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Psychiatry > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

_______ are our pain receptors

A

nociceptors

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2
Q

Along with the skin, nociceptors can be located in our ________ and __________

A

organs, blood vessels

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3
Q

What are the different types of pain?

A

nociceptive, neuropathic, mixed

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4
Q

______ pain serves a biological function.

A

Acute

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5
Q

What are the major transmitters of pain?

A

Glutamate, Substance P, CGRP

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6
Q

Describe the ascending pain pathway

A

Nociceptor –> Dorsal Root Ganglion –> Dorsal horn –> Brain (pain perception)

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7
Q

______ fibers are myelinated and large

A

A fibers

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8
Q

______ fibers are myelinated autonomics.

A

B fibers

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9
Q

A- Beta fibers are involved in ________.

A

touch

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10
Q

A- Delta fibers are involved in __________.

A

pain and temperature

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11
Q

_____ fibers are unmyelinated and play a role in pain and temperature

A

C fibers

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12
Q

A-alpha fibers are involved in _______.

A

motor/position

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13
Q

A-gamma fibers are involved in _______.

A

motor

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14
Q

C fibers go to lamina _____

A

II (2)

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15
Q

A-delta fibers go to lamina __ and __

A

I and V

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16
Q

A - Beta fibers go to lamina __

A

III

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17
Q

What can cause pain to be very different to control in regards to fibers?

A

Sometimes fibers switch which lamina they go to

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18
Q

_________ tract is where we process pain

A

Neospinalthalamic tract

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19
Q

_________ tract is our fear center, why we cry with pain.

A

paleospinal

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20
Q

_________ tract increases awareness of pain. (waking up in the middle of the night from a belly ache)

A

spinoreticular

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21
Q

Viscera pain has a ______(high/low) density of afferents.

A

low

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22
Q

Visceral afferents ascend up the spinal cord with _______ and enter spinal cord alongside ________.

A

sympathetics, spinal nerves

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23
Q

Why do patients experiencing a heart attack experience arm or jaw pain?

A

Known as referred pain. Cardiac afferents travel with somatics from the arm and jaw.

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24
Q

_____ fibers carry fast pain and _____ fibers carry slow pain.

A

A-delta, C

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25
Q

Gate Control Theory: A-delta and C pain fibers have a ______ effect on ______ to transmit pain to the brain.

A

Postitive, Dorsal Horn

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26
Q

Gate Control Theory: A-beta fibers have interneurons that have ______ effect on _________ for pain.

A

negative, dorsal horn

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27
Q

Touching a spot where you’re hurt relieves the pain due to what?

A

Gate control theory, A-beta fibers have interneurons that have an inhibitory effects on dorsal horn pain neurons.

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28
Q

How does the brain modulate pain?

A

Descending inhibition via endorphins, 5HT, and NE

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29
Q

________ is pain with touch.

A

allodynia

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30
Q

_________ amplified pain from a noxious stimulus.

A

Hyperalgesia

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31
Q

________ is hyperalgesia around an injury

A

secondary hyperalgesia

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32
Q

Allodynia in injured area is explained by _________ sensitization.

A

peripheral

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33
Q

Allodynia in non-inflamed areas and secondary hyperalgesia is explained by _________ sensitization.

A

central

34
Q

______ and _______ play a role. in opioid resistant pain

A

Neural sprouting, phenotypic switching

35
Q

What are the mechanisms of central sensitization?

A

Wind up, neural sprouting, phenotypic switching, CNS prostaglandins

36
Q

Wind up occurs in the ______ at the _____ neuron

A

Dorsal horn, secondary

37
Q

Explain Wind up Mechanism

A

C fiber from body releases SP and glutamate —-> Turns on NMDA receptor
Milder pain but explosive pain to the brain

38
Q

Why don’t opioids work for central sensitization caused by Wind up?

A

Opioids do not turn off NMDA receptor that causes wind up

39
Q

Central reorganization leads to ________.

A

allodynia.

40
Q

Central reorganization mechanism

A

A-Beta touch fiber reorganized from dorsal horn touch neuron to dorsal horn pain neuron

41
Q

Why is pain caused by central reorganization resistant to opioids?

A

A-beta touch fibers have no opioid receptors

A-beta touch fibers switch from lamina 3 to lamina 2.

42
Q

In central reorganization A-Beta touch fibers switch from lamina ____ to lamina _____.

A

III, II

43
Q

Allodynia is modulated by _____ fibers.

A

A-beta

44
Q

Explain phenotypic switching

A

A-beta fibers that should only be communicating to touch neurons now release pain neurotransmitters

45
Q

_______ and _______ are pain neurotransmitters.

A

SP, glutamate

46
Q

What do prostaglandins sensitize?

A

pain nerve endings and CNS pain

47
Q

Explain pain relief mechanism of NSAIDs

A

Enter CNS via CSF leading to acute pain relief.

48
Q

Are NSAIDs able to work without inflammation?

A

Yes

49
Q

_______ can be used for pain relief due to central sensitization.

A

NSAIDs, can enter the CNS

50
Q

Explain opioid mechanism

A

Decrease C-fiber transmission

Increase descending system activity

51
Q

Why doing opioids work for central sensitization due to CNS prostaglandins?

A

CNS prostaglandins blunt descending inhibitory system

52
Q

Three mechanisms of opioid resistant pain (ex.neuropathy) ?

A

wind up defeats C fiber transmission inhibition

CNS PGs blunt descending inhibitory system

A-beter fibers dont have opioid receptors on them

53
Q

Examples of biological variability in pain

A
  1. sensitivity and # of NMDA receptors
  2. Prostoglandin making capability
  3. neural sprouting
  4. strength of descending inhibitory system
54
Q

The rate of death for patients with congenital insensitivity to pain in the first three years is ____ percent.

A

20

55
Q

_____ percent is the efficacy of a placebo.

A

30

56
Q

Placebo effect is reversible using which drug __________? What does this say about the mechanism of placebo?

A

Naloxone, placebos may be endorphin modulated with endogenous opioid system

57
Q

What is used if opioids fail?

A

regional/neuraxial analgesia

58
Q

What should be utilized before using regional/neuraxial analgesia?

A

Rotation

NSAIDs

hot pack/cold pack

59
Q

Epidurals infuse anesthetics into the _______ (not the ______.)

A

spinal canal, CSF

60
Q

Pathway of epidural

A

skin, supraspinous ligament, interspinous ligament,ligament flavum, epidural space

61
Q

What technique is used to find epidural space?

A

When pushing through the ligament alot of resistance but once hit epidural space saline is able to flow freely

62
Q

_______ used in lower and upper extremity surgeries and post operative pain management without opioids.

A

Peripheral nerve block

63
Q

Who would not benefit from a peripheral nerve block

A

individuals that are a fall risks, motor rehab required

64
Q

_______ does not have a motor block.

A

wound infiltration

65
Q

When is ketamine used?

A

if opioids and NSAIDs fail and patient is anticoagulated

66
Q

Ketamine acts as an antagonist of _________ receptors.

A

NMDA

67
Q

Individuals that are anticoagulated cannot use _______ anesthesia.

A

regional

68
Q

If pain still persist with ketamine use what could pain be due t?

A

central sensitization

69
Q

Which class antidepressants are used to treat pain?

A

TCAs and SNRIs

70
Q

`What is the mechanism used by antidepressants to treat pain?

A

enhances descending inhibitory system

71
Q

Antiepileptic drugs are used to treat ______ pain.

A

lancinating neuropathic pain

72
Q

_______ is a second generation gabapentin

A

Pregablin

73
Q

________ approved in use of painful diabetic neuropathy.

A

Gabapentin

74
Q

Mechanism of antiepileptic drugs

A

Most block voltage sensitive NA channels

decrease excitation and increase inhibition via various mechanisms

75
Q

What effect does blocking Na channels have on APs?

A

Decreases frequency of APs, raises threshold for repetitive AP generation, prevents burst firing of neurons

76
Q

Prevention or repetitive APs may prevent ________.

A

Wind up

77
Q

_________ is a muscle relaxant with a TCA type structure

A

Cyclobenzaprine

78
Q

__________ is a muscle relaxant that works as a GABA A agonist

A

Meoxolone

79
Q

_________ is a muscle relaxant that works as a GABA B agonist

A

Baclofen

80
Q

Once on 100mg of morphine equivalence/day at _____ the risk of overdose.

A

9x

81
Q

Do opioids work in chronic pain?

A

rarely

82
Q

Vicodin is composed of _______ and _______.

A

hydrocodone, acetaminophen

Psychiatry (2 decks)

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