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Questions and Answers
What does nociception refer to?
What does nociception refer to?
Which of the following describes acute pain?
Which of the following describes acute pain?
Which process is NOT part of the four processes of pain?
Which process is NOT part of the four processes of pain?
What indicates that pain is a personal and individual experience?
What indicates that pain is a personal and individual experience?
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What does 'good pain' typically serve?
What does 'good pain' typically serve?
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What characterizes chronic pain?
What characterizes chronic pain?
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Which of the following conditions is an example of neuropathic pain?
Which of the following conditions is an example of neuropathic pain?
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What is the primary effect of analgesics?
What is the primary effect of analgesics?
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Which factor is likely to raise pain tolerance?
Which factor is likely to raise pain tolerance?
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What type of pain is associated with psychiatric disorders?
What type of pain is associated with psychiatric disorders?
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What does the term 'allodynia' refer to?
What does the term 'allodynia' refer to?
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In what way do anesthetics differ from analgesics?
In what way do anesthetics differ from analgesics?
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Which term describes pain that occurs in a different area from the actual source?
Which term describes pain that occurs in a different area from the actual source?
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Which receptors are primarily involved in the analgesic effects of opioids?
Which receptors are primarily involved in the analgesic effects of opioids?
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What is a common characteristic of full agonist opioid analgesics?
What is a common characteristic of full agonist opioid analgesics?
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What effect do opioid agonists typically produce related to the respiratory system?
What effect do opioid agonists typically produce related to the respiratory system?
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Which of the following properties is associated with interactions at the δ receptor?
Which of the following properties is associated with interactions at the δ receptor?
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What is the effect of opioid agonists on the gastrointestinal system?
What is the effect of opioid agonists on the gastrointestinal system?
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What potential psychological side effect can opioid agonists produce through their action on kappa receptors?
What potential psychological side effect can opioid agonists produce through their action on kappa receptors?
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How do opioids have an antitussive effect?
How do opioids have an antitussive effect?
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What mechanism leads to miosis (pinpoint pupils) associated with opioid use?
What mechanism leads to miosis (pinpoint pupils) associated with opioid use?
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What are the primary receptors that morphine acts upon to exert its analgesic effects?
What are the primary receptors that morphine acts upon to exert its analgesic effects?
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Which of the following is NOT a pharmacological property of morphine?
Which of the following is NOT a pharmacological property of morphine?
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What indicates the risk associated with the use of morphine during pregnancy?
What indicates the risk associated with the use of morphine during pregnancy?
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Which opioid is primarily indicated for treatment of diarrhea?
Which opioid is primarily indicated for treatment of diarrhea?
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How does morphine primarily affect the gastrointestinal system?
How does morphine primarily affect the gastrointestinal system?
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Which opioid is characterized by having a longer action than morphine?
Which opioid is characterized by having a longer action than morphine?
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What effect does morphine have on the respiratory center?
What effect does morphine have on the respiratory center?
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Which condition could be aggravated by increased tone in the sphincter of Oddi due to morphine?
Which condition could be aggravated by increased tone in the sphincter of Oddi due to morphine?
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What is the main characteristic of chronic pain management?
What is the main characteristic of chronic pain management?
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Which medication is used for around-the-clock treatment of cancer pain?
Which medication is used for around-the-clock treatment of cancer pain?
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Which of the following is NOT a common adverse effect of opioid analgesics?
Which of the following is NOT a common adverse effect of opioid analgesics?
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What is the purpose of adjuvant medications in pain management?
What is the purpose of adjuvant medications in pain management?
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What condition is a contraindication for the use of morphine?
What condition is a contraindication for the use of morphine?
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Which opioid is a moderate analgesic that is often combined with acetaminophen?
Which opioid is a moderate analgesic that is often combined with acetaminophen?
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What is the main concern with the use of CNS depressants alongside opioid analgesics?
What is the main concern with the use of CNS depressants alongside opioid analgesics?
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Which of the following describes the use of naloxone?
Which of the following describes the use of naloxone?
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What is the primary purpose of naloxone in opioid treatment?
What is the primary purpose of naloxone in opioid treatment?
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What characterizes physical dependence on opioids?
What characterizes physical dependence on opioids?
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What is a common method of administration for naloxone in emergency situations?
What is a common method of administration for naloxone in emergency situations?
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Which statement about opioid tolerance is correct?
Which statement about opioid tolerance is correct?
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Which withdrawal symptom is related to opioid abstinence syndrome?
Which withdrawal symptom is related to opioid abstinence syndrome?
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What should be monitored in patients receiving opioid analgesics?
What should be monitored in patients receiving opioid analgesics?
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What is a recommended strategy to manage constipation in opioid users?
What is a recommended strategy to manage constipation in opioid users?
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What potential side effect indicates respiratory depression in a patient on opioids?
What potential side effect indicates respiratory depression in a patient on opioids?
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Study Notes
Pain and Analgesic Drugs
- Analgesic drugs selectively block pain sensations without affecting other functions or consciousness.
- Anesthetics block nerve conduction, causing loss of sensation (local) or loss of sensation and consciousness (general).
- Pain is a personal experience, and individuals vary greatly in their perception.
- Nociception is the detection of noxious stimuli, or stimuli that can damage tissue.
- Pain involves four processes: transduction, transmission, perception, and modulation.
- Pain assessment needs a qualified individual who can evaluate the pain.
- A pain assessment tool, like the OUCH scale, helps quantify pain intensity.
- Acute pain is sudden in onset and usually resolves after treatment.
- Nociceptive stimuli, like stepping on a nail, activate nociceptive pathways that cause acute pain.
- Chronic pain lasts longer than six weeks, is often persistent or recurring, and can be challenging to treat. Types include mild musculoskeletal, deep pain, neuropathic pain, and chronic pain of indeterminate cause.
- Neuropathic pain results from nerve injury or infection. Examples include phantom limb pain, trigeminal neuralgia, shingles, and diabetic neuropathy.
- Forms of pain include chronic pain of indeterminate cause, and pain associated with psychiatric disorders (e.g., depression).
- Somatic pain originates in the skin and other tissues. Examples include superficial and visceral (internal organs), specifically vascular and respiratory. Referred pain appears in areas away from the source of pain.
- Factors that influence pain tolerance include discomfort, insomnia, anxiety, fear, anger, boredom, sadness, depression, introversion, social abandonment, mental isolation.
- Factors that improve pain tolerance include relief of symptoms, sleep, relaxation, explanation and support, understanding empathy, diversions, companionship, mood improvement, and understanding the significance of pain.
- Analgesia is a process that aims to alleviate pain by addressing the cause.
- Opioids, specifically, work in the brain.
Opioids
- Opioids are morphine-like compounds that bind to opioid receptors on nerve endings.
- Opioids include morphine, codeine, methadone, fentanyl, diamorphine (heroin), levorphanol, hydromorphone, and oxycodone.
- Analgesics, including opioids, can be categorized as agonists (e.g., morphine) which directly activate receptors; or partial agonists (less potent).
- Agonist-antagonist opioids (e.g., buprenorphine) have both agonist and antagonist effects at different opioid receptors.
- Opioid interactions exist and can be detrimental causing cumulative effects from CNS depressants like antipsychotics, antihistamines, sedatives (benzodiazepines, barbiturates), and alcohol.
Opioid Receptors
- μ (mu) receptors are linked to analgesia ( pain relief) and located in the brain (cortex, medulla, thalamus, limbic system, amygdala), spinal cord, and other areas.
- κ (kappa) receptors influence analgesia and are found in the brain and spinal cord, associated with dysphoria and hallucinations.
Pharmacological Properties of Opioids
- Opioids produce analgesia (pain relief).
- Opioids can induce sedation.
- Opioids can cause feelings of euphoria and tranquility due to central dopaminergic pathways.
- Opioids can suppress the cough reflex through the cough center in the medulla.
- Opioids can lead to respiratory depression (a serious side effect) by directly affecting the brainstem respiratory center.
- Opioids can result in nausea and vomiting caused by stimulation of the chemoreceptor trigger zone of the medulla.
- Opioids can cause the pupils to constrict (miosis).
- Opioids cause tolerance and dependence.
- Opioids can cause constipation, urinary retention, and hypotension.
- Opioids can cause dilation of cutaneous blood vessels (warm skin).
- Opioids can cause itching and sweating.
Opioid Analgesics - Morphine
- Morphine is an analgesic primarily targeting μ receptors in the brain and spinal cord.
- Morphine is administered through intravenous (IV), intramuscular (IM), subcutaneous (SC), oral (PO), or intrathecal routes.
- Morphine's metabolism occurs through the liver, with a half-life of approximately 2-4 hours.
- Morphine is sometimes used for cancer pain, but is not without risk in pregnancy.
- Morphine's pharmacological properties include analgesia, sedation, euphoria, antitussive effects, and respiratory depression.
Analgesics and Cancer Pain
- Chronic cancer pain often requires around-the-clock (ATC) treatment with opioids.
- Breakthrough pain can arise even when chronic pain is managed. Rescue medications are helpful.
- NSAIDs (non-steroidal anti-inflammatory drugs) and adjuvants are used often as added support.
- Sustained release morphine (MS Contin) is a common treatment.
WHO Pain Management Ladder
- The WHO pain ladder is a treatment approach to managing pain with varying drug intervention, from non-opioids to opioids, depending on the severity of pain.
Cancer Pain - NSAIDs and Adjuvants
- NSAIDs are commonly used for pain management in cancer patients.
- Adjuvant therapies (like antidepressants, anti seizure meds, and corticosteroids) can assist in pain management.
Morphine: Contraindications and Cautions
- Morphine is contraindicated in individuals with severe asthma or respiratory insufficiency due to possible respiratory depression.
- Morphine use is cautioned in those with hepatic (liver) dysfunction, and/or elevated intracranial pressure (ICP).
Opioid Analgesics: Adverse Effects
- Opioids commonly cause respiratory depression, CNS depression, nausea and vomiting, constipation.
- Other adverse effects include hypotension, histamine release, urinary retention, diaphoresis, and miosis.
Opioid Analgesics: Interactions
- Opioids can interact with central nervous system (CNS) depressants such as antipsychotics, antihistamines, sedatives, and alcohol.
Moderate Opioid Analgesics, Examples:
- Codeine (3-methylmorphine): a less strong analgesic than morphine, typically needs combination.
- Oxycodone (Oxycontin, Percodan): often combined with acetaminophen (e.g., Percocet), metabolized to work.
- Buprenorphine: agonist-antagonist;
Opioid Antagonists
- Naloxone (Narcan) and naltrexone are opioid antagonists used to reverse opioid-induced respiratory depression.
Treating Opioid Addiction
- Methadone programs and buprenorphine/naloxone (Suboxone) combinations are utilized.
Opioid Tolerance
- Tolerance is a common physiological result of sustained opioid treatment, reducing opioid effects.
Opioid Physical Dependence
- Physical dependence occurs with chronic opioid use; abrupt discontinuation causes withdrawal.
- Withdrawal symptoms are unpleasant but usually not dangerous and can be managed with medical supervision.
Opioids: Implications for Clinical Care
- Oral opioids should be taken with food to minimize gastric upset.
- Respiratory depression is a critical clinical concern. Vital signs monitoring is essential.
- Constipation is a common adverse effect and needs management.
- Orthostatic hypotension should be avoided with slow position changes.
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Description
This quiz explores the concepts of pain and analgesic drugs, including how they function and their effects on pain perception. Understand the differences between acute and chronic pain, the importance of pain assessment, and the processes involved in nociception. Test your knowledge on analgesics and anesthetics!
