Pain Therapeutics

Question 1

TPRV1 is a

Answer 1

transient potential receptor subunit - an ion channel pore involved in detecting pain

Question 2

TPRV1 is activated by

Answer 2

H+ in intersitial fluid
cpsaicin
temperature

Question 3

In response to acute injury, cells lyse and release

Answer 3

Acid H+, ATP

Question 4

Induction of COX2 leads to

Answer 4

prostaglandin synthesis

Question 5

Mediators released in response to trauma include

Answer 5

bradykinin
serotonin
histamine
prostaglandins
cytokines

Question 6

When nociceptors are activated, axons reflexively release

Answer 6

substance P, CGRP

Question 7

Nociceptor sensitization refers to what in terms of threshold?

Answer 7

reduction

Question 8

Generally, aspirins and NSAIDs target _______ to _________

Answer 8

COX2 to reduce prostaglandins

Question 9

The primary transmission of pain at the level of the spinal cord is reliant on

Answer 9

Glutamine and inhibitory filtering responses mediated by glycine and GABAnergic receptors

Question 10

When a pain neuron comes into the SC __________ is released

Answer 10

Glutamate

Question 11

Glutamate acts primarily on

Answer 11

AMPA and NMDA receptors

Question 12

NMDA receptors have _________ threshold and are activated in _____________

Answer 12

high threshold; prolonged pain/stimulus

Question 13

Activation of the NMDA receptor leads to

Answer 13

displacement of Mg2+ plug, causing the cell to re-model, causing 2’ SC sensitixation

Question 14

Activation of NMDA receptors and 2’ SC sensitization is responsible for resistance to what class of drugs?

Answer 14

Opiods

Question 15

Ketamine acts at the __________ channel

Answer 15

NMDA

Question 16

Endorphins are natural

Answer 16

opiods

Question 17

Morphine is an

Answer 17

opiate

Question 18

Opioids act _________ to ________ NT release

Answer 18

pre-synaptically; decrease

Question 19

Endogenous opioids have _________ properties

Answer 19

anti-nociceptive

Question 20

Noradrenergic and 5HT3 fibres are ______ and act to ________

Answer 20

descending; inhibit incoming pain signals and tf SC transmission of pain

Question 21

N type VGCa channel receptors are on

Answer 21

interneurons in the SC

Question 22

Pain information is relayed to the _____________ area of the brain

Answer 22

Periaqueductal grey (PAG)

Question 23

Stimulation of the PAG

Answer 23

causes analgesia

Question 24

PAG is activated by

Answer 24

endogenous opioids

Question 25

What are the side effects of opioids?

Answer 25

``` ventilatory depression drowsiness and sedation postop nausea and vomiting pruritis urinary retention ileus, constipation delay of H discharge faetal respiratory depression ```

Question 26

What is multimodal analgesia?

Answer 26

Using a smaller doses of opioids in combination with other non-opioid analgesic drugs

Question 27

What is pre-emptive analgesia?

Answer 27

eg prior to surgery, injury

Question 28

What is regional anaesthesia?

Answer 28

Nerve block to prevent transmission

Question 29

Lignocaine blocks

Answer 29

Sodium channels to prevent nerve transmission

Question 30

What drugs are used in epidurals?

Answer 30

Amide local anaesthetics, opiods

Question 31

Epidural is given at what level?

Answer 31

L3/L4 - these nerves go to the uterus and birth canal