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Behaviour > 230: Pain > Flashcards

230: Pain Flashcards

1
Q

Cause of Congenital Insensitivity to Pain

A

sodium channel mutations

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2
Q

list some inflammatory chemical pain stimulaters

A

histamine, bradykinin, prostaglandin

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3
Q

name the thermal pain receptor

A

capsaicin (TRPV1) ( temperatures above 43 degrees c.)

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4
Q

where are Meissner’s Corpuscles

A

in the skin (stretch receptors)

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5
Q

where are Pacinian Corpuscles

A

in the skin ( touch receptor)

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6
Q

where are merkel discs?

A

in the skin ( mechanoreceptors, respond to pressure)

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7
Q

where are Ruffini end organs?

A

in the skin (mechanoreceptor responds to pressure)

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8
Q

Fast, mylinated nociceptor

A

A delta fibres

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9
Q

unmylinated slow nociceptor

A

C-fibres

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10
Q

activation of which receptor inhibits pain ( rub it better)

A

A beta ( block A delta fibre info via interneurone in the spinal cord) ( e.g. Man City GK broke neck can be seen rubbing neck while playing on).

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11
Q

common local anaesthetic (blocks voltage gated Na channels)

A

lidocane

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12
Q

common anticonvulsant/ mood stabiliser ( blocks voltage gated Na channel)

A

carbamazepine

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13
Q

what do the descending pathways do?

A

modulate the ascending sensory pathway ( via endogenous opiods)

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14
Q

what causes phantom limb pain?

A

sensory confusion because 2nd and 3rd order nociceptors are still there even though the primary one has been removed ( or never existed).
A beta afferents can sprout into the lamina and synapse on to the send order nociceptor.

The somatosensory cortex can also get rewired ( if arm is missing the nuclei for that are creeps into face and shoulder)

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15
Q

list some opiates

A

morphine, codeine, heroin

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16
Q

most potent analgesic metabotropic opioid receptor?

A

mu and delta (also most addictive)

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17
Q

List some endogenous opioids and their roles

A

Endorphins ( reward), Enkephalins (delta receptor agonist…descending pathway inhibit sensory pathway), Dynorphins ( kappa receptor agonist)

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18
Q

Cox - synthesised by and inhibited by?

A

synthesis = prostaglandins. inhibited by aspirin.

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19
Q

What is substance P

A

neuropeptide dilates blood vessels and triggers histamine release

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20
Q

what is bradykinin

A

neurotransmitter involved in chronic pain

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21
Q

what is histamine

A

neurotransmitter involved in chronic pain

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22
Q

what do NSAIDS target

A

inflammation

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23
Q

hyperalgesis

A

stimulus hurts more than it should

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24
Q

allodynia

A

stimulus hurts when it shouldn’t

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25
Q

parasthesia

A

pain in the absence of stimulus

26
Q

referred pain: right shoulder

A

liver and gallbladder

27
Q

referred pain: retrosternal and left arm

A

heart

28
Q

referred pain of small intestine, colon, stomach and appendix

A

central abdo ( appendix moves to right flank when peritoneum becomes involved?)

29
Q

referred pain: flanks

A

ureters

30
Q

referred pain spine landmark: C3-4

A

diaphragm

31
Q

referred pain spine landmark: T1-4

A

heart

32
Q

referred pain spine landmark: T6-9

A

stomach

33
Q

referred pain spine landmark: T7-8

A

gall bladder

34
Q

referred pain spine landmark: T9-10

A

duodenum

35
Q

referred pain spine landmark: T10 right

A

appendix

36
Q

referred pain spine landmark: T10-12

A

reproductive organs

37
Q

referred pain spine landmark: L1-2

A

kidney, ureter

38
Q

process involved in stress induced analgesia (e.g. climber cutting own arm off to rescue himself)

A

Amygdala projections from cortex to periaquiductal grey opioid release.

39
Q

what does the substantial gelatinosa do?

A

area of the posterior horn where the 1st order neurones of the spinothalamic tract synapse

40
Q

what does the nucleus proprius do?

A

area of the posterior horn where the 1st order neurones of the spinothalamic tract synapse

41
Q

step one of WHO pain ladder

A

nonopoid (+/-adjuvants) (ibuprofen, naproxen, paracetamol)

42
Q

ibuprofen works how?

A

inhibits COX - COX 2 is the main enzyme to catalyse production of prostaglandins.

43
Q

paracetamol works how?

A

reduces central prostaglandin synthesis

44
Q

naproxen works how?

A

NSAID ( Cox inhibition)

45
Q

sterp 2 of the WHO pain ladder

A

weak opioid + non-opioid (+/- adjuvants) (weak opioids are codeine and dihydrocodeine)

46
Q

codeine works how?

A

opioid analgesic

47
Q

dihydrocodeine works how?

A

Fentanyl how does it wo

48
Q

COX 2 specific inhibitors

A

Celecoxib and Etoricoxib

49
Q

Tramadol side effects

A

reduces epileptic seizure threshold, hallucinations/ confusion, withdrawal issues, addiction abuse

50
Q

non-opioid properties of Tramadol

A

inhibits reuptake of norepinephrine and stimulates serotonin release.

51
Q

caution required when prescribing tramadol to someone on SSRIs, why?

A

tramadol increases Seratonin release therefore ‘serotonin syndrome’ risk - autonomic hyperactivity (enters - diarohea) , neuromuscular abnormality (tremor), mental status change (agitation, hypervigilance)

52
Q

Fentanyl how does it work?

A

opioid ( potent mu receptor agonist)

53
Q

Side effects of opioids

A

initial: nausea and vomiting, drowsiness, unsteaadiness, delirium. ongoing: constipation. Occasional: sweating, dry mouth, hallucinations, pruritis ( itchy skin),. longterm: endocrine/immune. rare/overdose: psychological depression/ respiratory depression

54
Q

opioid antagonist (in overdose)

A

naloxone

55
Q

WHO pain ladder step 3

A

strong opioid (fentanyl, morphine, oxycodone) plus non-opioid (=/- adjuvant)

56
Q

paracetamol overdose antidote?

A

N-acetyl cisteine and glutathione to mop up free radicals

57
Q

MST

A

morphine sulphate tablets!

58
Q

how do bisphoshonates work?

A

stop bone degradation via reduced osteoclast activity.

59
Q

how to anti epileptics work as analgesics?

A

neuropathic pain - reduce glutamate release at synapse e.g. gabapentin inhibits pre synaptic Ca channel ( if calcium doesn’t go in glutamate doesn’t get realised) carbamazepine - blocks Na channel presynaptically.

60
Q

Treatment of Painful Diabetic Peripheral Neuropathy (PDPN)

A

Duloxetine (serotonin noradrenaline reuptake inhibitor (SNRI)

61
Q

nociceptive pain originates where?

A

in the tissue

62
Q

neuropathic pain originates where?

A

from damaged nerves.

Behaviour (12 decks)

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