Instructions for using this template. Remember this is Jeopardy, so where I have written Answer this is the prompt the students will see, and where I have Question should be the student s response. To enter your questions and answers, click once on the text on the slide, then highlight and just type over what s there to replace it. If you hit Delete or Backspace, it sometimes makes the text box disappear. When clicking on the slide to move to the next appropriate slide, be sure you see the hand, not the arrow. (If you put your cursor over a text box, it will be an arrow and WILL NOT take you to the right location.) Choose a category. You will be given the answer. You must give the correct question. Click to begin. Click here for Final Jeopardy 1
Definitions Pain Physiology Pain Medications Potpourri Medication Side Effects 10 Point 10 Point 10 Point 10 Point 10 Point 20 Points 20 Points 20 Points 20 Points 20 Points 30 Points 30 Points 30 Points 30 Points 30 Points 40 Points 40 Points 40 Points 40 Points 40 Points 50 Points 50 Points 50 Points 50 Points 50 Points An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. (IASP, 1994) What is Pain? 2
Pain of the musculoskeletal system or skin. It is well localized with an aching or throbbing quality. What is somatic pain? Pain caused by injury to or dysfunction of the nervous system. Treatment usually includes adjuvant analgesics. 3
What is neuropathic pain? A psychological dependence. It is characterized by one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving. What is addiction? 4
A decrease in one or more effects of the opioid (e.g., decreased analgesia, sedation or respiratory depression.) What is tolerance? Conversion of one energy form to another. The damaged cells release substances (e.g. PG, BK, 5HT, SP, H) that activate pain receptors. The activation leads to the generation of an action potential. 5
What is transduction? The movement of the pain impulse from the site of transduction to the brain. What is transmission? 6
Conscious experience of pain. What is perception of pain? Changing or inhibiting pain impulses. Neurons originating in the brain stem descend to the spinal cord and release substances ( 5HT, NE, endogenous opioids) that inhibit the transmission of pain impulses. 7
What is modulation? They interfere with the reuptake of NE and 5HT, thereby increasing their availability to inhibit noxious stimuli and produce analgesia. (e.g. nortriptyline, desipramine, duloxetine) What are antidepressants? 8
These drugs bind to mu receptor sites (and also to kappa and delta sites) producing analgesia. What are opioids? Opioid that has fallen out of favor because high doses are needed to achieve pain relief and a neurotoxic metabolite accumulates in CNS increasing seizure risk. 9
What is meperidine or Demerol? An opioid recommended for opioid tolerant patients with stable, chronic pain. A disadvantage is that the dosage can not be adjusted quickly. What is transdermal fentanyl patch? 10
Drugs with other specific indications that have been found to be effective analgesics for selected types of pain. (e.g. tricyclic antidepressants, corticosteriods, anticonvulsants, topical anesthetics) What are adjuvant analgesics? They reduce pain by blocking + ions, thereby decreasing the action potential. e.g. gabapentin(neurontin), pregabalin (lyrica) 11
What are anticonvulsants? The single most reliable indicator of pain. What is selfreport? 12
Some clinicians, patients, and caregivers avoid opioids due to this. What is addiction? Infants and young children, confused older adults, patients morbidly obese or who have sleep apnea and those taking other drugs that potentiate opioids are not candidates for this. 13
What is a PCA pump? Opioids, corticosteroids, biphosphonates, gallium nitrate, calcitonin and strontium-89 treat this. What is bone pain? 14
Morphine, 2 to 6 mg IV every 2h PRN for pain is an example of this. What is a PRN range order? Itching, nausea & vomiting, sedation, respiratory depression, constipation 15
What are opioid side effects? The one opioid side effect that NEVER goes away. What is constipation? 16
Side effect experienced by 15%-70% patients taking opioids. May be relieved by drugs like promethazine, prochlorperazine, haloperidol and metoclopramide. In severe cases a 5HT antagonist may be useful. What is nausea and vomiting? This side effect is seen at initiation of opioid therapy and with dose increases. It is experienced by 20%-60% patients. 17
What is sedation? In rare instance, may be given in small incremental doses that improve respiratory function without reversing analgesia. (? 0.4mg in 10 ml saline administered 0.5 ml boluses IV PRN q 2 mins.) What is naloxone? 18
Make your wager This treatment should not be used by any route of administration in the assessment and/or management of pain in any individual regardless of age or diagnosis unless done within the context of an IRB-approved clinical trial. What is placebo use? 19