NSG 533 Advanced Pharmacology Exam 2
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the most common symptom prompting
patients to visit primary care providers.
pain More than 80% of patients who visit
physicians report pain. Often remains
under treated.
pain from a normal process that results
in noxious stimuli being perceived as
painful. Explained by ongoing tissue in-
jury.
nociceptive pain
thermal, mechanical and chemical no-
ciceptors that engage "withdrawal" re-
flex followed by inflammatory response
to protect injured tissue
pain sensitivity due to an abnormal pro-
functional pain cessing or function of the central nervous
system in response to normal stimuli
Pain caused by lesions or other damage
neruopathic pain
to the nervous system.
progressive deterioration of nerve func-
Diabetic peripheral neuropathy tion that results in loss of sensory per-
ception
is pain that occurs as a result of injury
or surgery, under 3 months. Poorly treat-
ed acute pain can cause psychological
stress and compromise the immune sys-
tem. Somatic acute pain is an injury to
acute pain
skin, bone, joint, muscle and connec-
tive tissue. Visceral pain involves injury
to nerves on internal organs. Treat ag-
gressively. Examples: cut hand, menstru-
al cramps.
can be intermittent or persistent, more
than 3 months. Main affects include a)
effects on physical function b) psycho-
logical changes c) social consequences
and d) societal consequences. Usually
involving life threatening diseases such
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as cancers, aids, progressive neuro-
logical diseases, end stage organ fail-
ure, dementia. Management should be
chronic pain multimodal with cognitive interventions,
physical manipulations, pharmacological
agents, surgical interventions, and re-
gional or spinal anesthesia.
Painn is associated with a progressive
life-threatening disease like cancer, aids,
neurologic diseases, end stage organ
failure, and dementia. Goal is pain alle-
viation and prevention. Dependence or
chronic malignant pain
addiction is not a concern. Pain not asso-
ciated with life threatening disease and
lasting more than 6 months beyond the
healing period is referred to as "chronic
nonmalignant pain."
imagery, distraction, relaxation, psy-
chotherapy, biofeedback, cognitive be-
What are some non-pharmacological havioral therapy, support groups, and
approaches to pain? spiritual counseling. Physical therapy,
heat, cold, water, ultrasound, TENS,
massage and therapeutic exercise.
* 1- nonopioid
WHO 3 step analgesic ladder * 2 - opioid for mild to moderate pain
* 3 - opioid for moderate to severe pain
mild pain/nonopioid analgesics such as
NSAIDS or acetaminophen w/ or w/out
WHO first step pain ladder adjuvants (such as pregablin) .. "sore-
ness." Med examples: apap 1000mg q
6hrs, ibu600mg q6 hrs
Non-steroidal anti-inflammatory drugs.
associated with several clinically signif-
icant contraindications and drug inter-
NSAIDs
actions. NSAIDS are equally effective
in analgesia, antipyretic and anti-inflam-
matory effects. Choice should include
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STEPS (simplicity, tolerability, evidence,
price, safety). If patient fails therapy with
an agent from one class of NSAIDs, use
of an agent from another class is reason-
able.
Celecoxib (Celebrex) selective agents
(celecoxib) have ideal indication in pa-
tients with high risk for GI bleed, high
intolerance of non-selective NSAIDS,
or treatment failure with non-selective
COX2 inhibitors
agents. NSAIDs are of minimal value in
neuropathic pain. NSAIDs produce a flat
dose response curve (celling effect) with
higher doses providing no greater effica-
cy than moderate doses.
Tylenol. blocks PG synthesis in CNS,
inhibits peripheral pain impulses. APAP
Acetaminophen does not interfere with COX 1 or COX2
and thus has no anti-inflammatory bene-
fits.
moderate pain: weak opioids (hy-
drocodone, codeine, tramadol) w/ or
w/out nonopioid analgesics w/ or w/out
WHO pain ladder step 2
adjuvants "every time I do something, it
hurts" med examples: apa325mg + cod
60mg q4 hrs
severe and persistent pain, potent opi-
oids (morphine, tapentadol, oxycodone,
hydromorphone, fentanyl, w/ or w/out
non-opioid analgesics and with or with-
WHO pain ladder step 3
out adjuvants "no matter what I do it
hurts, theres a bone sticking out of my
skin!" Examples; morphine 10mg q4 hrs,
hydromorphone 4mg q4 hr
