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Pain > test 2 > Flashcards

test 2 Flashcards

1
Q

poorly controlled pain may lead to __ pain states.

A

chronic

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2
Q

what does acute pain do to heart rate, PVR, ABP, myocardial contraction, and myocardial work?

A

increased

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3
Q

what does acute pain due to tidal volume, vital capacity, total lung capacity, etc?

A

decreased

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4
Q

what does acute pain do to gastric emptying, intestinal motility?

A

decreased, but increased sphincter tone

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5
Q

what does acute pain do to platelet aggregation and venostasis?

A

increased

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6
Q

what does acute pain do to immune function?

A

decreased

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7
Q

what does acute pain do to urinary sphincter tone?

A

increased

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8
Q

red flags

A

preop pain, fear of outcome, catastrophize pain, expect postop pain

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9
Q

what enzyme converts arachidonic acid into prostaglandins?

A

cyclooxygenase COX 1 and 2

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10
Q

what enzymes do nsaids work on?

A

cyclooxygenase 1 and 2 COX 1 and 2

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11
Q

What is the role of prostaglandins?

A

SENSITIZE nociceptors to pain, feel pain at a 4 instead of a 9

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12
Q

COX 1 is constituitive, what does that mean?

A

It is prolific in all body tissues, produced on a daily basis just like insulin

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13
Q

COX 2 is inducible, what does that mean?

A

Not produced on a daily basis, only when induced by inflammation, mediates pain, fever, carcinogenesis

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14
Q

What is COX 1 responsible for? and thus what would it do if we inhibited it?

A

responsible for platelet aggregation, gastic mucosal integrity, and renal function. If we inhibit it we have decreased platelet aggregations (aspirin), gastric irritation (ulcers) and renal microvascular constriction

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15
Q

When is celecoxib contraindicated?

A

hypersensitivity to sulfonamides (sulfa side chain) or ASA, caution in asthmatics d/t conversion of arachidonic acid into lukotrienes, causing bronchoconstriction

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16
Q

is toradol selective or non-selective COX inhibitor?

A

non-selective, therefore caution with coagulopathy, renal failure, ulcer, GI bleed, asthma, risk of postop bleeding

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17
Q

limit toradol use to __ days

A

5

18
Q

your patient weighs >50 kg, how much ofirmev and how often?

A

4 grams TOTAL per day, divided into 1000mg q 6 or 650 q 4

19
Q

your patient weighs <50 kg, how much ofirmev and how often?

A

max 75mg/kg/day, divided into 15mg/kg q 6 or 12.5 mg/kg q 4

20
Q

when is ofirmev contraindicated?

A

liver failure

21
Q

where is mu1 found?

A

supraspinal, in the periaquad

22
Q

where is mu2 found?

A

spine and periphery

23
Q

where are opioid receptors found in the spinal cord?

A

substantia gelatinosa Rexed lamina 2

24
Q

how do opioids work pre and post synaptically?

A 
pre = decrease adenylate cyclase and inhibit calcium channels
post = increase potassium excretion leading to hyperpolarization
25
Q

In time I can please everyone but susie sally

A

IV, tracheal, intercostal, caudal, paracervical, epidural, brachial, SAB/sciatic/femoral, subcutaneous

26
Q

fentanyl metabolism, metabolites, excretion

A

liver metabolism by N-dealkylation, inactive metabolites, renal excretion

27
Q

morphine metabolism, metabolites, excretion

A

hepatic glucuronidation, morphine-3 inactive / morphine-6 active (still asleep at 3 AM but active by 6AM), renal excretion

28
Q

hydromorphone metabolism, metabolites, excretion

A

liver conjugation, inactive metabolite,

29
Q

ketamine

A

NMDA antagonist, NMDA receptor at rest remains closed due to magnesium plug.

30
Q

NMDA receptors are activated by

A

glutamate

31
Q

activation of the a2 receptor (via clonidine or precedex) results in inhibition of ___

A

adenyl cyclase and decreased cAMP

32
Q

alpha agonists inhibit __ and activate __

A 
inhibit = presynaptic calcium channels
activate = postsynaptic potassium channels equals hyperpolarized
33
Q

where do alpha 2 agonists work in the brain?

A

locus coeruleus, posterior to the pons

34
Q

who is a poor candidate for a alpha 2 agonist?

A

depleted catecholamines, elderly, immunosuppressed, young and weak

35
Q

what’s the advantage of dexmedetomidine over clonidine?

A

7-10x more highly selective for alpha2 (1,620:1) vs. clonidine (220:1)

36
Q

side effects of precedex and clonidine?

A

sedation, hypotension, bradycardia

37
Q

dosing for precedex?

A

1mcg/kg bolus, infusion 0.2-0.7 mcg/kg/hr

38
Q

PCA bolus dose for morphine

A

0.5 - 2.5 mg

39
Q

PCA bolus dose for fentanyl

A

10-20 mcg

40
Q

PCA bolus dose for hydromorphone

A

0.05 - 0.25 mg (1/10 of the morphine dose)

41
Q

all PCA lockouts are basically

A

5-10 minutes

Pain (4 decks)

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