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100 Cards in this Set
- Front
- Back
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what increases endorphins (6)
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exercise-running
breif pain and stress sexual activity massive trauma placebos TENS/accupuncture? |
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what decreases endorphins (4)
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prolonged pain
stress MS ETOH |
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what are endorphins
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endogenous opiods
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pure Mu agonists medications (5)
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MS
methadone dilaudid demerol |
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Pure Mu antagonist meds (1)
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narcan
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Partial Mu agonists meds (1)
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buprenex
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Partial Mu antagonists meds (3)
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stadol
nubain talwin |
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what do agonists do
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turn on
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what do antagonists do
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turn off
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what do Mu meds do (6)
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analgesia
resp depression px dependence tolerance constipation euphoria |
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what do Kappa meds do (4)
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analgesia
sedation no px dependence no resp depression |
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what are the Kappa agonists (4)
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stadol
nubain talwin buprenex |
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what are the kappa antagonists (1)
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narcan
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are not analgesics or sedatives
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neuromuscular blockers
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should be avoided for longterm use
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demerol
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things to remember with meds (5)
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check equianalgesic chart
ATC analgesics titrate to effect 1st pass metab steady state |
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drug administration is balanced by drug elimination
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steady state
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when is steady state acheived
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5 half lives of the drug
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what is steady state independent of
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dose and frequency
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not related to steady state but will increase serum concentration
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loading dose
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given dose of the drug produces less analgesia or requires a larger dose for the same relief
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tolerance
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the point beyond which no additional analgesia is obtained
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ceiling effect
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altered physiological state produced by repeated administratin of an opiate
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px dependence
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Se of px dependence (7)
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tearing
yawning insomnia dilated pupils n/v diarrhea muscle spasms |
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behavioral respose characterized by overwhelming preoccupation with securing and using a drug
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addiction
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4 A's of Nsaids
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analgesia
antipyretic anti-inflammatory antiplatelet |
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when combined with narcotics often get better pain relief with less narcotic
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NSAIDs
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Se of NSAIDS
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Gi irritation
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what are the non-narcotic analgesics (NSAIDs) (3)
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aspirin
tylenol motrin |
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characteristics of aspirin
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analgesic
anti-pyretic anti-inflammatory antiplt |
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when is aspirin used (3)
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PEDs
rheumatic fever kawasakis |
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characteristics of tylenol
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analgesic
antipyretic |
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what is the dose of tylenol
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10-15mg/kg q 4-6hrs
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what is the max dose of tylenol in 24 hrs
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5
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motrin characteristics
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anti-inflammatory
anti-plt antipyretic anagesic |
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dose of motrin
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10mg/kg q 6-8hrs
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what is COX 1 protective of (2)
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Gi tract
renal plt aggregation |
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where is COX 2 found
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kidneys and CNS
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induced by noxious stimuli that cause inflammation and pain
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COx 2
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what are the Cox 2's (3)
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celecoxib (celebrex)
rofeccoxib (Vioxx) valdecoxib (Bextra) |
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characteristics of toradol (ketorolac) (4)
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NSAID analgesic/anti-inflam
IV/IM/PO 0.5-1.0mg/kg short term -5days |
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SE of toradol (3)
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ARF
elevation liver enzymes prolonged bleeding time |
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what is important with toradol in renal pts
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dose lower
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antagonists for opiates
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narcan
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narcotics-opiates characteristics
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Mu receptors
no ceiling effect narcan revers. |
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SE of opiates (6)
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resp depress
hypotension constipation euphoria hitamine release itching |
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what are the opiates narcotics (5)
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MS
fentanyl merperidine diluadid codeine |
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what is morphine
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opiate analgesic
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effects of morphine
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analgesic
sedation some immobility |
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characteristics of morphine (3)
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0.05-0.1mg/kg slowly
diute in peds-titrate peak for resp dep in 20min |
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antidote for morphine
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narcan
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Se of morphine (5)
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resp depression
hypotension itching flusing rash/hives |
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when is the peak for resp dep for morphine
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20min
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characteristics of fentanyl (6)
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oralet/IM/IV
1-2mcg/kg - titrate to effect rapid onset in 1-5min duration 1/2hr-1hr 100x more potent than morphine |
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what is fentanyl
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analgesia
sedation some immobilty |
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what is important with fentanyl (2)
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give slowly d/t skeletal muscle and chest wall rigidity
100x more potent than morphine |
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fentanyl lozenge (antiq) characteristics (6)
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approved in 1998
>15kg $6-15/lozenge Ca pain hard to control dose safety/packing issues |
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dilaudid characteristics (5)
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PO/IM/IV/R
7x more potent than MS IV onset STAT half life 2.5hrs .015mg/kg q 4-6 hrs |
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Demerol (meperidine) characteristics (6)
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duration 2-3 hrs
irritating to tissues not for long term use induces Szs not reversible 5 half lives to excrete 15-30hrs |
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SE of demerol (3)
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Szs
CNS excitation tremors |
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Narcan characteristics (4)
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Give IV slowly until desired response
onset 2min repeat q 2-3min duration 15-60min |
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what are the agonist/antagonists for kappa analgesia (3)
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nubain
stadol talwin |
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characteristics of nubain/stadol/talwin (5)
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kappa analgesia
blocks Mu pure agonists ceiling effect duration 3-6hrs onset 2-4min |
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what should be watched for when switching from mu to kappa
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w/d
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Se of Nubain (2)
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icreased ICp
resp dep |
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what does valium do (6)
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supresses muscle spasms
sedation antianxiety some immobility amnestic no analgesia |
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characteristics of valium (5)
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need to support airway
resp dep/apnea painful Im or IV doesnt mix well w/other meds resedation with PO in 6-8hrs |
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what does versed do (4)
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immobility
sedation amnesia antianxiolytic |
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usually used as a secondary agent in peds d/t being unpredictable
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versed
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characteristics of versed
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req's cardiac mtr
variety of routes Iv burns (10-15min) support airway |
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antidote for versed
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flumazenil
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benzos+morphine =
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resp dep
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characteristics of flumazenil (romazicon) (5)
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reversal for sedation/amnesia
rapid onset duration <1hr painful IV- give slowly 1/2-1min may cause Szs |
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USED FOR NEUROPATHIC PAIN
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TCAs
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what does lower dose of TCAs avoid (3)
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sedation
dry mouth urinary retention |
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used for neuropathic pain and primarily affets C fibers
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gabapentin
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reduce edema in tumor and nerve tissue, and used for bone mets
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gluccocorticoids
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used for neuralgia
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lidocaine patches
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Se of epidural (3)
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nausea
itching urinary retention |
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what are the meds for epidurals (4)
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bupivocaine
lidocaine MS fentanyl |
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characteristics of epidurals (3)
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assess n/v, resp function
mtr drng/insertion site mtr for 24 hrs after dc |
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acts on opiate receptors in spinal canal
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epidural
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onset and duration of MS in epidural
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on- 30-60 min
dur 6-24hrs |
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onset and duration of fentanyl in epidural
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on 10-15min
dur 4-5hrs |
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characteristics of PCA (8)
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more pt control
less anxiety pt can titrate quick relief basal/bolus/both loading dose no trauma after insertion mtr pattern of use |
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without loading dose of PCA how long does it take for basal rate to start working
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at least 3hrs
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what is effective pain mngt (3)
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recognizing pain
know pt's rights education to family/pts/etc |
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dissociative anesthetic
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ketamine
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how can ketamine be given for analgesia
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subanestheic doses
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characteristics of ketamine (3)
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rapid onset
short duration IV/IM/R |
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SE of ketamine (3)
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*nystagmus
*increases secretions(laryngospasms) *increases P,BP, CI, ICp |
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emergent reactins of ketamine are pretreated with what
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midazolam
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used for increased secretions with use of ketamine
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glycopyrolate
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what are barriers to pain with Geri's (3)
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belief that pain is normal
fear of opiods don't ever say pain---use aching/discomfort |
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estimated % of older adults to have pain
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58-70%
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what are the most common painful conditions in Geri's (4)
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musculoskeletal
osteoarthritis low back pain previous Fx sites |
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pain associated with what in Geris' (2)
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Px disability
psychosocial problems |
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Chronic pain in Geri results in what (5)
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depression
sleep disturbance decreased mobility decreased hlthcare utilization Px and social role dysfunction |
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what are some indicators of pain in the elderly (5)
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*sad/frightened
*chanting/callin out/profanity *fidgeting/restlessness/w/d *change in eating/sleeping *confusion/irritability |
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tx cautions for pain in elderly (4)
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*metabolize drug slower
*>risk for adverse effects *r/o Gi bleeding w/NSAIDS *multiple drug use (interactions) |
