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Chapters 3 and 4 Pathology
- 2. Pharmacology
Integrated medical science involving
chemistry, biochemistry, anatomy,
physiology, microbiology, and more
Study of drugs, their actions, dosage,
therapeutic uses, adverse effects
Drug therapy is directly linked to the
pathophysiology of a particular disease.
Drugs may come from natural sources.
Plants, animals, microorganisms
Drugs also may be synthesized.
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- 3. Drugs
Promote healing
Anti-inflammatory
Cure disease
Antibacterial
Control or slow progress of a disease
Cancer chemotherapy
Prevent disease
Vaccine
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- 4. Drugs (Cont.)
Alter neurotransmission
Antidepressants
Decrease risk of complications
Anticoagulants
Increase function and comfort
Analgesics for pain
Provide replacement therapy
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Insulin
Reduce excessive activity in the body
Proton pump inhibitors
- 5. Disciplines of Pharmacology
Pharmacodynamics
Pharmacokinetics
Pharmacotherapeutics
Toxicology
Pharmacy
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- 6. Drug Effects
Therapeutic (desired) action may be:
Stimulating or inhibiting cell function
Blocking biochemical actions in tissues
Classification
Grouped by their primary pharmacologic action
and effect
Indications
Approved for uses to treat conditions for which the
drug has been proved to be effective
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- 7. Drug Effects (Cont.)
Generally, drugs possess more than one effect
on the body.
Contraindications
Circumstances under which a drug should not be
administered
Side effects
Mild, undesirable effects of a drug, even at
recommended dose
Adverse or toxic effects
Drug effects that are dangerous, cause significant
tissue damage, or are life-threatening
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- 8. Specific Adverse Drug Effects
Hypersensitivity―allergic reactions
Reactions may be mild or can result in
anaphylaxis.
Idiosyncratic reactions
Unusual responses to a drug
Iatrogenic
Negative effect associated with administration of
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drug
Teratogenic
Harmful effect on fetus, developmental defects
- 9. Specific Adverse Drug Effects
(Cont.)
Interactions: drug effect modified by
combination with another drug
Synergism
• Effect of drug combination may be greater than the sum
of the effects of the individual drugs.
Antagonism
• Combination greatly decreases the effect of each drug.
Potentiation
• One drug enhances the effect of a second drug.
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- 10. Administration and Distribution of
Drugs
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Dose
Amount of drug required to produce the desired
effect in adult
Expressed by a weight or measure
Expressed by time factor (e.g., twice a day)
Child’s dose
Best calculated by child’s weight, not age
“Loading dose”
Larger dose may be administered initially to raise
blood levels to an effective level
- 11. Administration and Distribution of
Drugs (Cont.)
Frequency of dosing
Important to maintain effective blood levels of the
drug without reaching toxic levels
Optimum dosing schedule
Established for each drug based on
• Absorption, transport in the blood, half-life of the drug
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Timing
Directions regarding
• Timing related to meals
• Daily events
• Sleep
- 12. Factors Affecting Blood
Levels of Drugs
Regular intake, normal distribution and
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excretion
- 13. Factors Affecting Blood Levels of
Drugs (Cont.)
Factors: taking drug at irregular intervals,
missing doses
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- 14. Factors Affecting Blood
Levels of Drugs (Cont.)
Factors: taking double dose or too frequently
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- 15. Factors Influencing
Blood Levels of a Drug
Liver and kidney function
Absorption and excretion
Circulation and cardiovascular function
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Age
Body weight and proportion of fatty tissue
Activity level, exercise
Food and fluid intake
Genetic factors
Health status, presence of other diseases,
chronic or acute
- 16. Administration and Distribution
of Drugs
Drugs can be administered for acting locally or
have a systemic action.
Drug enters body by chosen route
Absorbed into blood or acts at local site
Travels in the bloodstream
Arrives at site of action
Exerts its effect
Is metabolized into inactive compounds
Is excreted from the body
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- 17. Routes of Drug Administration
Oral tablet, capsule, liquid
Sublingual
Subcutaneous injection
Intramuscular injection
Intravenous injection
Inhalation
Topical (gel, cream, spray, liquid)
Suppository
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- 18. Administration and Distribution
of Drugs (Cont.)
Some drugs can only be taken via one route.
Oral medication
Absorbed from stomach or intestine
Transported to the liver
Released into general circulation
Intramuscular injection
Gradually absorbed into the blood
Blood transports drug
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- 20. Drug Mechanisms and Receptors
Common pharmacologic action requires drug-receptor
interaction.
Drugs may stimulate receptors directly.
Drugs may block receptor site for normal
chemicals of the body
Specificity of drug dependent on mode of
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action
Drugs that interact with several metabolic
pathways or common functions are likely to
have greater side effects.
- 21. Receptors and Drug Action
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- 22. Prescriptions
Prescription―a signed legal document that
must include the following:
Patient’s name, address, and age (if significant)
Prescriber’s name, address, and identification
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number
Date
Name and amount of the drug
Dosage
Route and directions for using the drug
Permission for additional quantities
- 23. Drug Nomenclature and
Classification
Each drug has a generic name, a trade
name, and a chemical name
Generic name: unique, official, simple name
for a specific drug
For example, ASA
Trade, proprietary, or brand name
For example, aspirin
Chemical name: chemical component
For example, acetylsalicylic acid
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- 24. Examples of Drug Nomenclature
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- 25. Drug Regulation
U.S. Food and Drug Administration*
Regulates the production, labeling, distribution,
and other aspects of drug control
Scheduled drugs
Drugs considered to have a risk for potential
adverse side effects, abuse, or dependency
Over-the-counter (OTC) drugs
Available without prescription
*Food and Drug Directorate in Canada.
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- 26. Traditional Forms of Therapy
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- 27. Physiotherapy
Assesses physical function
Works to reduce pain, restore any deficit and
prevent further physical dysfunction
Involves individualized treatment and
rehabilitation
Physiotherapy may include the following:
Appropriate exercise
Use of ultrasound
Transcutaneous electrical nerve stimulation
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(TENS)
Other methods to alleviate pain, increase function
- 28. Physiotherapist
Treats acute injuries as well as chronic
conditions
Practice includes the following:
Pain disorders
Acute neurologic disorders
Musculoskeletal disorders
Cardiopulmonary disorders
Infants with congenital abnormalities
Children and adults with injuries that affect
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mobility
- 29. Occupational Therapist
Provides functional assessment related to
normal activities of daily living
Provides guidance and practical assistance to
maintain independence
Integrates remediation of motor control,
cognition, and visual-spatial perception
Necessary for patient safety
Teaches use of adaptations for specific
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needs
Assesses technologies available for use in
home and workplace
- 30. Speech and Language
Pathologist
Assesses and treats those with
communication or swallowing problems
Patients may include the following:
Infant with swallowing and feeding problems
Child with hearing deficit who is mute
Adult with aphasia following a stroke
Child with delayed speech
Individual with dysarthria
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- 31. Nutritionist-Dietitian
Expert in nutritional needs of the body in
health and illness
Advises on nutritional needs and food
management suited to a specific diagnosis
Example: diabetes
Supervises food services in hospitals and
other health care institutions
May consult on the dangers of extreme diets
and eating disorders
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- 32. Registered Massage Therapist
Uses a variety of massage techniques to:
Increase circulation
Reduce pain
Increase flexibility for patients with joint pain or
problems with body alignment
May use:
• Soothing aromatics
• Acupuncture
• Other modalities
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- 33. Osteopath
Osteopaths are medically licensed doctors in
many jurisdictions.
Uses many medical treatment methods
In addition, an osteopath:
Promotes body’s natural healing processes by
incorporating manipulations of the musculoskeletal
system (e.g., use of chest percussion to relief
respiratory congestion)
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- 34. Chiropractic
Based on the concept that one’s health status
is dependent on the state of the nervous
system
Frequently involves manipulations of the
vertebral column
May involve deep tissue massage,
acupressure, and/or acupuncture
Radiology may be used for diagnosis.
No drugs or surgery
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- 36. Principles
These therapies are used in conjunction with
medically related therapies.
All practitioners should know about various
therapies that the client is using.
Use of complementary therapy does not
require abandoning medical therapy.
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- 37. Noncontact Therapeutic Touch
Energy is exchanged between people for
relief of pain and anxiety and to promote
healing.
Consciously forms a positive intent to heal
Location of problem areas by scanning body
with the hands
Healing is promoted by lightly touching the skin or
moving the hands just above the body surface.
Imagery, light, or colors may be incorporated.
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- 38. Naturopathy
Treatment based on the following:
Promoting natural foods
Massage
Exercise
Fresh air
Acupuncture
Herbal compounds
Nutrition
Physical manipulations
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- 39. Homeopathy
Goal is to stimulate the immune system and
natural healing powers of the body by use of
the following:
Plant products
Animal products
Mineral products
Offending toxic substance is identified for each
disease state.
• Diluted several thousand-fold
• The diluted toxin is then administered to treat the
problem.
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- 40. Herbalism
First documented in ancient Egypt
Use of herbs and plants for treatment of acute
conditions or prevention of disease
Efforts are being focused on the following:
Providing standardized content
Providing efficacy
Improving purity
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- 41. Aromatherapy
Uses essential oils that have therapeutic
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effects
Thought to act on neural pathways through
the olfactory system
Oils may be
Absorbed through the skin into the general
circulation
• When bathing
• With massage
Inhaled
- 42. Asian Concepts of Disease
and Healing
Based on balance or imbalance of life
energy―qi
Disease is caused by a deficit or excess of qi.
Qi is derived from three sources:
Inherited or ancestral factors
Food ingested
Air breathed in
Qi flows along specific channels―meridians.
All organs and body parts are connected.
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- 43. Asian Concepts of Disease
and Healing (Cont.)
Acupuncture
Increases energy, function; blocks pain pathways
Involves Inserting fine needles into the various
meridian acupoints (365)
• Each point has specific and generalized therapeutic
actions.
Treatment on average uses 5 to 15 needles.
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Shiatsu
Japanese―acupuncture without needles
Uses slow, deep, gentle pressure to specific points
Often used for stress-related illness and back pain;
provides relaxation
- 44. Asian Concepts of Disease
and Healing (Cont.)
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Yoga
Combines physical activity in the form of
stretching postures with meditation
Improves flexibility, muscle tone, endurance,
overall health; reduces stress
Reflexology
Relates points on feet and hands to 10
longitudinal zones in the body
Practitioner uses varying degrees of pressure.
Relieves stress and muscle tension
- 45. Asian Concepts of Disease
and Healing (Cont.)
Craniosacral therapy
Used by a variety of health care practitioners
Therapy deals with the pulsing rhythm of
cerebrospinal fluid around brain and spinal cord
Gentle palpation and manipulation of skull and
vertebrae
Ayurveda
Special dietary plans, yoga, and herbal remedies
are commonly used.
Balance of body factors results in healthy mind
and body
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- 47. Pain
Unpleasant sensation
Discomfort caused by stimulation of pain receptors
Body defense mechanism
Warning of a problem
Complex mechanisms
Many not totally understood
Subjective scales
Developed to compare pain levels over time
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- 48. Causes of Pain
Inflammation
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Infection
Ischemia and tissue necrosis
Stretching of tissue
Stretching of tendons, ligaments, joint
capsule
Chemicals
Burns
Muscle spasm
- 49. Somatic Versus Visceral Pain
Somatic pain
From skin (cutaneous)
Bone muscle
Conducted by sensory fibers
Visceral pain
Originates in organs
Conducted by sympathetic fibers
May be acute or chronic
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- 50. Pain Pathways
Nociceptors (pain receptors) are free sensory
nerve endings.
May be stimulated by:
Temperature
• Extremes of temperature
Chemicals
• Examples: acids, bradykinin, histamine, prostaglandin
Physical means
• Example: pressure
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- 51. Pain (Cont.)
Pain threshold
Level of stimulation required to elicit a pain
response
Usually does not vary among individuals
Pain tolerance
Ability to cope with pain
Culturally related
Varies among individuals
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- 52. Pain Pathways
Nociceptors
Stimulated by
• Thermal means: extreme temperatures
• Chemical: For example, acids or chemicals produced by
body (e.g., bradykinin, histamine, prostaglandin)
• Physical: pressure
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- 53. Pain Fibers
Afferent fibers
Myelinated A delta fibers
Transmit impulses very rapidly
Acute pain
• Sudden, sharp, localized
Unmyelinated C fibers
Transmit impulses slowly
Chronic pain
• Diffuse, dull, burning, or aching sensation
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- 54. Pain Pathways (Cont.)
Dermatome
Area of skin innervated by a specific spinal nerve
Somatosensory cortex → “mapped”
• Corresponds to source of pain stimuli
Reflex response
Involuntary muscle contraction away from pain
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source
Involuntary muscle contraction to guard against
movement
- 55. Pain Pathways (Cont.)
Spinothalamic bundle in the spinal cord
Neospinothalamic tract → fast impulses; acute
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pain
Paleospinothalamic tract → slow impulses;
chronic, dull pain
Spinothalamic tracts connect with reticular
formation of brain
- 56. Pain Pathways (Cont.)
Somatic sensory area in the cerebral cortex
located in the parietal lobe
Perception and localization of sensation
Hypothalamus and limbic system
Emotional factors
Communication with other regions of the
brain to integrate responses
Reticular activating system (RAS)
Reticular formation in the pons and medulla
Awareness of incoming brain stimuli
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- 58. Physiology of Pain and
Pain Control
Gate control theory
Control systems, “gates” built into normal pain
pathways
Can modify pain stimuli conduction and
transmission in the spinal cord and brain
Gates open
• Pain impulses transmitted from periphery to brain
Gates closed
• Reduces or modifies the passage of pain impulses
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- 61. Pain Control
Application of ice
Impulses from temperature receptors close gates.
Transcutaneous electrical nerve stimulation
(TENS)
Increases sensory stimulation at site, blocking
pain transmission
Opiate-like chemicals (opioids)
Secreted by interneurons of the CNS
(endogenous)
Block conduction of pain impulses to the CNS
Resemble morphine
• Enkephalins, dynorphins, beta-lipoproteins
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- 62. Signs, Symptoms, and
Diagnosis of Pain
Location of pain
Descriptive terms
Aching, burning, sharp, throbbing, widespread,
cramping, constant, periodic, unbearable,
moderate
Timing of pain
Association with an activity
Physical evidence of pain
Pallor and sweating
High blood pressure, tachycardia
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- 63. Signs, Symptoms, and
Diagnosis of Pain (Cont.)
Nausea and vomiting
May occur with acute pain
Fainting and dizziness
May occur with acute pain
Anxiety and fear
Frequently evident in people with chest pain or
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trauma
- 64. Signs, Symptoms, and
Diagnosis of Pain (Cont.)
Clenched fists or rigid faces
Restlessness or constant motion
Guarding area to prevent stimulation of
receptors
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- 65. Young Children and Pain
Infants respond physiologically
Examples: tachycardia, increased blood pressure,
facial expressions
Great variations in different developmental
stages:
Different coping mechanisms
Range of behavior
Often have difficulty describing the pain
Withdrawal and lack of communication in older
children
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- 66. Referred Pain
Source may be difficult to determine.
Pain may be perceived at site distant from
source
Characteristic of visceral damage in the abdominal
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organs
Heart attack or ischemia in the heart
- 67. Location of Referred Pain
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- 68. Phantom Pain
Usually in adults
More common if chronic pain has occurred
Can follow an amputation
Pain, itching, tingling
Usually does not respond to common pain
therapies
May resolve within weeks to months
Phenomenon not fully understood
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- 69. Pain Perception and Response
Pain tolerance
Degree of pain, intensity, or duration
May be increased by endorphin release
May be reduced because of fatigue or stress
Varies among people in different situations
Pain perception
Subjective but can be compared from day to day
in same person
Response to pain
Influenced by personality, emotions, and cultural
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norms
- 70. Acute Pain
Usually sudden and severe, short term
Indicates tissue damage
May be localized or generalized
Initiates physiologic stress response
↑ Blood pressure and heart rate; cool, pale, moist
skin; ↑ respiratory rate; ↑ skeletal muscle tension
Vomiting may occur.
Strong emotional response may occur.
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- 71. Chronic Pain
Occurs over extended time; may be recurrent
Usually more difficult to treat than acute pain
Often perceived to be generalized
Individual may be fatigued, irritable,
depressed
Sleep disturbances common
Specific cause may be less apparent.
Appetite may be affected.
Can lead to weight gain or loss
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- 72. Chronic Pain (Cont.)
Frequently affects daily activities
Accommodation and pacing of activities may be
required.
Periods of acute pain may accompany
chronic pain conditions.
Usually reduces tolerance to additional pain
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- 73. Comparison of Acute
and Chronic Pain
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- 74. Headache: Types and Causes
Congested sinuses, nasal congestion, eye
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strain
Muscle spasm and tension
From emotional stress
In temporal area
Temporomandibular joint syndrome
Migraine
Abnormal blood flow and metabolism in the brain
Intracranial headaches
Increased pressure inside the skull
- 75. Headache: Types and
Causes (Cont.)
Central pain
Caused by dysfunction or damage to the brain or
spinal cord
Neuropathic pain
Caused by trauma or disease involving the
peripheral nerves
Ischemic pain
Results from a profound, sudden loss of blood flow
to an organ or tissue
Cancer-related pain
Caused by advance of the disease; pain associated
with treatment; result of coexisting disease
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- 76. Methods of Managing Pain
Remove cause of pain as soon as possible
Use of analgesic medications
Orally
Parenterally (injection)
Transdermal patch
Classified by ability to relieve
• Mild pain
• Moderate pain
• Severe pain
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- 78. Methods of Managing
Pain (Cont.)
Sedatives and antianxiety drugs
Adjuncts to analgesic therapy
Promote rest and relaxation
May reduce dosage requirements for analgesic
Chronic and increasing pain
May occur in cancer
Stepwise fashion to reduce pain
Tolerance to narcotics develops over time
• Increase dose requirements
• New drug may be required
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- 79. Methods of Managing
Pain (Cont.)
Severe pain
Patients administer medication, as needed.
Patient-controlled analgesia (PCA)
Lessens overall consumption of narcotics
Intractable pain
Cannot be controlled with medication
Surgical intervention is a choice.
• Rhizotomy
• Cordotomy
• Injections
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- 80. Anesthesia
Local anesthesia
Injected or applied to skin or mucous membranes
Spinal or regional anesthesia
Blocks pain from legs or abdomen
General anesthesia
Causes loss of consciousness (gas or injection)
Neuroleptanesthesia
Patient can respond to commands.
Relatively unaware of procedure, no discomfort
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Editor's Notes
- You may wish to discuss non-pharmacological methods of pain control as well.