contents (potassium & hydrogen)

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12
Q

Substance P

A

neuropeptide released by C-fibers

sensitize pain receptors –> decrease pain threshold

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13
Q

Hyperalgesia

A

increased sensitivity to pain

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14
Q

Neurogenic inflammation

A

substance p released by C-fibers
activates mast cells to rls histamine
histamine –> vasodilation increasing inflammation

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15
Q

Allodynia

A

pain perceived in response to a non-painful stimulus

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16
Q

Excitatory neurotransmitters

A

glutamate
substance P
norepinephrine
dopamine

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17
Q

Inhibitory interneurons

A

loc near the dorsal horn

release GABA to inhibit 2nd order neurons

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18
Q

Gate control theory

A

the dorsal horn acts as pain gate where incoming nerve impulses COMPETE to get through
increasing non-painful sensation can decrease pain by activating inhibitory interneurons

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19
Q

Gate control pathway

A

nociceptors stimulated –> pain sensation
glutamate & substance P are released from axon terminal of nociceptors
2nd order neurons @ the dorsal horn excited & generate AP
pain gate is opened –> impulse proceeds to thalamus

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20
Q

A-beta fibers

A

another type of sensory fiber that responds to non-painful stimuli

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21
Q

Gate control modulation

A

A-beta fibers stimulate inhibitory interneurons at the dorsal horn –> release GABA –> hyperpolarizes 2nd order neuron (takes longer for 2nd order neuron to depolarize)
A-beta fibers travel via the MCL pathway. A-delta ascends the spinothalamic tract

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22
Q

Serotonergic pathways

A

descending neurons rls serotonin

serotonin activate opioid-releasing interneurons

23
Q

Endogenous opioids

A

enkephalins
endorphins
dynorphin

24
Q

Modulation phsyiology

A

rls of serotonin activates opioid interneurons loc near the dorsal horn
opioids bind to receptors on the 2nd order neuron hyperpolarizing them & bind to nociceptors inhibiting rls of glutamate & substance p (excitatory neurotransmitters)

25
Q

Where are opioid receptors most concentrated?

A

brainstem

regulate descending pathways

26
Q

Opioids MOA

A

act at all steps of pain pathway

transmission, transduction, perception, modulation

27
Q

Local anesthesia MOA

A

block Na+ channels –> inhibit production of APs blocking pain sensation
(transduction & transmission)

28
Q

NSAID MOA

A

inhibit production of PGs that sensitize nociceptors (transduction)

29
Q

4 P’s of pain management

A

Prevention
Psychological
Physical
Pharmaceutical

30
Q

Breakthrough pain

A

transient increase in pain

31
Q

Multi-modal analgesia

A

combines analgesics from 2+ drug classes to act on different parts of the pain pathway
increased therapeutic fx, decreased risk

32
Q

Non-opioid analgesia

A

NSAIDs
acetaminophen
adjuvants (antidepressants, anticonvulsants)

33
Q

Mild opioids

A

codeine

tramadol

34
Q

Where are opioid receptors located

A

brain
spinal cord
GI tract plexus
periphery

35
Q

Therapeutic fx of opioids

A

analgesia
sedation
euphoria

36
Q

Types of opioid receptors

A

mu (main)
kappa
delta

37
Q

PK of opioids

A 
IV = most reliable
IM/SC = variable absorption
metabolized by liver
excreted by kidneys/bile
teratogenic
38
Q

Common adverse fx of opioids

A 
nausea/vomiting
sedation (happens before respiratory depression)
constipation
pruritus
urinary retention
respiratory depression
hypotension (vasodilation)
39
Q

PCA assessments

A 
drug concentration
dose (loading, bolus)
delay interval
4-hr dose limit
attempts
successful attempts
total injections
40
Q

Epidural assessment

A

sensory dermatome

motor score

41
Q

Withdrawal

A

body develops a physical dependence on a drug –> withdrawal symptoms occur when drug is stopped/decreased

42
Q

Tolerance

A

body develops increased tolerance for drug requiring higher amounts for same therapeutic fx

43
Q

Addiction

A

physiologic compulsion to take a drug for its euphoric/psychic fx

44
Q

S/S of overdose

A 
choking
cyanosis
dizziness/disorientation
cold/clammy skin
slow/absent breathing
somnolence
pinpoint pupils
45
Q

Adverse fx of opioid antagonists

A

headache
tachycardia
hypertension
+w/drawal symptoms

46
Q

S/S of withdrawal

A 
increased HR & BP
vomiting
diarrhea
anxiety
shivering
tremors
yawning
body aches
sweating
sneezing/runny nose
abdominal cramps
47
Q

Inhibitory neurotransmitters

A

serotonin
gaba
dopamine

48
Q

Opioid neurons

A

release endogenous opioids that act on presynaptic and postsynaptic neurons

49
Q

Opioids & presynaptic neuron

A

binds to receptors inhibiting the opening of calcium channel gates –> inhibits release of neurotransmitters

50
Q

Opioids & postsynaptic neuron

A

hyperpolarizes postsynaptic neuron –> decreased nerve transmission

51
Q

What # on the pain scale are pts comfortable at

A

0-3

52
Q

Location of opioid receptors

A

brainstem
spinal cord
peripheral nerves
GI tract

53
Q

Methadone

A

opioid agonist
long acting
higher risk of overdose
similar adverse fx as opioids

54
Q

Suboxone

A

buprenorphine + naloxone
partial opioid agonist
less likely to cause overdose (d/t naloxone)
preferred agonist

BSNC 3000 (11 decks)

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