NURS 3550H Lecture Notes - Lecture 5: Chronic Pain, Substance P, Nociceptor
28 Dec 2018
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If possible use combinations (e. g. tyenol 3: decreases the amount of opioids used, use medications that work by different methods. Endogenous opioids functions to reduce pain transmission: natural ligands (normally bind to opioid receptors, enkephalins, dynorphins, endorphins, receptors http://www. the-scientist. com/feb2014/feature1_pg36full. jpg. The reward system in the brain plays a part in addiction/dependence due to release of dopamine. Several routes: oral, intramuscular, intravenous, subcutaneous, epidural, and intrathecal. Not very lipid-soluble: does not cross blood-brain barrier easily, fraction of dose reaches site of analgesic action. Cyp 2d6, cyp 3a4 metabolize several opioids. Dec gi activity (use stool softeners to decrease effects: can cause stool impaction. Cough centre: found within the medulla, causes suppression of the cough centre, can cause buildup of mucus and cause pneumonia. Gi: dec tone and sphincters, direct in gi and indirect in cns, biliary colic (pain in bile duct) Prolonged use: neurotoxicity, decreased cortisol levels increased prolactin levels, decreased lh, fsh, t, e immunosuppression, therefore, increasing infection rates.
