Patho Exam 3 Flashcards
Unpleasant sensory and emotional experience associated with actual or potential tissue damage
Pain
Pain that results from injury to tissues
Nociceptive pain
Two types of nociceptive pain
Somatic and visceral
Injury to somatic issues (bones joints muscles)
Somatic pain
Injury to visceral organs (small intestines)
Visceral pain
Results from injury to peripheral nerves, response poorly to opioids
Neuropathic pain
Conscious experience of pain
perception
Pain impulses are enhanced by ______
prostaglandins, substance P (make nerve endings more sensitive to pain)
Brain suppresses pain by using endogenous opioid compounds such as:
endorphins/ enkephalins
what integrates and interprets pain sensations
parietal lobe of the cerebral cortex
what governs the emotional response to pain
cingulate gyrus
relay station- (to and from periphery)- “OUCH! thats a 10 on pain scale!”
thalamus
learning and memory- “don’t forget you did that, idiot”
hippocampus
treating the excruciating pain with narcotics not only activates the pain control system but also activates the dopaminergic reward system
Amygdala/nucleus accumbens
sudden onset pain, usually subsides once treated
acute pain
persistent or reoccurring, lasts 3-6 months, often difficult to treat
chronic pain
Areas of skin that send their sensory
information into specific spinal cord segments, visceral structures share these sensory afferents with skin areas
dermatomes
maximal intensity of the visceral pain are in the _____/______ areas, up neck, down inner arm
retrosternal/ percordial
Arises from internal organs such as the
intestine, bladder and heart, tumor involvement or obstruction
visceral pain
radiated from origin to different site
referred pain
drugs that relieve pain without causing the loss of consciousness
analgesics
most effective pain relievers available
opioids
Increasing the dose beyond the upper limit provides no greater analgesia
Analgesic ceiling
most dangerous acetaminophen interaction
alcohol
hepatotoxicity of acetaminophen can be reversed with ________
acetylcysteine
Works by preventing the hepatotoxic metabolites of acetaminophen from forming
acetylcysteine
Bad-tasting with odor of rotten eggs, Vomiting of oral dose common, Available in IV
acetylcysteine
overdose of acetaminophen
hepatic necrosis
hepatic necrosis symptoms
hepatic failure, coma, death
early symps: N/V, diarrhea, sweating, abdominal pain
Inhibits cyclooxygenase and has antiinflammatory,
analgesic, and antipyretic actions
ibuprofen
Adverse effects of NSAIDs
heartburn, ulceration and GI bleeding, acute renal failure, CV risk, MI, Stroke, thrombotic event
Opium was used primarily as a sedative and
as a
treatment for diarrhea
3 classes of opioid receptors
Mu, Kappa, Delta
Mu receptors:
Analgesia, respiratory depression,
euphoria, sedation, decrease GI motility and
physical dependence
Kappa receptors:
Analgesia, decrease GI motility
and sedation
the prototypical opioid and is used as
the standard of comparison for all other opioids
morphine
Other strong opioid agonists :
Fentanyl, Hydromorphone
moderate to strong opioid agonists:
Codeine, oxycodone, hydrocodone
Relieves pain without affecting other senses (for
example, sight, touch, smell, and hearing), no loss of conciousness
morphine
AE of morphine
resp. depression, constipation, orthostatic hypotension, urinary retention, cough suppression, increased ICP, Euphoria/dysphoria, sedation
State in which an abstinence syndrome will occur if the dependence-producing drug is abruptly withdrawn; it is NOT equated with addiction
Physical dependence
Drug use that is inconsistent with medical or social norms
abuse
Behavior pattern characterized by continued use of a psychoactive substance despite physical, psychologic, or social harm
addiction
Large organ behind stomach, Exocrine & endocrine gland, Role in regulation of
glucose homeostasis
pancreas
Hormone secreting part of pancreas
islets of Langerhans
4 Types of cells: pancreas
alpha, beta, delta, F cells
make & secrete glucagon
alpha cells
make and secrete insulin
beta cells
alpha cells, breakdown for energy
glucagon
beta cells, storage of excess energy
insulin
glucagon secreted
from pancreas (alpha)
hypoglycemia
Provides fuel through glycogenolysis,
breakdown of glycogen into glucose, Causes liver to release glucose to
tissues, increases BG
glucagon
aka dextrose, Primary source of energy in body, simplest form of carb, circulates in blood to meet requirements for quick energy
glucose
low BG level, Confusion, irritability,
tremors, sweating; coma and death
hypoglycemia
high BG level, polyuria, polydipsia,
polyphagia, weight loss, fatigue
hyperglycemia
Secreted from pancreas, Goes to liver, Breaks down glycogen into
glucose
glucagon
Storage of glucose in the liver
glycogen
Source of energy, Stored in liver as glycogen
glucose
Daily secretion of insulin
40-50 U
Increased _____ release when food is
digested
insulin
Balance of glucagon & insulin fail, Issues with insulin supply or poor use of available insulin
diabetes mellitus
Leading cause of adult blindness, end stage renal disease, & lower limb amputation, More that half have hypertension & high cholesterol
DM
Hgb A1C 6.5% or HIGHER=
- random glucose of 200mg/dL or HIGHER
DM
Measures glycosylated hemoglobin as a percentage of total Hgb
hemoglobin A1C
ADA normal < ____%
5.7%
ADA hgbA1C goal for patient
with diabetes < __-__%
6.5-7%
Autoimmune disorder, antibodies developed against b cells, Lack of insulin production/ production of defective insulin, B cell destruction for months before symptoms
Type 1 DM
Type 1 DM: 3 P’s
polyuria, polydipsia, polyphagia
Body cannot get glucose; breaks down
fat & protein- attempt for energy
weight loss in DM type 1
Body cells lack needed energy from
glucose
weakness/fatigue in Dm type 1
insulin resistance and/or inadequate insulin secretion, Combination of inadequate insulin secretion,
insulin resistance, ineffective use of insulin, pancreas makes SOME insulin
type 2 Diabetes mellitus
Distinction between type 1 and type 2 = presence of ______ ___
endogenous insulin
S/S of hyperglycemia- appear when 50-
80% of Beta cells are
no longer secreting
insulin
type 2 DM
autoimmune destruction, No endogenous insulin, Juvenile onset; < 20, normal insulin receptors and insulin treatment
Type 1 DM
overweight, age, family hx,
genetic, Normal to high insulin; then reduced, Decreased or defective receptors
treatment of weight loss, diet/exercise, oral meds, maybe insulin
type 2 DM
_____ restores patient’s ability to:
* Metabolize carbs, fats, & proteins
* Store glucose in the liver
* Convert glycogen to fat stores
insulin
number of units of insulin per milliliter
concentration
Deliver long and rapid/short acting insulin
basal-bolus insulin
long – acting insulin to keep BG from
fluctuating
basal
Rapid acting insulin to mimic burst
insulin in response to ↑ BG levels
bolus
