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Pharmacology > pain pathway > Flashcards

pain pathway Flashcards

1
Q

Occurs when a person taking a drug will go through withdrawal upon discontinuation of a drug.

A

dependence

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2
Q

painful information is projected to the supraspinal brain regions if the gate is open, although painful stimulus is not felt if the gate is closed by the simultaneous inhibitory impulses

A

Gate control theory

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3
Q

hypothesis that provides theoretical basis for massage, TENS, & acupuncture

A

Gate control theory

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4
Q

Requires higher doses of a drug to achieve a given effect

A

Tolerance

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5
Q

When a person can’t stop using a drug despite negative consequences from using that drug.

A

Addiction

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6
Q

tolerance to one drug produced tolerance to another that works similarly

A

cross tolerance

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7
Q

NMDA antagonists

A

Ketamine
Methadone
magnesium

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8
Q

Blocks NMDA receptor on postsynaptic spinal neuron in dorsal horn

A

Magnesium

Fewer side effects than ketamine

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9
Q

Activation of which opioid receptor is primarily responsible for respiratory depression?

A

mu 2

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10
Q

DEA opiod schedule

A

2

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11
Q

where are opioid receptors mostly found

A

Dorsal horn of the spinal cord

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12
Q

Purpose of Morphine Equivalent Dose (MED)
* Uses:

A
  1. Estimating total dosing when
    multiple opioids used
  2. Need to change opioids without
    losing efficacy
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13
Q

Equipotent Doses of meperidine

A

0.1x
100mg

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14
Q

Equipotent Doses Dilauid

A

7x
1.4mg

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15
Q

Equipotent Doses Alfenatnil

A

10x
1000mcg

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16
Q

Equipotent Doses Remifentanyl

A

100x
100mcg

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17
Q

Equipotent Doses Fentanyl

A

100x
100mcg

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18
Q

Equipotent Doses Sufenanil

A

1000x
10mcg

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19
Q

skeletal muscle rigidity common w what 4 meds

A

Sufentanil
Fentanyl
Remifentanyl
Alfentanyl

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20
Q

reason for skeletal muscle rigidity

A

Mu receptor stim in the CNS

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21
Q

5 SE of skeletal muscle rigidity

A

Increased O2 consumption
Increased ICP
Increase PVR

Decrease MVO2
Decreased chest wall compliance

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22
Q

treatment skeletal muscle rigidity

A

Paralysis and intubation

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23
Q

where does skeletal muscle rigidity effect

A

*larynx (greatest), Abdomen, thorax, throat

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24
Q

where does euphoria and reward happen for opiods

A

1 Nucleus accumbens with synaptic spasticity.

2 Ventral tegmental area

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25
Q

where does respiratory depression occur in the brain with opiods

A

Pons
Medulla

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26
Q

Remifentanil metabolism

A

ester → hydrolysis in plasma by nonspecific esterases

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27
Q

3 opiods with active metabolites

A

Morphine –> M6G and M3G
Meperidine –> Normeperidine
Codiene –> morphine –>

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28
Q

5 risks for respiratory depression with PCA

A

Basal rate
Administration of other sedatives
Old age
Pulmonary disease
OSA

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29
Q

Drugs that effect transduction

A

NSAIDS
Local anesthetic
Steroids
Antihistamines
Opioids

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30
Q

NSAID MOA

A

inhibits COX –> stops arachadonic acid to prostaglandins –> which stops substance p

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31
Q

Nociceptors

A

most are ion channels that create action potential
-Chemical
-Mechanical
-Thermal

inactive until stimulated

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32
Q

A delta fiber

A
  1. Fast, sharp, well-localized
  2. Myelinated
  3. Conduction speed: 5-30 m/s
  4. Larger diameter
  5. Synapse at lamina I and V

glutamate

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33
Q

c fibers (unmyelinated)

A
  1. Slow, long-lasting, dull, aching, diffuse
  2. Unmyelinated
  3. Conduction speed: <2m/s
  4. Smaller diameter
  5. Synapse at lamina I and II
    a. Rexed laminae II in dorsal horn of spinal cord- substantia gelatinosa

substance p

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34
Q

what is Dorsolateral tracts of
Lissauer

A

When first-order neurons enter the spinal cord, they can
branch into ascending or descending collaterals (go up or
down 1-2 spinal segments) before they penetrate the gray matter of dorsal horn

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35
Q

dorsal root of SC is responsible for

A

sensory

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36
Q

ventral root of SC is responsible for

A

motor

37
Q

2 important neurotransmitters in dorsal horn are PRO-nociceptive

A

Substance P (c fibers)
Glutamate (a delta fibers)

38
Q

Second order pathway: transmission

A

from Dorsal horn –> crosses over anterolateral system (SC) and up to thalamus (brain)

39
Q

third order pathway: transmision

A

thalamus → cerebral cortex & limbic system (cell body in thalamus)

40
Q

third order neuron synapse at

A

somatosensory cortex in parietal lobe

41
Q

Trigeminal nerve facial pain pathway

A

trigeminal nerve skips spinal cords and goes directly to brain

42
Q

Nociceptors transform painful stimulus (pressure, thermal,
chemical) into a signal, or action potential.

A

Transduction

43
Q

The process of transferring pain information from the
peripheral to central nervous system and up to the brain
along neuronal axons. Reflex arc is included.

A

transmission

44
Q

drugs that effect transmission

A

local anesthetics

45
Q

Local Anesthetic MOA

A

block Na channels

46
Q

anticonvulsant MOA for pain

A

block calcium entry into presynaptic neurons which decreases
neurotransmitter release

47
Q

antidepressant MOA for pain

A

block the reuptake of serotonin and norepinephrine in the CNS, so
they are able to aid in the inhibitory pathway which uses serotonin and
norepinephrine. This can enhance the natural opioid pathway.

48
Q

process of altering pain transmission

A

modulation

49
Q

5 Meds that affect modulation

A

Neuraxial opioids
NMDA antagonists
AchE inhibitors
SSRI/SNRI
A2 agonists

50
Q

Enhanced Pain: Modulation

A

-ENHANCED by central sensitization.
-Occurs in dorsal horn.
-Brain perceives a higher degree of pain for a stimulus
-May contribute to chronic pain

51
Q

what is an enhancement in the functional status of neurons and circuits in nociceptive pathways throughout the neuraxis caused by INCREASES in membrane excitability, synaptic efficacy, or a reduced inhibition?

A

Central sensitization

52
Q

critical regions underlying descending pain modulation

A
  1. Periaqueductal gray P.A.G. (brain stem) –>
  2. Nucleus raphe magnus ( rostroventral medulla R.V.M.)–>
  3. substantia gelatinosa
53
Q

they connect spinal motor and sensory neurons

A

interneurons

54
Q

What do interneurons release when stimulated by NE and Serotonin?

A

enkephalin (endogenous opioid)
endorphin
dynorphin

55
Q

norepinephrine and serotonin from descending pathway stop pain in 2 ways:

A
  1. inhibit substance P release from 1st order neuron
  2. stimulates interneuron to release enkephalin
56
Q

what two things does enkephalin do to stop pain?

A
  1. stops the release of substance p
  2. stops depolarization of second-order neuron
57
Q

endogenous neurotransmitters that suppress pain (Modulation):

A

NE
Serotonin
Endorphins
Gaba ? (where)
Glycine ? (where)

58
Q

where does pain perception occur

A

thalamus
(cortex important for discrimination of specific sensory experience)

59
Q

Drugs that effect perception

A

General anesthetics
Opioids
Alpha 2 agonists

60
Q

activation of nociceptors

A

activate specific subtypes of sodium channels to generate action potentials

(called Nav1.7 and Nav1.8 channels).

61
Q

phantom limb pain occurs in absence of what?

A

nociception or nociceptors

62
Q

where does a lot of attentuation/modulation of pain occur

A

substantia gelitinosa RL2

63
Q

3 Ionotropic glutamate receptors

A

NMDA
AMPA
Kainate

(a central ion channel pores activated by glutamate)

64
Q

Metabotropic Glutamate Receptors

A

mGluR 1-8

65
Q

where does spinothalamic tract (STT) go?

A

lamina 1 to the thalamus
associated with
1. Lateral: pain, temperature
2. anterior: touch, pressure

66
Q

Pain in the brain
Third Order Neuron

A

thalamus –> Somatosensory cortex

67
Q

Limbic System Cingulate Cortex

A

emotional
response, behavior regulation

68
Q

Hypothalamus

A

ANS response (incr HR and BP)

69
Q

Amyglada

A

fear

70
Q

Hippocampus and prefrontal cortex

A

memory, perception of pain

71
Q

accumbens

A

motivation

72
Q

Insula

A

processes painful experiences and drives
learning from pain

73
Q

motor response to pain

A

Signal is sent back down which releases endogenous opioid (enkephalin), blocks Ca++ influx into 1st order neuron, inhibiting substance P and stimulates enkepalin and serotonin

74
Q

Interneuron MOA to stop firing of second-order neuron

A
  1. Opens K channels
  2. Hyperpolarize the cell (more negative).
    (Usually post synaptic cells)
  3. Block Ca++ channel presynaptically so neurotransmitters are not released (decrease in pain)
75
Q

Nociception

A

perception of pain

76
Q

Endogenous chemicals and mediators that contribute to induction of nociception

A

bradykinin
protons
prostaglanin E
purines
cytokines
serotonin
histamine

77
Q

analgesia

A

diminished or absence of pain without loss of consciousness

78
Q

allodonia

A

pain due to a stimulus that does not normally provoke pain

a type of neuropathic pain

79
Q

dysesthesia

A

“abnormal sensation”; a general term for cutaneous symptoms without a primary cutaneous condition, such as pruritus, burning, tingling, stinging, crawling, hypoesthesia

painful, itchy, burning, or restrictive sensations

80
Q

hyperalgesia

A

an exaggerated response to a usually painful stimulus

a type of neuropathic pain
(Remifentanyl causes hyperalgesia)

81
Q

neuralgia

A

similar to dysesthesia but associated with a specific condition. Intense, intermittent pain, numbness and tingling along nerve pathway

82
Q

parasthesia

A

tingling or prickling sensations usually in hands or feet but can happen anywhere; cool sensitivity

83
Q

when pain receptors in the tissue are stimulated (musculoskeletal pain)

-gnawing, aching, or cramping

A

somatic pain

84
Q

pain from internal organs and blood vessels; vague symptoms such as aching, squeezing and radiating pain

A

Visceral pain

85
Q

Visceral pain is transmitted up to the brain via which spinal tract?

A

Dorsal column tract

SOMETIMES shares a second-order neurons with somatic pain tract

86
Q

Which of the following is true regarding
visceral pain?

A. Visceral pain tracts follow dermatomal patterns
B. Visceral nociceptors are very similar to cutaneous nociceptors
C. Visceral pain tracts cross in the thalamus rather than the spinal cord
D. Visceral pain tracts sometimes share second-order neurons with
somatic pain tracts

A

D

87
Q

visceral pain fibers cross

A

at the medulla (rather than spinal cord)

88
Q

neuropathy

A

damage or dysfunction to one or more nerves resulting in numbness, tingling and muscle weakness; usually in hands and feet
(i.e. diabetic neuropathy)

Pharmacology (10 decks)

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