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71 Cards in this Set
- Front
- Back
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Name the 6 Neurotransmitters (Excitatory)
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Prostaglandins
Bradykinin Substance P Histamine Serotonin Neuromodulators (Inhibitory) |
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Name the Four phases to pain
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Transduction
Transmission Perception Modulation |
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sensoral pain nerve fiber
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Nociceptor
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A physiological process that converts energy produced by pain causing stimuli into electrical energy
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Transduction
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A physiological process that moves the pain impulse down the nerve fibers
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Transmission
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What type of fast working peripheral nerve fibers send sharp, localized, and distinct sensations that specify the source of the pain and detect its intensity
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Myelinated A-delta fibers
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What type of slow working peripheral nerve fibers relay impulses that are poorly localized, burning and persistent
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Unmyelinated C fibers
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The point at which a person becomes aware of pain
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Perception
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Inhibitory Neurotransmitters
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Endogenous Opioids
Serotonin Norepinephrine Gamma aminobutyric acid (GABA) |
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A physiological process which inhibits pain
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Modulation
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A 1965 theory that suggested that pain impulses pass through an open gate and are blocked when a gate is closed. Closing the gate is the basis for nonpharmalogical interventions
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Melwack and Wall's Gate control theory
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The point at which a person feels pain
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Pain threshold
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Level of pain a person is willing to accept
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Pain tolerance
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List the different types of pain
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Acute
Chronic Chronic Episodic Cancer Pain Pain by Inferred Pathological Process Idiopathic Pain |
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Type of pain that is protective, has an identifiable cause, is of short duration, has limited tissue damage and emotional response
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Acute Pain
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Type of pain that lasts longer than 6 months and is constant or recurring with mild to severe intensity
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Chronic/Persistent Pain
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Type of pain that occurs sporadically over an extended period of time
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Chronic Episodic Pain
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Type of pain caused by tumor progression, pathological processes, invasive procedures, toxicities of treatment, infection and physical limitation
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Cancer Pain
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Pain distant from but related to the point of origin
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Referred Pain
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Type of Pain from an inferred pathological process that is characterized by normal processing of stimuli that damages normal tissues or has the potential to do so if prolonged. Usually treated with Opioids and/or Non-Opioids
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Nociceptive Pain
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List the 2 types of Nociceptive Pain
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Somatic
Visceral |
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Type of Pain that comes from bone, muscle, joints, skin or connective tissue, usually throbbing or aching in quality and is localized
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Somatic
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Type of pain that arises from internal organs such as the GI tract, and pancreas. It could have tumor involvement, or obstruction of a hollow viscus
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Visceral Pain
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Type of pain that is classified by inferred pathology and is characterized by abnormal processing of sensory input by the peripheral or central nervous system is usually treated with analgesics
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Neuropathic pain
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2 types of Neuropathic pain
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Centrally generated pain
Peripherally generated pain |
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2 Types of Centrally Generated Pain
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Deafferentation
Sympathetically Maintained |
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2 Types of Peripherally Generated Pain
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Polyneuropathies
Mononeuropathies |
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A type of centrally generated pain that has injury to either the peripheral or central nervous system
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Deafferentation Pain
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A type of centrally generated pain that is associated with impaired regulation of the autonomic nervous system
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Sympathetically maintained pain
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A type of peripherally generated pain that is felt along the distribution of many peripheral nerves
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Polyneuropathies
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A type of peripherally generated pain that is usually associated with a known peripheral nerve injury with pain felt at least partly along the distribution of the damaged nerve
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Mononeuropathies
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Chronic Pain in that absence of identifiable physical or psychological cause or pain perceived as excessive for the extent of a pathological condition
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Idiopathic
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Name 4 physiological factors that influence pain
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Age
Fatigue Genes Neurological Function |
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Name 4 social factors that influence pain
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Attention(to pain)
Previous experience Family and social support Spiritual factors |
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Name 2 Psychological factors that influence pain
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Anxiety
Coping Style |
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Characteristics of pain
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Onset and Duration
Location Intensity Quality Pain Pattern Relief Measures Contributing Symptoms Effects of Pain on the Patient |
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Classifications of pain by location
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Superficial or Cutaneous
Deep or visceral Referred Radiating |
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Involves stimulation of the skin with a mild electrical current
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Transcutaneous electrical nerve stimulation (TENS)
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The most common and effective pain relief
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Analgesics
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Name the 3 types of Analgesics
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Non-opioids, including acetaminophen and NSAIDS
Opioids also called Narcotics and Adjuvants |
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A variety of medications that enhance Analgesics or have Analgesic properties
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Adjuvants
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How do you treat overdoses of Acetaminophen and acetylcsyteine
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Mucomyst
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What is the maximum 24-hour dose for Acetaminphen and Aspirin
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4 grams
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Give 4 examples of opioids
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Percocet (Oxycodone)
Vicodin (Hydrocodone) Lortab(Hydrocodone) Ultracet (Tramadol) |
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Treatment of Acute post-operative pains begins with which classification of drugs
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NSAIDS
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NSAIDS inhibit the synthesis of what neurotransmitter
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Prostaglandins
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If you inhibit the synthesis of prostaglandins, this is what happens
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You inhibit cellular respnses to inflammation
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Compared to opioids what 2 side effects do not occur with NSAIDS
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Does not depress the central nervous system
Does not interfere with bowel or bladder function |
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Why is it not recommened to use NSAIDS in older patients
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Because is could cause GI Bleeding and Renal insufficiency
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Mild to moderate musculoskeletal pain in older adults is effectively managed with which drug
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Acetominophen
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Some patients with Asthma and/or allergies to Aspirin are sometimes allergic to which medication
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NSAIDS
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What is the only Cox-2 Inhibitor currently available
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Celebrex
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Which patients cannot receive celebrex?
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Patients with a sulfa allergy
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What classification of drug is normally prescribed for moderate to severe pain
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Opioid or opioid like analgesics
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How do opioids and opioid like analgesics work?
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They work by binding with opiate receptors to modify perceptions of pain
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Name two potential adverse effects for patients taking Opioids or Opioid like Analgesics
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Respiratoy Depression
Sedation |
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Describe the action to take if a patient experiences respiratory depression while taking Opioids
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Administer Naloxone(Narcan) 0.4 mg diluted with 9 mL of saline. Give 0.5 mL va IVP every 2 minutes until respiratory rate is >8 breaths per minute with god depth
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How often do you reassess a patient who has recreive Naloxone(narcan)?
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Every 15 minutes for 2 hours
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Why do you continue to reassess a patient after they have received Naloxone(Narcan)
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Since Naloxone has a shorter duration than that of the opioid, respiratory depression may return
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List additional adverse effects of Opioids?
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Nausea, vomiting, constipation, itching, urinary retention, myoclonus, and altered mental processes
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Which analgesic is not recommende, esp. in older adults because of its toxic metabolite ?
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Meperidine(Demerol)
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What should you consider before administering Opioids?
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Current treatments
Diseases/Conditions Organ(Kidney/Liver) function |
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What situations require special considerations when administering opioids?
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Breat-feeding mothers
Dialysis Patients Neurolgical conditions Respiratory conditions Abdominal Surgery |
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Name some Adjuvants which successfully treat neuropathic pain
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Tricyclic antidepressants
Anticonvulsants Infusional Lidocaine |
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Name an Adjuvant which relieves pain associated with inflammation and Bone Metastisis
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Corticosteroids
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Name 2 Adjuvants which are given for bone pain
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Biphosphonates
Calcitonin |
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Name 3 tolerance prone drug classes
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Opioids
Barbituates Nitrates |
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If a patient doesn't get up and ambulate while being treated for pain what 2 complications can develop
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Pneumonia
Thromboembolism |
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Reassesment time for for pain after administering oral medications
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30-45 minutes
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Reassessment for pain after administering intramuscular analgesics
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15-30 minutes
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Reassessment time for pain after administering IV medications
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5-15 minutes
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