Exam 4 - Non-Malignant Pain - Pcp 2011

Front 1

What is modulation?

Back 1

Modulation is the alteration of neural activity along the pain transmission pathway.

Front 2

True or false: if perception was removed from the pain processing system there would be no response to pain

Back 2

True - perception is required to fully respond to pain

Front 3

What is perception?

Back 3

Perception is the final stage of the pain signal process where pain becomes a conscious experience.

Front 4

True or false: pain is the most common reason for which individuals seek medical attention

Back 4

True - pain is the most common reason and cough is the most common symptom

Front 5

What is the definition of pain?

Back 5

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage

Front 6

True or false: nociception is the activation of nociceptors where stimuli are converted to electrical activity

Back 6

False - nociception is the physiologic process of activation of specialized neural pathways via tissue damaging stimuli or potentially tissue damaging stimuli.

Front 7

What is transduction?

Back 7

Transduction is the activation of nociceptors and the conversion of stimuli into electrical activity

Front 8

What is transmission?

Back 8

Transmission is when electrical activity is transmitted through the nervous system

Front 9

True or false: somatic pain is pain that arises from internal organs and visceral pain is pain that arises from other parts of the body besides internal organs.

Back 9

False - somatic pain is pain that arises from parts of the body that are not considered internal organs.

Front 10

True or false: large diameter fibers transmit sharp pain, small diameter fibers transmit dull pain.

Back 10

True - large diameter fibers are myelinated and transmit sharp, well localized pain whereas small diameter fibers are unmyelinated and transmit dull, poorly localized pain.

Front 11

True or false: pain is a physical and mental issue and therefore there is a neuropathic pain component

Back 11

True - hyperalgesia is an example of neuropathic pain

Front 12

True or false: patients who are in chronic pain may no longer exhibit signs of suffering

Back 12

True - patients may show no signs of suffering in chronic or persistent pain

Front 13

Define chronic pain

Back 13

Chronic pain is pain that persists beyond reasonable anticipated period of healing or a pain stated that is associated with an intractable or incurable disease.

Front 14

What are the (5) features of a neuropathic pain element? hint: BETSS

Back 14

Burning
Electric
Tingling
Shock-like
Shooting

Front 15

What are the (5) features of a somatic pain element? hint: SPLAT

Back 15

Sharp
Pressure
Localized
Aching
Throbbing

Front 16

True or false: chronic pain usually results in hypertension & tachycardia

Back 16

False - acute pain causes hypertension and tachycardia

Front 17

Define the PQRST process of a patient interview

Back 17

Palliation/provocation of pain
Quality of pain
Radiation of pain
Severity of pain
Temporal(time) of pain

Front 18

True or false: pain has no diagnostic test and so therefore is assessed using verbal scales or visual scales

Back 18

True - the key assessment tools of pain are verbal and visual scales

Front 19

Define the difference between hyperalgesia and allodynia

Back 19

Hyperalgesia is heightened response to pain
Allodynia is a painful response to something not normally painful

Front 20

True or false: insomnia, medicinal dependence, and depression are common responses to chronic pain

Back 20

True - these three features are all responses to chronic pain

Front 21

State the four "A's" of pain treatment outcomes

Back 21

Analgesia
Activites of daily living
Adverse Effects
Abberant Behavior - addiction

Front 22

What are some predictors of abberant behavior? hint: SAMANTHA

Back 22

Sexual abuse
Alcoholism
Marijuana
Age
Tobacco
History
ADD (or other psychologic disease)

Front 23

What are some strategies to address abberant behavior? hint: OPRAS visit

Back 23

Opioid agreement
Pill counts
Random urine tests
Addiction services
Short term scripts
Visits (frequent)

Front 24

Define the purpose of a rescue dose pain medication

Back 24

Rescue doses are used to alleviate episodic pain between dosing intervals - particularly in combination with long-acting opioid preparations

Front 25

How do you calculate a rescue dose for opioid therapy?

Back 25

10-20% of total daily opioid dose every 2-4 hours PRN

Front 26

What are some key issues with non-opioid analgesics?

Back 26

Impaired platelet aggreation
GI irritation and bleeding
Renal/hepatic issues

Front 27

What is the MOA for local anesthetics in topical analgesics?

Back 27

Local anesthetics block voltage-gated sodium channel mediated neuronal excitability

Front 28

True or false: the majority of local anesthetics are from the "caine" family and therefore allergies need to be addressed

Back 28

True - it is important to be aware of patient allergies in regards to "caines"

Front 29

What is the most typical indication for the use of Lidoderm?

Back 29

Lidoderm is indicated for post herpetic neuralgia

Front 30

What is the MOA for rubifacients and capsaicin?

Back 30

Both are peripheral acting analgesics. Rubifacients are counter-irritants that excite then desensitize nocicpetors whereas Capsaicin depletes substance P and calcitonin

Front 31

True or false: topical NSAIDs are useful because they provide low concentrations in the dermis thus preventing systemic toxicity

Back 31

False - topical NSAIDS can achieve high concentrations in the dermis

Front 32

True or false: diclofenac patch and gel are examples of topical NSAIDs

Back 32

True - the patch is approved for sprains and bruises with the gel approved for osteoarthritis

Front 33

True or false: it may be necessary to add sedatives to injectable local anesthetics to counteract their side effects

Back 33

False - injectable local anesthetics can cause cardiovascular/CNS/respiratory depression and thus have additive effects when taken with sedatives

Front 34

True or false: renal impairment may require monitoring and titration of morphine, merperidine, and propoxyphene

Back 34

True - these agents require close monitoring and titration in patients with renal impairment

Front 35

True or false: tolerance can occur during opioid use and thus patients with chronic opioid use will not experience N/V, sedation, respiratory depression, or constipation

Back 35

False - only N/V, respiratory depression, and sedation become tolerable.

Front 36

True or false: kappa-receptor opioid agonists, partial mu agonists, and mu-receptor opioid antagonists are used in labor

Back 36

True - these drugs do not cross the placenta and as a result are safe for patients in labor

Front 37

True or false: kappa-receptor opioid agonists + group are used in post-op because they do not affect the CNS

Back 37

False - kappa-receptor opioid agonists + group are not first line for post op because it can affect the post-op neural evaluation

Front 38

True or false: kappa-receptor opioid agonists + group are freely interchangable with opioids so long as the proper dosing adjustment is calculated

Back 38

False - antagonism occurs when switching between a kapp-receptor opioid agonist + group and opioid

Front 39

What is the recommended postoperative analgesic agent?

Back 39

Ketorolac is useful for postoperative analgesia because it avoids CNS effects but cannot be used in patients with bleeding risks

Front 40

What is the standard initial dose for PCA?

Back 40

1mg morphine is the standard initial dose for PCA and should be administered every 6-20 minutes at patient discretion.

Front 41

True or false: when converting from one opioid agent to another it is important to calculate the total daily equivalent dose and then reduce that amount by 25%

Back 41

True - different drugs mean different responses so a reduction of dose by 25% is a safety precaution that MUST be performed when switching opioid agents

Front 42

True or false: when a patient goes from oral morphine to IV morphine the vital signs should be monitored every 8 hours

Back 42

False - vital signs need to be monitored every 30 minutes for the first 4 hours after the first loading dose

Front 43

What are the steps to converting from oral morphine to IV morphine?

Back 43

1. convert total PO to total IV equivalent
2. calculate infusion rate for 24hr
3. administer loading dose if needed
4. calculate rescue dose

Front 44

What is the calculation for an IV rescue dose?

Back 44

50-200% of hourly infusion every 15 minutes PRN

Front 45

True or false: an IV morphine drip of 8mg/hr has a loading dose of 8mg

Back 45

True - the loading dose of IV morphine is equal to it's infusion rate.