Pain management Flashcards
A state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time is known as ___.
tolerance
A state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist is known as ___ ___.
physical dependence
A primary, chronic, neurobiologic disease, w/genetic, psychosocial, and environmental factors influencing its development and manifestations is known as ___. Characterized by behaviors that include: impaired control over ___ use, ___ use, continues used despite ___, and ___.
addiction, drug, compulsive, harm, craving
An iatrogenic misinterpretation caused by undertreatment of pain that is misidentified by the clinician is inappropriate drug-seeking behavior is known as ___. The behavior ceases when adequate pain relief is provided.
pseudoaddiction
Induced inadvertently by medical treatment or procedures of a physician is known as ___.
iatrogenic addiction
The pain pathway has 4 processes that include: ___, ___, ___, and ___.
transduction, transmission, perception of pain, modulation
The pain pathway begins at the ___ ___, travels to the ___ ___ and up to the ___ of the brain, where it causes descending modulation.
peripheral tissues, spinal cord, hypothalamus
___ and ___ help to reduce pain post-operatively and reduce the need for opioids.
NSAIDS, COX-2’s
___ ___ and ___ block the pain before it even begins.
nerve blocks, anticonvulsants
Opioids do not work on pain itself, they work on the ___ of pain to diminish it.
perception
___, ___, and ___ work to block the pain as well.
tricyclic antidepressants, selective norepinephrine reuptake inhibitors, and anticonvulsants
Noriceptive pain (aka ___), is well-___ and is characterized as ___, ___, and ___. ___ in origin. Responsive to ___, ___, ___, ___ ___. Examples include: ___-___ pain, ___, ___ bones, ___ metastasis, ___.
somatic, localized, dull achy, tender, muscloskeletal, opioids, NSAIDS, steroids, muscle relaxants, post-op, sprains, broken, bone, arthritis
Nociceptive pain (aka ___), involves ___ organs. Is ___-localized and characterized by ___, __, and ___. May refer to other ___. Usually responsive to ___. Examples include: ___, ___-related, bowel ___, liver or brain ___.
visceral, solid, poorly, pressure, tight, crampy, areas, opioids, pancreatitis, constipation, obstruction, cancer
Neuropathic pain may be peripheral, central, sympathetically. Characterized as ___, ___, ___, and ___. ___ responsive to opioids, but may respond to TCA’s, anticonvulsants, or other anesthetics. Examples include: ___, ___, ___ from strokes, ___ neuralgia, ___ limb pain, ___ neuropathy from diabetes or chemo.
sharp, shooting, stabbing, burning, poorly, shingles, sciatica, pain, trigeminal, phantom, peripheral
The most important took for assessing pain is the pt’s ___-___.
self report
Use the ___ method for assessment of pain, which stands for ___, ___, ___, ___, and ___.
WILDA, words, intensity, location, duration, aggravating/alleviating factors
Non-opioids include ___, ___, and ___/___.
acetaminophen, ASA, NSAIDS/COX-2’s
Unless contraindicated, any analgesic regiment should include a ___ medication, even if pain is severe enough to require the addition of an ___.
non-opioid, opioid
___ mg is the limit in a 24hr period for acetaminophen.
4,000mg
___ is the non-opioid of choice for pt’s w/renal disease.
acetaminophen
Acetaminophen can cause excessive ___ for pt’s on warfarin. Can also cause moderate ___ in b/p.
anticoagulation, increase
ASA should be avoided in ___.
children
ASA inhibits ___ aggregation. Common s/e is ___ and ___.
platelet, gastritis, bleeding
Non-selective NSAIDS are useful in pain that involves ___. Adverse effects include ___, ___, and ___.
inflammation, GI, renal, CV
Non-selective NSAIDS include:
ketorolac (Toradol), ibuprofen (Motrin/Advil), naproxen (Naprosyn)
Ketorolac needs to be limited to ___ days d/t precipitating ___ failure.
5, renal
Celecoxib (aka ___) is a COX-2 selective NSAID and works as an analgesic. Great thing about it is that is doesn’t have any effect on ___ or the ___ tract.
Celebrex, platelets, GI
celecoxib (Celebrex) is indicated for relief of ___, ___ ___, and ___ ___.
osteoarthritis, RA, acute pain
Adjuvant/Coanalgesic meds are used for ___ pain, rather than ___ pain and help pt’s who are ___. Caution w/the addition of ___ effects.
chronic, acute, suffering, sedating
Antidepressants, anticonvulsants, corticosteroids, benzodiazepines, antihistamines, analeptics, and muscle relaxants are all known as selected ___/___ meds.
adjuvant/coanalgesic
___ are typically used for chronic pain. Examples include med groups of: ___, ___, ___, and ___.
antidepressants, TCA, SSRI, SNRI, atypical
TCA’s include:
amitriptyline (Elavil), nortyptyline (Pamelor)
SSRI’s include:
fluoxetine (Prozac), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro)
SSRI’s have less analgesic effect than ___, but also fewer s/e.
TCA’s
SNRI’s include:
duloxetine (Cymbalta), venlafaxine (Effexor)
Anytime a pt c/o numbness, tingling, burning, pressure, hot, or cold sensations, an ___ medication is good tx.
anticonvulsant
Anticonvulsants include:
gabapentin (Neurontin), cabamazepine (Tegretol), valproate (Depakote), clonazepam (Klonopin), phenytoin (Dilantin), topiramate (Topamax), lamotrigine (Lamictal), pregabalin (Lyrica)
___ is typically used for trigeminal neuralgia.
cabamazepine (Tegretol)
