Pain Flashcards
Acute Pain
Diminishes as healing occurs; responds well to analgesics
Chronic Pain
Lasts longer than three months, nerves may have become oversensitive and react to even a slight stimulus
Neuropathic Pain
C/B damage to PNS or CNS; not well-controlled by opioids alone, needs adjuvent therapy
Characteristics of neuropathic pain
Numbing, shooting, stabbing, sharp, electric shock-like, burning. Example- diabetic nueropathy
Tolerance
Body adapts so exposure to a drug changes that result in a decrease in one or more of the drugs effects
Physical Dependance
Symptoms c/b abrupt cessation, rapid dose reduction, decreased blood level, and/or administration of an antagonist
Addiction
Primary, chronic, nuerobiologic disease w/genetic, psychosocial and environmental factors
Incident Pain
Transient increase in pain that is caused by a specific activity or event that precipitates pain. Examples- dressing changes, movement, position changes, and procedures such as catheterization
Breakthrough Pain
Transient, moderate to severe pain that occurs in patients whose baseline persistent pain is otherwise mild to moderate and fairly well controlled. 3-5 min, can last up to 30 min. Can happen several times a day
OLD CART
Onset, location, duration, characteristics, aggravating factors, relieving factors, treatment
Non-Opiods
Mild to moderate pain. NSAIDS decrease production of pain-sensitizing chemicals. Dont produce tolerance or dependence. Have an analgesic ceiling. Used with opioids to lower opioid dose.
ASA (non-opioid)
Use limited due to side effects
Tylenol (non-opioid)
Does not cause bleeding, but can be toxic to the liver
NSAIDS
Can cause bleeding, renal toxicity, CHF in elderly, some interactions with anticoagulants, oral hypoglycemics, antihypertensives, diuretics
How do opioids work?
Modify the perception of pain
Opioids: Agonists
morphine, oxycodone, hydrocodone, codeine, methadone, hydromorphone.
Often combined with non-opioid analgesics limiting the total daily dose that can be given. Potent, have no analgesic ceiling, can be given through several routes
Opioids: Agonist-antagonist
Nubain, Talwin, Stadol
Produce less resp depression but cause more dysphoria and agitation, have an analgesic ceiling, can lead to withdrawal, not used much
Avoid giving these drugs:
Darvon and Demerol- produce a toxic metabolite causing seizures
Opioids
Use for moderate to severe pain, use for breakthrough pain. Only need one b/c they are all similar pharmacologically. Can give by any route, oral route is preferred unless pain is severe or need dose titration. .
Opioids: Codeine
Weak opioid, requires an enzyme to break it down to work, not good for severe pain
Opioids: Hydrocodone
Always combined with Tylenol or Ibuprofen, so does is limited
Opioids: Oxycodone
Single or combined, long acting is OxyContin