PAIN FINAL - Lecture 2/10

Trephination

drilling or scraping a hole into the skull

What was the reason for performing trephination?

To release “evil spirits inhabiting your skull” by creating a hole for them to escape

T/F: Trephination was healthy

F, caused infection

Theriac

a treatment for pain, contains a mixture of roots, barks, leaves, flowers, seeds, oils

T/F: Theriac doesn’t work

F, it does reduce pain

What is the active ingredient in theriac?

Opium poppy

Which 2 ingredients have analgesic properties?

willow bark & opium poppy

What was the first morphine and pharmaceutical company?

Merck KGaA, Darmstadt, Germany, founded 1668

What year was Morphine out in the world?

1668

How do you make morphine?

Opium poppy + chemistry

Where and when did the first demonstration of anesthesia take place?

“Ether Dome”, Massachusetts General Hospital, 1846

Opiates

A drug that is based somehow on the structure of opium

Which route of drug administration is the hardest to perform?

Intravenous

Subcutaneous drug administration

Injection into the tissue just under the skin

Intramuscular drug administration

Injection directly into a muscle for faster absorption than subcutaneous

Intravenous drug administration

Injection directly into a vein for immediate effect

Transdermal drug administration

Drug absorbed through the skin, often via a patch

Implantation drug administration

Drug placed under the skin in a small device or pellet for slow, long-term release

Which route of drug administration is the fastest?

Intravenous

How do drugs know where to go in the body?

Drugs do not know where they’re going, they go everywhere they can, and only bind where they’re designed to

Pharmacodynamics

what the drug does to the body

Pharmacokinetics

what the body does to the drug

Patient-Controlled Analgesia (PCA)

patient gives themselves morphine (or another opiate) by a remote through an IV line, stop before too much

What is the more common side effect of opiates?

Constipation

Why do opiates cause side effects?

Because they bind to opioid receptors all over the body, not just at the target site

T/F: If Morphine was developed today, it would easy be approved

F

How prevalent is constipation among opiates users?

Up to 80%

Which of the following analgesics are NOT an NSAID?

Acetaminophen

NSAIDs

Drugs that work against inflammation, since a lot of pain is caused by inflammation

T/F: NSAIDs are special, they are NOT analgesics

F

OCT analgesic

Drugs that do not require a prescription

Why do drug companies sometimes mix drugs together?

To innovate and increase sales

What is acetaminophen used for?

It’s an analgesic, relieves pain but doesnt reduce inflammation

Which common drugs are NSAIDs?

Aspirin, Ibuprofen, Naproxen sodium

Morphine, Codeine and Fentanyl are examples of…

Opioids

Morphine and Codeine are examples of…

Opiates

What makes up the vast majority of drugs currently being sold?

OTC opiates, local anesthetics, and migraine drugs

What is the most common psychological treatment modality today?

Cognitive behavioural therapy

Ex. You text Cora who doesn’t reply for a few hours. Your automatic thought is probably “she’s mad at me”. Looking at it from another perspective “Maybe her phone died, maybe she’s busy” is an example of…

Cognitive behavioural therapy

Which type of doctor is most interested in pain management?

Anesthesiologists

What does EMG stand for?

Electromyograph

What does TENS stand for?

Transcutaneous electrical nerve stimulation

What does the suffix “-octomy” mean?

Incision

What does the suffix “-ectomy” mean?

Removal

In pain treatment, what might be added besides medication?

Stimulators or pumps

Which of the following is NOT one of the main pain treatment choices?

Radiological

What is the purpose of an EMG in pain treatment?

Measures the electrical activity in muscles

How does TENS help in pain treatment?

Sends mild electrical impulses through the skin to block pain signals or release endorphins

What is a vital sign?

Something a paramedic/nurse is required by law to measure and record

Why are doctors hesitant to make pain the 5th vital sign?

Because all the other vital signs are objective while pain is subjective

What are the 4 vital signs?

Pulse, Blood pressure, Temperature, Respiratory rate