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BB2 > 8 - Pharmacology of Pain > Flashcards

8 - Pharmacology of Pain Flashcards

1
Q

What causes central sensitisation

A

2nd order neurons at the dorsal horn release glutamate and peptides
the GLUT acts on AMPA and NMDA receptors in the SC
Persistent activation of AMPA and NMDA causes altered gene expression and INC in intracellular CA (inc depolarisation) and up-regulation of PGs and COX enzymes

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2
Q

Where do opioid receptors act in the NS

A

PAG
NRPG
Dorsal horn
Periphery

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3
Q

Factors that influence pain perception

A

Cognition
Mood
Context
Genetics

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4
Q

Ligands of opiods

A

POMC - Propriomelanocortin
Proenkephalin
Prodynorphin

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5
Q

Characteristics of Opioids

A

Co-release
Co-transmission
Relative receptor selectivity

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6
Q

How many kappa receptors are there

A

3

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7
Q

What type of molecule are opioids

A

Peptides

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8
Q

What is the action of morphine

A

Potassium activation
Decrease in calcium conductance
Overall decreased excitability and decreased release of NTS

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9
Q

Examples of opioids

A 
Codeine 
Tramadol
Morphine
Oxymorphone
Hydrocodone
Methadone
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10
Q

Effects of opioids on CNS

A

Analgesia, respiratory depression, drowsiness, euphoria, nausea

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11
Q

Effects of opioids on CVS

A

Hypotension

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12
Q

Effects of opioids on GI system

A

Constipation,

urinary urgency

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13
Q

Opioid with active metabolite M6G

A

Morphine

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14
Q

Opioid with high solubility and used in cachexia

A

Heroin

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15
Q

U1 receptor agonist – less respiratory depression

A

Meptazinol

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16
Q

opiate antagonist with short half life

A

Naloxone

17
Q

Paracetamol

A

reduces the active oxidised form of COX-2

Analgesic, antipyretic but little anti-inflammatory effect

18
Q

Action of NSAIDs

A

Inhibition of COX enzymes

19
Q

Aspirin

A

COX-1 and COX-2 inhibitor): analgesic, antipyretic, anti-inflammatory

20
Q

Ibuprofen, diclofenac, ketoprofen

A

COX-1 and COX-2 inhibition

analgesic and anti-inflammatory effects

21
Q

Refecoxib

A

Selective COX-2 inhibitor

22
Q

Indications of NSAIDS

A

Rheumatoid arthritis, osteoarthritis, dysmenorrhea, gout, muscle spasm

23
Q

SE of NSAIDs

A

Nausea

GI bleeding

24
Q

Other non-opioid medication

A

Anticonvulsants

TCAs

25
Q

Anticonvulsants

A

Carbamazepine, Sodium valporate - act on Na channels

Pregabalin - Acts on A2d subunit of Ca channels

26
Q

TCA

A

Amitriptyline - Inhibit the reuptake of amines and block Na and Ca channels

27
Q

Examples of local anaesthetics

A

Lignocaine
Bupivacaine
Prilocaine

28
Q

MoA of local anaesthetics

A

Blockade of Na channels

29
Q

Mode of administration of local anaethetics

A

surface, infiltration, epidural…

30
Q

Risk in local anaesthetics

A

hypotension, respiratory depression, bradycardia

31
Q

Mode of administration of general anaesthetics

A

inhalational or intravenous

32
Q

Mechanism of action of general anaethetics

A

activation of inhibitory receptors or inhibition of excitatory receptors

33
Q

Inhalation general anaethetics

A

Halothane, Xenon, NO, Enflurane, Isoflurane, Desflurane, Sevoflurane

34
Q

Intravenous general anaesthetics

A

Propofol, Thiopental, Etomidate, Ketamine, Midazolam

35
Q

What is the most common facial pain syndrome

A

Trigeminal neuralgia

36
Q

Symptoms of trigeminal neuralgia

A

Sudden, paroxysmal attacks of pain: electric shock-like, sharp, stabbing, commonly unilateral, lasts from a few seconds to a few minutes

37
Q

Cause of trigeminal neuralgia

A

Compression, distortion or stretching of the nerve V root fibres by a branch of the anterior or posterior inferior cerebellar artery

38
Q

Treatment of trigeminal neuralgia

A

carbamazepine

BB2 (27 decks)

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