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apex review > Opioid & non-opioid analgesics > Flashcards

Opioid & non-opioid analgesics Flashcards

1
Q

Identify the process by which a nociceptor converts a chemical stimulus into an action potential.
a. transmission
b. transduction
c. perception
d. modulation

A

b. transduction

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2
Q

Transduction occurs when a

A

chemical, mechanical, or thermal stimulus is sensed by a nociceptor and converted into an action potential

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3
Q

Transmission occurs when

A

the afferent pain signal travels from the peripheral nervous system to the central nervous system via a 3-neuron pathway

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4
Q

Modulation is when the

A

pain signal is modified (inhibited or augmented) as it advances towards the cerebral cortex

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5
Q

Perception is when the

A

pain signal is processed and “perceived” in the cerebral cortex and limbic system

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6
Q

Nociception is divided into four processes including

A

transmission
transduction
modulation
perception

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7
Q

A-delta fibers transmit

A

“fast pain” that is sharp and well-localized

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8
Q

C-fibers transmit

A

“slow pain” that is dull and poorly localized

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9
Q

Inflammation also contributes to

A

reduced threshold to pain stimulus (allodynia)
increased response to pain stimulus (hyperalgesia)

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10
Q

Drugs that target transduction include

A

NSAIDs
LAs
steroids
antihistamines
opioids

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11
Q

What is a first order neuron

A

periphery to dorsal horn

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12
Q

what is a second-order neuron?

A

dorsal horn to thalamus

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13
Q

What is a third-order neuron?

A

thalamus to cerebral cortex

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14
Q

Drugs that target transmission include

A

local anesthetics

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15
Q

Perception means

A

how we “feel” about pain

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16
Q

Drugs that target perception include

A

general anesthetics
opioids
alpha-2 agonists

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17
Q

The most important site of modulation is

A

the substantia gelatinosa in the dorsal horn (rexed lamina 2 & 3)

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18
Q

Pain is inhibited when

A

spinal neurons release GABA & glycine (inhibitor neurotransmitters)
2. the descending pain pathway release NE, serotonin, and endorphins

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19
Q

Pain is augmented by

A

wind-up
central sensitization

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20
Q

Drugs that target modulation include

A

neuraxial opioids
NMDA antagonists
alpha 2 agonists
AchE inhibitors
SSRIs
SNRIs

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21
Q

Molecular mechanisms of opioid receptor stimulation include: (select 2)
a. decreased cAMP production
b. increased calcium conductance
c. increased adenylate cyclase activity
d. increased potassium conductance

A

a. decreased cAMP production
d. increased potassium conductance

22
Q

Opioid receptor stimulation reduces

A

neurotransmitter release from presynaptic neurons and hyperpolarizes postsynaptic neurons

23
Q

Where are opioid receptors located?

A

brain
spinal cord
peripheral

24
Q

Where in the brain are opioid receptors located?

A

periaqueductal gray
locus coeruleus
rostral ventral medulla

25
Q

Where in the spinal cord are opioid receptors located?

A

primary afferent neurons in the dorsal horn
interneurons

26
Q

Where in the periphery are opioid receptors located?

A

sensory neurons
immune cells

27
Q

What are the four types of opioid receptors?

A

all are G-proteins
-Mu
-Delta
-Kappa
-ORL1

28
Q

The existence of ______________ has yet to be proven

A

mu receptor subtypes

29
Q

Stimulation of kappa receptors helps _________ but can also ____________

A

quell shivering; but can also cause dysphoria, delirium, and hallucinations

30
Q

Key physiologic effects of Mu receptor stimulation include

A

analgesia, bradycardia, respiratory depression, euphoria, physical dependence, and constipation

31
Q

Describe how opioids work at the receptor level.

A
  1. opioid binds to a receptor
  2. G protein is activated
  3. adenylate cyclase is inhibited
  4. less cAMP is produced
  5. Ca+2 conductance is decreased
  6. K+ conductance is increased
32
Q

What is the precursor of the Mu receptor?

A

pre-proopiomelanocrtin–> endorphins

33
Q

What is the precursor of the Delta receptor?

A

Pre-enkephalin–> enkephalins

34
Q

What is the precursor of the kappa receptor?

A

pre-dynorphin–> dynorphins

35
Q

What is the only opioid receptor that causes bradycardia?

A

Mu

36
Q

What opioid receptors cause miosis?

A

Mu &kappa

37
Q

What opioid receptors cause urinary retention?

A

Mu & delta

38
Q

What opioid receptor causes diuresis?

A

kappa

39
Q

What opioid receptor has antishivering properties?

A

kappa

40
Q

What opioid receptors cause pruritus?

A

Mu & delta

41
Q

What opioid receptors lead to nausea & vomiting?

A

Mu

42
Q

What are the effects of Mu1?

A

analgesia (suraspinal & spinal)
bradycardia

43
Q

What are the effects of Mu2?

A

analgesic (spinal only)
respiratory depression
constipation
physical dependence

44
Q

What are the effects of Mu3?

A

immune suppression

45
Q

Cardiovascular consequences of opioid administration in healthy patients include:
a. bradycardia
b. myocardial depression
c. hypotension
d. impaired baroreceptor reflex

A

a. bradycardia

46
Q

Do opioids effect blood pressure?

A

Nope- only minimal effect

47
Q

Opioids cause nausea and vomiting by

A

stimulating the chemoreceptor trigger zone in the medulla and possible interaction with the vestibular apparatus

48
Q

Opioids produce respiratory depression by

A

shifting the CO2 response curve to the right

49
Q

Agents that produce histamine release include

A

morphine, meperidine, and codeine

50
Q

Opioids may be implicated in _______________ through inhibition of cellular and humoral immune function.

A

cancer recurrence

51
Q

Opioids cause _________________________ which can be reversed with ___________ or _____________

A

contraction of the sphincter of Oddi; naloxone or glucagon

52
Q

In women, morphine is associated with a:

A

greater analgesic potency
slower onset of action
longer duration of action
lower postoperative opioid consumption

apex review (224 decks)

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