PC707-module 5-Pain Exam with 100% Verified and Updated Solutions

PC707-module 5-Pain Exam with 100% Verified and Updated Solutions In order to prescribe drugs, you must have what? - answerDEA number If opioids are needed--how can you decrease the risk of dependence? - answer-smallest dose for the shortest amount of time is advised* Who can usually be consulted and co-manage with if a patient is using long term opioids? - answer-pain clinic Types of pain: - answer-Nociceptive -Neuropathic -Mixed or "undetermined etiology" What is nociceptive pain? - answer- pain that arises from damage to or inflammation of tissue -Ex: arthropathies, ischemic disorders, myalgias, skin & mucous ulcers, fractures, renal stones, superficial pain (burns & scrapes), visceral pain (appendicitis, pancreatitis) What is neuropathic pain? - answer- pain that arises from abnormal or damaged pain nerves (PNS or CNS) -Ex: alcoholic or diabetic neuropathies, cancer pain, regional pain syndromes (fibromyalgia), HIV, MS, phantom limb pain, post herpetic neuralgia, trigeminal neuralgia, post CVA pain What is mixed or undetermined etiology pain? - answer-chronic reoccurring headaches -vasculitis What is acute pain? - answer-sudden onset & short duration What is chronic pain? - answer-lasts 3-6 months or longer What is the step-wise approach to pain management? - answer-non-opioids first (NSAIDs, nonpharmacologic options) -if pain persists or worsens--weak opioids -if pain persists or worsens--strong opioids -hopefully pain relief at this point--if not potential for nerve block, epidural, PCA pump, etc. Key points to remember about pain management: - answer-oral analgesics first if possible* -give doses at regular intervals & adjust the dose until the patient is comfortable -prescribe according to pain intensity--it is individualized* -the correct dose is the one that brings adequate pain relief -detailed written plan for patient and family What is an opioid? - answer-used for pain relief -binds to opioid receptors primarily in the CNS, spinal cord, GI tract -binds primarily to MU receptors and to some extent the KAPPA receptors* What are the 4 types of pain receptors? - answer-MU -KAPPA -Delta -Sigma What does the binding to MU receptors cause? What drugs bind primarily to these receptors? - answer-Analgesia* -Respiratory depression* -Euphoria* -Ex: morphine (Kadian), meperidine (Demerol), fentanyl (Sublimaze), hydromorphone hydrochloride (Dilaudid) etc. What does the binding to KAPPA receptors cause? What drugs bind primarily to these receptors? - answer-Analgesia* -Sedation* -Ex: nalbuphine (Nubain) & butorphanol (Stadol) What role do delta & sigma pain receptors play? - answer-it is not exactly known -cause dysphoria & hallucinations* Why do drugs that bind to primarily MU receptors also cause sedation? - answer-they also bind to KAPPA receptors to some extent--which causes sedation* Full opioid agonists: - answer-bind to MU receptors in the brain -produces a significant amount of endorphins which causes the euphoric feeling-which provides pain relief Partial opioid agonists: - answer-bind to MU receptors in the brain partially -antagonizes kappa receptors -produces endorphins but less than a full agonist* -these are harder to abuse* Ex: buprenorphine (Subutex) or buprenorphine with naloxone (Suboxone) Examples of strong opioid agonists: - answer-morphine, heroin, methadone, hydromorphone, oxymorphone, meperidine Examples of moderate opioid agonists: - answer-codeine, oxycodone, hydrocodone, etc. What happens if a person who has been taking full opioid agonists takes a partial opioid agonist? - answer-the partial opioid agonists have a stronger affinity for the MU receptor site--so it replaces the full agonists* -the person will experience withdrawal* as their receptors are now only "partially" activated What are mixed opioid agonist-antagonists? - answer-little to no action at the MU receptors--so decreased risk of respiratory depression -acts strongly at the KAPPA receptors (causing more sedation) -caution with patients using full opioid agonists--can also cause withdrawal -Ex: Stadol & Nubain What are opioid antagonists? - answer-bind to MU receptors but does NOT stimulate production of endorphins* -they block opioids from binding to receptors -Ex: Narcan & Reviva If you give a patient increasing doses of a partial agonist--are they at risk of overdose? - answer-no because increased doses start to plateau right below the respiratory depression threshold* -no matter how much medication is given--the receptors can only be partially activated* -this is why these medications are safer to use* -Ex: Subutex & Suboxone