Opioids and Pain Flashcards

1
Q

What are the two types of organic pain?

A

Nociceptive which is somatic (peripheral) or visceral (inner area organs leading to referred pain
Neuropathic which is injury to nerves

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2
Q

What is idiopathic pain

A

Isn’t associated with any causes but could be psychological

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3
Q

What are three types of peripheral nociceptive pain?

A

Osteoarthritis, rheumatoid arthritis and cancer pain

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4
Q

What are the causes of peripheral nociceptive pain and how do you treat it?

A

Inflammation or mechanical damage to tissue- tx with NSAIDs and opioids

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5
Q

What do you use to treat neuropathic pain?

A

NSAIDs, opioids, sodium channel blockers, antidepressants, neuroactive compounds

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6
Q

What are causes of central non nociceptive pain

A

Fibromyalgia, IBS, tension headache, idiopathic low back pain

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7
Q

What are the nociceptive somatic pain sensations

A

Stabbing aching or throbbing

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8
Q

What are some examples of nociceptive somatic pain?

A

Post postoperative pain, sickle cell crisis, sports, or exercise, injury, and arthritis

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9
Q

What are some examples of nociceptive visceral pain sensations?

A

Dull or crampy

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10
Q

What are examples of visceral pain causes?

A

Bowl and bladder distention and metastasis

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11
Q

What are the sensations of neuropathic pain?

A

Burning tingling electric shock

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12
Q

What is the four types of neuropathic pain?

A

Dysesthesia, paresthesia, hyperalgia, allodynia

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13
Q

What are the four types of neuropathic pain?

A

Peripheral neuropathy of diabetes, postherpetic neuralgia, phantom, limb pain, reflex sympathetic dystrophy

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14
Q

What patients can get reflex, sympathetic dystrophy

A

Phantom Lim pain and paraplegic or quadriplegic patients

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15
Q

What is transduction of pain?

A

A stimulus is converted into nerve impulse

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16
Q

What is the transmission of pain?

A

The impulse’s are carried to the brain

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17
Q

What is modulation of pain?

A

The brain and signals that caused the pain signals from the periphery to the be suppressed or amplified

18
Q

What is perception of pain?

A

Messages from the periphery that are interpreted by the brain

19
Q

Which category of pain may be described by the terms, burning tingling or electric shock

A

Neuropathic pain

20
Q

What are the two subgroups of nociceptive pain?

A

Somatic pain and visceral pain

21
Q

What category is pain from osteoarthritis?

A

Nociceptive pain, the subgroup of somatic pain

22
Q

How is an analgesic described

A

A substance that relieves pain without causing loss of consciousness

23
Q

What is the WHO pain relief ladder

A

Step one is non-opioids plus adjuvants step two is opioids from mild to moderate pain plus non-opioids plus advents step three is opioids from moderate to severe pain plus non-opioids plus adjuvants step four is invasive and mentally invasive treatments

24
Q

Which strong opioid agonist is not recommended for chronic pain

A

Demerol or meperidine because it can cause CNS excitability (not allowed in cancer pain)

25
Where are the mu 1 receptors located and what type of pain are they responsible for?
Supraspinal and they’re responsible for the central interpretation of pain
26
Where are MU 2 receptors located and what type of paint are they responsible for?
In the CNS and they control respiratory depression, spinal analgesia, euphoria, and physical dependence
27
What are the characteristics of Kappa receptors?
Minimal respiratory depression, little dependence, they treat visceral pain and activation, may antagonize mu receptors
28
What are the characteristics of Delta receptors?
They have less analgesia than MU receptors, but without respiratory depression and they are novel target for antidepressants
29
T or F oral morphine has a significant first pass effect
T
30
When is peak analgesia reached with morphine?
PO 30 min IR or 90 min ER rectal 20-60 minn SC and IM 50-90 min IV 20 min
31
How is morphine excreted?
Renal
32
How much of the oral morphine dose reaches the CNS after first past metabolism
40-50%
33
What are the two rare drug drug interactions with morphine?
Rifampin and ranitidine
34
What are the physical and psychological signs of dependence on morphine?
Restlessness, irritability, increased salivation, lacrimation, sweating muscle, cramps, vomiting, and diarrhea
35
What are the Biliary effects of morphine?
Increases the tone of the Billary sphincter of oddi which results in exacerbation of pain with Billary dysfunction or gallbladder attack
36
What are the neuroendocrine effects of morphine?
Stimulates the release of anti-Diuretic hormone and prolactin and inhibits release of a CTH and gonadotropic hormone
37
How does morphine affect the immune system?
It’s across his activity of lymphocytes, including natural killer cells after long-term use
38
What is pseudo addiction to morphine?
Caused by under treatment of pain and results in clock watching to take next dose. Appears to be drug seeking behaviors, but in fact, it’s just the patient in pain.
39
True or false acetaminophen has anti-inflammatory antipyretic and analgesic properties
False it is not anti-inflammatory
40
What is the name of the receptor that morphine binds to in the body?
MU receptor
41
Name at least two medication classes that are considered adjuvant pain medication
Steroids, anxiolytics, antidepressants, hypnotics, anticonvulsant, GABA agonist membrane, stabilizer, sodium chain, blockers, and MDA antagonist and cannabinoids
42
What term is used to Describe the phenomenon of a person whose pain is untreated.
Pseudo addiction