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Biochem Exam 5 > 11/29: Pain, Analgesia, and Anesthesia > Flashcards

11/29: Pain, Analgesia, and Anesthesia Flashcards

1
Q

What is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage?

A

Pain

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2
Q

What is pain of moderate or higher intensity accompanied by?

A

Anxiety and the urge to escape or terminate the feeling

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3
Q

What is the unconscious activity induced by a harmful stimulus applied to sense receptors?

A

Nociception

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4
Q

What is a harmful, poisonous or very unpleasant stimuli?

A

Noxious stimuli

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5
Q

What is an exaggerated response to a noxious stimulus?

A

Hyperalgesia

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6
Q

What is a sensation of pain in response to a normally innocuous stimulus?

A

Allodynia
e.g. the painful sensation from a warm shower when the skin is damaged by burns including sunburn

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7
Q

When intense, repeated, or prolonged stimuli are applied to damaged or inflamed tissues, the threshold for activating primary afferent nociceptors is lowered, and the frequency of firing is higher for all stimulus intensities

A

Sensitization

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8
Q

What medications contribute to sensitization?

A

inflammatory mediators such as bradykinin (BK), nerve-growth factor (NGF), some prostaglandins (PGs), and leukotrienes (LTs)

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9
Q

What signifies increased sensitivity of nociceptive afferent fibers, NOCICEPTION?

A

Hyperalgesia and allodynia

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10
Q

What is the inability or reduced ability to feel pain without
loss of consciousness or other sensations?

A

Analgesia

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11
Q

What are substances that reduce the ability to feel pain?

A

Analgesics
e.g. non-steroidal anti-inflammatory drugs,
acetaminophen, aspirin, opioids

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12
Q

What is insensitivity to pain?

A

Anesthesia

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13
Q

What are substances that produce a general insensitivity to pain?

A

Anesthetics

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14
Q

What depress the CNS to a sufficient degree to permit the performance of surgery and unpleasant procedures?

A

General anesthetics

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15
Q

What are examples of general anesthetics?

A

isoflurane, halothane, nitrous oxide, propofol

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16
Q

What are substance that when in contact with a nerve trunk can cause both sensory and motor paralysis in the area innervated?

A

Local anesthetics

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17
Q

What are examples of local anesthetics?

A

cocaine, lidocaine, bupivacaine

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18
Q

What mediate responses to touch and pressure?

A

Mechanoreceptors

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19
Q

What do mechanical nociceptors respond to?

A

Strong pressure
e.g., from a sharp object

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20
Q

What detect the sensations of warmth and cold?

A

Thermoreceptors

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21
Q

When are thermoreceptors activated?

A

by skin temperatures above 45°C or by severe cold (<20°C)

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22
Q

What are stimulated by a change in the chemical composition of the local environment?

A

Chemoreceptors

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23
Q

What include chemoreceptors?

A

receptors for taste and smell as well as visceral receptors that are sensitive to changes in the plasma level of O2, pH, and osmolality

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24
Q

What do chemically sensitive nocicreceptors respond to?

A

chemicals such as bradykinin, histamine, acidity, and environmental and chemical irritants, etc

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25
Q

Where are receptors on Nociceptive Sensory Neurons?

A

On the endings of nociceptive sensory nerves

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26
Q

What do Nociceptive Sensory Neurons respond to?

A

Noxious thermal, mechanical, or chemical stimuli

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27
Q

What are transient receptor potential channels?

A

TRPV1 (V = vanilloids)
TRPA1 (A = ankyrin)

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28
Q

What are TRPV1 receptors activated by?

A

Heat
Acids
Chemicals - capsaicin
(the active ingredient in hot peppers and an example of a vanilloid)

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29
Q

What are TRPA1 receptors activated by?

A

Mechanical
Cold
Chemical

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30
Q

What receptors are though to be the main ones dealing with acid induced pain?

A

ASIC receptors

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31
Q

What receptor does cold sensations activate?

A

TRPM8

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32
Q

What receptor does mechanical sensations activate?

A

TRPA1

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33
Q

What receptor does heat sensations activate?

A

TRPV1

34
Q

In addition to direct activation of receptors on nerve endings, what else do nociceptive sitmuli release?

A

Intermediate molecules that then activate receptors on the nerve ending

35
Q

What two receptors are used when ATP is released to cause pain?

A

P2X
P2Y

36
Q

Is P2X an ionotropic or G-protein receptor?

A

Ionotropic

37
Q

Is P2Y an ionotropic or G-protein receptor?

A

G-protein

38
Q

What 6 molecules act on G-protein coupled receptors to cause pain?

A

(BHPSSC)
Bradykinin
Histamine
Prostaglandins
Serotonin
Substance P
Calcitonin-gene related protein

39
Q

What receptor does NGF act on?

A

Tyrosine Kinase A

40
Q

What does NGF singaling through a tyrosine kinase receptor A cause?

A

Gene transcription

41
Q

What does ATP cause once it has bound to either P2X or P2Y?

A

a. Immediate depolarization with P2X
b. Gene expression or Immediate depolarization with P2Y

42
Q

ATP signaling mechanism on ionotropic receptors is very similar to?

A

Acetylcholine (ACh)

43
Q

Can all three types of receptors cause sensitization of nociceptive neurons?

A

Yes

44
Q

What are the two main changes that can be produced rfrom sensitization of nociceptive neurons?
KNOW THIS!!!

A
  1. immediate changes in neuronal responsiveness
    e.g, changes in membrane potential produced by altered calcium concentrations
  2. prolonged changes in neuronal responsiveness
    e.g, produced by changes in gene expression
45
Q

What nerve type is the primary type used for pain transmission?

A

Sensory afferent neurons

46
Q

What are the two types of sensory afferent neurons?

A

A-Beta
A-Delta/C axons

47
Q

How do A-Delta and C-axons differ

A

A-delta is myelinated while C-Axons are not

48
Q

What type of stimuli does A-Beta nerves respond to?

A

Light touching and moving stimuli

49
Q

What type of stimuli does A-delta nerves respond to?

A

Extremely painful stimuli

50
Q

Where do these axons cross within the spinal cord?

A

Ventrolateral quadrant within the ventrolateral spinothalamic tract

51
Q

What parts of the somatosensory cortex are activated by pain?

A

Primary and secondary somatosensory cortex and the cingulate gyrus on the side opposite the stimulus
- the amygdala, frontal lobe, and insular cortex are also activated

52
Q

What laminae do the unmyelinated C-fibers project to within the dorsal horn?

A

Superficial laminae 1 and 2

53
Q

What laminae do the myelinated A and Delta fibers project to in the dorsal horn?

A

Superficial laminae 1 and 5

54
Q

Where are somatosensory ganglia located at within the body?

A

Peripheral ganglia like DRG and Trigeminal ganglia

55
Q

Where do the spinothalamic tract axons ascend to?

A

Thalamus

56
Q

Where do the thalamic projections go to?
KNOW THIS!!!

A

Somatosensory cortex

57
Q

What does the somatosensory cortex mediate?
KNOW THIS!!!

A

Purely sensory aspect of pain
i. This is locations, intensity, quality

58
Q

Where do thalamic neurons project to?
KNOW THIS!!!

A

Cortical regions

59
Q

What does the cortical regions of the brain link pain with?
KNOW THIS!!!

A

Emotional responses
i. Why you remember painful events

60
Q

Does visceral sensation travel along the same central pathway as somatic sensation in
the spinothalamic tract and thalamic radiation?

A

Yes

61
Q

Are the cortical receiving areas for visceral sensation intermixed with somatic receiving areas?

A

Yes

62
Q

What does this mixing of visceral sensation create?

A

Referred pain

63
Q

What is the gate control mechanism for pain modulation?

A

Pain from nociceptive pathways can be interrupted by the addition of new stimulus to the site where the nerve is receiving the injury at
i. This is why rubbing shin after hitting it helps as new stimulus are generated and they use the same nerves

64
Q

What do interneurons within the superficial regions of the dorsal horn contain receptors for?

A

Endogenous opioid peptides

65
Q

What does activation of the postsynaptic opioid receptor do to the dorsal horn
interneuron?

A

Hyperpolarizes it causing an uptake in K

66
Q

What does activation of the presynaptic opioid receptor do to the dorsal horn?

A

Decrease in Ca so glutamate and substance P are decreased

67
Q

What do these two actions do to EPSPs within the dorsal horn?

A

Reduce its duration

68
Q

What is the main opioid used by dentists?

A

Morphine

69
Q

What is the mechanism of action of an opioid?

A
  1. Bind to receptors located on neurons
  2. Decrease intracellular calcium causing reduced NT
  3. Increase intracellular potassium causing hyperpolarization decreasing action potential propagation
70
Q

What are the two non-opioid analgesics used

A

Aspirin
Acetaminophen

71
Q

What are non-steroidal anti-inflammatory drugs (NSAIDs)?

A

Ibuprofen
Naproxen
Ketorolac
Celecoxib

72
Q

How do NSAIDs and aspirin work?

A

By inhibiting cyclooxygenase which causes a reduced production of
prostaglandins leading to a reduced inflammatory-mediated pain signaling and
nociceptor sensitivity

73
Q

What are local anesthetics?

A

Articaine
Bupivacaine
Cocaine
Lidocaine
Mepivacaine
prilocaine

74
Q

What are mechanisms of action of local anesthetics?

A
  • block sodium channels
  • reduces depolarization of neurons
  • renders neuron refractory to further depolarization
75
Q

What are examples of inhalational anesthetics?

A

Halothan
Isoflurane
Nitrous oxide

76
Q

What are parenteral (intravenous) anesthetics?

A

Propofol
Thiopental
Ketamine
Midazolam

77
Q

What is the mechanism of action of general anesthetics?

A

Increase sensitivity of the GABAA receptor to gamma-aminobutyric acid (GABA)
- enhancing inhibitory neurotransmission and depressing nervous system activity

78
Q

What is the mechanism of action of inhalational anesthetics?

A

enhance the capacity of glycine to activate glycine receptors
* which play an important role in inhibitory neurotransmission in the spinal cord and brainstem

79
Q

What is the mechanism of action of halogenated inhalational anesthetics?

A

activate some K+ channels known
* hyperpolarize neurons making them refractory to depolarization

80
Q

What do inhalational and intravenous anesthetics have substantial effects on?

A

synaptic transmission and much smaller effects on action potential generation or propagation

Biochem Exam 5 (11 decks)

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