week 9

What is nociceptive pain?

Pain caused by tissue damage

What is neuropathic pain?

Pain from damage to nerve cells

What is breakthrough pain?

Persistant pain that has been aggravated

What are clinical manifestations of pain? (4)

• Increased BP, HR, and RR

• Diaphoresis

• Pallor

• Dialated pupils

How does Acetaminophen treat pain?

Inhibits synthesis of prostoglandins

What is the difference between NSAIDs and Acetaminophen?

NSAIDs have anti-inflammatory properties, where Acetaminophen does not

What is the antidote to Acetaminophen?

Acetylcysteine

How do salicylates (Aspirin) treat pain?

Reduces the production of prostoglandins

What is important to remember about Aspirin?

Children should not take Aspirin due to the risk of Reye’s syndrome

What are the adverse effects of Aspirin? (2)

• GI distress

• Bleeding

How do NSAIDs treat pain?

Inhibit cyclooxygenase and prevent formation of prostoglandins

What are adverse effects of NSAIDs? (4)

• GI distress

• Bleeding

• Renal failure

• Stevens-Johnson syndrome

What is Stevens-Johnson syndrome?

a rare, serious disorder of the skin and mucous membranes that starts with flu-like symptoms, followed by a painful rash that spreads and blisters. Then the top layer of affected skin dies, sheds and begins to heal after several days.

How do selective COX-2 inhibitors treat pain?

Inhibits the enzyme COX-2 that is required for the synthesis of prostoglandins

What are selective COX-2 inhibitors usually used to treat?

Pain associated with osteoarthritis and rheumatoid arthritis

What are the 5 opioid receptors?

• Mu

• Kappa

• Sigma

• Delta

• Epsilon

What are the most important receptors for pain management? (2)

• Mu

• Kappa

What do opioid agonist drugs do to receptors?

stimulate receptors

What do opioid antagonist drugs do to receptors?

Block receptors

What does equianalgesic dose mean?

A dose of one analgesic that produces pain relieving effects equivalent to another analgesic

What is the “gold standard” drug for pain relief?

Morphine

What are adjuvants?

Drugs used in conjunction with opioid and non-opioid analgesics to either enhance or counteract its effects

What are 3 common drug classes used as adjuvants?

• Antidepressants

• Anti-seizure drugs

• Corticosteroids

What drugs may be effective for neuropathic pain? (2)

• Tricyclic antidepressants

• Gabapentin (Anti-seziure drug)

What is the basal rate? (Patient-Controlled Analgesia)

amount of medication infused every hour

What is dependance?

A physiological need for substance that results in withdrawal symptoms

What is tolerance?

An increasing need for a substance to achieve its effects

What is pseudodependance?

behaviours similar to those associated with addiction (like clock watching) that result from poorly managed pain

What are two medications approved to treat opioid use disorder?

• Methadone

• Buprenorphine-naloxone (Suboxone)