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Activation of a fibers closes the gate and inhibits

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Activation of “A” fibers: closes the gate and inhibits transmission to the brain Activation of “C” fibers: opens gate and allows impulse transmission to brain 6. Gate innerved by nerve fibers from brain, allowing the brain some control over gate Endogenous transmitters: the body produces two transmitters (enkephalins & endorphins) to fight pain and bond with opioid receptors and inhibit transmission of pain by closing the gate Treatment of Pain in Special Situations PCA: Patient controlled analgesic pump allowing patient to self-medicate PCA by proxy: when too much of the medication has been administered killing the patient In situations such as pain associated with malignancies, the main consideration in pain management is patient comfort and not prevention of drug addiction Placebos: inert drugs that lack actual medication- critics argue this is unethical because it requires the patient to be deceived Opioid tolerance: state of adaption in which exposure to a drug induces changes in drug receptors that result in reduced drug effects over time Opioid tolerant: patients who have been receiving opioid analgesic for a period of time and who are therefore at greater risk of opioid withdrawal upon sudden discontinuation of opioid use Breakthrough pain: pain that occurs between doses of pain medication Adjuvant Drugs: drugs that are added as a second drug for combined therapy with a primary drug and may have additive or independent analgesic properties, or both – these
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drugs assist primarily in relieving pain NSAIDS Anti-depressants (Ex: Amitriptyline) Anti-convulsants (ex: Gabapentin or Pregabalin) Corticosteroids Opioid ceiling effect: Drug reaches a maximum analgesic effect; the analgesic does not improve even with a higher dose Opioid analgesic: pain relives that contain opium, derived from the opium poppy or chemically related to opium Opioid analgesics prototypes Codeine sulfate, meperidine HCL, methadone HCL, morphine sulfate, propoxyphene HCL, hydromorphone, oxycodone, and fetanyl Mechanisms of Action Classifications based on their actions Agonist: binds to an opioid pain receptor in the brain and causes and analgesic response –the reduction of pain sensation Agonist- antagonis t: binds to a pain receptor but causes a weaker pain response than a full agonist Antagonist : binds to a pain receptors but does not reduce pain signals – it functions as a competitive agonist because it competes with and reverses the side effects of agonist and agonist-antagonists drugs at receptor sites Opioid receptors: Mu, Kappa, Delta, Sigma, and Epsilon (Mu, Kappa, Delta are the primary receptors that are most responsive) Indications Main use: to alleviate moderate to severe pain Often given with adjunct analgesic drugs to assist primary drugs with pain relief Opioids are also used for : cough center suppression, treatment of diarrhea, balanced anesthesia, and respiratory distress Contraindications (Known allergies and severe asthma)
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