pain Flashcards
Neuropathic pain
is caused by damage to peripheral nerves or CNS that results in the abnormal processing of stimuli
Nociceptive pain
is caused by damage to somatic or visceral tissue, which activates peripheral nociceptors. It is further classified as somatic or visceral.
Somatic pain is characterized as
deep, aching, sharp, or throbbing that is well localized and arises from bone, joint, muscle, skin, or connective tissue.
Visceral pain is often poorly localized and described
as deep aching, cramping, pressure, or referred and resulting from stimuli, such as stretch, compression, or ischemia of the hollow or solid internal organs or organ coverings.
Patients typically describe NEUROpathic pain
as a numbing, burning, shooting, stabbing, shock-like, or itchy sensation.
Common side effects of opioids (6) :
include :
constipation,
nausea
vomiting,
sedation,
respiratory depression,
and pruritus.
An “equianalgesic dose” is defined
* think of mcat
as “that dose at which two opioids (at steady-state) provide approximately the same pain relief.”
. For example, 10 mg of parenteral morphine should provide an equivalent amount of analgesic to 25 mg of morphine given by the oral route of administration (at steady state).
Patient-controlled analgesia (PCA) is
a method of pain management that allows patients to self-administer analgesic medications within preset limits. This approach provides patients with a level of control over their pain relief, allowing them to receive medication when needed and, in many cases, minimizing the delays associated with traditional nurse-administered or scheduled pain medications. The rationale for the use of patient-controlled analgesia includes several key considerations:
-need 2nd RN
- pain level
- assess respiratory ( every hour)
- must be able to lift hand/ambulate
-health teaches they won’t overdose
- visitors must not touch this
Kinds of MU agonists
Fentanyl
Morphine
Methacodone
Oxycodne
SOAPP
screener and opioid assessment for patients with pain
Opioids:
Oral opioids:
*What is APAP daily limit? Opioid with
narcotic) prescribed for moderate to severe pain* (Act on CNS to cause analgesia)
Codeine, Hydrocodone
Opiod with acetaminophen-Hydrocodone/acetaminophen; (Loratab, Vicodin)
*HT patient not to use additional acetaminophen at home
*What is APAP daily limit?
Opioid with NSAID- enhanced effect for moderate acute pain. Reduces pain and inflammation (hydrocodone / ibuprofen- Vicoprofen)
Breakthrough pain
Pain that “breaks through” relief provided by analgesics
Agonist:
a chemical that binds to receptor of a cell and triggers a response in the brain
Example:
(opioid, like morphine)
Antagonist: ( N word)
blocks the action of the agonist
Reverses the effect
Example:
naloxone - helps with overdoses
(Narcan)
Mu Receptors (job/ side effects/ side effects to report)
” CATCH UP DOSE”
FOR BREAKTHROUGH.are also known as Morphine Receptors. Mu Receptors are located in the Brain and are responsible for analgesia, sedation, associated side effects, and physical dependence.
Side effects: drowsiness, N/V, constipation, orthostatic hypotension. Assess respiratory rate before administering***
Report: respiratory depression,*** ineffectiveness,
hallucinations, allergic response.
*Keep naloxone on hand
Mu Mixed Agonist-Antagonist
(side effects * normal vs report*)
Analgesics having two actions: has one effect and inhibits another effect
A portion of the medication blocks opioid uptake
Milder opioid -less chance of respiratory depression and addictive potential..
Examples: pentazocine (Talwin), nalbuphine (Nubain)
***(be familiar with generic/trade names)
Side effects: diaphoresis
Report: urinary retention, hallucinations,allergic reaction
Ceiling effect:
the phenomenon in which a drug reaches a maximum effect, so that increasing the dosage does not increase its effectiveness NOT HARMFUL.no max dosage
ex) MU can continued to be increased because its ceiling affect unless adverse reaction occur
Partial Agonist
when would i use this?
Activates the opioid receptors in the brain, but to a much lesser degree then a full agonist
Milder opioid analgesic effect- lower abuse potential
Used to treat opioid addiction: easier withdrawal
Example:
Suboxone
(buprenorphine and naloxone)
Opiod Naïve:
Opiod tolerant:
patients who are not chronically receiving opioid analgesics daily
↑ risk of resp depression & sedation
patients who are chronically receiving opioid analgesics daily
become less sensitive and require more opioids to produce the same effect***
Opiate Antagonists ( Indication for use?)
- for unconscious people .They are used to reverse the effects of opioid overdose, and they can also be employed in the management of opioid addiction.
they wake up with pain…
IV NSAIDS ( side effects to be mindful) * think of story of little boy dying)
Ketoralac- (Toradol)
NSAID may be given PO, or parenteral (IV or IM)
Used intra or post operative with opioids for improved pain relief.
Toradol is used short-term (5 days or less) to treat moderate to severe pain,
HRF renal failure in dehydrated patients/ kidney functions look out for.
Analgesic- Acetaminophen IV as an adjunct for post operative pain
PRN vs PCA analgesia
PCA more steady pain control for breakthrough.
Medication – Morphine
Loading dose –
Dose (demand) –
Basal-
Lockout interval –
1-hour lockout:
Medication – Morphine 1 mg/ml
Loading dose – 1 mg IV
Dose (demand) –1 mg
Basal- 1mg/hr
Lockout interval – 6 minutes
1-hour lockout: 10 mg
Sedation Scale-
S =
1 =
2 =
3 =
4 =
S = sleeping, easy to arouse
1 = awake & alert
2 = slightly drowsy, easily arousable
3 = frequently drowsy, arousable, drifts off
to sleep during conversation
4 = somnolent, minimal or no response to
physical stimulation. THE WORST CALL HCP . look for in recovery room
