Week 5 Study Guide (Pain)(complete) Flashcards
What is Acute pain?
Time limited
Cause is usually known
Diminishes over time
May have observable signs, such as:
-Increased blood pressure and/or heart rate
-Agitation
-Guarding
What is Chronic pain? (non-malignant)
Persistent (>6 months)
Purposeless
May lead to depression
Increases with stress response
Often interferes with sleep
Autonomic adaptation
Somatic Pain
Well-localized
Sharp, aching, throbbing, gnawing
Activation of nociceptors resulting from cutaneous, musculoskeletal, and deep tissues
Examples: Bone pain, soft tissue injury, incisional
Nociceptive pain
Visceral pain
Poorly localized
Deep, aching, cramping, pressure, referred
Activation of nociceptors resulting from stretching, distention, or inflammation
Examples: bowel obstruction, biliary colic
Nociceptive pain
What is Nociception and what are the 4 steps?
Is the normal function of the physiologic systems that lead to the perception of noxious stimuli as being painful (4-step process)
Transduction
Transmission
Perception
Modulation
Transduction
Step 1:
nociceptors cause the release of serotonin, bradykinin, histamine, substance P, and prostaglandins
Naturally occurring morphine-like substances :
Endorphins
Enkephalins
Transmission
Step 2:
stimuli move from the peripheral nervous system, to the spinal cord to the ascending tract to the brain.
Perception
Step 3:
Point at which person is aware of pain: threshol is reached (end result)
Activation of high brain stractures
Varies from person to person
Modulation
4th Step/Phase of the pain impulse:
-Increasing or increading transmission of pain impulses in the spinal cord
Nociceptive fibers A-delta
Thinly myelinated, large in diameter, and fast-conducting fibers
Transmit sharp, localized (somatosensory) pain that is sensitive to mechanical and thermal stimuli
Nociceptive C-fibers
Unmyelinated, small in diameter, and slow-conducting fibers
Transmit dull, aching (visceral) pain that is diffuse
Drug-mimic neurotransmitter: Endorphins
Naturally occurring morphine-like substances
Heroin, Opiates, Alcohol
Natural pain killer
Enkephalins
Naturally occurring morphine-like substances
This is all thats in the power point?
neurochemicals/transmitters involved in pain:
Dopamine
Affect: Reward, stimulation, mood
Drug-mimic neurotransmitter: Cocaine, Heroin, Alcohol
Methamphetamine
neurochemicals/transmitters involved in pain: Serotonin
Affect: Mood, sleep, appetite
Drug-mimic neurotransmitter: THC, Alcohol, Methamphetamine
neurochemicals/transmitters involved in pain: GABA
Sedation, Anti-anxiety
Drug-mimic neurotransmitter: alcohol, barbituates, benzos
neurochemicals/transmitters involved in pain: Norephinephrine
Affect: mood, sedation, constriction of blood vessels
Drug-mimic neurotransmitter: methamphetamine
Opioid receptor: Mu
Mu (μ): Primarily pain receptors
Analgesia, respiratory depression, euphoria, decreased GI activity, sedation, and physical dependence
Opioid receptor: Kappa
Some analgesia, sedation, decreased GI motility
Dysphoria
Opioid receptor: Delta
Not fully understood
How do full opioid Agonists work
*Bind to opioid receptors resulting in activation
-Activation of mu receptors leads to analgesia as well as respiratory depression, euphoria, and sedation
-Activation of the kappa receptors leads to analgesia as well as sedation and decreased GI motility
*Medications:
Morphine, Fentanyl, Codeine, Oxycodone, Hydromorphone, Meperidine, and methadone
*Common side effects:
respiratory depression, constipation, orthostatic hypotension, and urinary retention
*High risk of dependence; are controlled substances
How do Opioid Agonists-Antagonists work
-Bind to more than one opioid receptor site, but block other receptors
-Medications: Buprenorphine (Buprenex; Subutex), Pentazocine (Talwin), and Nalbuphine (Nubain)
-Cause many of the same side effects:
Sedation
Respiratory distress
Constipation
May have more psychotic reactions
-Relief of pain in labor and delivery
-Be careful if patient is on chronic opioid therapy for pain. Can cause withdrawal in these patients
-Careful in COPD
-Those experiencing MI or with severe CAD (cardiac stimulation). Do not give Pentazocine to cardiac patients
-Hepatic and Renal disease
How do Opioid Antagonists work?
-Bind tightly to opioid receptors but do not activate them.
-Used to reverse opioids when levels are too high
Drugs:
Naloxone (Narcan, Evzio)
Naltrexone (Revia)
-Work by reversing the effects of opioids:
Respiratory distress
Hemodynamic instability
Over sedation
Those with opioid addiction will experience withdrawal
-Can be given IV, IM, SQ, or as a nasal spray
Name the 2 most common side effects of opioids?
Respiratory depression and constipation
Older adults: Pain
Numerous myths and misconceptions:
Fear of addiction
Impaired cognition/dementia
Financial
Pain is NOT part of the normal aging process
Not all older adults will complain of pain
Younger nurses afraid to ask about (don’t want to be disrespectful)
*Older Adults
Risk for respiratory depression, polypharmacy, falls
Age-related changes in absorption, distribution, metabolism, and elimination
Start low, Go slow
Routine bowel regimen
Pregnant/Lactating: Pain
Weigh benefits vs risks
Risk of neonatal opioid withdrawal syndrome
Should avoid opioids while pregnant
If already on opioids, consider methadone or buprenorphine
Role of Naloxone
Opioid antagonist
A nasal spray (narcan) can counteract the effects of an overdose of heroine or other opioids. Nalaxone has a stronger attraction to the brain’s receptors and displaces the opioids long enough to allow breathing to resume.
identify some of the adjuvant medications that may be used in the treatment of pain
NSAIDs
Corticosteroids**
Anti-depressants
Anti-convulsant
Local anesthetics
Muscle relaxants
Alpha 2 Adrenergic agonists
NMDA receptor antagonists
Cannabis
Hypnotics and Anxiolytics
Benzodiazepines
Identify medications in each group
Not sure if she means know about individual meds or to just kno what groups they belong in?
