A 65-year-old woman with breas

A 65-year-old woman with breast cancer is receiving hospicecare in her home. She is cur- rently receiving a long-acting opioidanalgesic supplemented with a short-acting combination opioid andnonnarcotic medication for break- through pain. A. Explain thedifference between the mecha- nisms and treatment of acute andchronic pain. B. Describe the action of opioid drugs in thetreatment of pain. C. Define the terms tolerance andcross-tolerance as they refer to the use of opioids for treatmentof pain.


1-Acute pain derives from combined effects of stimulatednociptors local inflammation ,systemic stress response mediters,andpsychological factors.

2- Opioids attach to proteins called opid receptors on nervecells in the brain,spinal cord,gut and other parts of the body.theopiods blocks pain messages sent from the body through the spinalcord to the brain.Opioids produce their effects by acting onspecefic opioid receptors mu,kappa and delta.these receptors arepresent in the CNS and other tissues.Stimulation of opiod receptorfinally results in a decreasse in the intracellular caicium whichin turn decrease the release of neurotransmitters.

3-Toleracne is a phrmacological concept describing subjectsreduced reaction to a drug following its repeated use.Increassingits dosage may re-amplyfy the effects of drugs.

Cross tolerance is a phenomena that occurs when tolerance to theeffects of a certain drug produces tolerance to another drug.Itoften happens between two drugs with similar functions oreffects.

Toleraance is defined as a requirement for increased doses of anopiod to acheive the same analgesic efefct.In clinical practice thedevelopment of either of these phenomena will lead to increasedpain with the usual consequenss of escalating dose ofopiod.Complete cross tolerance can develop as evidanced by the lackof anlgesic effect.

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