PAIN

Question 1

What are opioids used for?

Answer 1

reduce pain-defense mech to retract from danger/injurious agents

Question 2

What system does opioid act on?

Answer 2

CNS; thalamus, basal ganglia, anterior cingulate, insula–most consistently activated in acute pain

Question 3

How does the brainstem come into play?

Answer 3

BS and the descending pain modulatory system play a role in the ANTICIPATION and perception of pain. (can occur quickly)

Question 4

Clinical chronic pain

Answer 4

causes increasing activation of the pre-frontal cortical region which implies that chronic pain disturbs the cognitive and emotion perception and processing of everyday experience.

Question 5

At what levels can pain come into play?

Answer 5

..

Question 6

What does the interaction between pre-frontal cortex, basal ganglia, and amygdala correlate to?

Answer 6

hypervigilence…

Question 7

In what area does the opioid take action?

Answer 7

..

Question 8

What immediately happens when tissue is damaged?

Answer 8

Immediate release of inflamm chemicals (excitatory NT)-eg histamine and bradykinin

Question 9

What does bradykinin stimulate?

Answer 9

the release of

Question 10

What are the two types of transmission?

Answer 10

chemical..mechanical (order?)

Question 11

What are the steps of perception?

Answer 11

..

Question 12

What two groups are pain divided into?

Answer 12

Acute and chronic pain

Question 13

Examples of acute pain

Answer 13

• *heart attack
• acute appendicitis
• *bone fracture
• muscle sprain
• prolapsed disc

Question 14

Examples of chronic pain

Answer 14

• cancer
• neuropathy
• inflammation
• distensions
• eruptions

Question 15

Notes of Acute Pain

Answer 15

..

Question 16

Notes of Chronic Pain

Answer 16

..

Question 17

Acute pain management

Answer 17

reduce pain–>treat cause

Question 18

Chronic pain management

Answer 18

focused on reducing the pain

Question 19

A&C Pain management

Answer 19

• minimize pain, limit disability, maximize person’s fxn

- MULTIDISCIPLINARY-blends physical, emotional, intellectual and social variables

Question 20

4 main effects of chronic pain on the patient

Answer 20

1. physical functioning
   - ability to perform activities of daily living
   - sleep disturbances
2. psychological morbidity
   - depression
   - anxiety
   - anger
   - loss of self-esteem
3. social consequences
   - relationship with family/friends
   - intimacy/sexual activity
   - social isolation
4. societal consequences
   - healthcare cost
   - disability
   - lost workdays

Question 21

What is the most successful pain treatment?

Answer 21

OPIOIDS

Question 22

Important figures

Answer 22

Hippocrates, Marcus Aurelius, Galen of Pergamum, Solomon Snyder, Candace Pert

Question 23

Ways to make/get OPIOID

Answer 23

1. extraction
2. Synthesis
3. endogenous (endorphins)

Question 24

What receptor do opioids use?

Answer 24

the OPIOID RECEPTOR! in the nervous system

Question 25

What are the different types of receptors?

Answer 25

*Delta Kappa Mu Nociceptin

Question 26

Function of Delta Receptors

Answer 26

- analgesia - antidepressant effects - physical dependence

Question 27

Function of Kappa Receptors

Answer 27

- spinal analgesia - sedation - miosis - inhibition of ADH release - dysphoria

Question 28

Define analgesis

Answer 28

absence of pain without loss of consciousness; pain consists of BOTH sensory and affective (emotional) components. Opioids analgesic are unique in that they reduce both aspects of the pain experience

Question 29

Define antidepressant

Answer 29

alleviate mood disorder (some are related to euphoria..recreation drugs)

Question 30

Define physical dependence

Answer 30

chronic use of a drug that has produced tolerance

Question 31

Define sedation

Answer 31

.

Question 32

Define dysphoria

Answer 32

.

Question 33

how do opioid induce analgesia?

Answer 33

by reducing the amount of information

Question 34

LOCATION, LOCATION, LOCATION

Answer 34

(**Where are which receptors expressed???) - presynpatic: mu, kappa, delta - reduce calcium and increase potassium=decrease/inhibit transmitter release (hyperpolarize=reduce amt of AP) - postsynaptic: mu - increase/stimulate potassium-->IPSP

Question 35

At which two sites do opiod act?

Answer 35

pre and post synaptic opioid receptors

Question 36

Review p 22 diagram

Answer 36

..

Question 37

Acute effects of Opiates

Answer 37

inhibit LC neurons by activating K+ channels and inhibiting Na-dependent inward current -via G-proteins AND regulation of Na current via inhibition of cAMP pathway

Question 38

Chronic effects of Opiates

Answer 38

cAMP, PKA, TF

Question 39

CNS effects-Euphoria

Answer 39

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Question 40

CNS effects-Sedation

Answer 40

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Question 41

CNS effects-Cough Suppression

Answer 41

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Question 42

CNS effects-Respiratory Depression (** major prob with OD)

Answer 42

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Question 43

CNS effects-Miosis

Answer 43

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Question 44

CNS effects-Temperature

Answer 44

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Question 45

STRONG Opiods

Answer 45

MORPHINE, METHADONE, MERPERDINE

Question 46

Moderately STRONG Opioids

Answer 46

CODEINE, OXYCODONE

Question 47

Receptor agonist-ANTagonist Opioids

Answer 47

PENTAZOCINE, BUPRENORPHINE

Question 48

ANTagonist Opioids**

Answer 48

NALOXONE**

Question 49

Why not automatically use STRONG opiods?

Answer 49

dependence=no bueno

Question 50

MORPHINE

Answer 50

..

Question 51

MEPERIDINE

Answer 51

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Question 52

HYDROCODONE

Answer 52

..

Question 53

CODEINE

Answer 53

..

Question 54

Euphoria Diagram ..online ppt

Answer 54

..

Question 55

PENTAZOCINE

Answer 55

+(delta agonist)/-(kappa agnist, mu ANTagonist)--TWO enantiomers Indication: Side Effects: Withdrawal:

Question 56

NALOXONE

Answer 56

..

Question 57

Signs!!!

Answer 57

- blue lips | - unresponsive to pain stimuli

Question 58

Naloxone (narcan) if effective, but....

Answer 58

Opiod is still around, after injection in ~2hrs high (and OD) will return.

Question 59

OD-Nervous system

Answer 59

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Question 60

OD-Heart, blood and circulation

Answer 60

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Question 61

OD-Stomach

Answer 61

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Question 62

OD-sexual organs

Answer 62

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Question 63

METHADONE

Answer 63

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