ALH2202 Pain Management Study Guide PDF

Study Guide ALH2202 Topic #2 Pain Management This study guide is for the sole purpose of helping the student structure their studying habits. In no way are all items listed inclusive or exclusive of potential te...

Study Guide ALH2202 Topic #2 Pain Management This study guide is for the sole purpose of helping the student structure their studying habits. In no way are all items listed inclusive or exclusive of potential test questions. You are responsible for material from the lecture and your readings in the textbook. Chapter 10 – Analgesic Drugs 1. Identify the characteristics of acute pain and chronic pain a. Recall the definitions of Addiction, Agonist, Agonist-antagonist, Antagonist, Tolerance and Synergistic effects. b. Identify the differences between acute and chronic pain c. Recall the terms and characteristics of somatic pain, visceral pain, vascular pain, referred pain, phantom pain, central pain, and neuropathic pain. 2. Recall the use of analgesic drugs in the management of pain, including acute and chronic pain, cancer pain, and special pain situations. a. Recall the unique characteristics of opioid tolerance, opioid addiction, opioid dependence, and opioid toxicity. i. It is quite important to understand the definitions/differences in these terms: opioid physical dependence, opioid psychological dependence, opioid tolerance and opioid addiction. ii. When is dependency not an important issue to the healthcare professional? 1. In the terminal patient we are more concerned with opioid toxicity, but dependency is actually expected to occur in a patient on chronic pain medications (such as terminal patients). b. Recall what is meant by the “mu receptor” c. Identify the use of adjuvant drugs to enhance analgesia. i. Adjuvant pain medications can include tricyclic antidepressants, NSAIDs, and antiepileptic drugs. 1. This can be confusing but antidepressants, NSAIDs and antiepileptic drugs can be added to a patient’s pain management program as adjuvant drugs to help control pain. d. Identify the common categories of adjuvant pain medications. i. Identify the importance of gabapentin (Neurontin) as an adjuvant pain medication 1  Study Guide ALH2202 Topic #2 3. Identify examples of drugs classified as nonopioids, nonsteroidal anti-inflammatory drugs, opioids (opioid agonists, opioids with mixed actions, opioid agonists-antagonists, and antagonists), and miscellaneous drugs. a. Recall the differences between opioid agonists, opioid agonist/antagonist, and opioid antagonists. i. Identify specific drugs in each of these categories b. Recall how opioid agonists/antagonists and opioid antagonists are scheduled by the FDA. 4. Recall the mechanisms of action, indications, therapeutic effects, and significant adverse effects, of nonopioids, nonsteroidal anti-inflammatory drugs, opioids (opioid agonists, opioids with mixed actions, opioid agonists-antagonists, and antagonists), and miscellaneous drugs. a. Recall the common complications of opioid analgesics. b. Recall the appropriate treatment of opioid toxicity. c. Important drug categories and drugs in this topic are: i. Opioid Drugs 1. Opioid Agonists a. Codeine sulfate (Codeine) b. Meperidine hydrochloride (Demerol) c. Hydromorphone (Dilaudid) d. Morphine sulfate (Morphine) e. Oxycodone hydrochloride (Percocet) f. Fentanyl (Duragesic) 2. Opioid Agonists-Antagonists a. Nalbuphine (Nubain) b. Pentazocine (Talwin) 3. Opioid Antagonists a. Naloxone HCL (Narcan) ii. Nonopioid and Miscellaneous Analgesics 1. Acetaminophen (Tylenol) a. Recall the appropriate uses, contraindications, and toxicities associated with the acetaminophen. b. Recall the maximum recommended daily dose of acetaminophen for adults to prevent hepatotoxicity. 2  Study Guide ALH2202 Topic #2 2. Tramadol (Ultram) 3. Transdermal lidocaine (Lidoderm) Chapter 44 – Anti-inflammatory and Antigout Drugs 1. Recall the details of the inflammatory response and the part it plays in the generation of pain. a. Identify the signs and symptoms of chronic aspirin overdose, a condition known as salicylism. 2. Identify the characteristics of the various disease processes that are often identified as inflammatory in nature, such as rheumatoid arthritis, osteoarthritis, degenerative joint disorders, and gout. a. Specifically recall the mechanism of action and usefulness of misoprostol (Cytotec) during treatment of patients on NSAIDs 3. Recall the mechanisms of action, indications, therapeutic effects, and significant adverse effects, of the various anti-inflammatory and antigout drugs. a. Important drug categories and drugs in this topic are: i. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) a. Recall the important contraindications to NSAID use (renal disease) b. Recall the common adverse effects of NSAIDs c. Identify the therapeutic effects (indications) of NSAIDs i. These include their anti-inflammatory properties as well as the antipyretic properties 2. Salicylates a. Acetylsalicylic acid (Aspirin) i. Recall the relationship between aspirin and Reye’s syndrome. ii. Recall the effects of aspirin toxicity known as salicylism and the common symptoms such as tinnitus iii. Recall the usefulness of “low-dose” aspirin in patients, especially those with coronary artery disease and its antiplatelet properties which prevent clot formation 3. Acetic Acid Derivatives a. Indomethacin (Indocin) 3  Study Guide ALH2202 Topic #2 b. Diclofenac (Voltaren) c. Ketorolac (Toradol) 4. Propionic Acid Derivatives a. Ibuprofen (Motrin, Advil) 5. Cyclooxygenase-2 Inhibitors a. Celecoxib (Celebrex) 6. Enolic Acid Derivatives a. Meloxicam (Mobic) ii. Antigout Drugs 1. Allopurinol (Zyloprim) a. Works by inhibiting uric acid production which results in lower serum uric acid levels i. Which enzyme does allopurinol inhibit to produce its effects? 2. Probenecid (generic) a. Works by increasing uric acid excretion Chapter 11 – General and Local Anesthetics 1. Describe the basic differences between general anesthesia, moderate sedation (conscious sedation), and local anesthesia. a. Recall the specifics of the complication sometimes seen with general anesthesia known as malignant hyperthermia b. Recall that with local anesthesia nerve conduction is blocked only in the area where the anesthetic is applied and there is no loss of consciousness. i. Recall the order in which local anesthetics affect body functions. 1. Usually autonomic activity is affected first; then pain and other sensory functions are lost. Motor activity is the last to be lost. When the effects of the local anesthetic wear off, recovery occurs in reverse order: motor activity returns first, then sensory functions, and finally autonomic activity). 2. Recall the differences between depolarizing neuromuscular blocking drugs and nondepolarizing blocking drugs and their impact on the patient. 4  Study Guide ALH2202 Topic #2 a. Identify the adverse effect that is of primary concern when using neuromuscular blocking drugs. 3. Recall the mechanisms of action, indications, therapeutic effects, and significant adverse effects, associated with general and local anesthesia as well as drugs used for moderate or conscious sedation. a. Recall the serious side effect of general anesthesia known as malignant hyperthermia b. Important drug categories and drugs in this topic are: i. General Anesthetics 1. Dexmedetomidine (Precedex) a. Dexmedetomidine is also commonly used in the intensive care setting for sedation of mechanically ventilated patients; it is also used in patients experiencing alcohol withdrawal. 2. Propofol (Diprivan) 3. Sevoflurane (Ultane) ii. Drugs for Moderate Sedation iii. Local Anesthetics 1. Lidocaine (Xylocaine) a. Lidocaine belongs to the amide class of local anesthetics 2. Benzocaine (generic) a. Benzocaine belongs to the ester class of local anesthetics iv. Neuromuscular Blocking Drugs 1. Depolarizing Neuromuscular Blocking Drugs a. Succinylcholine (Anectine, Quelicin) 2. Nondepolarizing Neuromuscular Blocking Drugs a. Rocuronium (Zemuron) 5