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Anesthesia > Pain Management > Flashcards

Pain Management Flashcards

1
Q

Pain

A

An adverse sensory and emotional experience

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2
Q

Nociception

A

Perception of pain by the nervous system
* processed similarly in all mammals

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3
Q

4 Stages of Nociception

A
  1. Transduction
  2. Transmission
  3. Modulation
  4. Perception
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4
Q

Transduction

A

Conversion of mechanical energy into electrical energy (nerve impulses)

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5
Q

Transmission

A

Nerve impulse conducted along peripheral nerves leading to spinal cord

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6
Q

Modulation

A

Change in nerve impulse

  • impulses modified once in spinal cord
  • amplified or suppressed
  • advanced along spinal cord to brain once finished
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7
Q

Perception
What and where it occurs

A

Impulse processed and recognized as pain
*occurs in Thalamus

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8
Q

Pain & The Brain

A

Pain free region of the body
* no sensory nerves

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9
Q

Tissue Sensitivity to Pain

A

Degree of tissue sensitivity to pain is related to density of pain recepors present

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10
Q

Areas with High Density of Pain Receptors

A
  • Skin
  • Periosteum
  • Joint capsule
  • Muscle tendons
  • Arterial walls
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11
Q

Area with Low Densitity of Pain Receptors

A

Visceral and Thoracic Organs
* few sensory nerves
* visceral pain vague, hard to localize

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12
Q

Cardinal Signs of Inflammation

A
  1. Pain
  2. Heat
  3. Redness
  4. Swelling
  5. Loss of function
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13
Q

Clinical Signs of Pain

A
  • Increased HR and BP
  • Peripheral vasoconstriction
  • Pale MM
  • Rapid breathing or panting
  • Mydriasis
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14
Q

Perioperative Analgesia

A
  • Provide analgesia surrounding time of surgery
  • Multimodal Therapy & Preemptive Analgesia
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15
Q

Multimodal Therapy

A
  • Treating more than one pain receptor site at same time*
  • Prefered over using a single analgesic
  • Lower dosages used
  • Wide margin of safety

*using opioid and NSAID same time

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16
Q

“Wind up”

A
  • CNS hypersensitivity
  • Occurs with untreated, moderate-severe pain
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17
Q

“Wind up” Cause

A

Occurs when spinal cord neurons receive constant or longer term input from pain nerve fibers
* neurons become hypersensitive and hyperexcitable

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18
Q

NMDA

A
  • N-methyl-D-aspartate
  • Receptor that is activated in the spinal cord (hypersensitive)
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19
Q

Ketamine

And Wind-Up

A
  • Prevent “wind up”
  • Analgesic
  • Block NMDA receptor
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20
Q

CRI

A

Constant Rate Infusion of analgesics
* method of treating constant pain
* IV drip to administer mixture of analgesics
* Can be added to bag of IV fluids

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21
Q

CRI Medications

A
  • Morphine
  • Ketamine
  • Lidocaine
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22
Q

Opioids

A
  • Analgesic
  • Narcotics
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23
Q

Narcotics

Safety

A

Safest and most effective analgesic group available

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24
Q

Opiods

How They Work

A

Act at specific opioid receptors in CNS
* most activity in brain and spinal cord

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25
Q

Opioid Receptors

Categories

A
  • Mu
  • Kappa
  • Sigma
  • Delta
  • Epsilon
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26
Q

Morphine

Agonist

A
  • Mu agonist
  • Produces very effective pain control
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27
Q

Buprenorphine

Agonist

A
  • Mu agonist
  • Not as effective as morphine
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28
Q

Agonists

A

Agonists stimulate the recepors for effect

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29
Q

Antagonists

A

Antagonists block opioid receptors for effect
* will act as a reversal agant*

EX: naloxone or nalorphine

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30
Q

Agonists and Antagonists

Mixed

A

Will stimulate some receptors and block other receptors
* allows for analgesia while reducing addiction potential

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31
Q

Butorphanol

Mixed Agonist/Antagonist Classifications

A
  • kappa agonist
  • mu antagonist
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32
Q

Butorphanol

Analgesic

A
  • Will reverse analgesic effect of morphine
  • Acts as an analgesic, but not as effective as morphine
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33
Q

Narcotics

Side Effects

A
  • Panting
  • Respiratory depression (in high doses)
  • Bradycardia
  • GI tract stimulation
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34
Q

Morphine

A
  • Narcotic drug
  • Analgesic with some sedation
  • Should be given prior to painful event for greatest effect
35
Q

Morphine

Excitement

A

Excitement associated with histamine release

Horses
* causes excitement when used without sedation

Cats
* causes excitement when used in high doses

36
Q

Morphine

Side Effects

A
  • Vomiting
  • Bowel evacuation
  • Bradycardia

Atropine or Glycopyrollate will lessen GI side effects

37
Q

Fentanyl

A
  • Mu agonist
  • Synthetic opioid with 100x potency of morphine
38
Q

Fentanyl

Patch

A
  • Allows for TD administration for prolonged effect
  • Needs to be on for 24 hours
  • Provides about 72 hours of pain control
  • Schedule II
39
Q

Fentanyl

Recunyra

A
  • Transdermal solution
  • Applied to skin of the dorsal scapular area
  • Will be absorbed
  • One application = 4 days pain control
40
Q

Hydromorphone

A
  • Synthetic narcotic
  • 5x better analgesic than morphine
  • Mu agonist
  • Can be combines with tranquilizer (Ace)
41
Q

Torb

A
  • Kappa agonist
  • Will produce analgesia
  • Not as effective as morphine
  • Frequent redosing needed
  • Mild-moderate pain
42
Q

Buprenorphine

A
  • Partial mu agonist
  • Not as potent as morphine
  • Longer duration than torb (8 hrs)
  • Mild-moderate pain
43
Q

Tramadol

A
  • Synthetic derivative of codeine
  • Controlled substance
  • Mu agonist
  • Will cause sedation
44
Q

Tramadol

Pain Control

A

More effective in pain control than an NSAID
* may be used for longer, chronic pain (arthritis)

45
Q

Narcotic

Reversals

A
  • Nalorphine
  • Naloxone
46
Q

Nalorphine

A
  • Reverses effects of opioids
  • Very effective with morphine
  • Schedule III drug
47
Q

Naloxone

A
  • Rapidly reverses the effects of opioids
  • Not controlled
  • Effective for reversing hydromorphone
48
Q

Selective Nerve Blocks

A
  • Non-narcotic analgesics
  • Used to control pain and inflammation associated with arthritis

Ex: Carprofen (NSAID) for hip dysplasia

49
Q

Dysplasia

A

Abnormal growth or development

50
Q

Selective Nerve Blocks

Block What

A

Effect on peripheral tissues
* blocks production of COX-1 and COX-2
* reduces production of prostaglandin

51
Q

COX-1

A

Relates to the production of mucus protective layer of stomach
* protects from formation of stomach ulcers

Plays an important role in the renal blood supply

52
Q

COX-2

A

Produces prostaglandin associated with clinical signs of inflammation

53
Q

Prostaglandins

A

Produced in the process of inflammation
* produce susbtances that stimulate sensory nerve cells
* causes sensation of pain

54
Q

Salicylate Analgesics

A
  • Asprin-type products
  • Manage arthritis pain
  • May cause GI irritation*

*monitor for vomiting

55
Q

Salicylate

For Arthritis in Cats

A

May be used as long as administration is controlled
* not given more often than every 36-48 hours
* some NSAIDS are single use only*

*not to be repeated

Ex: Metacam

56
Q

Carprofen

A
  • Also called Rimadyl
  • Reversible inhibitor of COX-2 with some COX-1 activity
57
Q

Carprofen

Side Effects

A

Most Common Include
* vomiting
* anorexia
* lethargy

58
Q

Onsior

Robenicoxib

A
  • NSAID only approved for cats*
  • Control of postoperative pain and inflammation
  • Do not use with other NSAIDs or cortisones
  • Max use is 3 days

*need to be greater than 5.5 lbs and 6 months of age

59
Q

Onsior

Side Effects

A
  • Vomiting
  • Lethargy
  • Polyuria / Polydipsia

Robenicoxib

60
Q

Meloxicam

Metacam

A

Reversible inhibitor of COX-2 with some COX-1 activity

61
Q

Meloxicam

Form and Use in cats

A

Injectable form approved for cats
* one time only administration
* other NSAID use is extra-label

Metacam

62
Q

NSAIDs

Patient Caution

A

Use with caution in patients with:
* compromised renal function
* cardiac disease
* geriatrics

63
Q

NSAIDs

Combinations

A

May be combined with opioids
* for severe pain

Do not combine with glucocorticoids
* high potential for gastric ulcers

64
Q

NSAIDs
Use and Function

A
  • Impare renal blood flow
  • Used on healthy patients undergoing moderately painful procedures or experiencing moderate pain
65
Q

NSAIDs

General Anesthesia Length

A

If surgery expected to last longer than 30 minutes:
* administer IV fluids
* will help preserve renal blood flow

66
Q

Sucralfate

A
  • Treatement of gastric ulcers related to NSAIDs
  • Mucosal adherent that will protect ulcerated MM surface of stomach
67
Q

Famotidine, Ranitidine, Cimetadine

A
  • Help treat gastric ulcers related to NSAIDs
  • Reduce acid production in the stomach
68
Q

Misoprostil

A
  • Help treat gastric ulcers from NSAIDs
  • Promotes protective mucus layer in stomach
  • Prostaglandin medication
  • May induce labor
69
Q

NSAIDs

with Cortisones

A

Should never be used together
* increased chance of gastric ulcers
* increases wound healing time after surgery

70
Q

Local Anesthetics

A

Block selective nerves prior to or following surgery
* provide good pain relief
* block sodium movement across nerve cell membrane

71
Q

Local Anesthetics

Side Effects

A
  • Minimal
72
Q

Local Anesthetics

Dental Procedures

A

Infraorbital nerve block used

73
Q

Bupivicaine

A
  • Local anesthetic
  • Infiltrate intercostal nerves after thoracic surgery
  • Lasts longer than lidocaine
74
Q

Signs of Pain

A
  • Abnormal Respiration
  • Increased HR
  • Aggression
  • Lack of Grooming Behavior

If signs are confusing but surgery just happened, pain likely

75
Q

Acute Short Term

Pain Treatment

A

Best treated with opioid analgesics
* May be combined with a tranquilizers
* May also be combined with NSAIDs

76
Q

Chronic Long Term

Pain Treatment

A

Best treated with NSAIDs
* asprin may be used in cats*

*no more often than every 2nd day

77
Q

Xylazine

A
  • Alpha2 Adrenergic Agent
  • Causes vasoconstriction*
  • Good sedation and analgesic effect
  • Reversed with yohimbine

*increases arterial BP = lower HR and reflex vascular hypotension

78
Q

Dexdomitor

A
  • Alpha2 Adrenergic Stimulator
  • Good sedative and analgesic
  • May be used in CRI prep*

* for somatic and visceral pain control

79
Q

Dex Reversal

A

Reversed with antipamezole

80
Q

Gabapentin

A
  • Analgesic and Anticonvulsant
  • Decreases release of excitatory neurotransmitters*

*norepinephrine

81
Q

Gabapentin Use

A
  • Control of chronic pain
  • Reduce seizures in difficult cases
  • Reduce anxiety
82
Q

Gabapentin Side Effects

A

Seen in higher doses
* Sedation
* Ataxia

83
Q

Antipyretic

A

Relieves fever

Anesthesia (12 decks)

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