NSG 533 Advanced Pharmacology
Exam 2 (94 questions and
answers)
pain
the most common symptom prompting patients to visit primary
care providers. More than 80% of patients who visit physicians
report pain. Often remains under treated.
nociceptive pain
pain from a normal process that results in noxious stimuli being
perceived as painful. Explained by ongoing tissue injury.
thermal, mechanical and chemical nociceptors that engage
"withdrawal" reflex followed by inflammatory response to protect
injured tissue
functional pain
pain sensitivity due to an abnormal processing or function of the
central nervous system in response to normal stimuli
neruopathic pain
Pain caused by lesions or other damage to the nervous system.
Diabetic peripheral neuropathy
progressive deterioration of nerve function that results in loss of
sensory perception
acute pain
is pain that occurs as a result of injury or surgery, under 3
months. Poorly treated acute pain can cause psychological stress
and compromise the immune system. Somatic acute pain is an
injury to skin, bone, joint, muscle and connective tissue. Visceral
,pain involves injury to nerves on internal organs. Treat
aggressively. Examples: cut hand, menstrual cramps.
chronic pain
can be intermittent or persistent, more than 3 months. Main
affects include a) effects on physical function b) psychological
changes c) social consequences and d) societal consequences.
Usually involving life threatening diseases such as cancers, aids,
progressive neurological diseases, end stage organ failure,
dementia. Management should be multimodal with cognitive
interventions, physical manipulations, pharmacological agents,
surgical interventions, and regional or spinal anesthesia.
chronic malignant pain
Painn is associated with a progressive life-threatening disease like
cancer, aids, neurologic diseases, end stage organ failure, and
dementia. Goal is pain alleviation and prevention. Dependence or
addiction is not a concern. Pain not associated with life
threatening disease and lasting more than 6 months beyond the
healing period is referred to as "chronic nonmalignant pain."
What are some non-pharmacological approaches to pain?
imagery, distraction, relaxation, psychotherapy, biofeedback,
cognitive behavioral therapy, support groups, and spiritual
counseling. Physical therapy, heat, cold, water, ultrasound, TENS,
massage and therapeutic exercise.
WHO 3 step analgesic ladder
* 1- nonopioid
* 2 - opioid for mild to moderate pain
* 3 - opioid for moderate to severe pain
WHO first step pain ladder
, mild pain/nonopioid analgesics such as NSAIDS or acetaminophen
w/ or w/out adjuvants (such as pregablin) .. "soreness." Med
examples: apap 1000mg q 6hrs, ibu600mg q6 hrs
NSAIDs
Non-steroidal anti-inflammatory drugs. associated with several
clinically significant contraindications and drug interactions.
NSAIDS are equally effective in analgesia, antipyretic and anti-
inflammatory effects. Choice should include STEPS (simplicity,
tolerability, evidence, price, safety). If patient fails therapy with
an agent from one class of NSAIDs, use of an agent from another
class is reasonable.
COX2 inhibitors
Celecoxib (Celebrex) selective agents (celecoxib) have ideal
indication in patients with high risk for GI bleed, high intolerance
of non-selective NSAIDS, or treatment failure with non-selective
agents. NSAIDs are of minimal value in neuropathic pain. NSAIDs
produce a flat dose response curve (celling effect) with higher
doses providing no greater efficacy than moderate doses.
Acetaminophen
Tylenol. blocks PG synthesis in CNS, inhibits peripheral pain
impulses. APAP does not interfere with COX 1 or COX2 and thus
has no anti-inflammatory benefits.
WHO pain ladder step 2
moderate pain: weak opioids (hydrocodone, codeine, tramadol) w/
or w/out nonopioid analgesics w/ or w/out adjuvants "every time I
do something, it hurts" med examples: apa325mg + cod 60mg q4
hrs
WHO pain ladder step 3
severe and persistent pain, potent opioids (morphine, tapentadol,
oxycodone, hydromorphone, fentanyl, w/ or w/out non-opioid
Exam 2 (94 questions and
answers)
pain
the most common symptom prompting patients to visit primary
care providers. More than 80% of patients who visit physicians
report pain. Often remains under treated.
nociceptive pain
pain from a normal process that results in noxious stimuli being
perceived as painful. Explained by ongoing tissue injury.
thermal, mechanical and chemical nociceptors that engage
"withdrawal" reflex followed by inflammatory response to protect
injured tissue
functional pain
pain sensitivity due to an abnormal processing or function of the
central nervous system in response to normal stimuli
neruopathic pain
Pain caused by lesions or other damage to the nervous system.
Diabetic peripheral neuropathy
progressive deterioration of nerve function that results in loss of
sensory perception
acute pain
is pain that occurs as a result of injury or surgery, under 3
months. Poorly treated acute pain can cause psychological stress
and compromise the immune system. Somatic acute pain is an
injury to skin, bone, joint, muscle and connective tissue. Visceral
,pain involves injury to nerves on internal organs. Treat
aggressively. Examples: cut hand, menstrual cramps.
chronic pain
can be intermittent or persistent, more than 3 months. Main
affects include a) effects on physical function b) psychological
changes c) social consequences and d) societal consequences.
Usually involving life threatening diseases such as cancers, aids,
progressive neurological diseases, end stage organ failure,
dementia. Management should be multimodal with cognitive
interventions, physical manipulations, pharmacological agents,
surgical interventions, and regional or spinal anesthesia.
chronic malignant pain
Painn is associated with a progressive life-threatening disease like
cancer, aids, neurologic diseases, end stage organ failure, and
dementia. Goal is pain alleviation and prevention. Dependence or
addiction is not a concern. Pain not associated with life
threatening disease and lasting more than 6 months beyond the
healing period is referred to as "chronic nonmalignant pain."
What are some non-pharmacological approaches to pain?
imagery, distraction, relaxation, psychotherapy, biofeedback,
cognitive behavioral therapy, support groups, and spiritual
counseling. Physical therapy, heat, cold, water, ultrasound, TENS,
massage and therapeutic exercise.
WHO 3 step analgesic ladder
* 1- nonopioid
* 2 - opioid for mild to moderate pain
* 3 - opioid for moderate to severe pain
WHO first step pain ladder
, mild pain/nonopioid analgesics such as NSAIDS or acetaminophen
w/ or w/out adjuvants (such as pregablin) .. "soreness." Med
examples: apap 1000mg q 6hrs, ibu600mg q6 hrs
NSAIDs
Non-steroidal anti-inflammatory drugs. associated with several
clinically significant contraindications and drug interactions.
NSAIDS are equally effective in analgesia, antipyretic and anti-
inflammatory effects. Choice should include STEPS (simplicity,
tolerability, evidence, price, safety). If patient fails therapy with
an agent from one class of NSAIDs, use of an agent from another
class is reasonable.
COX2 inhibitors
Celecoxib (Celebrex) selective agents (celecoxib) have ideal
indication in patients with high risk for GI bleed, high intolerance
of non-selective NSAIDS, or treatment failure with non-selective
agents. NSAIDs are of minimal value in neuropathic pain. NSAIDs
produce a flat dose response curve (celling effect) with higher
doses providing no greater efficacy than moderate doses.
Acetaminophen
Tylenol. blocks PG synthesis in CNS, inhibits peripheral pain
impulses. APAP does not interfere with COX 1 or COX2 and thus
has no anti-inflammatory benefits.
WHO pain ladder step 2
moderate pain: weak opioids (hydrocodone, codeine, tramadol) w/
or w/out nonopioid analgesics w/ or w/out adjuvants "every time I
do something, it hurts" med examples: apa325mg + cod 60mg q4
hrs
WHO pain ladder step 3
severe and persistent pain, potent opioids (morphine, tapentadol,
oxycodone, hydromorphone, fentanyl, w/ or w/out non-opioid
