Pain Flashcards
acute
1 sec - <6 months
chronic
> 6 months
somatic
- actual injury
- localized pain from peripheral nociceptors activation w/o injury to peripheral nerve or CNS
nociceptive
stimulation of peripheral nerve fibers that respond to stimuli approaching or exceeding harmful intensity
neuropathic
lesions/dz affecting somatosensory system
visceral
internal organs
analgesic
relieves pain
narcotic
any analgesic, CNS depressant, or other drug that may cause physical dependence
opiate/opioid
endogenous opioid-peptides, synthetic, or semisynthetic which have similar actions to morphine
tolerance
- larger dose required to produce same effect
- cross-tolerance: tolerance to another drug in same class
physical dependence
- withdrawal sx if drug stopped abruptly
- body requires continued presence of drug to fxn nml
addiction
- continued use of drug despite physical, psych, or social harm
- behavioral
abuse
-intentional misuse of drugs inconsistent w/ medical or social norms
morphine (MS Contin)
- action: opioid agonist analgesic
- use: analgesic; anxiety; sedation; sense of well being
- precautions: respiratory suppression; decreased uterine contraction, fetal depression; biliary colic; miosis
- adverse effects: constipation; cough suppression (post-op pna risk)
- considerations: dilute and push slowly
- drug interactions: intensifies ae’s of alcohol, barbiturates, benzos
- antidote = naloxone
meperidine (Demerol)
- action: opioid analgesic; local anesthetic
- use: drug induced rigors; post anesthesia shivering; alt to other opioids
- precautions: normeperidine metabolite is toxic; NTE >600 mg/24hr for >2 days
- differences w/ morphine: less resp depression, constipation, and vomiting; less apt to release histamine or increase biliary tract pressure; shorter duration of action; poor oral bioavailability
naloxone (Narcan)
- action: opioid antagonist
- use: reversal of opioid OD
- precautions: give IV, IM, sub-Q (PO has high first-pass effect); given prior to opioid will block opioid action; acute withdrawal effect
- considerations: maintain open airway and be prepared to provide artificial ventiltion and cardiac support
-addiction tx: PO given at 50 mg/day
hydrocodone bitartrate and acetaminophen (Vicodin, Norco)
- actions: opioid combo
- use: analgesic and antipyretic
- adverse effects: resp dep; hepatotoxicity; abuse
- drug interactions: amiodarone (inhibitor); barbiturates, Tegretol (inducers)
- considerations: avoid abrupt cessation
methadone (Methadose)
- actions: opioid analgesic; similar to morphine
- use: relieve severe/chronic pain
- precautions: severe dysrhythmias prolongs QT interval, V-fib; resp suppression
- considerations: EKG for chest pain
- drug interactions: sertraline, rifampin (inhibitors); Tegretol, phenobarb, phenytoin, barbiturate anesthetics (inducers); caution w/ many HIV ARVs
- methadone maintenance: sub methadone for opioid; admin gradually in smaller doses
- methadone suppression: prevents opioid induced euphoria by giving addicts larger doses of methadone (>100 mg/day)
alcohol
- action: CNS depressant; enhances serotonin; binds w GABA receptors
- precautions: tolerance; dose dependent (thiamine deficiency)
- adverse effects: damage to myocardium, HTN; resp dep; liver damage, cirrhosis, cancer; erosive gastritis, varices; brease and colorectal cancer
- interactions: NSAIDs can cause liver damage w/ 2-4 drinks/day (NSAID limit NTE 2g/day
CAGE
- Cut down - have you ever thought about cutting down?
- Annoyed - hav people annoyed you by criticizing?
- Guilty - have you ever felt guilty?
- Eye opener - have you ever had a drink the first thing in the morning to steady your nerves or get rid of a hangover?
- alcohol withdrawal = sx that occur d/t physiologic response to alcohol dependence
- -low dependence: 12-24 hr/ anxiety, disturbed sleep, nausea, mild tremors, weakness
- -high dependence: 12-72 hr/ cramps, NV, intense tremors, tachy, HTN, fever
- -severe dependence: delirium tremens (DTs)- hallucinations, disorientation, tremors, sz
- alcohol withdrawal management
- -benzos: dec sx; stabilize VS; prevent sz
- -beta-adrenergic blockers: improve VS; dec autonomic component
- -alpha-adrenergic blockers: improve VS; dec autonomic component
chlordiazepoxide (Librium)
use: anxiety; acute alcohol withdrawal; pre-op relaxation
lorazepam (Ativan)
-precautions: renal/hepatic dz; addiction
alprazolam (Xanax)
-use: anxiety; panic disorders
diazepam (Valium)
- use: IV for status epilepticus; anxiety; insomnia; muscle spasm; alcohol withdrawal
- precautions: inject slowly into a large vein flush w/ NSS pre/post
benzo drug interactions
alcohol; CNS depressant; opioid analgesics; anesthetics; tricyclic antidepressants
