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N116 > Pain > Flashcards

Pain Flashcards

1
Q

How can pain be defined

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

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2
Q

Sensory receptors

A

Monitor conditions inside or outside the body

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3
Q

The receptive field

A

The area monitored by a single receptor cell

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4
Q

The smaller the receptive field…

A

The more precise the sensory information can be localized

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5
Q

Sensation

A

The arriving sensory information in the form of action potentials

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6
Q

How is pain sensation information routed

A

Routed to specific cortex based on location and nature of stimulus

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7
Q

Perception

A

Conscious awareness and interpretation of sensory input by the integration areas of cerebral cortex

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8
Q

Adaptation

A

A reduction in sensitivity in the presence of a constant stimulus
Reduces the amount of information arriving at cerebral cortex

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9
Q

General sense include

A 
Temperature
Pain
Touch
Pressure
Vibration
Proprioception (body position)
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10
Q

Classes of General Sensory Receptors

A

Nociceptors
Thermoreceptors
Mechanoreceptors
Chemoreceptors

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11
Q

Nociceptors

A

Respond to pain

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12
Q

Thermoreceptors

A

respond to temperature

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13
Q

Mechanoreceptors

A

respond to physical distortion

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14
Q

chemoreceptors

A

Respond to chemical stimuli

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15
Q

What are nociceptors

A

Free nerve endings in skin, muscles, joints, arteries, and the viscera that respond and adapt very slowly to chemical, mechanical, and thermal stimuli

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16
Q

Nociceptors are very common in

A

in superficial skin, joint capsules, covering of bones, and around blood vessels

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17
Q

Nociceptors respond to…

A

Extremes of temperature, mechanical damage, or dissolved chemicals

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18
Q

What is the size of nociceptors receptive fields

A

Large that can detect a wide range of stimuli

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19
Q

Neuroanatomy of pain

A

Transduction
Transmission
Perception
Modulation

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20
Q

Transduction

A

activation of nociceptors

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21
Q

Transmission

A

Conduction to dorsal horn and up spinal cord

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22
Q

Perception

A

Sensory-discriminative system
Motivational-affective system
Cognitive-evalautive system

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23
Q

Modulation

A

Facilitation or inhibition of transmission before, during, or after perception

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24
Q

Where are neuromodulators located?

A

Pathways of nervous system

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25
Q

What are neuromodulators triggered by?

A

tissue injury and inflammation

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26
Q

Which are excitatory neurotransmitters in CNS and PNS

A

Substance P
Glutamate
Calcitonin

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27
Q

Inhibitory neurotransmitters

A

GABA
Glycine
Serotonin
Norepinephrine

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28
Q

Pathways of Modulation

A

Descending inhibitory or facilitatory pathway
Segmental inhibition of pain
Diffuse noxious inhibitory control (DNIC)
Placebo effect

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29
Q

Descending inhibitory or faciliatory pathway

A

Inhibits or facilitates pain by activating opioid receptors

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30
Q

Segmental inhibition of pain

A

A beta fibres stimulate inhibitory interneurons and decrease pain transmission

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31
Q

Diffuse noxious inhibitory control

A

Pain relieved when 2 noxious stimuli occur at the same time from different sites

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32
Q

Placebo effect

A

Cognitive expectations cause physiological effects

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33
Q

Pain Threshold

A

Point at which a stimulus is perceived as pain

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34
Q

Perceptual dominance

A

Pain at one location may cause an increase in the threshold in another location

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35
Q

Pain tolerance

A

Duration of time or the intensity of pain that a person will endure before initiation of pain responses

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36
Q

Types of pain

A

Fast pain
Slow pain
Referred pain

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37
Q

Fast pain

A

Also known as prickling pain
Localized sensations
Transmitted quickly to CNS through myelinated axons

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38
Q

Slow pain

A

Also known as burning and aching pain
Transmitted by unmyelinated axons
Identified only as general area involved

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39
Q

Referred pain

A

Perception of pain in an unrelated area of the body

Usually from pain related to visceral organs

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40
Q

Sources of pain

A

Visceral pain
Deep somatic pain
Cutaneous pain
Referred pain

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41
Q

Classification of pain

A

Acute

Chronic

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42
Q

Acute pain

A

Intense pain over a defined period of time
Pain lasts over a few days and may result in increased heart rate, respiratory rate and sweating
Typically occurs over less than 6 weeks

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43
Q

Chronic pain

A

Longer than 3-6 months

Can interfere with daily activities

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44
Q

Acute pain protective mechanism

A

Alerts an individual to a condition or experience that is immediately harmful to the body

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45
Q

Acute somatic pain

A

Arises from skin, joints, and muscles

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46
Q

Acute somatic Pain A delta fibres

A

Pain is sharp and well localized

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47
Q

Acute somatic pain C fibres

A

Dull aching and poorly localized pain

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48
Q

Acute Visceral Pain

A

Pain in the internal organs and lining of the body cavities

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49
Q

Acute visceral pain transmitted by C fibres

A

Poorly localized with an aching, gnawing, throbbing or intermittent cramping quality

50
Q

Neuropathic pain

A

Chronic

Amplification of pain without stimulation

51
Q

Neuropathic pain is often described as

A

Burning, shooting, shock like or tingling

52
Q

Peripheral neuropathic pain

A

Caused by peripheral nerve lesions

53
Q

Central neuropathic pain

A

Caused by lesion or dysfunction in brain or spinal cord

54
Q

PQRSTU

A 
Provocative or palliative
Quality of pain
Region of body
Severity
Timing and onset of pain
Understanding of pain
55
Q

Who is an expert on their pain

A

the patient

56
Q

Barriers to effective pain management

A 
Lack of information 
Limited training
Fear of addictive nature of opiates 
Lack of information with combining therapies
ineffective assessment
57
Q

Nonpharmacological Pain interventions

A 
Massage
Positioning and body alignment
Splinting
Thermal interventions 
Mind-body therapies
Acupuncture
Biofeedback therapy
Relaxation therapy 
Art or music therapy
Imagery 
Chiropractic manipulation
Hypnosis
Therapeutic touch 
Transcutaneous electrical stimulation
Energy therapies
Physical and Aquatic therapy
58
Q

Two categories every of analgesics

A

Non opioids

Opioids

59
Q

When should non opioids be used

A

Minor (0-4) to moderate pain (4-6)

60
Q

When should opioids be used

A

Severe pain (7-10)

61
Q

Adjuvant analgesics

A

Enhance the analgesic action of non opioids and opioids
Assist the primary drugs in relieving pain
Allow for smaller dosages of opioids to be described

62
Q

Non opioids

A

Acetaminophen
NSAIDS
Tramadol
Clonidine

63
Q

Opiod Analgesics

A

Morphine
Fentanyl
Hydromorphone
Oxycodone

64
Q

Adjuvant analgesics

A

Local anesthetic (Bupivacine, Ropivacaine, lidocaine)
Anticonvulsants (Gabapentin, pregabalin)
Antidepressants (Desipramine, nortiptyline, duloxetine)

65
Q

Endogenous Opioids

A

Morphine-like neuropeptides

Enkephalins

66
Q

Morphine-like neuropeptides

A

Bind with opioid receptors to inhibit pain impulses in periphery, spinal cord and brain

67
Q

Enkephalins

A

Have pharmacological actions similar to morphine

Bind as direct agonists to opioid receptors

68
Q

Most common natural opioid

A

Endorphins
Dynorphins
Endomorphins

69
Q

Acetaminophen overdose leads to..

A

hepatotoxicity due to the formation of toxic metabolites

70
Q

What is Acetylcysteine used for

A

Acetaminophen overdoses
Used to reduce the extent of liver damage
detoxifies the toxic metabolite and allows for other routes of metabolism

71
Q

Adverse effects of Acetlycysteine

A 
Flushing
Urticaria
Rash
Hypotension
Bronchospasm
72
Q

Endocannabinoids are classified as?

A

Classified as escanoids

73
Q

What are endocannabinoids synthesized from?

A

Phospholipids

74
Q

Endocannabinoids

A

Cannabis produces a resin contains cannabinoids

Analgesic in humans

75
Q

Drawbacks of endocannbinoids

A

Psychoactive and addictive properties

76
Q

What is the prototype drug for severe pain

A

Morphine

77
Q

Opioids

A

Narcotic analgesic

Can be natural or synthetic

78
Q

In what type of pain should adjuvant medications be used with opioids

A

Neuropathic pain

79
Q

Morphine Sulphate

A

Controlled substance derived from the opium poppy

CNS depressant

80
Q

Are epidurals available for morphine sulphate?

A

yes

81
Q

Morphine Sulphate Route

A

PO
IV
SC
IM

82
Q

Morphine sulphate Onset of action

A

Rapid

83
Q

Morphine sulphate Peak

A

30-60 min

84
Q

Morphine sulphate half life

A

1.7-4.5 hours

85
Q

Morphine sulphate duration of action

A

6-7 hours

86
Q

How do opioids work?

A

Bind to the pain receptors in the brain and cause an analgesic response
Work by exerting their action by interacting with at least 6 types of receptors

87
Q

MU Receptor responses

A 
Analgesia
 Decreased GI motility
Euphoria
Physical dependence
Respiratory depression
Sedation
88
Q

Kappa Receptor Responses

A

Analgesia
Decreased GI motility
Miosis
Sedation

89
Q

General effects of opioids

A 
Suppress cough reflex
Slow GI motility
Sedation
Euphoria
Intense relaxation
Respiratory depression
Nausea and vomiting
Potential for physical and psychological dependence
90
Q

Use opioids with caution in patients with

A

hepatic disease

91
Q

Side effects of opioids

A 
Respiratory depression
Constipation
Decreased LOC
Orthostatic hypotension 
Nausea and vomiting
Urinary output
92
Q

Opiod overdose

A

Overly aggressive pain therapy or substance abuse

93
Q

Most commonly abused opioids

A

Morphine
Meperidine
Heroin

94
Q

Manifestations of Opioid overdose

A 
Euphoria
Arousable somnolence
Nausea
Pinpoint pupils
Slow and shallow respirations
Coma
Seizures
95
Q

Opiod overdose treatment Action

A

Blocks MU and Kappa receptors

Given if the patient is experiencing severe respiratory distress

96
Q

Opioid overdose treatment Pharmacokinetics

A

Well absorbed following SC or IM administration

Widely distributed and crosses BBB and placenta

97
Q

Opioid overdose treatment half life

A

60-90 min in adults

Up to 3 hours in neonates

98
Q

Opioid overdose treatment adverse effects

A

Minimal toxicity

Rapid reversal for analgesic

99
Q

Opioid overdose treatment Drug interactions

A

Reversal or analgesic effects of opioid agonist and antagonist

100
Q

Opioid overdose treatment prototype

A

Naloxone (Narcan)

101
Q

Nursing considerations for naloxone

A

Know when to administer it
Monitor CV status
Monitor withdrawal post administration
Monitor VS during and after administration

102
Q

What is the treatment for opioid dependence?

A

Methadone

103
Q

Combination Medication

A

Common practice to combine opioids and non opioids into a single tablet
Work to relieve pain

104
Q

How do combination medication work?

A

Keep the doses of narcotic small to reduce dependence and opioid related side effects

105
Q

Percocet

A

Oxycodone (HCL)- 5mg

Acetaminophen- 325mg

106
Q

Atasol 30

A

Acetaminophen- 325mg
Caffeine- 30mg
Codeine- 30mg

107
Q

Tylenol with codeine No. 3

A

Acetaminophen- 325mg
Caffeine- 15mg
Codeine- 15mg

108
Q

Migraine

A

Familial, episodic disorder whose marker is headache and is defined as repeated, episodic headache lasting 4 to 72 hours

109
Q

Migraines are caused by…

A

Caused by combination of multiple genetic and environmental factors

110
Q

Diagnosis of Migraine

A

Unilateral, throbbing, worsened by movement, moderate or severe, and any one of these symptoms: nausea, vomiting, photophobia, or phonophobia

111
Q

Migraine Triggers

A 
Altered sleep patterns
Skipping meals
Overexertion
Weather change
Stress or relaxation from stress
Hormonal changes
Bright lights
Strong smells
Chemicals
112
Q

Cluster headaches

A

Occur in clusters (minutes to hours) for a period of days, followed by a long period of spontaneous remission

113
Q

Tension headaches

A

Most common
Mild to moderate bilateral headache with a sensation of a tight band or pressure around the head with gradual onset of pain
May last hours or days

114
Q

Headache Treatments

A

begin with acetaminophen or NSAIDS

then triptans or ergot alkaloids

115
Q

Triptans

A

Selective for serotonin řeceptors
Constrict certain inter cranial vessels
Aborts migraine with or without aura

116
Q

Ergot Alkaloids

A

Interact with adrenergic, dopamine, and serotonin blockers

Aborts migraines

117
Q

3 origins of labor pain

A

Visceral
Somatic
referred

118
Q

First stage of labor pain

A

Uterine contractions
Decrease in blood flow causing local oxygen defecit
Pain is felt from uterine contractions

119
Q

Second stage of labor pain

A

Sharp burning pain Somatic pain
Distention & tration on the peritoneum and uterocervical supports
Pressure against the bladder & rectum
Stretching & dissention of perineal tissues & the
pelfic floor
Lacerations of soft tissue (cervix, vagina, perineum)

120
Q

Stage three of labor pain

A

Uterine in nature

Similar to the first stage of labor

121
Q

Drug exposure during pregnancy

A

Opioid use can have a negative effect on mothers and their babies
Infants can be born with breathing and feeding problems
Preterm birth
Low birthweight
Maternal mortality
Neonatal abstinence Syndrome

N116 (11 decks)

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