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23 Cards in this Set
- Front
- Back
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Gate Control Theory of Pain |
Spinal cord contains neurological gate that blocks or allows pain signals to travel to the brain |
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Three Systems Involving Pain Perception |
Sensory/discriminative: processes info about strength/intensity/time/location of pain; results in automatic withdrawal Motivational/affective: individual’s conditioned avoidance behaviors to pain Cognitive/evaluative: individual’s learned behavior to pain |
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Effects of Endorphins |
Neuropeptides that inhibit transmission of pain signals to spinal cord and brain Bind with mu receptors |
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Acute Pain |
Protective mechanism; begins suddenly and relieved when stimulus is removed Can be somatic, visceral, or referred pain Lasts less than 3-6 months Resolves with healing Responds to opioids SNS response |
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Uses of Opioid Agonist-Antagonists |
Pain relief, opioid dependence/withdrawal effects from opioid agonists |
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Uses of Opioid Antagonists |
Reversal of opioid overdose |
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Adverse Effects of Opioids |
Respiratory depression, drowsiness, confusion, nausea, constipation, physical dependence |
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Management of Opioids |
Dosing: pain status should be evaluated before and one hour after administration, should be given on fixed schedule Best practice: PO route, ATC dosing, use other nonopioids in conjunction, use one class of narcotics |
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Roles of Mu, Kappa, and Delta Opioid Receptors |
Enkephalins: body’s natural opioids Endorphins—bind with mu receptors Dynorphins—bind with kappa receptors Endomorphins—bind with mu receptors Have actions similar to morphine: respiratory depression, pain relief, euphoria |
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Meperidine (Demerol) |
Clinical use: relieves severe pain that can’t be treated by other opioids Should only be used for a few days Adverse effects: typical opioid side effects, when taken long-term a toxic metabolite can accumulate causing seizures, dyshoria, and agitation; can also cause withdrawal effects by blocking opioid agonists |
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Opioid Dependence |
Individuals taking opioids can develop tolerance to analgesia, euphoria, sedation, and respiratory depression This leads to increased dosing of the drug which can cause physical dependence and addiction Abuse liability |
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Chronic Pain |
Lasts longer than 3-6 months May not have single cause Opioids may not work Responses other than SNS May be sudden onset or gradual Produces behavior changes Peripheral or central neuropathic pain |
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Uses of Opioid Agonists |
Pain relief, sedation |
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Uses of Opioid Agonist-Antagonists |
Pain relief, treating opioid dependence/withdrawal effects from opioid agonists |
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Use of Opioid Antagonists |
Reversal of opioid overdose |
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Adverse Effects of Opioids |
Respiratory depression, drowsiness, confusion, nausea, constipation, physical dependence Overdose Triad: Respiratory depression Coma (hypotension) Miosis |
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Pure/Strong Opioid Agonists |
Activate mu and kappa receptors Include morphine, codeine, fentanyl, meperidine (Demerol), methadone, oxycodone, hydromorphone, oxymorphone |
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Morphine |
Clinical use: relieves moderate to severe pain, decreases BP and workload on the heart for MI Avoid with other CNS depressants: Phenergan, alcohol, barbiturates, benzodiazepines Adverse effects: respiratory depression, constipation, hypotension, urinary retention, miosis, cough suppression, biliary colic, tolerance and physical dependence |
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Opioid Antagonists |
Action: block opioid receptors Include naloxone (Narcan) |
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Uses of Opioid Agonists |
Pain relief, sedation, euphoria |
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Nonopioids for Mild to Moderate Pain |
Tylenol NSAIDs Nerve medications: Gabapentin, pregabalin Antidepressants: Cymbalta, Effexor Muscle relaxers Anesthesia: Lidocaine, epidurals, nerve blockers |
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Opioids for Mild to Moderate Pain |
Tramadol—opioid and nonopioid mechanisms Codeine with Tylenol Hydrocodone |
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Opioids for Moderate to Severe Pain |
Morphine Fentanyl Oxycodone/hydrocodone Methadone Suboxone Oxycodone (Oxycontin)/hydromorphone (Dilaudid) |
