Part 2-1 (Management of pain and inflammation)

Question 1

Analgesics

Answer 1

Opioids

Nonopioids

Question 2

Anti-inflammatory agents

Answer 2

NSAIDs

Glucocorticoids

Question 3

Opioids

Answer 3

Narcotics

Morphine

Question 4

Nonopioids

Answer 4

NSAIDs

Acetominophen

Question 5

Opioid Analgesics

Answer 5

Alter pain perception
Used in moderate-severe pain
Indicated in: acute pain (sx, trauma) chronic pain (Cancer)

Question 6

Common opioids

Answer 6

Codeine
Fentanyl
Hydrocodone
Morphine
Oxycodone
Tramadol

Question 7

Types of Opioids

Answer 7

Strong agonists (Morphine, fentanyl)
Moderate agonists (Codeine, Oxycodone)
Antagonists (Naloxone)
Mixed agonists/antagonists

Question 8

Opioids primary mechanisms of action

Answer 8

Act on: Spinal cord dorsal grey matter, Brain

Bind to specific receptors located on presynaptic nerve terminals and postsynaptic neurons

Question 9

Opioids can also affect

Answer 9

Peripheral neurons: decrease sensitivity of neuron that initiates painful impulse
Descending pain pathways: remove inhibition of central anti-pain circuits

Question 10

Opioid Summary

Answer 10

1. Decrease synaptic activity in ascending pain pathways
2. Decrease sensitivity of sensory neurons that send pain
3. Activate descending anti-pain pathways

Question 11

Opioid mild adverse effects

Answer 11

Sedation
Mood changes
Confusion
Nausea
Constipation

Question 12

Opioid serious adverse effects

Answer 12

Orthostatic hypotension
Respiratory depression
Potential for addiction

Question 13

Tolerance

Answer 13

Need more drug to achieve same effect

Question 14

Physical dependence

Answer 14

Onset of withdrawal if drug suddenly stopped

Question 15

Opioid withdrawal physical symptoms

Answer 15

Body aches
Gooseflesh
Weakness/fatigue
Sweating
Tachycardia

Question 16

Risk of Opioid tolerance and dependence minimal if

Answer 16

Patient doesnt have hx of substance abuse
Pain is physiological
Dosage matches pt’s pain levels

Question 17

Role of PCA

Answer 17

Patient controlled analgesia
Pump prevents overdose
Smaller, more frequent doses

Question 18

PCA benefits

Answer 18

Better pain control with fewer side effects
Increased patient satisfaction
Requires patient awareness

Question 19

Opioid induced hyperalgesia

Answer 19

May increase pain in some patients

Opioids turn on nociceptive pathways that use glutamate

Question 20

Opioids rehabilitation concern

Answer 20

Be alert for orthostatic hypotension
Monitor for signs of respiratory depression
Monitor pain levels