Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

*Barash > Acute Pain > Flashcards

Acute Pain Flashcards

1
Q

This drug is a relatively inexpensive synthetic opioid considered to be a broad-spectrum opioid because it is a (1) μ receptor agonist, (2) NMDA antagonist, and (3) inhibitor of monoamine transmitter reuptake, making it potentially useful for the treatment of neuropathic pain. It is generally not necessary to adjust the dosage of methadone in patients with renal insufficiency.

A

Methadone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

This drug is a highly lipophilic partial μ opioid receptor (MOR) agonist, κ receptor (KOR) antagonist, and ORL1 agonist. It is a lipophilic opioid with moderate intrinsic activity and a high affinity for the μ opioid receptor. It also produces less constipation and less cognitive dysfunction than other μ opioid receptor agonists and does not prolong the QTc interval like methadone.

A

Buprenorphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

This drug is an excellent alternative for the treatment of acute pain in the patient who cannot tolerate morphine secondary to allergy or other sensitivity.

A

Buprenorphine

In the adult patient the parenteral dose of buprenorphine is 300 μg, which is equivalent to 10 mg of morphine.

A novel (off-label) route of administration of buprenorphine is the PERINEURAL application of the drug with local anesthetic. Referred to as multimodal perineural analgesia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

These drugs are orally active, centrally acting synthetic analgesics possessing a novel mechanism of action which combines μ receptor agonist activity with monoamine reuptake inhibition.

A

Tramadol (inhibits reuptake of NE & serotonin) (MILD-MOD pain)
Tapentadol (inhibits reuptake of NE) (does not require enzymatic conversion to an active drug) (MOD-SEVERE pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Advantages of tapentadol over tramadol include

A
  1. lack of CYP450 drug interactions
  2. lower risk of seizures and serotonin syndrome
  3. superior analgesia
  4. fewer GI side effects
  5. less variation in individual drug response secondary to genetic polymorphism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Serotonin Syndrome

A
  1. mental status changes
  2. autonomic instability
  3. neuromuscular aberrations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Is the constitutive enzyme that produces prostaglandins, which are important for general “house-keeping” functions such as gastric protection and hemostasis.

A

COX-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Is the inducible form of the enzyme that produces prostaglandins that mediate pain, inflammation, fever, and carcinogenesis.

A

COX-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Is the key mediator of both peripheral and central pain sensitization.

A

PGE2

Peripherally, prostaglandins do not directly mediate pain; rather, they contribute to hyperalgesia by sensitizing nociceptors to other mediators of pain sensation such as histamine and bradykinin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Read

A

Unlike the opioids, NSAIDs exhibit a “ceiling effect” with respect to maximum analgesic effects.

The optimal dose of ketorolac for postoperative pain control is 15 to 30 mg intravenously every 6 to 8 hours, not to exceed 5 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

This drug inhibits prostanoid synthesis. It does not enter the active site COX but reduces Fe IV to Fe III and prevents activation of the peroxide catalytic moiety and therefore inhibits PGH2 synthesis.

A

Paracetamol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Read

A

NSAIDs and COX-2–selective inhibitors should not be administered to patients with known hypersensitivity to the drugs or to patients with Samters triad (aka aspirin triad), which is a medical condition
characterized by asthma, aspirin insensitivity, and nasal polyposis.

Finally, avoid celecoxib and valdecoxib in patients with allergic-type reactions to sulfonamides.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

This drug has both analgesic and antipyretic properties, similar to aspirin, but is devoid of any anti-inflammatory effects. The drug is primarily a centrally acting inhibitor of the COX enzyme with minimal peripheral effects. Acetaminophen neither enters the active site of the COX enzyme nor binds to the COX site, but instead it prevents COX activation by reducing heme at the peroxidase site of the enzyme.

A

Paracetamol

In adults, 2 g of oral acetaminophen is equivalent to 200 mg of celecoxib.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

MC side effect of dextromethorphan?

A

Nausea and vomiting

Because the intravenous administration of large doses can lead to hypotension and tachycardia, the intramuscular route may be the preferred route of delivery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

An NMDA receptor antagonist which has been shown to both inhibit secondary hyperalgesia following peripheral burn injury and cause a reduction in temporal summation of pain.

A

Dextropmethorphan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Side effects from clonidine include sedation, hypotension, and bradycardia if the dose exceeds?

A

150 ug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

This drug is a potent and highly selective α2-adrenoreceptor agonist which demonstrates cardioprotective, neuroprotective, and renoprotective effects against hypoxic/ischemic injury.

A

Dexmedetomidine

The drug does not decrease gut motility and prevents postoperative nausea and vomiting and shivering.

Has no anticholinergic effects and promotes more physiological sleep pattern attributes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Read

A

The most frequently observed adverse effects associated with the use of dexmedetomidine are bradycardia and hypotension, which can be adequately treated with atropine, glycopyrrolate, and ephedrine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Compared to traditional analgesics, which decrease afferent input from the site of tissue injury, these drugs decrease the hyperexcitability of dorsal horn neurons caused by tissue damage.

A

Gabapentinoids

Although structurally similar to GABA these drugs are not GABAergic and do not bind GABAA GABAb GABAc radioligand sites or allosteric GABA receptor sites.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Read

A

Although structurally similar to GABA these drugs are not GABAergic and do not bind GABAA GABAb GABAc radioligand sites or allosteric GABA receptor sites.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Read

A

The antinociceptive mechanism of action of the gabapentinoids has two aspects: modulation of the calcium-induced release of glutamate centrally in the dorsal horn, and activation of descending noradrenergic pathways in the spinal cord and brain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

The gastrointestinal absorption of gabapentin occurs only in the?

A

Duodenum through a SATURABLE transport system resulting in bioavailability that decreases with increasing doses.

Preoperative dosing of gabapentin as high as 1,200 mg orally has been recommended

In the opioid-naive patient, the preoperative dose of gabapentin should rarely exceed 300 mg orally.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pregabalin, on the other hand, is absorbed in?

A

small intestines through a NONSATURABLE transport system and has a linear pharmacokinetic profile (dose-independent absorption), and is more potent than gabapentin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Read

A

However, because it takes gabapentin and pregabalin 4 to 6 hours and 8 hours, respectively, to reach peak cerebrospinal fluid levels dosing of the drug the evening prior to surgery may ultimately prove to be the most beneficial method of administration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Read

A

The glucocorticoids are well known for their analgesic, anti-inflammatory, and antiemetic effects. Inhibition of cytosolic phospholipase A2 upstream from the lipoxygenase and COX enzymes in the prostaglandin cascade most certainly accounts for both their anti-inflammatory and analgesic effects by inhibiting leukotriene and prostaglandin production.

The recommended preoperative intravenous dose is 0.11 to 0.2 mg/kg. Because the drug has been reported to cause perineal irritation in 50% to 70% of individuals following rapid administration, prudence dictates that the drug be diluted in 50 mL of normal saline and injected over 10 minutes prior to surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Read

A

Dexamethasone has also been administered via the perineural route as part of a four-drug cocktail. The perineural dose of dexamethasone should never exceed 1 mg per plexus!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

This drug is not recommended for use in an intravenous PCA secondary to accumulation of its potentially toxic metabolite normeperidine.

A

Meperidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

The five variables associated with all modes of PCA include

A
  1. bolus dose
  2. incremental (demand) dose
  3. lockout interval
  4. background infusion rate
  5. 1- and 4-hour limits

A typical PCA regimen in an otherwise healthy adult would be an incremental dose of 1 to 2 mg of morphine with an 8- to 10-minute lockout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Read

A

The authors do not recommend a background infusion of opioid in the opioid-naive patient. A background infusion should be reserved for the patient with chronic malignant or nonmalignant pain who is opioid-tolerant or in patients with persistent pain who have failed a trial of incremental PCA dosing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Relative Risk Factors Associated with the Use of Patient-controlled Analgesia

A
  1. Pulmonary disease
  2. OSA
  3. Renal or hepatic dysfunction
  4. CHF
  5. Closed head injury
  6. Altered mental status
  7. Lactating mothers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

The optimal duration of epidural analgesia has not been determined, but recommendations are that the infusion be continued for at least?

A

2 to 4 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Read

A

In general, the epidural administration of HYDROPHILIC opioids tends to have a slow onset, long duration, and a mechanism of action that is primarily spinal in nature.

The epidural administration of LIPOPHILIC opioids, on the other hand, has a quick onset, short duration, and a mechanism of action that is primarily supraspinal, secondary to rapid systemic uptake.

33
Q

Read

A

Bolus administration of fentanyl appears to have a segmental analgesic effect whereas epidural infusion of fentanyl appears to have a nonsegmental (systemic) effect.

34
Q

In the opioid- tolerant patient taking more than 250 mg/day of oral morphine, what drug may be considered to be the epidural opioid of choice because of its high intrinsic activity.

A

Sulfentanil

35
Q

What is the most common form of epidural infusion?

A

local anesthetic–opioid combinations

36
Q

Read

A

Although bupivacaine plus fentanyl may be the most common combination, bupivacaine plus morphine makes more sense from a bioavailability point of view.

Hydromorphone plus bupovacaine (less risk of pruritus)

37
Q

Opioid analgesics for intrathecal analgesia (6)

A
  1. Morphine
  2. Hydromorphone
  3. Meperidine
  4. Methadone
  5. Fentanyl
  6. Sulfentanil
38
Q

What nerve is commonly spared in interscalene block?

A

Ulnar

39
Q

Most common technique used in ultrasound guided blocks

A

In-plane approach

Transducer (axial oblique plane)

40
Q

What are the boundaries of the corner pocket

A 
subclavian artery (medially)
first rib (inferiorly)
brachial plexus (superiorly and laterally)
41
Q

Lumbar plexus is formed by what nerve roots?

A

L1-L4

42
Q

The lumbar plexus gives rise to what nerves

A
  1. femoral (saphenous)
  2. obturator
  3. lateral femoral cutaneous
  4. ilioinguinal & iliohypogastric
  5. genitofemoral nerves
43
Q

Contraindication for psoas compartment block

A

Anticoagulated patient

44
Q

Femoral nerve is formed by?

A

L2-L4

it is ideally visualized at the level of the inguinal crease

at this level, the nerve is positioned approximately 0.5 cm LATERAL to the femoral artery

45
Q

Femoral artery terminates as what nerve?

A

Saphenous

46
Q

This nerve is the only branch of the lumbar plexus below the knee
and is the largest sensory terminal branch of the femoral nerve.

A

Saphenous

47
Q

The potential advantage of the Adductor canal block over the FNB is?

A

analgesia without significant motor blockade

48
Q

Sciatic nerve originates from?

A

L4-S3

49
Q

Read

A

The PVS is defined anteriorly by the parietal pleura, posteriorly by the costotransverse ligament, superiorly by the occiput, inferiorly by the alar of the sacrum, and medially by the vertebral body, intervertebral disc, and the intervertebral foramen. Laterally, the PVS is contiguous with the intercostal space.

50
Q

TBP is performed at the thoracic level. When performed in the lumbar region it is better known as a ?

and when performed at the cervical level it is referred to as a?

A

psoas compartment block

deep cervical plexus block

51
Q

Alternative for paravertebral block?

A

pectoral nerve block

52
Q

This block is a relatively new block that is indicated for latissimus dorsi flap reconstruction and multiple rib fractures.

A

serratus plane block

The block is performed at the level of the FIFTH rib in the mid-axillary line

53
Q

triangle of Petit (TOP)

A

latissimus dorsi muscle posteriorly

external oblique (EO) anteriorly

iliac crest caudally

54
Q

Is a “physiologic state of adaptation to a specific psychoactive substance

A

Physical dependence

55
Q

is characterized by an increased sympathetic and parasympathetic response that results in hypertension, tachycardia, diaphoresis, abdominal cramping, and diarrhea.

A

Opioid withdrawal

56
Q

a state in which an increased dosage of a psychoactive substance is needed to produce a desired effect.

A

Tolerance

57
Q

is a biopsychosocial disease characterized by dysfunctional behavior that involves craving, compulsive use, loss of control, and the continued use of a drug in spite of adverse consequences.

A

Addiction

58
Q

describes the patient who has behavioral features of addiction secondary to undertreatment of the pain syndrome.

A

Pseudoaddiction

59
Q

The reader is reminded that patients receiving more than 200 mg of methadone per day can develop a?

A

prolonged QT interval

It is therefore recommended that a baseline electrocardiogram be obtained for comparison.

60
Q

Read

A

Exact opioid dosing guidelines do not exist but because of receptor downregulation secondary to chronic opioid administration, opioid doses may need to be increased 30% to 100% vis-à-vis the opioid-naive patient. Because of receptor downregulation an alternative opioid may be useful in this setting. Opioid rotation takes advantage of the fact that the new opioid will bind a different opioid receptor subtype and be metabolized differently. Following the cancer pain model, the dose of the new opioid is less than 50% of the calculated equianalgesic dose because of incomplete cross-tolerance.

61
Q

Read

A

The key components to establishing a successful perioperative pain management service begins with an institutional commitment to support
the service.

62
Q

The forms of neuropathic pain include?

A
  1. Postherpetic neuralgia (PHN)
  2. diabetic peripheral neuropathy (DPN)
  3. Complex regional pain syndrome (CRPS)
  4. human immunodeficiency virus neuropathy
  5. phantom limb pain
63
Q

Nociceptive pain, also called physiologic pain has two main types:

A

radicular pain (e.g., disk herniation) and somatic pain (e.g., facet or hip joint arthritic pain)

64
Q

True or false

Propofol at very low doses (e.g., 10 mg) has been useful to treat pruritus, not only induced by neuraxial opiates but also the pruritus associated with cholestatic liver disease.

A

True

65
Q

1:200,000 means

A

1:200,000 means: 1 g/200,000 mL = 1000 mg/200,000 mL = 1,000,000 mcg/ 200,000 mL = 5 mcg/mL

66
Q

A dose of 1 to 5 mg of epidural morphine is approximately equal to an intrathecal dose of?

A

0.1 to 0.3 mg of morphine

67
Q

Read

A

Sensory block is two to three dermatomes higher than the motor block. However, with epidural anesthesia, the sympathetic and sensory blocks tend to be at the same dermatome level and are higher than the motor block

68
Q

This disease is defined as pain persisting for more than 3 months after resolution of the rash, increases.

A

Postherpetic neuralgia

69
Q

refers to spontaneous pain in an area or region that is anesthetic.

A

Anesthesia dolorosa

70
Q

Refers is an unpleasant abnormal sensation, whether spontaneous or evoked.

A

Dysesthesia

71
Q

The potency of local anesthetics is directly related to their lipid solubility. In general, the speed or onset of action of local anesthetics is related to the?

A

pka

72
Q

Read

A

There are four clinical stages of epidural abscess symptom progression. Initially, localized back pain develops. The second stage includes nerve root or radicular pain. The third stage involves motor and sensory deficits or sphincter dysfunction, followed by the last stage of paraplegia.

73
Q

Is related to entrapment of the lateral femoral cutaneous nerve as it courses below the inguinal ligament and is associated with burning pain over the lateral aspect of the thigh. It is not a complication of epidural anesthesia.

A

Meralgia paresthetica

74
Q

The main feature is burning, with continuous pain that is exacerbated by normal movement, cutaneous stimulation, or stress, usually weeks after the injury. The pain is not anatomically distributed. Other associated features include cool, red, clammy skin and hair loss in the involved extremity. Chronic cases may be associated with atrophy and osteoporosis

A

complex regional pain syndrome (CRPS)

75
Q

A retrobulbar block anesthetizes the three cranial nerves (3)

A

3
4
6

76
Q

the greatest plasma concentration of local anesthetic

A 
intercostal block
caudal epidural
lumbar epidural
brachial plexus
sciatic/femoral nerve block
subcutaneous
77
Q

Occurs when head flexion causes shooting sensations down the back and into the lower limbs. It is a sign of posterior column disease

A

Lhermitte sign

Named after Jean Lhermitt

78
Q

Read

A

Bezold-Jarisch reflex (hypotension and bradycardia)

79
Q

Aα fibers are efferent to the skeletal muscles. Aβ fibers are afferent from the skin and joints to provide touch and proprioception sensations. A-gamma (Aγ) fibers are 3 to 6 μm in diameter, have conduction velocities of 15 to 35 m/sec, and are efferent to the muscle spindles to provide muscle tone. A-delta (Aδ) fibers are 1 to 4 μm in diameter and have conduction velocities of 5 to 25 m/sec and are afferent fibers, which provide sharp localized pain and temperature and touch sensations.

A

B fibers are myelinated, preganglionic sympathetic nerve fibers that are less than 3 μm in diameter, have medium conduction velocities 3 to 15 m/sec, and are involved with various autonomic nervous system control. C fibers are nonmyelinated, postganglionic sympathetic nerves that are 0.3 to 1.3 μm in diameter and have slow conduction velocities of 0.1 to 2 m/sec. C fibers are afferent sensory nerves involved with nonlocalized pain, temperature, and touch sensations.

*Barash (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions