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Priniclpes Of Anesthesia > Exam 3 - acute pain > Flashcards

Exam 3 - acute pain Flashcards

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1
Q

Definition of pain

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

a physiological, emotional and behavioral experience

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2
Q

algesia

A

Increased sensitivity to pain

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3
Q

algogenic

A

pain producing

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4
Q

allodynia

A

a normally nonharmful stimuli is perceived as painful

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5
Q

analgesia

A

absence of pain in presence of normally painful stimuli

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6
Q

dysesthesia

A

unpleasant painful abnormal sensation, whether evoked or spontaneous

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7
Q

hyperalgesia

A

a heightened response to a normally painful stimulus

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8
Q

Neuralgia

A

pain in distribution of a peripheral nerve

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9
Q

Neuropathy

A

Abnormal disturbance in the function of nerves

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10
Q

Paresthesia

A

abnormal sensation whether spontaneous or evoked

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11
Q

fibromyalgia has

A

allodynia

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12
Q

herpes zoster has

A

neuralgia

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13
Q

surgical incision has

A

algogenic

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14
Q

Nociceptive is

A

tissue injury

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15
Q

non nociceptive neuropathic is

A

nerve injury

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16
Q

nociceptors detect

A

acute pain to tissue injury and chronic pain from swelling or injury

temp, pressure, stretch

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17
Q

Nociceptive pain can be (3)

A
  1. somatic
  2. visceral
  3. radicular
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18
Q

Somatic pain

A

identifiable location as a result of tissue causing release of chemicals from injured cells

localized, sharp in nature

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19
Q

Visceral pain definition and associations

A

diffuse, can be referred

dull cramping/squeezing or vague

associated with autonomic reflexes (nausea, vomiting, diarrhea)

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20
Q

Radicular pain description and cause

A

irritation of the nerve root

numbness, weakness, tingling, pins and needles

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21
Q

Neuropathic pain description and cause

A

caused by damage to peripheral or central neural structures

burning, tingling or shocl like

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22
Q

Non-nociceptive pain

A

Chronic - neuropathic or idopathic

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23
Q

Idiopathic pain description

A

Psychogenic pain associated with chronic pain

No apparent cause

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24
Q

Phases of Nociceptive pain (4)

A
  1. Transduction
  2. transmission
  3. Perception
  4. Modulation
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25
transduction
Transmission of noxious stimuli into action potential
26
transmission
Pain message moves to spine and on to brain (signal enters brainstem or thalmus and extends to cerebral cortex)
27
A-delta and C fibers are
noxious stimulus pathways to the brain
28
A-gamma and C fiber are (afferent or efferent)
afferent
29
A-delta and C fiber pathway:
found in dorsal root ganglion --> dorsal cord -->divide and ascend in the tract of Lissauer
30
A-delta and C fibers decend:
1-3segmetns of tract of Lissauer
31
Perception includes (3)
1. attention 2. expectation 3. interpretation
32
Modulation roles (4)
1. Brain interacts with nerves to modulate or alter pain experience 2. adjust the intensity and duration 3. involves release of chemicals (i.e. endorphins and serotonin 4. decrease transmission of pain signals
33
Modulation stages
1. Periphery 2.Dorsal horn 3. Descending inhibitory pathway 4. Cortical
34
Periphery stage of modulation
descending dorsolateral efferent pathway is activated
35
Primary afferent fibers:
A-delta and C fibers
36
A delta fiber pathway: Speed, characteristics and pain type
fast-sharp,peircing pain large myelinated (fast bunny)
37
A delta fibers terminate in
Rexed's lamina I, V
38
C fibers pathway: speed, characteristics, pain type
Dull, chronic pain. Dull, aching, burning small unmyelinated slow turtle
39
C fibers terminate in
lamina II and III
40
Dorsal horn modulation stage
nural impulses modulated in spinal cord (dorsal horn) by "gatelike" process before traveling to CNS
41
Gate theory
APs are transmitted that inhibit inhibitory neuron projection neuron is activated opening the gate *think of pressure before IV stick
42
Modulation stage 3: Descending inhibitory pathway controls the
ascending pathway
43
Modulation stage 3: Descending inhibitory pathway releases _____ and inhibits ____
releases serotonin and noradrenergic neuron and inhibits substance P
44
Inhibitory nerotransmitters in descending pathway:
-enkephalin -glycine -norepinephrine -serotonin -GABA
45
Enkephalin
binds to opiate receptors on pre-synaptic first order neurons and post-synaptic second order afferent fibers =decrease substance P release = suppress ascending pain transmission
46
Stage 4 modulation: Cortical role
Pain learning and memory remembers "that hurt"
47
central sensitization
neural plasticity that occurs in CNS
48
central sensitization occurs by
Repetitive stimulation of injury and repetitive firing in dorsal horn nociceptorsce
49
central sensitization can cause
activation of lower non-nociceptive mechanoreceptors to trigger a pain response - chronic pain
50
Two major ascending pain pathways:
1. Direct lateral spinothalmic 2. Indirect medial spinoreticulothalmic
51
Indirect medial spinoreticulothalamic pathway pain
deep somatic and visceral (dull)
52
Lateral spinothalmic pathway pain
sharp
53
Second order neuron location
dorsal horn - cross midline of spinal cord -->thalmus
54
Third order neuron location
Thalmus -->specific area of somatosensory cortex
55
mediators are
released from inflammatory cells/injured tissue
56
Mediator categories:
1. vasoactive amines 2. peptides 3. Eicosanoids
57
Vasoactive amiens:
1. HIstamine 2. Serotonin
58
Peptide amines:
1. bradykinen
59
Eicosanoids:
1. Thromboxane 2. Leukotrienes 3. Prostaglandins
60
Bradykinen role and cause
stimulates peripheral nociceptors causes algesia (increased sensitivity to pain)
61
Histamine role and cause
maintain acute-phase response vasodilation and edama
62
Arachidonic acid role and examples
important substrate in synthesis of active mediators of inflammation (such as cox 1 and 2) ex: prostiglandins and thromboxanes
63
Cyclooxygenase (aka cox 1) is secreted in
vascular endothelium, stomach, forbrain, uterine epithelium, kidney
64
cox two is stimulated at
site of inflammation primary periphery
64
Cox 2 is responsible for
pain and fever
64
IP receptor biological effects
Vasodilator antiaggregant
64
Endorphins (peptide NTs) role and example
attatches to endorphin (opiate) receptors of axon terminals of pain afferents --> inhibits release of substance P -->limits sensation of pain (mediated by descending projections) ex. enkephalin
65
TP receptor biological effects
Vasoconstrictor Proaggregant
66
EP receptor biological effects
Vasodilator Neuroprotective Neurodestructive
67
DP receptor biological effects
Vasodilator antiinflammatory proapoptotic
68
FP receptor biological effects
vasodilator antiaggregant
69
Substance P is a _____ released from _______
Neurotransmitter released from afferent nociceptor C fibers
70
Substance P is involved with
slow chronic pain, systemic
71
Substance P action
1. vasodilation 2. extravasation of plasma proteins (edema) 3. degranulation of mast cells 4. sensitization of stimulated sensory nerve
72
Glutamate
major excitatory neurotransmitter
73
glutamate is released in
1. CNS 2. A-delta afferent nerve fibers 3. C primary afferent nerve fibers
74
glutamate is involved with what type of pain?
fast and sharp
75
Serotonin location and release
descending pathway, released from platelets after tissue injury
76
Serotonin role
algesic effect of peripheral nociceptors
77
Prostaglandins (PGs) are synthesized from
cox 1 and cox 2
78
Prostaglandins role
sensitize peripheral nociceptors, cause hyperalgesia Prolonged pain, keeps going
79
Cytokines: what are they and what to they cause
released in response to tissue injury Increasein PGs -->cause excitation and sensitization of nociceptive fibers
80
CGRP released from _____ and cause ____ effects (calcitonin gene related peptide)
released from peripheral C fibers and cause LOCAL vasodilation, plasma extravasation, sensitization of sensory nerve
81
Major neurotransmitter released from A-delta fibers is
glutamate
82
glutamate binds to
AMPA and NMDA receptors on postsynaptic membrane
83
Major neurotransmitter that is released from C fibers
Substance P
84
substance P binds to
NK-1 neurokinen-1 receptors on postsynaptic membrane
85
Endorphine MOA and result
binds to pre-synaptic neuron (from descending pathway) to prevent substance P secretion Substance P does not bind to norciceptive neuron
86
How does acute pain activate SNS?
Increases released catecholamines and adrenal glands, increased cortisol release
87
Pain effects on respiratory system (3)
- decreased vital capacity (VC) -decreased inspiratory capacity (IC) -decreased functional residual capacity (FRC)
88
decreased VS can cause
V/Q mismatch
89
NSAID MOA
inhibits cox-2 = prevents PG formation = less substance P and glutamate
90
Ketorolac MOA
nonselective COX inhibitor
91
Ketorlac contraindication
GI bleeding, renal impairment, asthma, possible impairment in bone healing
92
Celbrex class and MOA
NSAID inhibitor of Cox-2
93
Fentanyl vs morphine
fentanyl is 80-100 x more potent than morphine
94
Fentanyl onset and duration
short 2-5 min onset 30 min duration
95
most widely used narcotic for acute and chronic pain
morphine
96
Hydromorphone vs morphine
Hydromorphone 7-8 times more potent
97
Dependence can be
physiologic or psychologic
98
physiologic dependence
Withdrawal
99
psychological dependence
need for a specific substance either for positive effect or avoidance of negative
100
Addiction
cravings, obsessive thinking, impaired behavior control, compulsive drug taking, inability to recognize problem
101
Pseudoaddiction
origin in inadequate analgesia - actually have a pain problem. Not drug seeking NOT psychological dependence
102
Opioid tolerance
repeated exposure to a drug = need higher dose for analgesia
103
opioid tolerance mechanisms (4)
1. enzyme induction or down regulation of opioid receptors 2.drug-receptor interaction 3. cellular alteration 4. long term adaptations in gene expression
104
If opioid tolerance is suspected:
opioid rotation
105
Opioid-induced hyperalgesia
worsening pain/spreading pain/pain in different location hard to differentiate from tolerance
106
Ketamine MOA
NMDA antagonist
107
Clonidine MOA
Centrally acting selective partial alpha-2 agonist (and some alpha 1)
108
Acute pain adjucts
1. ketamine 2. clonidine 3. dexmedetomidine 4. local anesthestics 5. PCA 6. Epidural 7. Spinal
109
Dexmedetomidine MOA
highly selective alpha-2 agonist
110
activation of alpha 2 receptor results in
inhibition of adenylate cyclase and decreased cAMP levels = reduced neurotransmitter release
111
Local anesthetics MOA
inhibit conduction of action potentials in ascending pathway
112
common PCA drugs (3)
1. morphine 2. hydromophone 4. fentanyl
113
Epidurals are a combination of
local anesthetic and narcotic (synergy)
114
Spinal MOA
Hydrophillic opioids surround spinal cord and bind to specific pre and post synaptic receptors within the dorsal horn
115
McLott mix is for _____ and includes _____ (4)
opioid free anestheisla 1. lidocaine 2. ketamine 3. magnesium 4. dex

Priniclpes Of Anesthesia (19 decks)

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