Opioid & non-opioid analgesics

Question 1

Identify the process by which a nociceptor converts a chemical stimulus into an action potential.
a. transmission
b. transduction
c. perception
d. modulation

Answer 1

b. transduction

Question 2

Transduction occurs when a

Answer 2

chemical, mechanical, or thermal stimulus is sensed by a nociceptor and converted into an action potential

Question 3

Transmission occurs when

Answer 3

the afferent pain signal travels from the peripheral nervous system to the central nervous system via a 3-neuron pathway

Question 4

Modulation is when the

Answer 4

pain signal is modified (inhibited or augmented) as it advances towards the cerebral cortex

Question 5

Perception is when the

Answer 5

pain signal is processed and “perceived” in the cerebral cortex and limbic system

Question 6

Nociception is divided into four processes including

Answer 6

transmission
transduction
modulation
perception

Question 7

A-delta fibers transmit

Answer 7

“fast pain” that is sharp and well-localized

Question 8

C-fibers transmit

Answer 8

“slow pain” that is dull and poorly localized

Question 9

Inflammation also contributes to

Answer 9

reduced threshold to pain stimulus (allodynia)
increased response to pain stimulus (hyperalgesia)

Question 10

Drugs that target transduction include

Answer 10

NSAIDs
LAs
steroids
antihistamines
opioids

Question 11

What is a first order neuron

Answer 11

periphery to dorsal horn

Question 12

what is a second-order neuron?

Answer 12

dorsal horn to thalamus

Question 13

What is a third-order neuron?

Answer 13

thalamus to cerebral cortex

Question 14

Drugs that target transmission include

Answer 14

local anesthetics

Question 15

Perception means

Answer 15

how we “feel” about pain

Question 16

Drugs that target perception include

Answer 16

general anesthetics
opioids
alpha-2 agonists

Question 17

The most important site of modulation is

Answer 17

the substantia gelatinosa in the dorsal horn (rexed lamina 2 & 3)

Question 18

Pain is inhibited when

Answer 18

spinal neurons release GABA & glycine (inhibitor neurotransmitters)
2. the descending pain pathway release NE, serotonin, and endorphins

Question 19

Pain is augmented by

Answer 19

wind-up
central sensitization

Question 20

Drugs that target modulation include

Answer 20

neuraxial opioids
NMDA antagonists
alpha 2 agonists
AchE inhibitors
SSRIs
SNRIs

Question 21

Molecular mechanisms of opioid receptor stimulation include: (select 2)
a. decreased cAMP production
b. increased calcium conductance
c. increased adenylate cyclase activity
d. increased potassium conductance

Answer 21

a. decreased cAMP production
d. increased potassium conductance

Question 22

Opioid receptor stimulation reduces

Answer 22

neurotransmitter release from presynaptic neurons and hyperpolarizes postsynaptic neurons

Question 23

Where are opioid receptors located?

Answer 23

brain
spinal cord
peripheral

Question 24

Where in the brain are opioid receptors located?

Answer 24

periaqueductal gray
locus coeruleus
rostral ventral medulla

Question 25

Where in the spinal cord are opioid receptors located?

Answer 25

primary afferent neurons in the dorsal horn interneurons

Question 26

Where in the periphery are opioid receptors located?

Answer 26

sensory neurons immune cells

Question 27

What are the four types of opioid receptors?

Answer 27

all are G-proteins -Mu -Delta -Kappa -ORL1

Question 28

The existence of ______________ has yet to be proven

Answer 28

mu receptor subtypes

Question 29

Stimulation of kappa receptors helps _________ but can also ____________

Answer 29

quell shivering; but can also cause dysphoria, delirium, and hallucinations

Question 30

Key physiologic effects of Mu receptor stimulation include

Answer 30

analgesia, bradycardia, respiratory depression, euphoria, physical dependence, and constipation

Question 31

Describe how opioids work at the receptor level.

Answer 31

1. opioid binds to a receptor 2. G protein is activated 3. adenylate cyclase is inhibited 4. less cAMP is produced 5. Ca+2 conductance is decreased 6. K+ conductance is increased

Question 32

What is the precursor of the Mu receptor?

Answer 32

pre-proopiomelanocrtin--> endorphins

Question 33

What is the precursor of the Delta receptor?

Answer 33

Pre-enkephalin--> enkephalins

Question 34

What is the precursor of the kappa receptor?

Answer 34

pre-dynorphin--> dynorphins

Question 35

What is the only opioid receptor that causes bradycardia?

Answer 35

Mu

Question 36

What opioid receptors cause miosis?

Answer 36

Mu &kappa

Question 37

What opioid receptors cause urinary retention?

Answer 37

Mu & delta

Question 38

What opioid receptor causes diuresis?

Answer 38

kappa

Question 39

What opioid receptor has antishivering properties?

Answer 39

kappa

Question 40

What opioid receptors cause pruritus?

Answer 40

Mu & delta

Question 41

What opioid receptors lead to nausea & vomiting?

Answer 41

Mu

Question 42

What are the effects of Mu1?

Answer 42

analgesia (suraspinal & spinal) bradycardia

Question 43

What are the effects of Mu2?

Answer 43

analgesic (spinal only) respiratory depression constipation physical dependence

Question 44

What are the effects of Mu3?

Answer 44

immune suppression

Question 45

Cardiovascular consequences of opioid administration in healthy patients include: a. bradycardia b. myocardial depression c. hypotension d. impaired baroreceptor reflex

Answer 45

a. bradycardia

Question 46

Do opioids effect blood pressure?

Answer 46

Nope- only minimal effect

Question 47

Opioids cause nausea and vomiting by

Answer 47

stimulating the chemoreceptor trigger zone in the medulla and possible interaction with the vestibular apparatus

Question 48

Opioids produce respiratory depression by

Answer 48

shifting the CO2 response curve to the right

Question 49

Agents that produce histamine release include

Answer 49

morphine, meperidine, and codeine

Question 50

Opioids may be implicated in _______________ through inhibition of cellular and humoral immune function.

Answer 50

cancer recurrence

Question 51

Opioids cause _________________________ which can be reversed with ___________ or _____________

Answer 51

contraction of the sphincter of Oddi; naloxone or glucagon

Question 52

In women, morphine is associated with a:

Answer 52

greater analgesic potency slower onset of action longer duration of action lower postoperative opioid consumption