Pain Management Quiz #2 Flashcards
What is another name for tract?
- Lissauer
- Module
- Funiculus
- Anterolateral
Funiculus
The primary afferent neuron originates in the periphery and terminates in the ____?
- Rexed’s laminae I-V
- Tract of Lissauer
- Dorsal root ganglion
- Reticular formation
Rexed’s laminae I-V
Secondary neurons transmitting pain terminate in the ___?
- Thalamus
- Cerebral cortex
- Pons
- Medulla
thalamus
Which funicular modulates pain?
- lateral spinothalmic
- anterolateral system
- ventral spinothalamic
- dorsolateral
dorsolateral
Perception of pain occurs once the signal is recognized by the ___?
- medulla
- cerebral cortex
- midbrain
- pons
cerebral cortex
Two types of second-order neurons exist. One is nociceptive. The other is ___?
- A delta
- C
- WDR
- A beta
WDR
What are the cardiovascular physiologic effects of acute pain(5) and the adverse outcomes related to each effect?
- increased HR—>dysrhythmias
- increased PVR—>angina
- increased ABP—>myocardial ischemia
- increased myocardial contraction—>myocardial infarction
- increased myocardial work—->myocardial infarction
What are the pulmonary physiologic effects of acute pain(5) and the adverse outcomes related to each effect?
- decreased VC—>vent/perfusion mismatch
- decreased TV—>atelectasis
- decreased TLC—>pneumonia
- muscle spasms(resp/abdominal)—>hypoventilation
- decreased ability to cough/deep breath
- ——>hypoxia/hypercarbia
What are the gastrointestinal physiologic effects of acute pain(3) and the adverse outcomes related to each effect?
- decreased gastric emptying—>nausea/vomiting
- decreased intestinal motility—>paralytic ileus
- increased smooth muscle sphincter tone
What are the coagulation physiologic effects of acute pain(2) and the adverse outcomes related to each effect?
- increased platelet aggregation—>thrombosis
2. venostasis—>DVT/PE
What are the immunologic physiologic effects of acute pain(1) and the adverse outcomes related to each effect?
- decreased immune function—>increased risk of infection
What are the genitourinary physiologic effects of acute pain(1) and the adverse outcomes related to each effect?
- increased urinary sphincter tone—>oliguria and urinary retention
What are 5 psychological adverse outcomes related to acute pain?
- fear
- anxiety
- depression
- feelings of helplessness
- anger
What are the 4 most important indicators of acute postoperative pain?
- the presence of preoperative pain
- patient fear regarding the outcome of his/her surgery
- patients who catastrophize pain
- expected pain postoperatively
What are 3 scales used in acute pain assessment?
- visual analog scale(a psychometric response scale which can be used in questionnaires)
- numerical rating scale(on a scale of 1-10 where is your pain?)
- Wong-Baker FACES scale(pediatrics/develop mentally challenged adults)
What is preemptive analgesia?
Technique used to treat pre-op pain by providing analgesia. Jury still out if it works
- its high controversial
- Multimodal(peripheral/central mechanisms)best approach
What are the three types of acute pain analgesics?
- Nonsteroidal Anti-inflammatory Drugs
- Opioids
- Analgesic Adjuncts
NSAIDs all possess what three properties?
- anti-inflammatory
- antipyretic
- analgesic properties
NSAIDs produce their therapeutic effects by ______ and thereby preventing ____________.
- inhibiting cyclooxygenase(COX)
- conversion of arachidonic acid to prostaglandins
In relation to acute pain, what are prostaglandins responsible for?
Prostaglandins(primarily PGE1 and PGE2) are responsible for sensitizing and amplifying peripheral nociceptors to the inflammatory mediators(substance P, bradykinin, and serotonin) which are released when tissue is traumatized.
prostaglandins lower the pain threshold! We want to prevent formation of prostaglandins
Cyclooxygenase(COX) exists in two isoforms: COX-1 and COX-2
What is COX-1 responsible for?
- responsible for platelet aggregation, gastric mucosal integrity and renal function
- inhibition leads to platelet inhibition, gastric irritation, renal microvasculature constriction.
Cyclooxygenase(COX) exists in two isoforms: COX-1 and COX-2
What is COX-2 responsible for?
-inducible enzyme that in the presence of inflammation releases prostaglandins, thereby mediating pain, fever, and carcinogenesis
What is the only COX-2 selective NSAID available in the US, and what type of patient is it contraindicated in?
- Celebrex
- contraindicated in known hypersensitivity to sulfonamides or ASA. Caution in asthmatics b/c COX-2 inhibitors can convert arachidonic acid to the precursor of leukotrienes, potentially causing bronchoconstriction
What type of NSAID is ketorolac(toradol)?
nonselective COX inhibiter(COX 1 and COX 2)
30 mg of ketorolac IM is = to ____ mg of morphine IM?
12 mg IM
Ketorolac’s use should be limited to?
limit its use <= 5 days
What is Ketorolac contraindicated in?
coagulopathies, renal failure, active PUD, GI bleeding, asthma, hypersensitivity to NSAIDs, and surgery that involves a high risk for postop bleeding
What is Acetaminophen used for?
- mainly analgesic and antipyretic properties with little anti-inflammatory effects
- excellent drug for multimodal therapy