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23 Cards in this Set
- Front
- Back
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What is the pathophysiology of acute pain vs chronic pain?
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Pathophysiology of Pain
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What is acute pain?
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relief of pain : highly desirable
dependence/tolerance :unusual psychological component: usually not present organic cause : common insomnia :unusual treatment goal: cure |
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What is chronic pain?
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relief of pain : Highly desirable
dependence/tolerance: common psychological component: often a major problem organic cause : not present insomnia :common treatment goal: comfort/rehab |
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What is noreceptive pain?
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Somatic-musculoskelatal tissues, well localozed
viceral- compression of orrgans, poorly localized, continual aching |
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What is neuropathic pain?
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injury to the peripheral or CNS, shooting, burning pain associated with paresthesias.
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What is addiction?
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Dfn: psychological dependence
compulsion to take a drug on a continuous or periodic basis in order to feel its psychic effects. tolerance may or may not be present. results in substantial harm to self or others. Myths of Addiction |
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What is a common Myth?
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Most chronic pain patients
will become dependent; almost none will become addicted. |
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What are the factors suggestive of addiction?
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individual or FH of substance abuse.
-(+) urine tox screen -legal intoxication and still highly functioning -pre-occupation with substance -manipulative behavior -multiple requests for early refills -multiple er visits -reported stolen or lost prescription -using several providers or pharmacies -hoarding |
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What is dependence?
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defn: physical dependence
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What is tolerance?
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defn: physiological adaptation
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What is common with treating people with pain?
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Addiction is rare in patients
treated for pain; tolerance and dependence are common. |
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What are the pharmacologic rules of treatment of pain?
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-identify the source
-use the least potent with the fewest side effects -titrate dose and administer for adequate duration -refrain from use on an as need basis -recognize analgesic side effect -avoid excess sedation -adjust the route of administration to the needs of the patient -use equianalgesic doses -do not use placebo therapy to diagnose psychogenic pain |
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What are the indications for apirin and NSAIDS?
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inhibit peripheral prostaglandins that are
important in nociceptor sensitization |
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What are the indications for semisynthetic opiod analgesics?
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Semi-Synthetic Opioid
Analgesics oxycodone (Percodan,OxyContin) hydrocordone (Lortab, Vicodin) Tramadol (Ultram) weak mu receptor -indicated for moderate to severe pain -binds to mu-opiod receptors but only partially antagonized by naloxone -less respiratory depression and histamine release. |
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What are opiod analgesics?
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The Opioids
Receptor Classification |
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What are the indications of morphine sulfate?
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Morphine Sulfate
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What are the indications for MS Contin?
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MS Contin
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What are the indications for Hydromorphone?
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hydromorphone (Dilaudid)
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What are the indications for transdermal fentanyl?
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fentanyl (Duragesic)
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What are the indications for naloxone?
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naloxone (Narcan)
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What are some contorversies in pain management?
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Controversies in Pain
Management |
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What are the indications for the geriatric population?
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Geriatric population
* elderly more susceptible to CNS side effects and constipation * elderly do better with & should be prescribed Percocet & Oxycontin more often * use lower doses |
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What are the principles of pharmacologic prescription for nonmalignant chronic pain?
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-safety is priority
-review potential side effects with both medical conditions and other meds -balance side effect profiles against efficacy -select combinations of meds from different classes -avoid irrational polypharmacy |
