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NURS2500: Pathophysiology/Pharmacology/Assessment > Week 4 - Pain Medications and Management > Flashcards

Week 4 - Pain Medications and Management Flashcards

1
Q

What is multimodal therapy? (2)

A
  • There is no single, universal treatment for pain
  • using two or more classes of analgesics or interventions to target different pain mechanisms in the PNS or CNS
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2
Q

How does multimodal therapy work? (3)

A
  • purposeful combination of pain medications to maximize relief and prevent gaps in treatment is effective
  • may allow lower doses to each of the drugs, which can lead to few side effects
  • offers promise of reducing the incidence of prolonged or persistent postsurgical pain
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3
Q

Why is multimodal therapy different for complex chronic pain?

A
  • combining analgesics like anticonvulsants, antidepressants and local anesthetics to target differing underlying mechanisms
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4
Q

What are the 3 analgesic groups for pain?

A
  1. Nonopioid analgesics
  2. opioid analgesics
  3. Adjuvant analgesics
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5
Q

What are the different nonopioid analgesics? (3)

A
  • acetaminophen
  • nonselective NSAIDS (ibuprofen, naproxen, ketorolac)
  • COX-2 selective NSAIDS (celecoxib)
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6
Q

What are the different opioid analgesics? (4)

A
  • morphine
  • fentanyl
  • hydromorphone
  • oxycodone
    i think they are a brand class that block transmission of nocireception to CNS
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7
Q

What are the different adjuvant analgesics? (3)

A
  • local anesthetics (bupivacaine, ropivacaine, lidocaine)
  • Anticonvulsants (gabapentin, pregabalin)
  • Antidepressants (desipramine, nortiptyline, duloxetine)
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8
Q

What are the medications on the WHO step-ladder for mild pain? (5)

A

NON-OPIOIDS, pain 1-3
- ASA
- Acetaminophen
- NSAIDS
- Adjuvants

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9
Q

What are the medications on the WHO step-ladder for moderate pain? (7)

A

WEAK OPIOIDS, pain 4-6
- A/Codeine
- A/Hydrocodone
- A/Oxycodone
- A/Dihydrocodeine
- Tramadol
+- Adjuvants

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10
Q

What are the medications on the WHO step-ladder for severe pain? (8)

A
  • pain 7-10
  • Morphine
  • Hydromorphine
  • Methadone
  • Levorphanol
  • Fentanyl
  • Oxycodone
    +- Adjuvants
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11
Q

As mentioned earlier, what is the first rung of WHO analgesic ladder medications? (8)

A
  1. NSAIDS
    - salicylates
    Aspirin
    - propionic acid derivates
    —–Ibuprofen (motrin, Advil)
    —– Naproxen (naprosyn)
    - Selective COX-2 inhibitors (celcoxib (celebrex))
    - Acetaminophen - similar to NSAIDS, but no anti-inflammatory action
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12
Q

What are the characteristics of non-opioids? (3)

A
  • used for mild pain
  • available OTC
  • There is a ceiling, so exceeding doses has no benefits
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13
Q

How NSAIDS work in the body diagram

A
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14
Q

The second rung on the pain ladder are opioids with non-opiods. What level of pain are they used to treat? (2)

A
  • Most effective and primary drugs for moderate to severe pain
  • Weak opioids with Acetaminophen
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15
Q

What can opioids with non-opioids cause? (5)

A
  • sedation
  • euphoria
  • constipation
  • Respiratory depression
  • urinary retention
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16
Q

The second rung on the pain ladder are opioids with non-opioids. Why can they be risky to use? (2)

A
  • with continuous use, tolerance develop (may need.a stronger opioid or increase the dosage)
  • can also result in physical dependence (NOT the same as addiction)
17
Q

What type of pain is opioid analgesics used for? (2)

A
  • Mainstay in management of moderate to severe nociceptive types of pain
  • postoperative, surgical trauma and burn pain
18
Q

How do opioid analgesics work (3)

A
  • produces effects by interacting with opioid receptor sites located throughout the body
  • like in peripheral tissues, GI system, spinal cord and brain
  • binds to receptor sites, produces analgesia AND unwanted side effects
19
Q

What are the unwanted side effects of opioid analgesics? (3)

A
  • slowing of GI
  • Constipation
  • respiratory depression
20
Q

How do pure opioid agonists work? (2)

A
  • bind primarily to the mu-type receptors in the CNS
  • first line for mild-moderate pain
21
Q

What does it mean for pure opioid analgesics to have to ceiling effect? (3)

A
  • increase dosage produces increased pain relief
  • can adjust based on pain severity
  • subject to abuse but rare when used appropriately
22
Q

What are the 3 pure opioid agonist?

A

morphine, fentanyl, hydromorphone

NURS2500: Pathophysiology/Pharmacology/Assessment (107 decks)

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