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72 Cards in this Set

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