Neurology-Exam-3 (1).pdf - Neurology Exam 3 Study Guide PHARMACOTHERAPY PAIN(RAT#2 Dr Morgan(5 hours LO 1 Describe the pathophysiology of pain LO 2

Neurology-Exam-3 (1).pdf - Neurology Exam 3 Study Guide...

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Neurology Exam 3 Study Guide PHARMACOTHERAPY: PAIN (RAT #2) - Dr. Morgan (5 hours) LO 1. Describe the pathophysiology of pain. LO 2. Characterize the pain associated with acute pain and chronic pain. LO 3. Identify the tools used for assessment of pain. LO 4. Describe the barriers associated with pain management. Location in Body Transduction (and inflammation) Tissue injury releases chemical mediators which activate nociceptors to cause nerve impulses 5-HT, K+, histamine, PG, bradykinin, substance P, Na and Ca channels Local anesthetics NSAIDs/steroids Opioids NMDA antagonists α2 agonists Peripheral nociceptors Na and K influx Local anesthetics Peripheral nerve Substance P Glutamate Aspartate NMDA receptors Local anesthetics Opioids NMDA antagonists NSAIDs α2 agonists Dorsal horn Endogenous opioids 5-HT NE DA GABA Opioids Antiepileptics SNRIs Brain Neurology Exam 3 Study Guide | Page 1
Musculoskeletal pain, dull, aching, worsened with activity Trauma, inflammation, excessive activity, etc Visceral Pain detected by nociceptors from internal organs Internal pain, dull, vague, pressure-like, deep squeezing, diffuse Distension, perforation, inflammation, impaction or constipation, abdominal wall spasms, etc Burning, tingling, shooting, stinging, or “pins and needles,” stabbing, piercing, cutting, radiating Many etiologies
Goals of Pain Management Massage Acupuncture Psychological interventions CBT: patients are taught how to cope with pain, music therapy, guided imagery, coping strategies, etc Pain support groups Biofeedback Hypnosis Individual psychotherapy Self-management Enhance coping skills (pain, stress) Meditation Gradually progressive daily exercise program Physical therapy Improves function Prevent worsening Prevent injury by teaching proper body mechanics *TENS does not really help for chronic low back pain Pain rating: 4-6 / 10 Moderate pain Pain rating: 7-10 / 10 Severe pain Opioid + APAP combo OR NSAID alone +/- adjuvant analgesics as appropriate. Always consider around-the-clock regimens. Use prn regimes for breakthrough pain or when pain displays great variability or has greatly subsided. May use NSAIDs around the clock with an opioid as needed when risk does not outweigh benefits. Opioid analgesics +/- adjuvant analgesics as appropriate. Always consider around-the-clock regimens. Use prn regimes for breakthrough pain or when pain displays great variability or has greatly subsided. Use route of admin to fit needs of patient. Avoid excessive sedation when risk does not outweigh benefits WHO recommendation: APAP or NSAID, codeine, hydrocodone, oxycodone, dihydrocodeine, tramadol (not available with ASA or APAP) +/- adjuvants WHO recommendation: Morphine, hydromorphone, methadone, levorphanol, fentanyl, oxycodone +/- nonopioid analgesics +/- adjuvants Allows patient to control the amount of pain medication Lockout period (usually 6-10 min), which allows for onset of medication before more can be delivered Can also provide a basal infusion Good for patients who are NPO, have acute pain, or who require a basal dose Do not use in opioid naive patients Commonly used opioids: hydromorphone, fentanyl, morphine Assess # times/day button pushed and wen Goal: no more than 3x/hour

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