Pain and inflammation

Question 1

List the pain mediators 6

Answer 1

1. Bradykinin
2. 5-hydroxytryptamine
3. Noradrenaline
4. Substance P
5. Histamine
6. Prostaglandin

Question 2

What is pain? 4

Answer 2

Pain is the result of

1. Inflammatory mediator activating nociceptors
2. The nociceptors are in the peripheral nerves travel to dorsal horn
3. Dorsal horn to spinal tract
4. Spinal tract to sensory cortex

Question 3

Drugs that treat pain can either be classed as? 2

Answer 3

1. Short term management

2. Acute and chronic pain management

Question 4

Short term management of pain includes? 2

Answer 4

1. General anaesthetics

2. Local anaesthetics

Question 5

Acute and chronic pain management includes? 5

Answer 5

1. Neuropathic pain
2. Anti-inflammatory drugs
3. Paracetamol
4. Muscle relaxants
5. Opioids

Question 6

Neuropathic pain is treated with ?2

Answer 6

1. Antidepressants

2. Anticonvulsants

Question 7

Anti-inflammatory drugs include? 2

Answer 7

1. Glucocorticoids

2. NSAIDS

Question 8

What are the signs of inflammation? 5

Answer 8

1. Heat
2. Redness
3. Swelling
4. Pain
5. Loss of fucntion

Question 9

Describe acute inflammation 5

Answer 9

This is a normal response to tissue injury caused by:

1. Physical trauma
2. Toxic chemicals
3. Infectious organisms
4. Allergens

Question 10

Chronic inflammation is usually by:5

Answer 10

1. Chronic inflammatory diseases e.g. asthma

2. Auto-immune diseases e.g. rheumatoid arthritis, inflammatory bowel disease

Question 11

Describe the molecular pathway of inflammation 5

Answer 11

1. Tissue damage
2. The tissue damage activates phospholipase A2.
3. Phospholipase A2 converts phospholipids into arachidonic acid
4. Cycloxygenase converts arachidonic acid into inflammatory prostaglandins.
5. Prostaglandins stimulate nociceptors

Question 12

Explain how bronchoconstriction result from inflammation3

Answer 12

1. Inflammation results in the production of arachidonic acid.
2. Lipoxygenase converts arachidonic acid into leucotrienes
3. Leucotrienes result in broncho-constriction

Question 13

Describe glucocorticosteroids

Answer 13

Glucocorticosteroids are potent inhibitors of the inflammatory response and general immune response. They inhibit the action of phospholipase A2

Question 14

What are the pharmacological actions of glucocorticosteroids 2

Answer 14

1. Anti-inflammatory

2. Immunosuppressive agent

Question 15

What are dome of the indications for use of glucocorticosteroids?3

Answer 15

1. Asthma
2. Inflammatory bowel disease
3. Auto-immune disease

Question 16

Glucocorticosteroids have serious adverse effect profile. What are some of the limitations? 4

Answer 16

Glucocorticosteroids are contraindicated in:

1. Cushings syndrome
2. Diabetes
3. Immune suppression
4. Osteoporosis

Question 17

List examples of glucocorticosteroids

Answer 17

1. Hydrocortisone
2. Prednisone
3. Betamethasone

Question 18

Anaesthetics for short term management of pain. They can be categorized into: 2

Answer 18

1. General anaesthetics

2. Local anesthetics

Question 19

What are general anaesthetics used for? And what are they combined with?

Answer 19

General anaesthetics are used for surgery and are combined with opioid, benzodiazepine, neuromuscular blocker

Question 20

Name 3 general anaesthetics

Answer 20

1. Nitrous oxide
2. Sevoflurane
3. Halothane

Question 21

What do local anaesthetics do?

Answer 21

Local anaesthetics reversibly block impulse conduction along the nerve axons resulting in no pain sensation.

Question 22

Name a local anaesthetics

Answer 22

Lignocaine

Question 23

What are the therapeutic uses of local anaesthetics? 6

Answer 23

1. Spinal block anaesthesia
2. Suturing
3. Minor procedures
4. Mouth ulcers
5. Dental procedures
6. Epidural anaesthesia

Question 24

What is the MOA of opioids?

Answer 24

Opioids bind to opioid receptors which results in analgesia and sense of well being

Question 25

Opioids can be described as low and high efficacy opioids. List examples 3

Answer 25

1. Low efficacy opioid = codeine | 2. High efficacy opioid = morphine, pethidine

Question 26

What are the therapeutic uses of opioids?

Answer 26

1. Analgesic 2. Diarrhoea 3. Anti-tussive (suppresses coughing)

Question 27

What are the adverse effects of opioids?7

Answer 27

Central 1. Respiratory depression 2. Euphoria 3. Sedation 4. Nausea and vomiting Peripherally 1. Constipation

Question 28

What is a big problem with opioids?3

Answer 28

1. Highly addictive 2. Develop a tolerance, so need a higher dose for therapeutic benefit 3. Overdose results in respiratory depression

Question 29

What are the centrally acting muscle relaxants? And what do they provide?4

Answer 29

The centrally acting muscle relaxants provide symptomatic relief and include: 1. Cyclobenzaprine 2. Diazepam 3. Baclofen

Question 30

Describe the peripherally actin muscle relaxant. 2

Answer 30

Training is required to administer the peripheral muscle relaxant. This is known as botulinum toxin.

Question 31

How is pain graded? 6

Answer 31

1. Mild (3-5) 2. Moderate (6-8) 3. Severe (9-10)

Question 32

How should you manage mild pain (3-5)?

Answer 32

1. Paracetamol 2. Weak opioid (codeine) 3. NSAID

Question 33

How should you manage moderate pain (6-8)?

Answer 33

1. Paracetamol 2. NSAID 3. Codeine 4. Stronger opioid e.g. tramadol

Question 34

How should you manage severe pain (9-10)?

Answer 34

1. PCA (IV opioid) 2. Morphine / pethidine 3. Paracetamol (IV) 4. NSAIDS (IV/ IM)

Question 35

What is allodynia?

Answer 35

This is a condition where a light touch produces pain

Question 36

What is spontaneous dysthesias?

Answer 36

Shooting burning pain

Question 37

Explain neuropathic pain 3

Answer 37

1. Nerve injury results in peripheral nerve degeneration (neuroma) 2. Because of the peripheral nerve degeneration, spontaneous afferent activity and spinal sensitization can result in spontaneous dysethesias 3. Furthermore, spinal sensitization and Αβ afferent fibres can results in allodynia

Question 38

We can manage neuropathic pain with 2

Answer 38

1. Antidepressants | 2. Anticonvulsants

Question 39

Name an antidepressant used in neuropathic pain management

Answer 39

Amitriptilene

Question 40

Name anticonvulsants used in neuropathic pain management 2

Answer 40

1. Gabapentin | 2. Pregabalin

Question 41

Describe pain management in pregnancy 3

Answer 41

1. Avoid NSAID use throughout pregnancy as it causes bleeding in the baby 2. Use paracetamol monotherapy 3. Short course opioids

Question 42

Describe pain management in pediatrics 7

Answer 42

1. Multimodal therapy: 2. Paracetamol 2. NSAIDS 3. Anxiolytics (NB) 4. Glucocorticosteroids 5. Opioids (tilidine) NB!! 6. Local anaesthetics 7. Avoid aspirin

Question 43

Describe pain management in migrain

Answer 43

1. Mild: NSAID and anti-emetic | 2. Severe: add triptan (vasoconstriction)