Test 4- Dr. Wag

Question 1

pain is a _________ response

Answer 1

learned

Question 2

typically short lived, resolves when the inciting event removed or healing has taken place, usually sharp and sudden in nature

most pain falls under this category

Answer 2

Acute Pain

Question 3

lasts longer than the inciting event or the healing phase (3 months), associated with ongoing pathology, nagging persistent dull pain may have break through episodes

Answer 3

Chronic Pain

Question 4

episodes of exacerbated pain in a chronic pain patient, last for a short period of time before pain returns to baseline chronicity

Answer 4

Breakthrough Pain

Question 5

controls voluntary movements

Answer 5

Somatic Nervous System

Question 6

controls involuntary movements

Answer 6

Autonomic Nervous System

Question 7

On a 1-10 scale, how is pain defined?

Answer 7

0-4 = mild

5-6 = moderate

7-10 = severe

Question 8

most acute pain is specific and likely _________

Answer 8

nociceptive

Question 9

most chronic pain is _______

Answer 9

mixed

Question 10

the only UNMYELINATED fiber, the second in the blockade order, and results in pain relief and loss of temperature sensation when blocked

Answer 10

C Fibers

Question 11

this fiber is MYELINATED, the first to go off in the blockade, and results in increased skin temperature when blocked

Answer 11

B Fibers

Question 12

this fiber, along with the C fiber, is the second in the blockade but serves a function for fast pain and temperature

results in pain relief and loss of temperature sensation

Answer 12

A delta Fibers

Question 13

small fiber

thin, myelinated, slow, causes the gate to open, transmits sharp, prickly pain

Answer 13

A delta fibers

Question 14

small fiber

thin, UNmyelinated, slow, causes the gate to open, transmits dull, aching pain

Answer 14

C fiber

Question 15

large fiber

thick, myelinated, fast, causes the gate to close, transmits non-painful stimuli

Answer 15

A beta fibers

Question 16

what is the end result of peripheral pain?

Answer 16

scarring

Question 17

what is the end result of neuroinflammation?

Answer 17

constant pain

Question 18

It is preferable to NOT prescribe medication until the urine toxicology screen is obtained.

Answer 18

TRUE

Question 19

Depression can cause pain and pain can cause depression

Answer 19

TRUE

Question 20

pain initiated or caused by a primary lesion or dysfunction in the nervous system (CNS or PNS)

ex: Postherpatic neuralgia, Trigeminal neuralgia, painful diabetic neuropathy, post-surgical neuropathic pain

Answer 20

Neuropathic Pain

Question 21

How is neuropathic pain often described?

Answer 21

burning

tingling

hypersensitivity to touch or cold

Question 22

pain caused by injury to body tissues (musculoskeletal, cutaneous, or visceral)

ex: pain due to inflammation, limb pain after a fracture, joint pain due to OA, post-operataive visceral pain

Answer 22

Nociceptive Pain

Question 23

How is nocicpetive pain often described?

Answer 23

aching

sharp

throbbing

Question 24

pain with neuropathic and nociceptive components

Answer 24

Mixed pain

**most chronic pain is mixed pain

Question 25

what are some examples of mixed pain?

Answer 25

LBP with radiculopathy Cervical Radiculopathy Cancer Pain Carpal Tunnel Syndrome

Question 26

- 80% of adults will get this in life - female to male is equal - MC is acute, short term with spontaneous resolution - majority is musculoskeletal in nature - chronic is more than 12 weeks - treat with keeping active and NSAIDS

Answer 26

Low Back Pain

Question 27

What is the preferred test for working up a patient with LBP?

Answer 27

MRI can see all structures including nerves and soft tissues

Question 28

Heat is better for musculoskeletal pain

Answer 28

TRUE

Question 29

- chronic, affects most often the limbs, usually after injury or trauma - damage/malfunction to the PNS/CNS and its affects on the sympathetic nervous system - mild to severe pain with temperature changes, skin color changes, swelling, regional pain - symptoms vary in severity and duration, most cases are mild and recover gradually over time - individuals may not recover and have long term disability - MC is in women, around age 40

Answer 29

CRPS Complex Regional Pain Syndrome

Question 30

Type I CRPS

Answer 30

reflex, no injury, RSD, no known cause

Question 31

Type II CRPS

Answer 31

causative, event starts inflammatory process

Question 32

Not all anti-depressants are the same, as they vary in their NE effect and serotonin effect

Answer 32

TRUE

Question 33

this drug has demonstrated effectiveness in the treatment of chronic pain

Answer 33

Nortriptyline (Pamelor)

Question 34

this drug is indicated for diabetic peripheral neuropathic pain

Answer 34

Duloxetine (Cymbalta)

Question 35

this drug may decrease neuropathic pain and help with sleep and other mood disorders

Answer 35

Venlafaxine (Effexor, Effexor XR)

Question 36

Anticonvulsants can cause dizziness, somnolence, HA, confusion, N/V, weight changes, and abnormal thoughts that may lead to suicide

Answer 36

TRUE

Question 37

DOC for mild to moderate pain

Answer 37

Ibuprofen

Question 38

What NSAIDs are most commonly linked to hepatotoxicity?

Answer 38

Sulindac and Diclofenac

Question 39

these injections are best done with ultrasound

Answer 39

trigger point injections

Question 40

Neurotome blocks can be done anywhere

Answer 40

TRUE

Question 41

needles should never be placed above C6

Answer 41

TRUE

Question 42

Pudendal nerve blocks can be done both _________ and ________

Answer 42

internally externally

Question 43

What do you do if you have a CSF leak?

Answer 43

perform a blood patch

Question 44

direct exposure of the nerve placement of the electrode next to the nerve trunk done when the patient is awake biggest problem is erosion that results in revision

Answer 44

PNS Peripheral Nerve Stimulation

Question 45

any naturally occurring, semi-synthetic, synthetic compound that binds specifically to opioid receptors and shares properties of one or more of the endogenous opioids (hydromorphone, hydrocodone, tramadol, fentanyl, etc.)

Answer 45

Opioid

Question 46

any opioid alkaloid FOUND NATURALLY in the poppy plant | codeine, morphine, thebaine

Answer 46

Opiate

Question 47

a drug or other substance affecting mood or behavior and sold for non-medical use

Answer 47

Narcotic

Question 48

How should you order Fentanyl?

Answer 48

as a matrix, not a reservoir

Question 49

Do differences exists between brand and generic?

Answer 49

active ingredient the same, up to 20% difference in generic stick with same manufacturer if possible

Question 50

Neuropathic pain is opioid resistant

Answer 50

TRUE

Question 51

Respiratory Depression is enhanced when Benzo's are added to an opioid

Answer 51

TRUE

Question 52

Opioids are weak bases

Answer 52

TRUE

Question 53

Patients on 5 or more medications have a 50% risk of drug to drug interaction

Answer 53

TRUE

Question 54

What are the 4 A's of pain management?

Answer 54

Analgesia Adverse Affects Adverse Events Aberrant Behaviors

Question 55

times of breakthrough pain are irregular takes 10 mins from baseline to peek 69% predictable 2 episodes a day give patient a long acting baseline medication short acting must be given before an episode, otherwise drug won't be treating anything

Answer 55

Chronic Pain

Question 56

New patient is taking pain meds. When should you screen them with UT?

Answer 56

first 8 to 10 days

Question 57

(5-HT) CDVD I AMN (NE)

Answer 57

Spectrum of Antidepressants

Question 58

What Benzo has the Shortest Half Life? Fastest onset?

Answer 58

Shortest half life = Oxazepam Fastest onset = Diazepam

Question 59

Neonatal Benzo withdrawal includes hypertonia, hyperreflexia, hyperactivity, and vomiting. How long does this last?

Answer 59

3-6 months

Question 60

What are the MC SE's of Benzos?

Answer 60

insomnia gastric problems tremors agitaton fearfulness muscle spasms

Question 61

10% of Benzo patients experience what?

Answer 61

Protracted Withdrawal

Question 62

Spasticity is a muscle tone disorder that results in the imbalance of excitatory and inhibitory inputs at the level of the __________

Answer 62

spinal cord

Question 63

What is the only muscle relaxant that DOES have significant effect at the muscle fiber rather than acting at the spinal cord, brainstem or cerebrum?

Answer 63

Dantrolene

Question 64

Cyclobenzaprine has anti-Ach properties, such as dry mouth, constipation, nausea, urinary retention, tachycardia, blurred vision, and confusion

Answer 64

TRUE

Question 65

with this muscle relaxant, you must monitor the liver function when initiating

Answer 65

Metaxalone (Skelaxin)

Question 66

ETOH has cross reactivity with asthma inhalers on a toxicology screen

Answer 66

TRUE

Question 67

what is the most widely used drug (20% of hospital admissions are due to related diseases of this drug)

Answer 67

Ethanol

Question 68

ETOH may be present in people with...

Answer 68

a UTI E. coli diabetics with bacterial fermentation of urine

Question 69

single dose of 7grams will cause liver failure deathly to cats and snakes metabolized in the liver and is toxic to the skin also (SJS and TENS)

Answer 69

Acetaminophen

Question 70

If codeine/hydrocodone ration is

Answer 70

TRUE

Question 71

If codeine/morphine ration is

Answer 71

TRUE