Health Assessment Spring 26 > Acute Pain > Flashcards

Acute Pain Flashcards

(83 cards)

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1
Q

What is somatic pain?

A

Superficial: from skin, subcutaneous tissues, mucous membranes
Deep: From muscles tendons, joints bones

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2
Q

Visceral Pain

A

Parietal Pain: Localized to the area around the organ; sharp

Referred Pain: Dermatomes, think like a heart attack

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3
Q

Goals of pain control

A

-Optimal Patient comfort
-Attenuation of physiological responses to pain
-Preventing of development of chronic pain
-Control of anxiety/agitation

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4
Q

How to attain pain control goals?

A

Preemptive and preventive analgesia
Multimodal approach
Opioid free?

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5
Q

What are 2 biggest complaints in the hospital?

A

Pain and nausea

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6
Q

What are bad opioid side effects?

A

Addiction
Constipation
Nausea

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7
Q

3 phases of pain?

A

Acute pain
Chronic Nociceptive pain
Neuropathic pain

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8
Q

What patients have chronic nociceptive pain?

A

Cancer

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9
Q

DM and and fibromyalgia have. ____

A

Neuropathic pain

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10
Q

What kinds of disease can cause pain?

A

-Degenerative join/disc disease
DM
CV disease
Cancer

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11
Q

Considerations for pain in cancer patients?

A

Chronic pain
Large doses of anti emetics, opioids, immunosuppressant

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12
Q

Pain causes by immobility

A

Loss of functional status
-dementia :(
-CVA
Fracture surgery, amputation yadi yada yada

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13
Q

How do we manage end of life pain?

A
  • make them comfy
    -Could kill nerves causing pain (wtf)
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14
Q

Can we give ketamine for pain?

A

Hell yeah we can, it helps a lot with long term pain

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15
Q

RED FLAG SYMPTOMS

A

-CONSTITUTIONAL SYMPTOMS(POOP AND PEE)
- PAIN THAT WAKES PATIENT UP
-IMMUNOSUPRESSION
-SEVERE OR PROGRESSIVE NUEROLOGIC DEFECIT
-COLD PALE MOTTLED CYANOTIC
-NEW BOWEL BLADDER DYSFUNCTION
-SEVERE ABDOMINAL PAIN OR SIGNS OF SHOCK

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16
Q

Things can do that can cause/mimc red flag symptoms?

A

-hypoglycemia
-Lots of pressers
- Spinal causing nerve damage
-we could mask compartment syndrome
-nerve block classically could mask, but corndog says it improves finding

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17
Q

Consequence of poorly managed pain include

A
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18
Q

Do opioids blunt immune response?

A

Yes ):

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19
Q
A
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20
Q
A

Intensity theory
Men don’t tolerate pain very well
Strong emotional component to pain

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21
Q
A

Gate control theory
Lateral inhibition,

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22
Q

Acute Pain definition

A

Thermal, mechanical, and chemical damage with activate free afferent nerve endings

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23
Q

What happens with surgical incision?

A

Intentional trauma,
release of histamine and inflammatory
Peptides; Bradykinin
Lipids: Prostaglandins
Neurotransmitters: Serotonin

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24
Q

1st order neuron?

A

Site of injury to spinal cord?

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25
2nd order neuron?
spinal cord to thalamus
26
3rd order neurons
Thalamus to poscentral gyrus
27
A- Delta fiber properties
Myelinated Large diamater Fast velocity
28
What do A beta fibers transmit?
Light touch Proprioception
29
C fiber properties
Non myletinated Small SLow velocity
30
Transduction
Stimuli converted to AP
31
Transmission
AP conducted through nervous system
32
Modulation
Pain transmission alters afferent neural transmission (Dorsal Horn)
33
Perception
Integration of painful input into the somatosensory and limbic cortices
34
What is hyperalgesia? What can drug can cause this?
Increases sensitivity to pain Remifentanil
35
Allodynia
Stimuli not normally painful that are painful -Walking, light touch etc
36
What causes hyperalgesia? Primary vs Secondary
-tissue trauma releases local inflammatory mediators that can produce augmented sensitivity to stimuli - site of injury -increase neuron sensitive due to NMDA around area of injury
37
Pain sensitization graph
38
Neuropathic pain
Denervation of a body part causing numbness ouch
39
How does aging effect absorption?
Reduced gi motility and gi blood flow Gastric acid secretion decrease--> delayed onset of medications -Lyrica and Gabapentin decrease dosages
40
How does aging affect distribution?
Less protein Decrease volume of water Decrease muscles mass (robaxin) Proportion of body fat increases
41
Aging effect on metabolism, excretion/elimination
Decreases metabolism Decrease excretion/elimination need to dose on GFR (Vancomycin)
42
WHO pain relief ladder
Step 1: Non opioid Step 2: pain not improving-low dose opioid and non opioid Step 3: still in pain, stronger dose opioid
43
Analgesics chart
44
What does Mu receptor agonism do?
Analgesia, Respiratory depression, euphoria, reduced GI motility
45
What does Kappa agonism do?
Analgesia, dysphoria, psychosis, delusion/delirium, miosis, respiratory depression
46
What does delta agonism do?
Analgesia
47
48
Codeine:
3-Methoxymorphine Metabolized to morphine <12 no analgesia but can have side effects In Texas we can give 30mg 60mg no increased benefit
49
Codeine Interactions S/E Contraindications
The usual opioid alcohol The usual don't think too hard Hypersensitivity, iléus
50
Tramadol
Synthetic analogue + enantiomer Hits opioid, serotonin serotonin reuptake - enantiomer inhibts norepinephrine and a2
51
Metabolized tramadol:
metabolite is more potent be carerful with redosing 1/5 to 1/10 potent of morphine
52
Tramadol interactions
-Contraindicated in seizures - high N/V -Not associated with dependence, tolerance, addiction
53
Morphine
Friedrich Serturner
54
Morphine metabolites
Morphine 6 glucuronide- analgesia Morphine 3 glucuronide- adverse effects
55
Morphine dosing
-Depends on form -Well absorbed IM Duramorph, will not cross over to baby
56
Morphine Interactions
Avoid in patients with Renal impairment Morphine- 6 can accumulate Can give Low dose Benadryl 6.25mg) to combat histamine release
57
Oxycodone
-Semisynthetic, most used opioid -Made alone or with ASA/tylenol/ibuprofen -IR and CR
58
Oxycodone metabolism
Prodrug metabolized to oxymorphone Careful with renal patients as excreted
59
Methadone
-Good analgesic long 1/2 life up to 36 hours -can prevent long term addiction -Mu and NMDA, SSRI, MAOI
60
Methadone metabolism
-Carbamazepine Grapefruit juice and inducers -inactive metabolites
61
Methadone dosing
-Steady state can take 10 days
62
Methadone interactions
63
Fentanyl
-Phenylpiperidine -High potency, rapid onset, short duration
64
Fentanyl metabolism
-norfentanyl, similar to normeperidne, excreted in kindest -elimination prolonged due to lungs serving as a reservoir
65
Fentanyl dosing
66
Hydromorphone Dosing:
-Longer effect that morphine - Has hyromorphone- 3 glucuronide don't really dose post op due to length of duration -.2-.5 mg 15-20 minutes to take effect
67
Hydrocodone
-Similar to codeine 6-8x more potent
68
Hydrocodone metabolites
Hydromorphone Norhydrocodone
69
Hydrocodone interactions
-Meiosis -can cause hypotension with barbs, Mg, CBB
70
Buprenorphine
Agonist antagonist
71
Buprenorphine metabolism
norbuprenorphine full agonist for mu delta Partial kappa
72
Bupreniorphine dosing
.3 mg =10mg of buprenorphine
73
Buprenorphine
Can cause withdrawal
74
What routes to we give patients that cannot swallow
Umm Topical Rectal IV SUBCU Transmucosal Transdermal
75
Longer term use benefits of opioids vs Risks
-Pain reduction, fewer pain spikes, increase functionality -Dependence, addiction, overdose, withdrawal, constipation, delirium
76
Prevention and treatment of side effects
Choosing the two-fer Opiod rotation Non-Pharm/Non opiods
77
Non-opiods
-Analgesis, anti-inflammatory, antipyretic -NSAIDS -Peripheral tissue to inhibit formation of pain causing substances
78
Acetaminophen
-Pain and fever -Good firs line little anti-inflammatory (might be a good thing)
79
Adjuvant medications for pain
Antidepressants -Increase transmission in spina cord to reduce pain -Does not work right away Anticonvulsants -Gabapentin -Phenytoin -Careful intraop (gaba causes sedation)
80
Skeletal Muscle relaxants useful?
-Good for muscle pain, tension, headaches -Good for a visceral response -PO and IV robaxin
81
Should we put topical cream for pain?
-work for a shorter period of time -Capsaicin cream -Bengay -Lidoderm 5% (50mg/ml)
82
Non-pharmacologic
-Massage/ROM -PT -Relaxation techniques -Hypnosis -Acupuncture -Radiation -Nerve blocks -Heat/cold -Aromatherapy -Yoga/Tai Chi
83
Do I want to die?
Yes
Health Assessment Spring 26
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