Week 5 Study Guide (Pain)(complete) Flashcards
identify some of the adjuvant medications (drugs used in addition to primary pain meds) that may be used in the treatment of pain
Meds that are used in conjuction with other meds to help manage pain
NSAIDs
Corticosteroids**
Anti-depressants
Anti-convulsant
Local anesthetics
Muscle relaxants
Alpha 2 Adrenergic agonists
NMDA receptor antagonists
Cannabis
Hypnotics and Anxiolytics
Benzodiazepines
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: Opioid pain management
Weigh benefits vs risks
Risk of neonatal opioid withdrawal syndrome
Should avoid opioids while pregnant
If already on opioids, consider methadone or buprenorphine
Opioid receptor: Delta
Not fully understood
neurochemicals/transmitters involved in pain: Serotonin
(What does it affect? Which drugs mimics?)
Affect: Mood, sleep, appetite
Drug-mimic neurotransmitter: THC, Alcohol, Methamphetamine
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
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
Opioid receptor: Kappa
Some analgesia, sedation, decreased GI motility
Dysphoria
Opioid receptor: Mu
Mu (μ): Primarily pain receptors
Analgesia, respiratory depression, euphoria, decreased GI activity, sedation, and physical dependence
Visceral pain
Poorly localized (organ pain)
Deep, aching, cramping, pressure, referred
Activation of nociceptors resulting from stretching, distention, or inflammation
Examples: bowel obstruction, biliary colic
Nociceptive pain
Transmission
Step 2:
stimuli move from the peripheral nervous system, to the spinal cord to the ascending tract to the brain.
Drug-mimic neurotransmitter: Endorphins
Chemicals that mimic natural Endorphins
Naturally occurring morphine-like substances/Natural pain killer
Ex. Heroin, Opiates, Alcohol
Name the 2 most common side effects of opioids?
Respiratory depression and constipation
Nociceptive C-fibers
Unmyelinated, small in diameter, and slow-conducting fibers
Transmit dull, aching (visceral) pain that is diffuse
ViCCCCeral
Transduction
(When you drop a DUCE you’re releasing stuff )
Step 1:
nociceptors cause the release of serotonin, bradykinin, histamine, substance P, and prostaglandins
Naturally occurring morphine-like substances :
Endorphins
Enkephalins
Enkephalins
Naturally occurring morphine-like substances
This is all thats in the power point?
Modulation
4th Step/Phase of the pain impulse:
-Increasing or increading transmission of pain impulses in the spinal cord
What is Chronic pain? (non-malignant)
Persistent (>6 months)
Purposeless
May lead to depression
Increases with stress response
Often interferes with sleep
Autonomic adaptation
How do Opioid Agonists-Antagonists work
Contraindications?
-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
neurochemicals/transmitters involved in pain: GABA (think seizures)
Effect: Sedation, Anti-anxiety
Drug-mimic neurotransmitter: alcohol, barbituates, benzos
How do full opioid Agonists work? Medications and common side effects?
*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
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
neurochemicals/transmitters involved in pain:
Dopamine
Affect: Reward, stimulation, mood
Drug-mimic neurotransmitter: Cocaine, Heroin, Alcohol
Methamphetamine
neurochemicals/transmitters involved in pain: Norephinephrine
Affect: mood, sedation, constriction of blood vessels
Drug-mimic neurotransmitter: methamphetamine
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
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
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
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 medications in each group
Not sure if she means know about individual meds or to just kno what groups they belong in?
