PBL 2 - Aches And Pains

Question 1

Ibuprofen

Answer 1

NSAID

• Inhibits COX1 and COX2 (make prostaglandins)
• Can cross BBB to reduce prostaglandin E2

Question 2

Diclofenac (5)

Answer 2

• NSAID
• Treat moderate to severe pain
• Inhibit formation of prostaglandins by blocking COX1 & COX2
• Inhibit the production of leukotrienes by inhibiting lipoxygenase
• Prescribed for musculoskeletal pain

Question 3

Tramadol

Answer 3

• Opioid agonist
• Binds to μ-opioid receptor
• • inhibits the reuptake of serotonin and noradrenaline

Question 4

Amitriptyline (3)

Answer 4

• TCA antidepressant
• Prevention of migraines
• Treat neuropathic pain as anti-inflammatory effects
• SSRI & SNRI reuptake inhibitor

Question 5

Pregabaline (4)

Answer 5

• Treat epilepsy, neuropathic pain, fibromyalgia and generalised anxiety disorder
• Ion channel modulator that has rapid analgesic, anticonvulsant and anxiolytic effects
• Binds to a2 subunit of calcium channel - increases decarboxylase and blocks glutamate
• SE: dizziness, addiction

Question 6

Blocking which COX gives you acid corrosion of stomach?

Answer 6

COX2

Question 7

Don’t give Diclofenac to … (3)

Answer 7

People with increased risk of heart attack
Or ischaemic heart disease
Or peripheral artery disease

Question 8

Acupuncture works by (2)

Answer 8

Activating nociceptors - pain blocks pain (or inhibition blocks inhibition)
Activate a-beta fibres - GABA and enkephalin release, which results in both presynaptic, and postsynaptic nociceptor inhibition (from C fibres)

Question 9

Paracetamol (4)

Answer 9

acetaminophen

• antipyretic and analgesic
• Reduces COX2
• Acts on endogenous cannabinoid system

Question 10

Why doesn’t morphine work in tx neuropathic pain?

Answer 10

Nerve damage

Indigenous peptides CCK and receptors are up regulated by primary afferents and block action of morphine

Question 11

Slipped disc in scenario is at ..

Answer 11

L5

Question 12

Chronic pain lasts longer than …

Answer 12

12 weeks

Question 13

Allodynia

Answer 13

Pain in response to innocuous stimulus

Question 14

Hyperalgesia

Answer 14

Increased pain in response to painful stimuli

Question 15

Superior parietal cortex - made of (2)

Controls (1)

Answer 15

Amygdala ad insula

Controls intensity of emotion

Question 16

Anterior Cingulate cortex

Answer 16

Emotional reaction motivation

Question 17

Prefrontal cortex

Answer 17

Evaluation and cognition

Question 18

Insula

Answer 18

Emotion

Question 19

Amygdala

Answer 19

Aversion, emotional memory and response

Question 20

Spinoreticular tract -

Answer 20

Arousal, behavioural responses

Question 21

Spinomesencephalic tract

Answer 21

Ascending pain modulation

Autonomic interaction

Question 22

Post synaptic dorsal column pathway

Answer 22

Chronic pain

Question 23

Nociceptors:
TRPM8 -
TRPV1 -
ASCI -

Answer 23

TRPM8 - cold
TRPV1 - heat and acid
ASCI - acid stimulus

Question 24

Neospinothalamic -

Answer 24

Pressure and heavy touch localisation

Question 25

Paleospinotalmic

Answer 25

Temperature, pain and assessment of pain

Question 26

Inhibit pain pathway (4)

Answer 26

Ab input Brain stem input Na of 5HT input

Question 27

Sciatic nerve roots

Answer 27

L4-s3

Question 28

Physio works by:

Answer 28

Breaking down scar tissue and help regain normal flexibility