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72 Cards in this Set
- Front
- Back
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Define acute pain
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immediate phase of response to an insult or injury resulting from tissue damage.
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Define chronic pain
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it may persist well beyond actural tissue injury and healing.
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Nociceptic pain is...
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caused by the activation of the delta and C nociceptors in response to painful stimuli, such as injury (tissue damage)
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Neuropathic pain is...
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the term used to represent pain in which the underlying pathology is abnormal processing of stimuli in the peripheral or central nervous systems. (follows a radicular or radiating pattern).
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Delta Fibers are
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fast traveling Myelinated and responsive to mechanical stimuli. They sense sharp stinging cutting or pinching pain.
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C fibers are
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are slow traveling unmyelinated and responsive to mechanical chemical hormonal or thermal stimuli. They sense dull burning or aching pain
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Explain the path pain takes in order to "sense" pain or not.
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Stimulus--> Nociceptors--> Release Substance P--> Afferent neurons--> Brain--> Efferent neurons--> Release Enkephalin--> Substance P is either blocked or inhibited.
If substance P is released you will feel pain. |
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The ________ has the greatest control over nociceptor functioning.
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Forebrain
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Name the inhibitory substances that block or inhibit Substance P.
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Opioids, serotonin, norepinephrine, and gamma-aminobutyric acid (GABA).
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Inhibitory substances bind with ___ ____ on primary _______ and ____ ____ neurons to prevent further transmission of painful stimuli.
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Receptor sites
afferent dorsal horn |
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Stimulation of the _____ ______ produces and emotional response to the physical stimulus of pain.
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Limbic system
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What components of pain have a Sensory-discriminative aspect.
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Physical
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What components of pain have a affective-motivational aspect.
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Emotional
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What encompasses the sensory dimension of pain?
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location, intensity and quality
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Nociceptors are found in...
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skin, muscle, connective tissue, circulatory system and abdominal pelvic and thoracic visera.
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Effective use of non-pharmacologic measures that may decrease the dose of narcotics include
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relaxation therapy, guided imagery, biofeedback, music distraction, exercise, transcutaneous electrical nerve stimulation, & massage
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C Nociceptors are _____ traveling, responsive to stimuli such as_______, _____, _____, ____, & _____. These are sensed as ______, _______ & ______.
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mechanical, chemical, hormonal, or thermal stimuli. They sense dull, burning, or aching pain.
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Delta fibers are _____ traveling Myelinated and responsive to ____ stimuli. They sense ____, ____, ____, or ____ pain.
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fast
mechanical sharp stinging cutting or pinching |
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Analgesics drugs used to
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treat pain.
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Opioids or narcotics act on
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the CNS to interfere with pain the experience.
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NSAIDs act on the
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peripheral nervous system interfering with prostaglandin synthesis and preventing the transmission of pain impulses.
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Drugs used secondarily for pain relief are known as
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adjunct analgesics or co-analgesics
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Pain is...
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what the person says it is. It is multi-dimensional and subjective
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Define Addiction
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It involves compulsive use of the drug for a secondary gain, not for pain control.
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Dependence is characterized by...
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a withdrawl or abstinence syndrome when a drug is discontinued; it represents an exaggerated rebound from its acute effects.
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Tolerance means that...
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the body has become accustomed t the effects of a substance and that the patient must use more of it to achieve the desired effect.
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Rescue dose is...
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As-needed dose of short-acting opioid to provide relief of intermittent breakthrough pain
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Breakthrough pain is...
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used to describe transitory flare-ups of pain over baseline in a patient receiving opioid therapy.
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Define Opioid Agonists
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share the same mechanism of action, differing only in their potency and pharmacokinetic properties.
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Define Opioid antagonists
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a drug that blocks opioid receptors, used primarily in the treatment of opioid-induced respiratory depression.
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Define opioid agnist-antagonist.
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mixed opiod effects, bing agonists at some receptors and antagonists at others.
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The prototype drug for Strong narcotic agonist is...
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Morphine
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The prototype drug for mild narcotic agonist is
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Codeine
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The prototype for narcotic agonist-antagonist is
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Pentazocine
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The antagonist for strong narcotic agonists analgesics is...
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Naloxone (Narcan)
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What are the indications for Morphine.
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*To treat moderate to severe acute or chronic pain.
*And for pain associated with MI *Pulmonary edema |
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Describe the pharmacokinetics of Morphine
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Onset PO=UK, SQ=20min, IM=30min.
Peak: PO=60min, SQ=50-90min, IM=30-60min Duration: PO, SQ, IM=4-5hrs 35% protein binding Half-Life 2-4hrs. |
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What are the Contraindications or precautions of Morphine
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Respiratory complications and Hypersensitivity.
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What are the adverse effects of Morphine
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RESPIRATORY DEPRESSION, apnea, respiratory arrest, cardiac arrest, shock, coma, confusion, sedation, hypotension, & constipation.
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What are the elements of "Core Drug Knowledge".
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Pharmacotherapeutics
pharmacokinetics Contrraindications and precautions Adverse effects |
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What are the elements of "Core Patient Variables".
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Health Status,
Life Span & Gender lifestyle, diet, & habits Environment Culture & inherited traits. |
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What are the Core Patient variables to consider when administering morphine.
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Respiratory status
Age Tolerance and/or Dependence Closely monitor patient Pain is what the patient says it is. |
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Name the agents that interact with Morphine.
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*barbiturate anesthetics
*cimetidine *esmolol *other CNS depressants (alcohol, other narcotic analgesics) |
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How would you maximize the therapeutic effects Morphine?
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Assess for pain:
Provoking factor Quality Radiate Severity Time (how long has it lasted) |
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What would you teach a patient and family about morphine?
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The purpose of the therapy.
The importance of rating pain accurately. |
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What should the nurse assess always before administering morphine.
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Respiratory Rate.
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What is the prototype drug listed under mild narcotic agonists?
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Codeine
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What are the pharmacotherapeutics of Codeine?
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Treat mild to moderate pain
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What are the pharmacokinetics of Codeine?
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absorbed by GI track
Peaks in 1-2hrs Metabolized in liver by the P-450 system. |
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What are the contraindications and precautions associated with Codeine?
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*Do not administer to patients that need to caugh.
*Do not give with other narcotics. |
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What are the pharmacodynamics of Codeine?
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Acts at specific opioid receptors in the CNS to produce analgesia, euphoria, and sedation.
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What are the adverse side effects of Codeine?
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Drowsiness, sedation, dry mouth, nausea, vomiting and constipation.
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What drug interactions does codeine have?
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Antihistamines, phenothiazines, barbiturates, tricyclic antidepressants, cimetidine, and alcohol.
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What is the prototype for narcotic agonist-antagonists?
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Pentazocine (Talwin)
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What are the pharmacotherapeutics of Pentazocine?
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Agonist to control pain.
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What are the pharmacokinetics of pentazocine?
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*Peaks in 1-1 1/2 hrs.
*Duration is 3 hrs. *Well absorbed orally and from SQ and IM sites hepatic metabolism. |
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What are the pharmacodynamics of pentazocine?
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Mixed agonist-antagonist. Stimulates kappa receptors much as morphine does but also exhibits weak antagonist effects at the mu receptors.
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What are the contraindications and precautions of pentazocine?
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Hypersensitivity
Use caution with respiratory conditions |
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What are the adverse effects for pentazocine?
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Nausea vomiting dizziness lightheadedness respiratory depression and euphoria
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What are the drug interactions for pentazocine?
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Alcohol and CNS depressants.
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How would you maximize the therapeutic effects of pentazocine?
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Provide environmental controls to reduce sensory stimuli and to aid relaxation
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How would you minimize the adverse effects of pentazocine?
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Ensure that safety precautions are used
in case of overdosage naloxone is indicated. |
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What should you teach your patients about Pentazocine?
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Teach adverse effects teach how to take the medication properly
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What was the ongoing assessment and evaluation be for pentazocine?
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Nurse would monitor the effect of pentazocine on motor control sedation and pain
adequate pain control should be achieved without adverse affects |
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Which law provided regulation regarding the manufacture and distribution of certain drugs in 1914?
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Harrison narcotic law
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What established the drug enforcement agency the DEA?
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The comprehensive drug abuse prevention and control act passed in 1970
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What was responsible for categorizing narcotics known as schedules in five categories?
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The comprehensive drug abuse prevention and control act (1970).
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Schedule 1 drugs are defined as
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Those with potential for abuse that is so high as to be unacceptable. Examples of which are LSD and heroin.
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Schedule 2 drugs are described as
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High potential for abuse and extreme liability for physical and psychological dependence. included in those are amphetamines, opioid analgesics, dronabinol, & barbiturates
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Schedule 3 drugs are defined as
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Intermediate potential for abuse and intermediate liability for physical and psychological dependence. These are known as non-barbiturate sedatives, certain non-amphetamine CNS stimulants, and certain opioid analgesics.
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Schedule 4 drugs are defined as
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less abuse potential then schedule 3 with minimal liability for physical or psychological dependence these drugs include certain sedative/hypnotics, certain anti-anxiety, some barbiturates, benzodiazephines, chloral hydrate, pentazocine, and proproxyphine
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Schedule 5 drugs are defined as
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minimal abuse potential. These are available without prescription to patients 18 years or older
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