Lecture 7 review

Question 1

Pathway of pain

Answer 1

1) Transduction
2) Transmission
3) Perception
4) Modulation

Question 2

Transduction

Answer 2

1. Noxious stimuli cause cell damage with the release of sensitizing chemicals
   - Prostaglandins
   - Bradykinin
   - Serotonin
   - Substance P
   - Histamine
2. These substances activate nociceptors and lead to generation of action potential

Question 3

Transmission

Answer 3

Action potential continues from

• site of injury to spinal cord
• spinal cord to brain stem and thalamus
• thalamus to cortex for processing

Question 4

Perception

Answer 4

Conscious experience of pain

Question 5

Modulation

Answer 5

Neurons originating in the brain stem descend to the spinal cord and release substances (e.g. endogenous opioids) that inhibit nociceptive impulses

Question 6

PAIN acronym

Answer 6

Pattern
Area
Intensity
Nature

Question 7

Ceiling effect

Answer 7

Increasing the dose beyond an upper limit provides no greater analgesia

Question 8

“Step 1” drugs

Answer 8

Non-opioid analgesics

• aspirin and other salicylates
• NSAIDs
• acetaminophen

Question 9

Prototype

Answer 9

Drug that best represents a class of drugs

Question 10

Prodrug

Answer 10

Drug that requires conversion to its active form

Question 11

Opioid defintion

Answer 11

A general term that is defined as any drug, natural or synthetic, that has actions similar to those of morphine

Question 12

“Step 3” drugs

Answer 12

• Most are mu-receptor agonists
• potent
• no analgesic ceiling
• can be delivered via many routes

Question 13

Three main classes of opioid receptors

Answer 13

• mu receptors
• kappa receptors
• delta receptors

Question 14

Mu receptors

Answer 14

Analgesia, respiratory depression, euphoria, sedation, and physical dependence

Question 15

Kappa receptors

Answer 15

Analgesia and sedation

Question 16

Fentanyl compared to morphine

Answer 16

Fentanyl is 100 times the potency of morphine

Question 17

Equianalgesic dose

Answer 17

Dose of one analgesic equivalent in pain-relieving effects compared with another analgesic. E.g. Morphine 10 mg IV = Morphine 30 mg PO

Question 18

Gabapentin

Answer 18

An anticonvulsant. Helps reduce the pain that is hard to manage in neuropathic pain because it works at the neural level

Question 19

Sources of nociception

Answer 19

Somatic
Neuropathic
Visceral
Referred

Question 20

“Step 2” drugs

Answer 20

Weak opioids are combined with acetaminophen

Question 21

What kind of drug is acetaminophen?

Answer 21

Other non-opioid

Question 22

What kind of drug is acetylsalicylic acid (ASA, ECASA)?

Answer 22

NSAID

Question 23

What kind of drug is ibuprofen?

Answer 23

NSAID

Question 24

What kind of drug is diclofenac (Voltaren)?

Answer 24

NSAID

Question 25

What kind of drug is celecoxib (Celebrex)?

Answer 25

NSAID

Question 26

What kind of drug is codeine?

Answer 26

Opioid agonists with moderate efficacy

Question 27

What kind of drug is codeine + Acetaminophen?

Answer 27

Opioid agonists with moderate efficacy

Question 28

What kind of drug is morphine?

Answer 28

Opioid agonists with high efficacy

Question 29

What kind of drug is hydromorphone (Dilaudid)?

Answer 29

Opioid agonists with high efficacy

Question 30

What kind of drug is fentanyl?

Answer 30

Opioid agonists with high efficacy

Question 31

What kind of drug is naloxone hydrochloride?

Answer 31

Opioid antagonists