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Nurp 423 Exam 2 > Week 7 > Flashcards

Week 7 Flashcards

1
Q

A conscious experience that results from brain activity in response to noxious stimulus and engages the sensory, emotional, and cognitive processes of the brain.

A

Pain

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2
Q

The process that information about a noxious stimulus is conveyed to the brain.

A

Nociception

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3
Q

A physiological process whereby a noxious mechanical, chemical, or thermal stimulus in transducer via specialized receptors on primary afferents into an electrical impulse up to the brain.

A

Transduction

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4
Q

Once transduced and generated, nerve impulses are conducted to the CNS, using specific sodium channels.

A

Transmission

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5
Q

The process by which a noxious event is recognized as pain by a conscious person.

A

Perception

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6
Q

Inhibition of nociception impulses. Descending input from the brain stem influences central nociceptive transmission in the spinal cord. Neurons from the brain stem release 5HT and norepinephrine.

A

Descending modulation

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7
Q

These enhance normal modulation by interfering with reputable of 5HT and NE. In turn decreases the perception of pain.

A

Tricyclic antidepressants

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8
Q

Referred, colicky, diffuse pain in organs such as gall bladder, liver, intestines. Squeezing, cramping, bloating
Examples: UC, cholecystitis, peptic ulcer

A

Visceral pain

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9
Q

Well-localized pain caused by tissue damage to skin, soft tissue, muscle, or bone. Stabbing, aching, sharp
Examples: trauma, arthritis

A

Somatic

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10
Q

Injury or inflammation of nerves. Often coexists with somatic or visceral pain. Radicular, stocking like, burning, numb, electric, tingling
Examples: phantom limb syndrome, diabetic neuropathy, postherpetic neuralgia

A

Neuropathic

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11
Q

When is nociceptor pain functional in a fetus?

A

24 weeks

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12
Q

When is sucrose given and what age is it most effective?

A

Should be given 2 minutes before painful procedure

Most effective under 1 month of age

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13
Q

OLDCART:

A 
Onset
Location
Duration
Characteristics
Aggravating factors
Relieving factors
Treatment
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14
Q

Step 1 of WHO analgesic ladder:

A

Treat with non-opioid (Tylenol, Motrin)

+- adjuvant (gabapentin)

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15
Q

Step 2 of WHO ladder:

A

Moderate to severe pain or if fail step 1:
Use oral opioid + nonopioid (Percocet)
+- adjuvant

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16
Q

Step 3 of WHO ladder:

A

Severe pain or if fail step 2:
Treat with opioid for severe pain without nonopioid (oxycodone/ OxyContin)
Practice ATC dosing
Adjuvant medications

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17
Q

Tylenol MOA:

A

Believed to inhibit the synthesis of prostaglandins in the CNS and work peripherally to block pain impulse generation.

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18
Q

What is max Tylenol dose per day:

A

4g with monitoring

3g without monitoring

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19
Q

FDA recommends that no prescriber gives form of Tylenol that exceeds ___ mg/tablet

A

325

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20
Q

Pediatric Tylenol dosing:

A

10-15 mg/kg/dose every 4-6 hours

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21
Q

Side effects of Tylenol:

A

Skin rash, increased ALT/bilirubin

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22
Q

Tylenol contraindicated in:

A

Liver impairment

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23
Q

NSAIDs MOA:

A

Reversibly inhibits Cox 1 and Cox 2 enzymes, which results in decreased formation of prostaglandin precursors.

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24
Q

NSAIDs max dose per day:

A

Ibuprofen 3200 mg/day

Naproxen 1250 mg/day

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25
Q

Peds Motrin dosing:

A

5-10 mg/kg/dose every 4-6 hours (max 2400 mg/day)

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26
Q

Side effects of NSAIDs:

A

Edema, skin rash, epigastric, heartburn, ulcers

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27
Q

Monitoring parameters of NSAIDs:

A

Renal panel, CBC

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28
Q

Caution in NSAIDs:

A

HTN, renal disease, blood disorders,

Avoid in pregnancy

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29
Q

Topical eutectic mixture of lidocaine and prilocaine that anesthetizes skin before painful procedures

A

EMLA

30
Q

Indicated for acute pain related to sprains, strains, and OA

A

Voltaren gel (NSAID type gel)

31
Q

How many times a day can you use Voltaren gel?

A

Four

32
Q

Adjuvants to pain medication include:

A

SNRIs
TCAs
Anticonvulsants

33
Q

SNRI examples:

A

Cymbalta and Effexor

34
Q

SNRI MOA:

A

Potent inhibitor of neuronal serotonin and norepinephrine reuptake and a weak inhibitor of dopamine reuptake.

35
Q

Side effects of SNRIs:

A

Ha, nausea, drowsiness, xerostomia

36
Q

Clinical indication of SNRIs in pain:

A

Neuropathic pain, chronic musculoskeletal pain

37
Q

TCAs MOA in pain:

A

Central inhibition of norepinephrine and serotonin reuptake

38
Q

TCAs side effects:

A

Sedation, anticholinergic effects, postural hypotension, cognitive impairment

39
Q

Example of TCA and when to give?

A

Amitriptyline and give at night

40
Q

Avoid what population for TCAs?

A

The elderly: check EKG for conduction abnormalities prior to initiation

41
Q

Clinical indications for TCAs and pain:

A

Neuropathic pain and chronic pain

42
Q

Gabapentin MOA:

A

High affinity binding sites are located throughout the brain; sites correspond to the presence of voltage gates calcium channels which may modulate the release of exciting neurotransmitters which participate in nociception.

43
Q

Side effects of gabapentin:

A

Dizziness, drowsiness, ataxia, fatigue, peripheral edema

Give at night due to drowsiness

44
Q

Clinical indication for gabapentin and pain:

A

Neuropathic pain

45
Q

Pregabalin (lyrics) MOA:

A

Exerts antinociceptive and anticonvulsant activity; may also affect descending noradrenergic and serotonergic pain transmission pathways from the brain stem to the spinal cord

46
Q

Side effects of lyrica:

A

Peripheral edema, dizziness, drowsiness, ha, fatigue

47
Q

Monitoring parameters lyrica:

A

Sedation, weight gain, suicidality

48
Q

Indications for lyrica in pain:

A

Neuropathic pain

49
Q

Tramadol is for:

A

Moderate pain option that is a nonopioid that works on the opioid receptor.

50
Q

Tramadol MOA:

A

Bonds to mu-opiate receptors in the CNS causing inhibition of ascending pain pathways, altering the perception of and response to pain. Also, inhibits the reuptake of norepinephrine and serotonin.

51
Q

Side effects of tramadol:

A

Can lower seizure threshold, flushing, dizziness, ha, nausea, constipation

52
Q

Monitoring parameters of tramadol:

A

Sedation and suicidal ideation

53
Q

Caution with tramadol:

A

Risk for serotonin syndrome when combined with TCAs, SSRIs, SNRIs, and Triptans

54
Q

When stopping tramadol:

A

It needs to be tapered after chronic use

55
Q

Opioid MOA:

A

Bind to opioid receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; produces generalized CNS depression

56
Q

Primary opioid receptor:

A

Mu

57
Q

Opioid side effects:

A

Sedation, respiratory depression, nausea, vomiting, constipation, urinary retention, pruritus, confusion, and hypotension

58
Q

What opioids have active metabolites that can accumulate in renal impairment

A

Morphine, dilaudid, and codeine

59
Q

What opioid should not be used in opioid naive patients?

A

Fentanyl

60
Q

Pure opioid antagonist that competes and displaces opioids at opioid receptor sites

A

Naloxone

61
Q

Dose of naloxone:

A

0.4-2mg IV, IM, subQ, every 2-3 minutes

62
Q

Side effects of naloxone:

A

Flushing, HTN, tachycardia, agitation

63
Q

Caution with naloxone:

A

Patients with CV disease

64
Q

Monitoring parameters of naloxone:

A

RR, HR, BP, temperature, level of consciousness, ABGs, pulse ox

65
Q

When prescribing opioids patients must also have a:

A

Bowel regimen of motility focused laxatives

66
Q

What are options for bowel regimen with opioids?

A

Senna
Dulcolax
Miralax
(Promotility)

67
Q

What should be avoided for bowel regimen with opioids?

A

Bulk forming laxatives including Metamucil and citrocel

68
Q

Psychological dependence on the drugs. Often associated with drug seeking behaviors.

A

Addiction

69
Q

Expected effect of chronic opioid use. Presents as decreased duration of analgesia.

A

Tolerance

70
Q

Expected effect of chronic use. Not a sign of addiction. Withdrawal symptoms when opioid dose is markedly decreased.

A

Physical dependence

Nurp 423 Exam 2 (4 decks)

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