Pharm 26 Narcs & Non-Narcs

Front 1

What is Pain?

Back 1

"Whatever the patient says it is" and "exists whenever the patient says it does".

Front 2

Physiology of pain.

Back 2

Pain is received from the sensory nerves & travels to the posterior horn of the spinal cord. In the spinal cord these nerves form synapses with spinal cord nerves that then send impulses to the brain.

Front 3

A & C fibers

Back 3

A delta fibers (small and large) - Fast traveling. Respond to sharp pain as recult of mechanical stimulation. OPENS the gate and enhances the preception of pain. -C delta fibers (small fiber only) slow traveling. Respond to dull, burning, aching pain as a result of mechanical, thermal or chemical stimulation. OPENS the gate and enhances the preception of pain.

Front 4

Endorphins & Enkephalins

Back 4

Known as "natural painkillers". They bind to the opiate receptors which close the gate ans stop perception of pain. (morphine works the same way)

Front 5

Somatic pain

Back 5

bone, muscle, soft tissue

Front 6

Visceral pain

Back 6

deep tissue or organs

Front 7

Neuropathic pain

Back 7

shooting, burning (nerve pain)

Front 8

Acute pain

Back 8

Immediate phase of injury

Front 9

Chronic pain

Back 9

longer than 6 months

Front 10

Cancer pain

Back 10

progressive and debilitating

Front 11

Vascular pain

Back 11

vascular system, i.e. migraine headache

Front 12

Referred pain

Back 12

pain in different location than injury

Front 13

Pahntom pain

Back 13

pain in limb that was amputated

Front 14

Phychogenic pain

Back 14

real pain R/T psychological factors, not physical factors

Front 15

Central pain

Back 15

resulting from toumors, trauma to brain such as CVA

Front 16

Breakthrough pain

Back 16

Transitory flare-ups of pain over baseline pain

Front 17

Incidental pain

Back 17

R/T a specific movement or result from an injury at that specific moment

Front 18

Tolerance

Back 18

capacity for enduring a large amount of substance with out adverse effects / decreased sensitivity to the substance

Front 19

Cross-tolerance

Back 19

one drug or substance, such as ETOH, causing decrease in the effect of morphine

Front 20

Physical dependence

Back 20

will have physical withdrawl symptoms when taken off a drug but can be weaned off.

Front 21

Addiction

Back 21

Includes physical and psychological dependence. Also tolerance

Front 22

Signs and symptoms of pain

Back 22

Contorted facial expressions, changes in posture, Vitals, Sweating, restleness, lethargy / fatigue, depressed and unresponsive to stimuli

Front 23

Assessment of pain

Back 23

Dont just ask what pain is on a scale of 0-10. Have pt describe their pain, location of their pain,

Front 24

New pain / Old pain

Back 24

Never had it before. Old or same as before

Front 25

Non pharmacologicial intervention for pain

Back 25

Relaxation, guided imagry, biofeedback, music, massage, TENS

Front 26

How do opiods stop pain

Back 26

Works in the CNS. Bind to opiate receptors and prevent "substance P" from being released preventing pain to be experienced.

Front 27

Side effects of opiods

Back 27

sedation, disorientation, respiratory depression, constipation,

Front 28

Opiod antagonist

Back 28

Opiod antagonist reverses the effects of agonist

Front 29

Withdrawl symptoms of opiod antagonist

Back 29

Anxiety, irritability, chills, hot flashes, joint pain, diaphoresis

Front 30

Agents that may cause increased CNS depression when given with opioids

Back 30

Alcohol, antihistamines, benzodiazepines, antipsychotics

Front 31

What other therapeutic is codeine used for besides pain?

Back 31

Antitussive for cough

Front 32

Adverse effects that Meperidine may have on the elderly

Back 32

Can cause buildup of metabolites within 48hrs. Can become toxic causing seizures.

Front 33

Why do opioids cause N/V and constipation

Back 33

The act outside of the CNS (peripherally).

Front 34

Underlying cause of migraine headaches

Back 34

May be related to bradykinins (inflammatory response), serotonin or response to hormones/chemicals.

Front 35

Agents used to treat migraine headaches

Back 35

Ergot derivatives (ergotamine) ot Triptans (sumatriptan, Imitrex)

Front 36

Adverse effects of Ergot derivatives and Triptans (used to treat migraine headaches)

Back 36

> b/p, numbness, tingiling, dizziness, vertigo, numbness, tingiling in fingers/toes, muscle pain in extremities

Front 37

Triptan advantages

Back 37

< migraine, available by nasal spray, oral and SQ

Front 38

Migraine headaches

Back 38

One side of head, GI and CNS effects, personality changes, more common in women

Front 39

Tension headaches

Back 39

usually occurs at times of stress, entire head, 30 min - 1 week

Front 40

Cluster headaches

Back 40

Usually begin during sleep and involve sharp eye pain that radiates to neck and shoulde with sweatinf, flushing, tearing and nasal congestion, 15-90 min. Dialtion of blood vessels cause pressure on trigeminal nerve.

Front 41

Sinus headaches

Back 41

Behind browbone, cheekbones

Front 42

Nursing concerns when giving when givion Opioids by IM injection

Back 42

Monitor for irritation and extravasation. Caution at sites of poor circulation or chilled tissue (causes altered absorption)

Front 43

Proper administration of narcotic medication for pain

Back 43

monitor timing of doses, stay on schedule, administer promptly to prevent > in pain, use non drug therapy to < pain, monitor pain level, monitor pain response, monitor vitals,