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Anesthesia > 12. Chronic Pain > Flashcards

12. Chronic Pain Flashcards

1
Q

Difference between neuropathy, neuralgia, and neuritis

A

Neuropathy= Pain resulting from systemic disease

Neuralgia= Pain arising from Nervous system in response to non-painful stimuli

Neuritis= Pain from irritative non-neural disease

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2
Q

Examples of neuralgia, nueropathy and neuritis

A

Neuralgi= TN, MS, Vagoglossopharyngeal
Neuropathy= DM, Lupus, burning mouth (nutritional def.)
Neuritis=Odontogenic, post trauma, etc

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3
Q

What are the two types of Receptors responsible for activation of pain pathways

A

-EAA and tachykinin

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4
Q

EAA and Tachykinin neurotransmitters are

A 
EAA= aspartate and glutamate 
Tachykinins= Substance P and neurokinin
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5
Q

What are the two different kinds of EAA receptors

A

AMPA and NMDA

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6
Q

Describe the difference between AMPA and NMDA

A

AMPA

  • First pain
  • Responds to low level release of glutamate
  • Rapid and transient

NMA

  • Second pain
  • Response is delayed and prolonged due to aspartate release
  • Delayed and prolonged
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7
Q

Antagonists of EAA receptors

A

Opioids

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8
Q

Antagonists of Tachykinin receptors

A
  • Opioids
  • Alpha 1 antagonists
  • Alpha 2 agonist (cloniidine)
  • TCA
  • GABAB agonist (baclofen)
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9
Q

Side effects of long term NSAID use

A
  • Gastric upset .
  • Ulcers
  • Blood dyscrasias (platelet inhibition)
  • Potential teratogen
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10
Q

MOA of corticosteroids

A

Inhibition of Phopholipase A (decreases inflammation)

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11
Q

Uses for corticosteroids

A
  • painful RA

- Nerve injury (adjuvant therapy)

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12
Q

Side effects of long term corticosteroid use

A
  • Impaired wound healing and immunity
  • Adrenal suppression
  • Gastric irritation
  • Hyperglycemia
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13
Q

MOA of Capsaicin

A
  • Depletion of substance P

- Anti-inflammatory

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14
Q

Uses of capsaicin

A
  • Poster herpetic neuralgia

- Osteoarthritis (painful)

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15
Q

Action of baclofen

A

GABAB agonist –> analgesia

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16
Q

Uses of baclofen

A

Neuropathic pain (TN, myofascial pain)

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17
Q

(more/less) abuse of baclofen compared to benzons

A

-less abuse than benzo

18
Q

Uses of benzons

A

neuropathic pain (myofascial pain)

19
Q

Side effects of benzons

A
  • Dependence
  • Withdrawl
  • Teratogen
20
Q

MOA of opioids (

A

Bind kapa receptors

21
Q

Use of opiods

A

chronic pain

22
Q

Side effects of opiods

A
  • Abuse/dependence

- Sub-optimal pain control with recommended doses

23
Q

MOS of TCA

A

inhibition of serotonin reuptake –> modulation of descending pain pathways

24
Q

Uses of TCAs

A

Neuropathig pain (poster herpetic neuralgia, burning mouth, myofascial pain)

25
Q

Side effects of TCA use

A

-Anti-cholinergic effects (i.e dry mouth)

26
Q

Example of an alpha 1 antagonist is

A

guanethidine

27
Q

Alpha 1 antagonist (increases/decreases) SNS activity Alpha 2 agonist

A

both decrease

28
Q

Alpha 1 antagonist and Alpha 2 agonist used to treat

A

sympathetically mediated pain

29
Q

Side effects of alpha 1 antagonists and alpha 2 agonists

A

-postural hypotension

30
Q

Phenytoin is what class of drug

A

anticonvulsant

31
Q

anticonvulsants are used to treat

A

neuralgias (conditions that result from damage to the nervous system)

32
Q

Side effects of anti-convulsants used to treat neuralgias

A

Phenytoin= gingival hyperplasia

-Both result in ataxia, blood dyscrasia (i.e anemia and leukopenia)

33
Q

Pregabalin is what drug classification

A

anti-convulsant

34
Q

Pregabalin is similar to

A

gabapentin

35
Q

Gabapentin is what class of drug

A

anti-convulsant

36
Q

MOA of gabapentin

A

unknown- it is a gaba analog but doesn’t act on GABA receptor

37
Q

Uses of gabapentin

A

TN

38
Q

Side effects of gabapentin

A

ataxia, blood dyscrasia (leukopenia) , dizziness, same as other anti-convulsants

39
Q

Uses of pregabalin

A
  • Post herpetic neuralgia

- TN

40
Q

Caution for pregabalin should be taken due to

A

life-threatening angioedema

41
Q

Nerve blocks are used to treat

A

-myofascial pain, neurogenic pain

42
Q

Sider effects with long term use of nerve block

A
  • tissue trauma
  • Scarring
  • Infection

Anesthesia (12 decks)

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