Acute Pain & Opioid-Free Analgesia (Exam II)

Question 1

What types of somatic pain are there?

Answer 1

• Superficial: skin, SQ, mucous membranes
• Deep: muscles, bones, tendons

Question 2

What types of visceral pain are there?

Answer 2

• Parietal: sharp, localized organ pain.
• Referred: Cutaneous pain from convergence of visceral and somatic afferent input.

Question 3

Is chronic nociceptive pain or neuropathic pain more abnormal?

Answer 3

Neuropathic pain

Question 4

What are some possible cardiac consequences of poorly managed pain? (3)

Answer 4

↑ HR
↑ BP
↑ Cardiac workload

Question 5

What are some possible respiratory consequences of poorly managed pain? (5)

Answer 5

• Splinting (resp muscle spasm)
• ↓ VC
• Atelectasis
• Hypoxia
• Pulmonary infection risk

Question 6

What are some gastrointestinal consequences of poorly managed pain?

Answer 6

Ileus - delayed motility

Question 7

What are some possible renal consequences of poorly managed pain?

Answer 7

• Oliguria
• Urine retention

Question 8

What are some possible coagulative consequences of poorly managed pain?

Answer 8

↑ clot risk

Question 9

What are some possible immunologic consequences of poorly managed pain?

Answer 9

Immunosuppression

Question 10

What are some possible musculoskeletal consequences of poorly managed pain?

Answer 10

• Muscle fatigue & weakness
• Limited mobility ⇉ clotting

Question 11

What is the Specificity Theory?
Who came up with it?

Answer 11

Specific sensation w/ its own sensory system independent of touch and other senses - Descartes

Question 12

What theory linked pain and emotion?

Answer 12

Intensity Theory (Plato)

Question 13

Where is pain attenuated in the CNS according to gate theory?

Answer 13

Substantia Gelatinosa - functions as a “gate” for pain impulses that can be closed by non-painful impulses such as from A-beta fibers

Question 14

What chemicals are released upon tissue injury that mediate pain? (4)

Answer 14

• Histamine
• Bradykinin (peptide)
• Prostaglandins (lipids)
• Serotonin (neurotransmitters)

Question 15

Give an example of first order neurons.

Answer 15

Aδ and C

Question 16

Where do first order Aδ and C fibers synapse at?

Answer 16

Dorsal Root of the spinal cord

Question 17

What are the main differences from A-delta and C-fibers?

Answer 17

A-delta: myelinated, large, fast
C-fibers: unmyelinated, small, slow

Question 18

Where do second order neurons synapse at?

Answer 18

Thalamus

Question 19

What is the name of the process by which noxious stimuli are converted to action potentials?

Answer 19

Transduction

Question 20

What is the name of the process by which an action potential is conducted through the nervous system?

Answer 20

Transmission

Question 21

What is the name of the process by which pain transmission is altered along its afferent pathway?

Answer 21

Modulation

Question 22

What is the name of the process by which painful input is integrated in the somatosensory and limbic cortices of the brain?

Answer 22

Perception

Question 23

Hyperalgesia is the process by which tissue trauma releases _____ _______ ______ that produced augmented sensitivity to stimuli.

Answer 23

local inflammatory mediators

Question 24

What is primary hyperalgesia?

Answer 24

Augmented sensitivity to painful response.

or

Allodynia-style misinterpretation of non-painful stimuli.

Question 25

What is secondary hyperalgesia?

Answer 25

Increased neuronal excitability due to glutamate activation of NMDA receptors.

Question 26

What opioid may potentiate hyperalgesia?

Answer 26

Remifentanil

Question 27

What is the treatment for hyperalgesia that was mentioned in lecture?

Answer 27

Ketamine

Question 28

Differentiate Hyperalgesia and Allodynia. *In chart form*.

Answer 28

Question 29

What is the hallmark "negative" symptom of neuropathy?

Answer 29

numbness *Positive s/s can exist as well (pain, sensitivity, etc.*

Question 30

GI blood flow and motility increase as we age. T/F?

Answer 30

False. GI blood flow and motility decrease as we age

Question 31

Gastric acid secretion ______ as we age thus _______ gastric pH.

Answer 31

decreases; increasing

Question 32

What effect does aging have on nutrient absorption in the GI tract?

Answer 32

Minimal

Question 33

What occurs to muscle and fat mass as a patient ages?

Answer 33

Muscle decreases while fat increases

Question 34

A decrease in _______ affects your protein-bound drugs in aging.

Answer 34

albumin *causes more free drug in circulation*

Question 35

What occurs with hepatic function in the aging patient?

Answer 35

- ↓ hepatic blood flow - ↓ liver mass and metabolic activity

Question 36

What occurs with renal function due to aging?

Answer 36

- **↓ GFR** - ↓ kidney mass, blood flow, and functioning nephrons

Question 37

Do opioids or non-opioid analgesics exhibit a ceiling effect?

Answer 37

Non-opioid analgesics

Question 38

What opioid receptor is responsible for analgesia, respiratory depression, **euphoria**, and **reduced GI motility**?

Answer 38

Mu (μ) receptor

Question 39

What opioid receptor (when agonized) is responsible for analgesia, **dysphoria, psychosis, miosis**, and respiratory depression?

Answer 39

Κappa receptor

Question 40

What opioid receptor causes analgesia alone when bound by an agonist?

Answer 40

Delta

Question 41

What drug is described by the following organic structure: Substitution of methyl group for hydroxyl group on #3 carbon of morphine molecule. (3-methoxymorphine)

Answer 41

Codeine

Question 42

______ is much more reliably absorbed than morphine.

Answer 42

Codeine

Question 43

What drug exhibits side effects (without concurrent analgesia) in children? Why is this?

Answer 43

Codeine *Children lack enzymatic maturity needed to properly break down codeine*.

Question 44

What CYPs metabolize codeine?

Answer 44

CYP2D6 → morphine CYP3A4 → norcodeine