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1Fall24 PoA II > Acute Pain & Opioid-Free Analgesia (Exam II) > Flashcards

Acute Pain & Opioid-Free Analgesia (Exam II) Flashcards

1
Q

What types of somatic pain are there?

A
  • Superficial: skin, SQ, mucous membranes
  • Deep: muscles, bones, tendons
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2
Q

What types of visceral pain are there?

A
  • Parietal: sharp, localized organ pain.
  • Referred: Cutaneous pain from convergence of visceral and somatic afferent input.
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3
Q

Is chronic nociceptive pain or neuropathic pain more abnormal?

A

Neuropathic pain

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4
Q

What are some possible cardiac consequences of poorly managed pain? (3)

A

↑ HR
↑ BP
↑ Cardiac workload

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5
Q

What are some possible respiratory consequences of poorly managed pain? (5)

A
  • Splinting (resp muscle spasm)
  • ↓ VC
  • Atelectasis
  • Hypoxia
  • Pulmonary infection risk
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6
Q

What are some gastrointestinal consequences of poorly managed pain?

A

Ileus - delayed motility

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7
Q

What are some possible renal consequences of poorly managed pain?

A
  • Oliguria
  • Urine retention
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8
Q

What are some possible coagulative consequences of poorly managed pain?

A

↑ clot risk

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9
Q

What are some possible immunologic consequences of poorly managed pain?

A

Immunosuppression

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10
Q

What are some possible musculoskeletal consequences of poorly managed pain?

A
  • Muscle fatigue & weakness
  • Limited mobility ⇉ clotting
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11
Q

What is the Specificity Theory?
Who came up with it?

A

Specific sensation w/ its own sensory system independent of touch and other senses - Descartes

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12
Q

What theory linked pain and emotion?

A

Intensity Theory (Plato)

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13
Q

Where is pain attenuated in the CNS according to gate theory?

A

Substantia Gelatinosa - functions as a “gate” for pain impulses that can be closed by non-painful impulses such as from A-beta fibers

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14
Q

What chemicals are released upon tissue injury that mediate pain? (4)

A
  • Histamine
  • Bradykinin (peptide)
  • Prostaglandins (lipids)
  • Serotonin (neurotransmitters)
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15
Q

Give an example of first order neurons.

A

Aδ and C

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16
Q

Where do first order Aδ and C fibers synapse at?

A

Dorsal Root of the spinal cord

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17
Q

What are the main differences from A-delta and C-fibers?

A

A-delta: myelinated, large, fast
C-fibers: unmyelinated, small, slow

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18
Q

Where do second order neurons synapse at?

A

Thalamus

19
Q

What is the name of the process by which noxious stimuli are converted to action potentials?

A

Transduction

20
Q

What is the name of the process by which an action potential is conducted through the nervous system?

A

Transmission

21
Q

What is the name of the process by which pain transmission is altered along its afferent pathway?

A

Modulation

22
Q

What is the name of the process by which painful input is integrated in the somatosensory and limbic cortices of the brain?

A

Perception

23
Q

Hyperalgesia is the process by which tissue trauma releases _____ _______ ______ that produced augmented sensitivity to stimuli.

A

local inflammatory mediators

24
Q

What is primary hyperalgesia?

A

Augmented sensitivity to painful response.

or

Allodynia-style misinterpretation of non-painful stimuli.

25
Q

What is secondary hyperalgesia?

A

Increased neuronal excitability due to glutamate activation of NMDA receptors.

26
Q

What opioid may potentiate hyperalgesia?

A

Remifentanil

27
Q

What is the treatment for hyperalgesia that was mentioned in lecture?

A

Ketamine

28
Q

Differentiate Hyperalgesia and Allodynia.

In chart form.

A
29
Q

What is the hallmark “negative” symptom of neuropathy?

A

numbness

Positive s/s can exist as well (pain, sensitivity, etc.

30
Q

GI blood flow and motility increase as we age. T/F?

A

False.
GI blood flow and motility decrease as we age

31
Q

Gastric acid secretion ______ as we age thus _______ gastric pH.

A

decreases; increasing

32
Q

What effect does aging have on nutrient absorption in the GI tract?

A

Minimal

33
Q

What occurs to muscle and fat mass as a patient ages?

A

Muscle decreases while fat increases

34
Q

A decrease in _______ affects your protein-bound drugs in aging.

A

albumin
causes more free drug in circulation

35
Q

What occurs with hepatic function in the aging patient?

A
  • ↓ hepatic blood flow
  • ↓ liver mass and metabolic activity
36
Q

What occurs with renal function due to aging?

A
  • ↓ GFR
  • ↓ kidney mass, blood flow, and functioning nephrons
37
Q

Do opioids or non-opioid analgesics exhibit a ceiling effect?

A

Non-opioid analgesics

38
Q

What opioid receptor is responsible for analgesia, respiratory depression, euphoria, and reduced GI motility?

A

Mu (μ) receptor

39
Q

What opioid receptor (when agonized) is responsible for analgesia, dysphoria, psychosis, miosis, and respiratory depression?

A

Κappa receptor

40
Q

What opioid receptor causes analgesia alone when bound by an agonist?

A

Delta

41
Q

What drug is described by the following organic structure:

Substitution of methyl group for hydroxyl group on #3 carbon of morphine molecule.
(3-methoxymorphine)

A

Codeine

42
Q

______ is much more reliably absorbed than morphine.

A

Codeine

43
Q

What drug exhibits side effects (without concurrent analgesia) in children?
Why is this?

A

Codeine

Children lack enzymatic maturity needed to properly break down codeine.

44
Q

What CYPs metabolize codeine?

A

CYP2D6 → morphine
CYP3A4 → norcodeine

1Fall24 PoA II (34 decks)

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