MME
________ is morphine milligram equivalent and can be found using conversion charts.
what are pain receptors knwn as
nociceptors: they are active when a stimulant could cause tissue damage
A(n) ________ is a drug that alleviates pain.
analgesic
Morphine
________ is the standard by which other opioids are measured.
CNS
Non-narcotic analgesics inhibits prostaglandin production in the ________.
what does the Peripheral Nervous System do
detects temperature, pressure, touch, pain
Sensation
Heat, cold, pressure, or chemical stimulus to sensory receptors and nerve endings in the peripheral nervous system
Pain Receptors
Perceive the sensation of pain when stimulated
Pain
as physically or emotionally sensed discomfort that is associated with acute tissue damage or a sensory system malfunction
how to combination opioids works
by relieving pain both centrally and peripherally
Inflammation
causes a cascade of events that untimely forms prostaglandins
what kind of pain involves bones, muscles and ligamant
nociceptive (Somatic)
what kind of pain involves kidneys, liver and intestines
nociceptive (Visceral)
what kind of pain involves nerve damage
neuropathic
what kind of pain involves dysregulated pain processing in the central nervous system
centralized
Somatic Pain
originates from injury to body tissue
Visceral Pain
originates from problems with internal organs
Neuropathic Pain
from damage of nerve tissue
Patient feels pain when there is no obvious stimulus for it
Sympathetic-mediated pain; centralized
Background pain
describes a constant level of pain
Breakthrough pain
describes when pain of greater intensity occurs intermittently for no particular reason
Provoked pain
describes pain that is more intense than background pain but has a clear cause
dependence
A physical and emotional reliance on a drug; Withdrawal when drug is discontinued or dose is reduced
addiction
Compulsive disorder leading to continued use of drug despite harm
what do nonnarcotic analgesics do
Inhibits prostaglandin production in the CNS
what does aspirin do
inhibits cyclooxygenase, the enzyme that converts arachidonic acid to prostaglandins
anesthesia
an intervention for intentional loss of feeling in a person’s body or part of the body when pain relief, anxiety relief, or muscle relaxation is required for patient care
neuraxial anesthesia
blocks sensation through injection of an anesthetic into the CNS without making the patient unconscious
local anesthesia
is used for local pain reduction
general anesthesia
causes reversible unconsciousness and absence of response to painful stimuli.
what are the most potent anethetics
gases and vapors
malignant hyperthermia
a rare disease; A sudden and rapid rise in body temperature with irregularities in heart rhythm and breathing Fever of 110°F or more
what is sufentanil
5-10 times more potent than fentanyl
Name 3 benzodiazepines induction agents
diazepam (Valium)
lorazepam (Ativan)
midazolam
esters
are short-acting and are metabolized by pseudocholinesterase in the plasma
Amides
are longer-acting and are metabolized by liver enzymes
what is a migraine
A severe, throbbing, unilateral headache accompanied by symptoms such as nausea, vomiting, photophobia, phonophobia, hyperesthesia
Aura
Visual or sensory disturbances such as seeing flashing lights; shimmering heat waves; bright lights; dark halos in visual field; blurred, cloudy vision; transient loss of vision
pathophysiology
Dilation of cerebral surface vessels
Caffeine
A CNS stimulant used in combination with other analgesics to treat headache
what is nitrous oxide (N2O) used for
Memory loss, mildly slowed breathing
what is Capsaicin used for
topical pain treatment
Principles of OAT
must be treated with respect and dignity
What is Buprenorphine-Naloxone
therapeutic agent has been shown to be lower risk to patients in terms of safety. The potential for diversion exists however overdose is less likely to be fatal.
what is Sustained Release Oral Morphine (SROM)
Due to the risks of toxicity associated with bolus absorption and diversion, extra safeguards need to be in place and are referred to in the NBCP directive.
what is iOAT
not considered first line of therapy, however, injectable hydromorphone is a newer agent considered for use in OUD. It is considered to have high potential for diversion and risk to patient outcomes
Dispensing documentation
Pharmacists and pharmacy technicians must document each step in dispensing of OAT. Given that medication used in OUD may require dilution, and that the agents are desirable for purposes of diversion, the documentation required is greater than that required for dispensing of typical (non-OAT) oral dosage forms
Clinical Documentation
Pharmacists must document patient assessment. Pharmacists or pharmacy technicians must document follow-up of patients for observed dosing or take-home dispensing
College documentation
The COllege must know who is providing OAT
what is a carry audit
they may be asked at any time to appear in the pharmacy and bring with them the remainder of their take-home doses and empty bottles, in their own lock box.
SROM
To limit potential for diversion, slow-release oral morphine is only to be provided via daily observed ingestion
iOAT
To limit potential for diversion and encourage safe injection technique, iOAT is only to be provided via daily observed self-administration in accordance with policy and practice guidelines
Education and Training Documentation
Pharmacy professionals must document within the pharmacy’s QMP that they have established and maintained competency for providing OAT for patients with OUD