Pain

Question 1

acute

Answer 1

1 sec - <6 months

Question 2

chronic

Answer 2

> 6 months

Question 3

somatic

Answer 3

• actual injury

- localized pain from peripheral nociceptors activation w/o injury to peripheral nerve or CNS

Question 4

nociceptive

Answer 4

stimulation of peripheral nerve fibers that respond to stimuli approaching or exceeding harmful intensity

Question 5

neuropathic

Answer 5

lesions/dz affecting somatosensory system

Question 6

visceral

Answer 6

internal organs

Question 7

analgesic

Answer 7

relieves pain

Question 8

narcotic

Answer 8

any analgesic, CNS depressant, or other drug that may cause physical dependence

Question 9

opiate/opioid

Answer 9

endogenous opioid-peptides, synthetic, or semisynthetic which have similar actions to morphine

Question 10

tolerance

Answer 10

• larger dose required to produce same effect

- cross-tolerance: tolerance to another drug in same class

Question 11

physical dependence

Answer 11

• withdrawal sx if drug stopped abruptly

- body requires continued presence of drug to fxn nml

Question 12

addiction

Answer 12

• continued use of drug despite physical, psych, or social harm
• behavioral

Question 13

abuse

Answer 13

-intentional misuse of drugs inconsistent w/ medical or social norms

Question 14

morphine (MS Contin)

Answer 14

• 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

Question 15

meperidine (Demerol)

Answer 15

• 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

Question 16

naloxone (Narcan)

Answer 16

• 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

Question 17

hydrocodone bitartrate and acetaminophen (Vicodin, Norco)

Answer 17

• actions: opioid combo
• use: analgesic and antipyretic
• adverse effects: resp dep; hepatotoxicity; abuse
• drug interactions: amiodarone (inhibitor); barbiturates, Tegretol (inducers)
• considerations: avoid abrupt cessation

Question 18

methadone (Methadose)

Answer 18

• 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)

Question 19

alcohol

Answer 19

• 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

Question 20

chlordiazepoxide (Librium)

Answer 20

use: anxiety; acute alcohol withdrawal; pre-op relaxation

Question 21

lorazepam (Ativan)

Answer 21

-precautions: renal/hepatic dz; addiction

Question 22

alprazolam (Xanax)

Answer 22

-use: anxiety; panic disorders

Question 23

diazepam (Valium)

Answer 23

• use: IV for status epilepticus; anxiety; insomnia; muscle spasm; alcohol withdrawal
• precautions: inject slowly into a large vein flush w/ NSS pre/post

Question 24

benzo drug interactions

Answer 24

alcohol; CNS depressant; opioid analgesics; anesthetics; tricyclic antidepressants