pain mgmt

Question 1

Most reliable method for assessing pain

Answer 1

patients description of their experience

Question 2

what is the pain a result from

Answer 2

2 opposing neuronal pathways:

first pathway: origin to brain
- generating pain sensation

secondary pathway: originates in brain
- supressess impulses along first pathway
- diminished pain sensation

Question 3

what are pain receptors

Answer 3

mechanical
thermal
chemical

Question 4

what enhances pain sensitivity

Answer 4

prostaglandins

substance P

Question 5

Endogenous opioid compounds

Answer 5

released at synapse in brain and spinal cord to reduce pain

Question 6

Nociceptive pain

Answer 6

injury to tissues

somatic : sharp/loclized
visceral: poorly localized pain/ diffuse aching

responds to opioid analegics

Question 7

neuropathic pain

Answer 7

injury to peripheral nerves

sensations
- burning, jabbing tearing

responds poorly to opioid analgesics

responds positively to adjuvant analgesics (antidepressants, anticonvulsants)a

Question 8

adjuvant drug

Answer 8

used to increase the efficacy or potency of certain drugs

Question 9

what is pain in cancer patients caused by

Answer 9

caused by cancer itself
therapeutic interventions

metastases to bone= very common page

thearpeutic pain = 25%

Question 10

What type of drugs relieve pain for 90% of patients

Answer 10

Analgesics

Question 11

3 types of analgesics

Answer 11

Nonopiod (NSaids, acetaminophen

Opioid analgesics (oxycodone, fentanyl, morphine)

Adjuvant analgesics (amitriptyline, gabapentin, dextroamphetamine)

Question 12

Drug Selection Ladder

Answer 12

1) mild to moderate
- nonopioid analgesics

2) more severe pain/ persisting, INCREASING
- Opioids of moderate strength

3) Severe pain
- powerful opioids

Question 13

NCCN recomendations for pain mgmt

Answer 13

drug selection should be based upon patients pain intensity
-pain scale 4-10 directly with opioids

Question 14

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Answer 14

Aspirin
Ibuprofen

Question 15

NSAIDs mechanism

Answer 15

inhibits COX enzyme

result: pain relief, supression of inflammation and reduction of fever

Question 16

NSAIDs Adverse Effects

Answer 16

gastric ulceration- bleeding

under chemo: increased bleeding
- effects is increased due to suppression of bone marrow platelet production
- avoid aspirin –> irreversible inhibition platelet aggregation

Question 17

Acetaminophen

Answer 17

relieves mild to moderate

inhibits COX in CNS
- but not in PERIPHERY
- no antiflammatory
- no inhibition of plately aggregation

Question 18

acetaminophen drug interactions

Answer 18

can increase warfarin concentrations to toxic levels

Question 19

Opioid Analgesics

Answer 19

treatment for : moderate to severe cancer pain
- can relieve 90% all pain

Question 20

what should the route of cancer pain treatment be?

Answer 20

PO- preferred
or transdermal, rectal

Patient controlled analgesia
- indwelling IV or subQ cath
- pt controls
- prevents giving 2nd dose before first one takes full effect

Question 21

Adjuvant Analgesics

Answer 21

developed to treat depression, seizures, dysthmias

Question 22

what are adjuvant analgesics used for

Answer 22

complement effects of opioids
NOT A SUBSTITUTE

Question 23

what can adjuvant analgesics do

Answer 23

1) enhance opioid analgesia

2) manage concurrent symptoms that exacerbate pain

3) treat side effects

Question 24

What are some adjuvant analgesics

Answer 24

Amitriptyline (antidepressant)

Gabapentin (anti seizure drug)

Dextroamphetamine (CNS stimulant)

Question 25

Amitriptyline

benefit

adverse effects

Answer 25

reduces neuropathic pain

side benefit: elevates mood

adverse effects: orthostatic hypotension- dose at bedtime

Question 26

Gabapentin

Answer 26

relieve SHARP neuropathic pain by suppressing spont. neural firing

Question 27

dextroamphetamine

Answer 27

enhance opiod-induced analgesia

counteract opiod-induced sedation

rapid mood elevation