Exam 4 Flashcards
(116 cards)
1
Q
% of the population suffers from migranes, the majority being _ ().
A
14.7
female
after puberty, before menopause
2
Q
Migraine
A
recurring headache disorder manifesting in attacks lasting 4-72 hours
3
Q
Symptoms of a migraine
A
unilateral (sometimes bilateral) location
Pulsating quality
Moderate or severe intensity
Aggravation by routine physical intensity
Photo- and phono- phobia
4
Q
In the US, one in _ households has one sufferer of migraines
A
four
5
Q
Foods containing (5) are likely to trigger a migraine
A
MSG tyramine nitrates phenylethylamine aspartame
6
Q
Drugs containing (3) are likely to trigger a migraine
A
Estrogen (eg. OC)
Nitroglycerin
Excess analgesic use or withdrawal
7
Q
Abortive migraine therapy
A
goal is to stop the migraine once it starts
8
Q
Prophylactic migraine therapy
A
goal is to prevent migrains from occurring, drugs taken daily
9
Q
Abortive therapy drugs
A
NSAIDS + caffeine
Ergotamine
Dihydroergotamine
10
Q
Abortive therapy drug targets
A
AGONIST
5-HT1/1B/1D/1F, Alpha 1/2, D2
11
Q
Triptans (are/are not) effective for most patients
A
are not
12
Q
Abortive therapy CGRP drugs
A
Triptans
Olcegepant
Telcagepant
13
Q
criteria for prophylaxis frequency duration severity relief of drugs
A
2-3/mo
extreme severity
inadequate relief
14
Q
What drug is FDA approved for chronic migraine?
A
BotoxA
15
Q
Presynaptic effects of opioids
A
Blocks Ca2+ influx
K+ efflux
Decreases excitatory NT release
16
Q
Postsynaptic effects of opioids
A
Opens K+ channels
Inhibits AP generation
17
Q
morphine is a _
A
Mu agonist
18
Q
Codeine is _ potent than morephine
A
less
19
Q
Oxycodone has _ bioavailability
A
high
20
Q
Fentanyl is _ times more potent than morphine
A
100
21
Q
Methadone has a _ half-life
A
long
22
Q
Buprenorphine is a _
A
partial mu agonist
23
Q
Pentazocine is a _
A
mu and kappa agonist
24
Q
action of opioid analgesics are _.
A
widespread in the brain, SC, and below
25
opioids _ off cells via _
activate
| GABA
26
opioids _ on cells
inhibit
27
RVM on cells _ dorsal horn cells
excite
28
RVM off cells _ dorsal horn cells
inhibit
29
Morphine _ on-cells in the RVM
inhibits
30
Morphine _ off-cells in the RVM
excites
31
Neural circuits involved in addiction
DSM Th
VTA
LHyTh
VP
32
a selective _ receptor has been implicated in tolerance to opioids
CCK2
33
tolerance is probably mediated by _
desensitization of receptors and receptor downregulation
34
COX1 produces _
prostaglandins
35
COX2 becomes expressed in connection with _
inflammatory processes
36
Aspirin is toxic to the _
GI
37
Aspirin has a long duration effect on platelets that can effect _.
bleeding
38
Aspirin can cause _ in children under 10
Reye's syndrome
39
Tylenol/_ can cause _.
paracetamol
| hepatoxicity (liver failure)
40
prostaglandins are blocked by _, _, and _.
aspirin
indomethacin
common NSAIDs
41
Side effects of COX inhibitors include _ or _
GI bleeding
| perforation of stomach lining
42
Relative risk of NSAIDs increases with _
age
43
second generation selective COX2 inhibitors are called _
coxib compounds
44
coxib compounds cause less _ and _
stomach bleeding/perforation
45
coxib compounds have serious risks of _ in patients with preexisting problems
cardiovascular disorders
46
coxib compounds are mostly used for _
arthritis
47
more than _/day of acetaminophen(_) casues _
2,000mg
tylenol
liver failure
48
IS rheumatoid arthritis more prevalent in older or younger people?
younger
49
Disease modifying drugs are available (_) for OA or RA?
RA
50
Is OA or is RA an autoimmune disease?
RA
51
The most common form of persistent pain in the developed world is _
osteoarthritis
52
in most cases, _ can eliminate pain in most cases of osteoarthritis
joint replacement
53
Does osteoarthritis have central, peripheral, or both components?
both
54
_ is the first line of treatment for osteoarthritis and rheumatoid arthritis
NSAIDs
55
Osteoarthritis pain is _ in nature
nociceptive
56
The most effective treatment for osteoarthritis is _ or _
local anesthetic injection
| joint replacement
57
NSAIDs often become (more/less) effective over time
less
58
_ are almost always used in RA patients
TNF-alpha blocking therapies
59
Postherpetic neuralgia is treated with _
Analgesics/opioids/gabapentin
60
Diabetic neuropathy is treated with _
analgesics/opioids/carbamazepine /gabapentin
61
Trigeminal neuralgia is treated with
Carbamazepine/lamotrigine
62
Central poststroke pain is treated with _
amitriptyline/lamotrigine
63
HIV polneuropathy is treated with
lamotrigine
64
SCI/MS pain is treated with _
amitriptyline/lamotrigine
65
Postherpetic neuralgia affects _(_) and _
```
nerve fibers (DRG)
skin
```
66
postherpetic neuralgia is a complication of _
shingles
67
The chickenpox virus can remain dormant in _.
DRG neurons
68
The chickenpox virus (does/does not) have a vaccine
does
69
PHN causes loss of _
epidermal nerve fibers
70
_ is a glycation product and is an important factor in _
methylglyoxal
| diabetic neuropathy
71
daibetic neuropathy can lead to _ neuropathy.
peripheral
72
CRPS
complex regional pain syndrome
73
CRPS most often affects _
the distal extremities
74
current evidence suggests that all CRPS cases are casued by _
nerve damage
75
Type I CRPS
no identified nerve damage
76
Type II CRPS
identified nerve damage
77
CRPS results in _
loss of epidermal nerve fibers
78
ectopic neural activity
spontaneous neural activity
79
There is strong evidence that _ arises from a _ and is responsible for neuropathic pain
ectopic activity
| neuroma
80
input deprivation (nerve severance) can lead to _ in the PNS, like expression of _ or _
plastic changes
VGNa+ channels (^)
VGK+ channels (v)
81
Anti-epileptics fall into either _ or _
gabapentinoids
| VGNa+ channel inhibitors
82
4 main anti-epileptic VGNa+ channel inhibitors
phentoin
valproic acid
amitriptyline
carbamazapine
83
2 classes of anti-depressants to treat neuropathic pain
SNRIs
| MAOIs
84
Concept of SNRIs
SNRIs increase NE availability in the dorsal horn, mimicking descending inhibition
85
Concept of MAOIs
increase NE availability in the dorsal horn, inhibit VGNa+ channels in some cases
86
most widely used topical treatment
capsaicin
87
concept of topical capsaicin
causes long-lasting desensitization of nociceptors, decreasing ectopic activity
88
second most widely used topical treatment
lidocaine patches
89
people with preexisting cancer pain are likely to be _.
sensitized to pain
90
concept of cancer pain
bone destruction injures nerves, likely provoking neuropathic pain
91
most common treatment for cancer pain
opioids
92
dysfunctional pain
pain with no organic origin
93
dysfunctional pain results in _ and _
decreased inhibition
| increased facilitation
94
damage to PNS leads to _ retraction
epidermal nerve fiber
95
damage to PNS leads to _ activity
ectopic
96
damage to PNS leads to _ of pain sensing neurons
sensitization
97
chronic pain conditions are either a _ or develop after _
continuation of acute post-surgery pain
| an asymptomatic period
98
NNT
number needed to treat for pain reduction to be at 50%
99
existing neuropathic pain therapeutics are _
ineffective
100
The most promising current treatment for neuropathic pain is _
p2x3 antagonists
101
Biologic drugs for pain therapy
Anti-NGF
Anti-CGRP
IL-10
102
Side effect of anti-NGF therapy
avascular necrosis
103
Anti-CGRP therapies are used to treat _ in clinical trials
migraines
104
Concept of disease modifying therapies
target underlying molecular mechanisms to reverse pathological changes in gene expression
105
translation of mRNA controls _
postsynaptic plasticity
106
_ localizes to nerve fibers
P-mTOR
107
Nerve injury, NGF, and IL-6 converge on the _ to control gene expression
eIF4F complex
108
_ decrease mTOR and ERK activity
AMP Kinase activators
109
salicylate (_) is a _
tylenol
| AMPK activator
110
AMPK activators reduce _
sensory neuron excitability
111
metformin is a _
AMPK activator
112
metformin treatment reverses _
neuropathic mechanical hypersensitivity
113
daily treatment for _ days reverses neuropathic mechanical hypersensitivity to normal
7 days
114
metformin treatment reverses nerve injury-induced _
microglial activation
115
channelrhodopsin
an algae light operated ion channel that has been engineered to control neuronal activity
116
halorhodopsin
a light activated chloride pump found in archaea
