Term
| 2 parts to Innate immunity |
|
Definition
| Bloodborn and physical barriers |
|
|
Term
|
Definition
Innate immunity (physical barriers)
Inflammatory response (protect from further injury, prevent infection, promote healing/repair)
Adaptive immunity (target invaders, memory) |
|
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Term
|
Definition
present at birth
prevents damage from environ (ROS)
Prevent infection by invaders |
|
|
Term
| 4 sites of infection prevention |
|
Definition
normal flora (skin and gut)
skin
mucous membranes
stomach acid |
|
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Term
|
Definition
| Tightly associated cells of the skin, and linings of GI, GU, and respiratory tracts |
|
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Term
| ___ is associated with psoriasis, influenza, inflammatory bowel disease and human immunodeficiency virus(HIV) |
|
Definition
| Dysregulated barrier function |
|
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Term
| Protective Function of Epithelial Cells |
|
Definition
Secrete biochemical substances that protect against infection
Create acidic environment
Mucus
Earwax
Perspiration
Saliva
Tears |
|
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Term
|
Definition
Nonpathogenic microorganisms
that reside on the body’s surface
Bacteria and fungi specific to that location |
|
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Term
| 3 Functions of normal flora |
|
Definition
GI tract: digest fatty acids, large polysaccharides, produce biotin, Vitamin K, aid in absorption of various ions (Ca, Fe, Mg)
Block attachment to the epithelium; inhibit colonization
Long term antibiotic use alters normal flora |
|
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Term
| 2 important opportunistic pathogens |
|
Definition
Candida albicans (yeast infec; thrush in mouth, skinfolds)
Clostridium difficile colitis (assoc. w/antibiotic use) |
|
|
Term
| Inflammatory Response (itis) is the ___ line of defense |
|
Definition
2nd line of defense; physical barrier has been breached
Interaction between humoral & cellular events |
|
|
Term
| 4 Characteristics of inflammatory response |
|
Definition
Occurs in tissue with blood supply
Activated within seconds after injury
Involves cellular & chemical components
General; non-specific |
|
|
Term
| Inflammatory process 3 phases |
|
Definition
Vascular permeability
Recruitment and emigration of leukocytes
Phagocytosis of antigens and debris |
|
|
Term
| Inflammatory process detailed |
|
Definition
| Injury -->adhesion and attraction-->vasodilation-->neutrophils and macrophages-->phagocytosis |
|
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Term
| Increased Vascular Permeability |
|
Definition
Brief vasoconstriction following injury →
Release of histamine, prostaglandins, leukotrienes → Endothelial cells contract & round up →
Increase capillary permeability (vasodilation) →
Increase hydrostatic pressure →
Fluid is pushed out into the tissue →
Swelling |
|
|
Term
| Cardinal signs of inflammation |
|
Definition
|
|
Term
|
Definition
Mast cell degranulation releases:
Histamine
Leukotrienes
Prostaglandins |
|
|
Term
|
Definition
Early mediator
Released by mast cells, basophils
Potent vasodilator; ↑ capillary permeability
Reduces BP if release is excessive
Causes bronchial constriction and mucus production
Present in allergic reactions, hay fever, skin reactions
treated w/histamine receptor antagonist (blocker)
2 types, H1 and H2 |
|
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Term
|
Definition
-Phospholipids formed from arachidonic acid (AA metabolization); cyclooxgenase pathway
-Vasodilation; ↑ capillary permeability
-Pain (direct effect on nerves)
-Arise from the cyclooxgenase (COX) pathway
-Found in various tissue
-ASA inhibits COX pathway |
|
|
Term
|
Definition
-Phospholipids formed from arachidonic acid (AA); lipooxygenase pathway
-5 subtypes
-Chemotactic, smooth muscle contraction,
bronchospasm, ↑ capillary permeability
-Leukotriene receptor blockers (asthma) |
|
|
Term
| Other chemical mediators of inflammation |
|
Definition
-cytokines (IL interleukin): peptides produced by macrophages, monocytes, neutrophils, B & T lymphs, fibroblasts, & ECs that communicate between immunity and inflammatory responses; pro and anti-inflammatory
-interferons (cytokine): prevent invasion of viruses, parasites
-chemokines (cytokine): chemotactic; WBCs; adhesion molecules |
|
|
Term
Recruitment &
emigration of leukocytes |
|
Definition
| bring in the white blood cells |
|
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Term
|
Definition
-Neutrophils normally rolls along the wall of the endothelium (pavementing )
-Injured EC become sticky (selectins) and adhere to the wall
-Move through the vessel wall (integrins)
-Migrate to tissue
-Chemotaxis |
|
|
Term
|
Definition
-Neutrophils and monocytes enter tissue and produce enzymes that can digest protein tissue
-Large number of neutrophils → acute
-Large number of monocytes & macrophages → chronic inflammation
-Inhibited by alpha1-antiproteases
-Granuloma (localized mass of inflamed tissue that could not be phagocytized) |
|
|
Term
|
Definition
-Localized symptoms
-Systemic symptoms
--Macrophage-derived cytokines responsible for effects (IL-6, IL-10, TNF-α) interleukin, tumor necrosis factor
--Fever, lethargy, neutrophilia, muscle catabolism
--Induction of acute phase proteins from liver
--Biomarker are non-specific: SED rate, CRP or hs-CRP |
|
|
Term
| Disorders Associated with Inflammation |
|
Definition
Arthritis
Hypertension (HTN)
Atherosclerosis
Inflammatory bowel disease (IBD)
Acne |
|
|
Term
|
Definition
Regeneration of tissue
Exudates transport leukocytes & Ab, dilute toxins, transport nutrients for repair |
|
|
Term
|
Definition
Serous
Serosanguinous
Fibrous
Purulent
hemorrhagic |
|
|
Term
|
Definition
Sed rate or ESR (erythrocyte sedimentation rate)
CRP C-reactive protein
CBC complete blood count |
|
|
Term
|
Definition
|
|
Term
| Hypersensitivity Reactions |
|
Definition
Type I- allergic reaction; anaphylaxis
Type II- autoimmune; loss of self
Type III-antigen-antibody complex precipitates out in blood and deposits in tissue
Type IV- cytotoxic cell-mediated reactions |
|
|
Term
| Type I: Allergic Reaction |
|
Definition
most common
-Mediated by IgE antibody
-Allergen (antigen) is recognized by B cell
-B cells make IgE antibodies against the allergen
-IgE binds the antigen, basophil, mast cell
-Degranulation
*Release of histamine, cytokines, chemokines, leukotrienes
-Immediate
4 cardinal signs of inflammation
specific to the area |
|
|
Term
|
Definition
-Medical emergency
-Rapid IgE response after exposure to an antigen
-Massive histamine-induced dilation
-Circulatory and airway collapse
-Itching, abdominal cramping, flushing of the skin, GI upset, breathing difficulties |
|
|
Term
|
Definition
-IgG or IgM antibodies attack
tissue antigens
-Loss of recognition of self
Transfusion reaction |
|
|
Term
|
Definition
Antigen-antibody complex is deposited in tissue
Activate complement and mast cell degranuation
Glomerular nephritis
Systemic lupus erythematosus (SLE) |
|
|
Term
|
Definition
-Mediated by T cells
-Delayed taking 24-72 hours
-helper T cells are activated by an antigen
-Proinflammatory cytokines
can be considered a Delayed allergic reactions
Poison ivy is an example of type IV |
|
|
Term
|
Definition
Anti-inflammatory Properties (NSAIDS)
-ASA
-Ibuprofen (Advil, Motrin)
-Naproxen (Aleve)
-Celecoxib (Celebrex)
Lacking anti-inflammatory properties
-Acetominophen (Tylenol)
*MOA: inhibit cyclooxygenase (COX) the enzyme that converts AA into prostanoids (PGs etc) |
|
|
Term
|
Definition
COX 1
Stomach
Platelets
Kidney
COX 2
Blood vessels
Kidney
Injured tissue
Brain
Colon |
|
|
Term
|
Definition
MOA: cannot inhibit PG synthesis outside the CNS
No anti-inflammatory effects
Does not supress platelts aggregation, gastric ulceration, decrease renal bloodflow
Overdose-severe liver injury |
|
|
Term
| Acetaminophen (and aspirin) overdose reversal agent |
|
Definition
| Acetylcysteine-restores glutathione to help the liver metabolize again |
|
|
Term
| Systemic Steroids for Anti-Inflammatory |
|
Definition
Focus on glucocorticoids
hydrocortisone
cortisone
prednisone
methylprednoisine
dexamethasone |
|
|
Term
|
Definition
Regulates metabolism
Regulates stress response
Immunoresponse
Effects on CNS |
|
|
Term
|
Definition
MOA (same if endogenous or synthetic)
Mediated by a specific intracellular receptor (GR);natural and synthetic steroids enter cells rapidly and interact with these intracellular receptors; resulting complexes modulate the transcription rate of specific genes and lead to an ↑↓ in the levels of specific proteins |
|
|
Term
| Glucocorticoids (GCS) 3 Anti inflammatory and anti-immunity effects |
|
Definition
Influence leukocyte migration, antigen processing, eosinophils and lymphatic tissues
Inhibit mediators (cytokines, prostaglandins) & phagocytosis
Inhibit accumulation of neutrophils, monocytes at the site of inflammation |
|
|
Term
|
Definition
Relief of inflammatory symptoms
Treatment of allergies |
|
|
Term
|
Definition
Lipid soluble; protein bound but not albumin
Metabolized by liver (CYP 450)
Excreted by kidney
Substantial lag time to |
|
|
Term
|
Definition
pharmalogic dose is greater than the physiologic dose
PO, IV, topical |
|
|
Term
|
Definition
Adrenal insufficiency
*Osteoporosis and resultant fractures
*Infection
*Glucose intolerance
*Myopathy
Fluid and electrolyte disturbances
Growth retardation
*Psychologic disturbances
Cataracts and glaucoma
Peptic ulcer disease
Iatrogenic Cushing’s syndrome
Use in pregnancy and lactation |
|
|
Term
| GCS and Adrenal suppression: Why can it develop? |
|
Definition
Adrenal suppression and physiologic stress
Glucocorticoid withdrawal
Taper the dosage over 7 days
Switch from multiple doses to single doses
Taper the dosage to 50% of physiologic values
Monitor for signs of insufficiency |
|
|
Term
|
Definition
Highly individualized
Determined empirically (trial and error)
No immediate threat – start low and slow
Immediate threat – start high; decrease as possible
Long-time use – smallest effective amount
Prolonged treatment with high doses only if disorder is life-threatening or has potential to cause permanent disability
Increase in times of stress
Wean gradually
Alternate-day therapy |
|
|
Term
|
Definition
Side effect is not a drug allergy
Hypotension, fatigue is not a true drug allergy |
|
|
Term
|
Definition
Hypersensitivity reaction is a drug allergy
Hives, wheezing, angioedema (true drug allergy)
Treated with anti-histamine |
|
|
Term
| Steven Johnson’s Syndrome |
|
Definition
Rare
1- 14 days after drug has been started
Skin starts sloughing off, linings of mucus membranes also |
|
|
Term
|
Definition
Swelling of the lips and tongue
Airway can close
Life-threatening
Call 911
STOP THE DRUG |
|
|
Term
| Common allergy-causing drugs |
|
Definition
-Sulfa drugs
-Anticonvulsants
-Insulin preparations (particularly animal sources of insulin)
-Iodinated (containing iodine) x-ray contrast dyes (these can cause allergy-like anaphylactoid reactions) |
|
|
Term
|
Definition
“An unpleasant sensory and emotional experience associated with actual or potential tissue damage” –IASP
“Whatever the experiencing person says it is, existing whenever the experiencing person says it does” –McCaffery |
|
|
Term
|
Definition
cognitive
emotional
motivational |
|
|
Term
|
Definition
| 7 rights: American Pain Foundation |
|
|
Term
|
Definition
Ronald Melzack & Patrick Wall
Small nerve fibers: pain receptors
Large nerve fibers: “normal“ nerve fibers (touch, pressure, vibration)
So, the more large fiber activity relative to thin fiber activity at the inhibitory cell, the less pain is felt.
This explains why we rub a smack. |
|
|
Term
| Nociception: The Pain Process |
|
Definition
Transduction
Transmission
Perception
Modulation |
|
|
Term
|
Definition
Process of converting noxious stimuli to an action potential or nociceptive impulse, activating nociceptors.
Nociceptors are stimulated |
|
|
Term
|
Definition
Direct damage to the nerve endings
Chemicals released at the site of tissue injury (serotonin, bradykinin, histamine, prostaglandins) stimulate a primary afferent nociceptor (PAN) to initiate an action potential |
|
|
Term
|
Definition
| Activated nerve fibers transmit the nociceptive impulse from the PNS to the CNS. |
|
|
Term
|
Definition
Larger, thinly myelinated
Skin
Thermal, mechanical stimuli
Fast traveling, "first pain"
HIghly localized 'sharp, stinging, cutting' |
|
|
Term
|
Definition
Smaller, unmyelinated
Muscle, connective tissue, viscera
Thermal, mechanical, chemical
Slower traveling 'second pain'
Poorly localized, more diffuse "dull, burning, achy" |
|
|
Term
| Ascending Spinal Pathways |
|
Definition
Neospinothalamic Tract
Paleospinothalamic Tract |
|
|
Term
|
Definition
A delta fibers transmit impulses
Transmit painful stimuli quickly and directly to thalamus and cortex
Thalamus interprets info about the nature & location of the stimuli more quickly |
|
|
Term
|
Definition
C fibers transmit impulses
Pain impulses to medulla, midbrain, part of thalalmus
Activate limbic system (emotional center ) and reticular formation (sleep-wake cycle) |
|
|
Term
|
Definition
Awareness & interpretation of pain from the results of neural processing of the painful stimulus
Involves several brain structures
Great variability in pain experiences |
|
|
Term
|
Definition
Pain Threshold: lowest intensity of a painful stimulus that is perceived. Varies on physiological factors.
Pain Expression: An individual’s response to pain, highly variable.
Pain Tolerance: Maximum degree of pain intensity a person is willing to tolerate before seeking relief. |
|
|
Term
|
Definition
alcohol
drugs
hypnosis
warmth
distraction
rubbing
faith, strong beliefs |
|
|
Term
|
Definition
fatigue
anger
boredom
anxiety
persistent pain
stress
depression |
|
|
Term
|
Definition
Modulation occurs via descending pathways.
Neuromodulators: endogenous opioids |
|
|
Term
| 4 Neuromodulators: endogenous opioids |
|
Definition
Protein hormones in the brain
Modulate nociceptor impulse inhibition
Endorphins: both endogenous & morphine
PAG area releases endorphins producing analgesic effects, blocking pain in the brain.
Enkaphalins: found in the thalamus
Inhibit substance P release in the pathway, decreasing pain signal transmission in the spinal cord |
|
|
Term
|
Definition
Mu, Kappa, sigma, delta receptors
Mu & Kappa: analgesic effects
Mu receptors: brainstem, limbic system, dorsal horn
Kappa receptors: spinal cord – modulate pain via descending pathways. |
|
|
Term
| Morphine predominantly work on . . . |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Nociceptive Pain Characteristics |
|
Definition
Caused by tissue damage
Stimulated by healthy, intact nociceptive afferent nerve fibers
Somatic & Visceral pain
Sharp, dull, aching sensations |
|
|
Term
| Neuropathic Pain Characteristics |
|
Definition
Caused by damage to nerve tissue
Characterized as unrelieved & persistent
Acute pain without sufficient relief may become neuropathic
Cramping, shooting, stabbing, burning sensations |
|
|
Term
|
Definition
Onset: Time of occurrence
Duration: Acute vs chronic
Severity/Intensity: 0 - 10
Mode of Transmission: Pain pathways vs referred pain
Location/Source: Superficial, deep, central
Causation: Nociceptive, neuropathic, psychophysiologic
Causative force/agent: spontaneous, self-inflected, etc. |
|
|
Term
|
Definition
|
|
Term
| Cutaneous/Superficial Pain |
|
Definition
Caused by injury to the skin / superficial tissues
Well-defined, localized pain for short duration
Relatively uncomplicated |
|
|
Term
|
Definition
Originates from ligaments, tendons, bones
Activated nociceptors on the body surface or musculoskeletal tissues (musculoskeletal pain)
Generally diffuse, sharp, dull, aching
Longer duration, less localized |
|
|
Term
|
Definition
Originates from viscera / internal organs
Caused by compression or injury in and around organs
Longer duration than somatic pain
Diffuse, poorly localized, vague, dull, generalized aching, squeezing pain
May radiate in other areas in the body: referred visceral pain (even harder to pinpoint location)
Nerve fibers innervating body organs for the SNS to the spinal cord, so may have SNS s/s. |
|
|
Term
|
Definition
Pain in an area distant from the site of painful stimuli
Occurs most often with damage or injury to visceral organs
Associated with interneurons or segments in the dorsal horn
Can be intense with little or no pain at the site of noxious stimuli |
|
|
Term
|
Definition
Sudden or profound loss of blood flow to the tissue causing hypoxia & injury, releasing inflammatory & pain-producing chemicals
Aching, burning, pricking pain
Example: cardiac tissue ischemia causes visceral pain radiating to the arm or jaw |
|
|
Term
|
Definition
| thrombus or embolus formation |
|
|
Term
|
Definition
| pain may develop gradually; cramping |
|
|
Term
| Cancer-Related / Malignant Pain |
|
Definition
Have qualities of both acute and chronic pain
Have an identifiable cause
Results from infiltration/compression of organs by and expanding tumor size or from cancer treatments
Bone metastasis cause most extreme pain |
|
|
Term
| Neurologic Pain: Radiculopathy |
|
Definition
pain, numbness, tingling, weakness along the nerve
Caused by mechanical compression or irritation of the spinal nerve
Most common areas: lumbar & cervical spine |
|
|
Term
|
Definition
Area of skin innervated by a single nerve root
Pain follows in a dermatome
Blueprint for a location of source of neurologic pain |
|
|
Term
| Physiological Responses to Pain |
|
Definition
Physiological: Sympathetic
Eyes: Dilated pupils
Mouth: Inhibited flow of saliva
Heart: Increased HR, BP, Resp
Lungs: Dilates bronchioles to increase oxygenation
Gut: Peristalsis & secretion inhibited n&v
Liver: Conversion of glycogen to glucose
Adrenals: Secretion of adreneline
Bladder: Urinary retention |
|
|
Term
| Psychological Responses to Pain |
|
Definition
Fear
Anxiety
Helplessness
Depression
Suffering
Hopelessness
Distress
Decreased will to live |
|
|
Term
|
Definition
| Pain from stimuli which are not normally painful. The pain may occur other than in the area stimulated. Allodynia means “other pain.” |
|
|
Term
|
Definition
| A burning pain and sensitivity to vibration or touch, usually in the hand or foot, at a site removed from an injury of a peripheral nerve that has healed |
|
|
Term
|
Definition
| An unpleasant abnormal sensation, which may be spontaneous or evoked, experienced by patients with neuropathic pain; distinct from pain in the classical sense |
|
|
Term
|
Definition
| A type of neuropathic pain that manifests as an episodic shooting, stabbing, or knifelike pain |
|
|
Term
|
Definition
| An abnormal sensation (like“pins & needles”) which may be spontaneous or evoked, often in patients with neuropathic pain |
|
|
Term
|
Definition
| A disease or degenerative state in which motor, sensory, vasomotor nerve fibers may be affected. May manifest as muscle weakness and atrophy, pain, or numbness |
|
|
Term
|
Definition
-Character & quality
-Pattern
-Intensity
-P – what provokes the pain (aggravating factors) & palliative measures (alleviating factors)
-Q – quality of pain
-R – region & radiation of pain
-S – severity (quantity) & setting
-T – timing
-Aggravating/Alleviating Factors
-Personal meaning: how pain affects life |
|
|
Term
|
Definition
| American Pain Society 12 Principles of Pain Management |
|
|
Term
| World Health Org (WHO) Pain Control Ladder |
|
Definition
Step 1: Mild Pain (0-3), start with a nonopioid
Step 2: Mild pain that persists or increases & Moderate Pain (4-6), use a weak opioid or opioid-nonopioid combo
Step 3: Moderate pain that persist or increases & Severe pain (7-10), use a strong opioid |
|
|
Term
|
Definition
Dose of one analgesic that is equivalent in pain-relieving effects to another analgesic
Allows substitution of analgesics |
|
|
Term
|
Definition
Opioid analgesics: act on the CNS to alter the perception of pain
Non-opioid analgesics: block impulses in the periphery and decrease prostaglandin synthesis |
|
|
Term
|
Definition
| enhance pain relief when used in conjunction with analgesics |
|
|
Term
| 4 Pharmacotherapy Guidelines |
|
Definition
1. Aim for monotherapy
2. Medication must result in…
-Improved pain control
-Tolerable side effects
3. Both provider and patient must recognize individual variability
4. Slow titration until…
-Significant pain relief
-Intolerable side effects |
|
|
Term
| Non-Opioid Analgesics Examples |
|
Definition
Acetaminophen
Aspirin
Traditional NSAIDs
COX-2 Inhibitors
: Tylenol, Bayer, Advil, Celebrex |
|
|
Term
|
Definition
| primary site for opiate effects; produce analgesia, euphoria, sedation, respiratory depression, physical dependence |
|
|
Term
|
Definition
| produce analgesia, sedation, and psychotomimetic effects |
|
|
Term
| Examples of Muscle Relaxants |
|
Definition
Cyclobenzaprine (Flexeril)
Carisoprodol (Soma)
Methocarbamol (Robaxin)
Metaxalone (Skelaxin) |
|
|
Term
|
Definition
morphine sulfate (eg, Roxanol™, MSIR®)
codeine
hydrocodone (eg, Zydone®, Vicodin®, Lortab®, Vicoprofen®)*
oxycodone (eg, Roxicodone™, Oxy IR®, Percocet®, Tylox®, Percodan®)*
hydromorphone (Dilaudid®)
oxymorphone (Numorphan®)
fentanyl (Actiq®) |
|
|
Term
|
Definition
Gold standard: Relieves pain without affecting other sensations
Most effective for constant, dull pain |
|
|
Term
|
Definition
methadone
sustained-release morphine (eg, MS Contin®, Avinza™; Kadian®, Oramorph®)
sustained-release oxycodone (Oxycontin®)
transdermal fentanyl (Duragesic®) |
|
|
Term
|
Definition
Potent synthetic opioid, 100 times stronger than morphine
Rapidly binds to mu receptor
Used for induction and maintenance of anesthesia during surgery
Lozenges/lollipops for breakthrough cancer pain |
|
|
Term
|
Definition
Long half-life
Cheap!
Monitor closely for arrhythmias
Should be prescribed by pain or palliative care specialist – unique equianalgesic conversion |
|
|
Term
|
Definition
First synthetic opioid, invented in 1932 as a “safer” alternative to morphine
Contraindicated – normeperedine (active metabolite) acts as a CNS stimulant causing seizures & delirium |
|
|
Term
| Patient Controlled Analgesia (PCA) |
|
Definition
Allows the patient to control the dosage of opioid analgesia received
Increased pain relief & patient satisfaction
Decreased daily dosages & anxiety
Commonly used for post-op or aggressive new onset pain
Drugs most frequently used: Morphine, Hydromorphone (Dilaudid) |
|
|
Term
|
Definition
-Less analgesia, decreased respiratory depression , decreased potential for abuse
-Codeine: combined with Acetaminophen 300 mg
T2: 15mg, T3: 30mg, T4: 60mg
-Oxycodone:
Combos: +aspirin: Percodan, +acetaminophen: Percocet, +ibuprofen: Combunox
Controlled release oxycodone: Oxycontin, ATC pain relief given q 12 hours
-Hydrocodone: most midely prescribed drug in US
Only available in combination with other drugs
Combos: +aspirin: Lortab, +acetaminophen: Vicodin, Norco, +ibuprofen: Vicoprofen |
|
|
Term
|
Definition
Opioid antagonists at both mu & kappa
Results in rapid reversal of analgesic effects and side effects of opioids
1. Naloxone (Narcan) (rapid return of pain, slow injection)
2. Methylnaltrexone (Relistor) (works on GI tract for const--no return of pain) |
|
|
Term
|
Definition
Respiratory depression
Nausea, vomiting, ileus
Sedation, mental clouding
Cough suppression
Constipation
Euphoria
Pruritus
Urinary retention |
|
|
Term
|
Definition
Morphine is the prototype drug
Oxycodone has street value
Hydromorphone has poor oral availability
Methadone is a great drug, but
-Negative pre-conceived notions
-Long half-life that is unpredictable
Demerol not a good drug for pain as it’s inactive metabolite can cause seizures
Fentanyl only comes in a patch
-Great for patients who cannot take PO
-Hard to titrate |
|
|
Term
|
Definition
| over time will need an increase dose to maintain same level of analgesic effect |
|
|
Term
|
Definition
| characterized by withdrawal symptoms when drug abruptly stopped |
|
|
Term
|
Definition
| demonstrates behaviors of craving and preoccupation with obtaining the drug when pain does not exist & despite physical harm |
|
|
Term
|
Definition
| behavior suggestive of addiction caused by undertreatment of pain |
|
|
Term
|
Definition
Add total of scheduled doses and immediate-release over 24 hour period of all opioids
Increase by 50% if initial dose not effective
Provide breakthrough dosing |
|
|
Term
| Types of Breakthrough Pain |
|
Definition
-Incident: elicited by specific activities
-Spontaneous: occurs unpredictably without warning
-End of dose failure: pain returns prior to end of interval so increase dose or decrease interval of drug. |
|
|
Term
|
Definition
Analgesia
Activities of daily living
Adverse effects
Aberrant drug-taking behaviors |
|
|
Term
| Adjuvants - Antidepressants |
|
Definition
Increases descending pain inhibitory action by preventing reuptake of serotonin & NE
Decreases cellular reuptake thus increasing inhibition of nociceptive signal transmission
Effective for burning type of neuropathic pain |
|
|
Term
| 3 Types of Antidepressants |
|
Definition
Tricyclics: good for continuous burning, tingling, or allodynia
SNRI: good for diabetic neuropathy & polyneuropathy
SSRI: conflicting data over benefit |
|
|
Term
| Adjuvants - Anticonvulsants |
|
Definition
Useful for neuropathic pain that is shooting, stabbing, lancinating, burning, tingling
Effective for post-herpetic neuralgia, diabetic neuropathy, fibromyalgia
Gabapentin (Neurontin) works by enhancing the inhibitory NT GABA.
Carbamazepine (Tegretol) decreases conductance in Na channels |
|
|
Term
|
Definition
Steroids - inhibit arachiodonic acid cascade thus inhibiting prostaglandin synth
Antihistamines - blocks histamine released by mast cells |
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Term
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Definition
Lidocaine - membrane stabilizer, disrupts action potentials in PAN
Capsaicin - depletes substance P |
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Term
| Non-pharmacological Methods |
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Definition
Distraction
Guided imagery
Hypnosis
Progressive Relaxation
Meditation
Massage
Transepidural nerve stimulator (TENS)
Acupuncture |
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Term
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Definition
| sensation of tingling, burning, pricking, or numbness of a person's skin with no apparent long-term physical effect |
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Term
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Definition
| term for damage to nerves of the peripheral nervous system,[1] which may be caused either by diseases of or trauma to the nerve or the side-effects of systemic illness. |
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Definition
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Definition
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