Pain Flashcards
Occurs with chronic exposure and is expected. There is a need for increased dose to maintain the same amount of analgesia.
Tolerance
Occurs with ongoing exposure and is expected. Manifested by a withdrawal syndrome that occurs when blood levels of the drug are abruptly decreased. This creates a need to taper when the opiods are no longer needed.
Physical Dependence
Neurologic condition arising from a drive to obtain and take substances for reasons other than the perscribed therapeutic value.
Addiction
Risk factors of addiction
younger age, personal or family history of substance abuse, and mood disorders
Type of pain that is sudden, and lasting shorter than 3 months. Generally can be identified by a precipitating event. Manifestations reflecting SN system are increased HR, RR, diaphoresis, pallor, anxiety, agitation, confusion, and urine retention
Acute Pain
Type of pain that can be gradual or sudden. May start with an acute injury but continues past the normal time for recovery. Cause of pain may not be known. Can be characterized by periods of waxing and waning. Predominant behavioral manifestations include flat affect, decreased physical movement/activity, withdrawal and social isolation.
Chronic Pain
Type of pain that is transient, moderate to severe pain that occurs in patients whose baseline persistent pain is otherwise mild to moderate and fairly controlled.
Breakthrough Pain (BTP)
- Average is 3-5 minutes, although some can last for up to 30 minutes
- Can be predictable or unpredictable, and can have one to many episodes per day
Pain caused by damage to peripheral nerves or structures in)
th e CNS. Can be central pain, peripheral neuropathies, differentiation pain, sympathetically maintained pain
Neuropathic pain
Pain caused by damage to somatic or visceral tissue. May be described as sharp, aching, throbbing, dull, and cramping. Somatic is characterized as superficial or deep.
Nociceptive Pain
- Visceral pain comes from activation of nociceptors in internal organs and lining of body cavities
- visceral responds to inflammation, stretching, and ischemia
What are differences between opiods and non-opiods when it comes to pain?
Non-opiods have a an analgesic ceiling, and no development of tolerance or physical dependence. Non-opiods are for mild to moderate and are over the counter.
What are common side effects of non-opiod medications?
- GI problems (dyspepsia, ulceration, hemorrhage)
- Renal Insufficiency
- Hypertension
What are risk factors associated with non-opiod?
Cox-2 inhibitors and NSAIDS have a potential for increased cardiovascular events
Side effects of opiods and how they are managed
- Constipation- give stool softeners, abulate, high fiber diet
- Nausea/vomiting- usually go away with time
- Sedation
- Respiratory Depression. If respirations go below 10-12 rpm, contact provider and cut the dose
- Pruritis (itching)- usually goes away over time
Why is pain under-treated?
reasons include healthcare providers, patients, and family caregivers
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
Whatever a patient says it is
Pain
Most of the time, when we see pain, we are looking at _____ pain.
Nociceptive *damage
What type of pain is associated with diabetes?
Neuropathic
Superficial or deep pain
Somatic -nociceptive
Conversion of noxious stimuli into action potential
Transduction
Process by which pain signals are relayed from the periphery to the spinal cord and brain
Transmission
When pain is recognized, defined, and responded to by the individual experiencing the pain
Percecption
Activation of descending pathways that exert inhibitory or facilitatory effects on pain transmission.
Modulation
*This is why pain is experienced differently from person to person
When giving pain medication, evaluate the effectiveness within ____
one hour
What are two types of non-opiod NSAIDs?
Cox-1 and Cox-2
Enzyme that converts acid into prostaglandins. Inhibits this.
Cox-1
- Motrin or Ibuprofen
- More widespread throughout the body and causes more effects
Primarily found at sites of injury. When they came out, everyone thought that they were safer, but they have cardiovascular risks too.
Cox-2
*celebrex
What is important to keep in mnid when giving non-opiod NSAIDs?
You always want to give with food, because they can be particularly irritating to the GI system.
How do opiods work?
They bind to receptors in the CNS, resulting in:
- inhibition of transmission of nociceptive input from the periphery to the spinal cord
- Altered limbic activity
- Activation of descending inhibitory pathways that modulate transmission in the spinal cord
What is the reversal agent for Mu agonists?
Naloxone (Narcan)
What is Morphine?
A Mu Agonist Opiod
List the Mu Agonist Opiods
-Morphine
-Hydromorphone (Dilaudid)
Methadone (Dolophine)
Levorphanol (Levo-Dromoran)
Fentanyl
Oxymorphone
Oxycodone (Percocet, Oxycontin)
Hydrocodone (Lortab, Vicodin)
Codeine (Tylenol #3)
Mixed Agonists/Antagonists
Pentazocine (Talwin)
Pentazocine plus naloxone (Talwin NX)
Butorphanol (Stadol)
Partial Agonists
Buprenorphine injectable (Buprenex) Buprenorphine plus naloxone SL (Suboxone)
*Binds to Cappa. Less respiratory depression, but not as good pain relief
What are opiods to avoid?
Meperidine (Demerol)
-Associated w/ neurotoxicity (seizures)
Propoxyphene (Darvon)-no longer available in U.S.
- Produces toxic metabolite that can cause seizures
- No more effective than acetaminophen
We start to consider opiods when we get to a pain level of _____
7
The only withdrawal that can kill you is _____
Alcohol
Older people metabolize drugs more _____
Slowly
Because NSAIDS are associated with a high risk of GI bleeding, you should use ____ when possible
Acetominphen
(true/false) With older people, there is a greater risk for drug/drug interactions.
True
(true/false) Analgesics can exacerbate cognitive impairments and ataxia`
True
*Titrate drugs slowly and monitor for side effects
If an unwanted consequence (i.e. hastened death) occurs as a result of an action taken to achieve a moral good (i.e. pain relief), the action is justified if the nurse’s intent is to relieve pain and not to hasten death.
Rule of Double Effect
