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Neuro 2 (Mo) > Review 2 > Flashcards

Review 2 Flashcards

1
Q

Chronic pain

A

Hyperalgesia

Allodynia

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2
Q

Hyperalgesia

A

Sensitized perfiery
Ad/C fiber
abnormally heightened sensitivity to pain.

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3
Q

Allodynia

A

AB fibers
refers to central pain sensitization (increased response of neurons) following painful, often repetitive, stimulation. Allodynia can lead to the triggering of a pain response from stimuli which do not normally provoke pain

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4
Q

NSAIDs

A

Work on sensitizing agents

PGs

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5
Q

Mechanisms of Neuropathic PainCentral Sensitization

A

NMDA receptor antagonists

α2δ ligands- VSCC (gabapentin)

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6
Q

Ectopic Activity

Mechanisms of Neuropathic Pain

A

Increased excitability of injured sensory neurons can generate pacemaker-like ectopic discharges that result in sensory inflow that is independent of any peripheral stimuli.

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7
Q

Peripheral
Sensitization
RX

A

VSSC
Carbamazepine
Oxcarbazepine
Lidocaine

Prostaglandins
NSAIDs

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8
Q

Central
Sensitization
RX

A

VSCC (α2δ ligands)
Gabapentin
Pregabalin

NMDA Receptors
Ketamine*

Prostaglandins
NSAIDs

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9
Q

Descending Inhibition

RX

A

NE
Opioid Receptors

TCADs*
SNRIs*
Tramadol
Opioids

Inhibitors of monoamine reuptake (TCADs-SNRIs) are NOT effective for ACUTE pain

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10
Q

Chronic Pain Management - Mechanistic Approach

A

↑ Descending inhibition

↓ Central/ perf sense

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11
Q

Activation of opioid receptors

A

opioid analgesics, tramadol

Enhancement of Descending Inhibitory pathway

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12
Q

Block of NE-5HT reuptake

A
  • antidepressants-TCAD*-SNRI-SSRI
  • First line

Enhancement of Descending Inhibitory pathway-

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13
Q

Principles of Chronic Pain Management

A

Non-opioid and adjuvant medications are emphasized

Adjuvants (useful for pain but not classified as analgesics)

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14
Q

Block of VSCC

Decrease in Central Sensitization

A

↓ excess NT release: anticonvulsants (α2δ ligands)

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15
Q

Block of NMDA-Glu receptors

A

ketamine

Decrease in Central Sensitization

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16
Q

Block of Cyclooxygenase-2

A

NSAID, celecoxib, acetaminophen

Decrease in Central Sensitization

17
Q

Block of VSSC

Decrease in Peripheral Sensitization

A

inhibit excess neurotransmission: local anesthetics, anticonvulsants

18
Q

No good evidence for long-term benefits of opioids – avoid in: _________, headaches-migraines, TMD, IBS

A

low back pain, fibromyalgia

19
Q

Anticonvulsants - Gabapentin and Pregabalin

A

Binds to α2δ subunit of VSCC - may act to ↓ release of excitatory NT glutamate in pain pathways

20
Q

Adverse Reactions

Anticonvulsants - Gabapentin and Pregabalin

A

better tolerated than other AEDs

Sedation - ataxia - dizziness

Generally free from drug-drug interactions

Risk of abuse with pregabalin - C-V controlled substance

Adjuvant Use in Selected Chronic Pain Syndromes

21
Q

NSAIDs, acetaminophen, COX-2 selective, aspirin

A

Nonopioid analgesics

22
Q

Opioid analgesics may be used for:

A

Acute neuropathic pain

Neuropathic cancer pain

Episodic exacerbations of severe pain

Should generally be reserved for moderate to severe pain that adversely impacts function or quality of life

23
Q

Controlled substances with high abuse potential –

A

CII-III

24
Q

neuropathic pain- Adjuvant Analgesics

A

Anticonvulsants

Antidepressants

Local anesthetics

25
Q 
Mild pain (rated 1-3)
Acute Pain Management
A

Non-opioid (e.g., NSAID or acetaminophen)

± Adjuvant analgesics*

*Generally more useful in chronic pain syndromes - discussed later

26
Q 
Moderate pain (rated 4-6)
Acute Pain Management
A

Immediate-release, short-acting opioids with slow titration

+ Non-opioid (NSAIDs more effective) ± adjuvant analgesics*

*Generally more useful in chronic pain syndromes - discussed later

27
Q 
Severe pain (rated 7-10)
Acute Pain Management
A

Immediate-release, short-acting opioids with rapid titration

+ Non-opioid ± adjuvant analgesics* (most commonly LAs)

Commonly managed with multimodal analgesia approach

*Generally more useful in chronic pain syndromes - discussed later

Neuro 2 (Mo) (25 decks)

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