Final

Question 1

Enkephalins, endorphans and opioid receptors target what Laminae of Rexad?

Answer 1

2

Question 2

Non-nociceptive example of WDR neurons

Answer 2

Type A beta

Question 3

What part of modulation causes hyperalgesia?

Answer 3

Dorsolateral funiculus

Question 4

Pt screams an asks for pain medicine when putting on EKG leads is an example of what?

Answer 4

allodynia

Question 5

Manipulation of small intestine would involve what fibers?

Answer 5

Type C (0.5-2 m/s)

Question 6

What NT is involved with an open wound on hand (picture)?

Answer 6

glutamate

Question 7

NT for type C fibers

Answer 7

substance P

Question 8

______ are alogenic substances and made from cyclooxygenase and can cause hyperalgesia

Answer 8

Prostaglandins

Question 9

(picture of burned hand) 1. Where are primary afferent neurons (A Delta and C) cell bodies? 2. Where do fibers descend or ascend? 3. After leaving tract of lissauer, the axon (still primary neurons) enter gray matter (rexad’s laminae I, II, V) of dorsal horn of spinal cord where they synapse with what?

(Actual ? had to do with neurons ascending/descending or crossing tract of lissauer??)

Answer 9

1. dorsal root ganglia of spinal cord
2. Tract of Lissauer
3. second-order neurons

Question 10

Visceral pain is ____ (nociceptive or non-nociceptive)

Answer 10

Nociceptive. So is somatic

Non-nociceptive pain: neuropathic, idiopathic, and psychogenic

Question 11

The three sensory neurons involved in transmission are:

Answer 11

1. Primary (stimulus to rexed laminae I/II/V)
2. Secondary (nociceptive and WDR, start in rexed laminae I, II, V- cross midline of spinal cord though anterior commissure and ascend anterolateral pathway of the spinothalmic tract to terminate in the lateral thalamus and intralaminar nuclei)
3. Tertiary (thalamus to cerebral cortex)

Question 12

Type A delta fibers NT and receptor

Answer 12

glutamate and NMDA

Question 13

NT stimulate peripheral nociceptors causing an influx of ___ ions to enter the nerve fiber membranes (depolarization) and a subsequent efflux of ____ (depolarization). This is a pain impulse.

Answer 13

Sodium

Potassium

Question 14

Third order/tertiary neurons terminate in the

Answer 14

cerebral cortex

Question 15

Another name for descending pathway

Answer 15

modulation. Efferent pathway. descends axons from cerebral cortex, hypothalamus, thalamus, periaquaductal gray, nucleus, raphe magnus, and locus ceruleus, via the dorsolateral funiculis, synapse with and suppress pain transmission to the brainstem and spinal cord dorsal horn

Question 16

Descending (afferent/efferent) fibers have to with modulation

Answer 16

efferent

Question 17

NT released on surgical incision

Answer 17

glutamate

Question 18

Pain is an unpleasant and ____ experience associated with actual or potential tissue damage or described in terms of such damage.

Answer 18

emotional

Question 19

Acute pain may result in…

Answer 19

atelectasis

Question 20

Prostaglandins enhance the release of

Answer 20

glutamate

Question 21

A 19 y/o boy rates his pain a 3 on 1-10 scale and is anxious and wheezing. BEST analgesic for him…

Answer 21

tylenol

Question 22

In the presence of inflammation, the administration of a non-selective cylclooxygenase inhibitor may result in

Answer 22

fever

Question 23

Doses for IV orfirmev

Answer 23

adult: 1000 mg q6h, 650 mg q4h, MAX 4000 mg/day
peds: 15 mg/kg q6h, 12.5 mg/kg q4h, MAX 75 mg/kg/day

Question 24

NSAIDS produce their therapeutic effects by inhibiting the conversion of arachidonic acid to:

Answer 24

prostoglandins

Question 25

centrally, opioid receptors are primarily located in which Rexed's Lamina?

Answer 25

two

Question 26

Which agent should be prescribed with caution in a patient with renal insufficiency?

Answer 26

Morphine (has active metabolites)

Question 27

Receptor that remains plugged by Magnesium

Answer 27

NMDA

Question 28

T/F: Morphine 3 glucuronide is an active metabolite

Answer 28

False. (morphine 6 glucuronide)

Question 29

In chronic pain states, ketamine is beneficial in reducing

Answer 29

allodynia

Question 30

Common side effect of alpha 2 agonist

Answer 30

decreased heart rate

Question 31

Fentanyl route that has the shortest duration of action

Answer 31

epidural

Question 32

T/F: Hydromorphone is a safe choice for patients suffering from renal insufficiency.

Answer 32

true (no active metabolites)

Question 33

The upper lockout interval for the majority of PCA prescribed opioids is

Answer 33

10 min

Question 34

Which PCA variable is least prescribed?

Answer 34

basal rate

Question 35

T/F: Inhibition of alpha 2 adrenoreceptors may result in supraspinal analgesia

Answer 35

false

Question 36

T/F: celocoxib (a selective cox 2 inhibitor) should be avoided in patients with asthma

Answer 36

True

Question 37

Which receptor is a known sympatholytic?

Answer 37

Alpha 2

Question 38

Continuous stimulation of the nociceptor terminal by which NT can lead to chronic pain?

Answer 38

glutamate

Question 39

____ plug in NMDA receptors renders them inactive

Answer 39

magnesium

Question 40

A systemic effect of exogenous steroid administration is

Answer 40

depression

Question 41

T/F: Medications for the treatment of chronic pain should be continue throughout the preoperative period

Answer 41

True

Question 42

When prescribing an antidepressant as part of a multimodal approach to chronic pain management one would expect effects to take place in

Answer 42

1 week (4-10 days)

Question 43

Methadone has a half life of

Answer 43

15-60 hours

Question 44

Epileptics on phenytoin affect the metabolism of

Answer 44

methadone

Question 45

A single epidural steroid injection can cause hypothalamic pituitary adrenal axis suppression lasting:

Answer 45

5 days- 5 weeks

Question 46

What NT plays the greatest role in "wind-up"

Answer 46

glutamate

Question 47

The preventative drug used in the treatment of neuropathic pain blocks the alpha 2 delta subunit of the presynaptic voltage gated calcium channels within the CNS is:

Answer 47

pregabalin (lyrica) or gabapentin (neurontin)