Anaesthetics (General)

Question 1

Nociception vs Pain

Answer 1

Nociception = Perception of noxious stimuli

Pain = Perception of noxious stimuli + emotional component

Question 2

Neuropathic Pain

Answer 2

Damage to somatosensory nervous system
- Trigeminal Neuralgia
- Phantom Limb Pain
- Pain following brain or nerve injury

Question 3

Chronic Pain

Answer 3

Pain that outlasts the tissue injury

Question 4

Chronic Pain (Hyperalgesia)

Answer 4

Increased feeling of pain to usual mild stimuli

Question 5

Chronic Pain (Allodynia)

Answer 5

Pain caused by usual stimuli that would not have caused pain

Question 6

Chronic Pain (Spontaneous)

Answer 6

Spontaneous pain without any stimuli

Question 7

A(alpha)
- Information carried?
- Myelinated?
- Diameter size?
- Conduction speed?

Answer 7

Carry proprioception information (Body Position)

Myelinated

Largest

Fastest

Question 8

A(beta)
- Information carried?
- Myelinated?
- Diameter size?
- Conduction speed?

Answer 8

Carry touch sensory information

Myelinated

Large

Fast

Question 9

A(delta)
- Information carried?
- Myelinated?
- Diameter size?
- Conduction speed?

Answer 9

Carry Pain information (Mechanical, Thermal) –> Sharp, Well localized pain

Myelinated

Small

Slow

Question 10

C
- Information carried?
- Myelinated?
- Diameter size?
- Conduction speed?

Answer 10

Carry Pain information (Mechanical, Thermal, Chemical) –> Dull, Burning pain

Non-myelinated

Smallest

Slowest

Question 11

Stimulus for Pain Transmission

Answer 11

A(delta) and C are for Pain transmission

Question 12

What pathways control pain transmission (Endogenous Pain Control)

Answer 12

Descending inhibitory pathways
- Brain to Dorsal Horn on Spine

Question 13

Pathways are rich with what kind of neurons
(Endogenous Pain Control)

Answer 13

Enkephalin/Endorphin containing neurons
- Endogenous Opioid Peptides

Expresses opioid receptors

Question 14

Noradrenergic Pain Inhibitory Pathways

Answer 14

Noradrenergic Pain Inhibitory Pathway
- Locus Coeruleus to Dorsal Horn on Spine

Question 15

Opioid Receptors are what kind of receptors?

Answer 15

GPCR (Gi/G0)

Question 16

Opioid Receptors form what kind of complexes

Answer 16

Homeric and Heteromeric Receptor Complexes

Question 17

Where are opioid receptors expressed

Answer 17

Brain and Spinal Cord

Question 18

Mu Opioid Receptors are responsible?

Answer 18

Analgesic effect of opioids, also some unwanted effects

Question 19

Analgesia

Answer 19

Loss of painful sensation

Question 20

Analgesic

Answer 20

Drug that relieves pain

Question 21

Opioids Effects

Answer 21

Anti-nociceptive and reduce emotional component of pain

Question 22

What kind of agonist are Opioids

Answer 22

Agonist / Partial agonist at Mu Receptors

Question 23

What kind of pain are Opioids used for?

Answer 23

Acute / Chronic pain
Mild pain
Anaesthesia

Question 24

Opioids of Mechanism of Action

Answer 24

Activates opioid receptors
- Opens K+ Channels
- Inhibits opening of voltage gated Ca2+ channels
–> Causes hyperpolarization of pain transmitting neurons
–> Decreasing excitability of pain neurons

Question 25

Opioids potential site of actions

Answer 25

• Specific Brain Nuclei
• Dorsal Horn of Spine (Prevent further neurotransmitter release)
• Periphery (Nociceptive Afferent Nerve Terminals)

Question 26

Unwanted Effects of Opioids

Answer 26

Sedation
Respiratory Depression
Euphoria (Dependence and Tolerance)

Question 27

NSAIDS effects

Answer 27

Analgesic, Antipyretic (reduce fever), Anti-Inflammatory

Question 28

What kind of pain are NSAIDS for?

Answer 28

Mild/Moderate Pain

Question 29

NSAIDS Mechanism of Action

Answer 29

• Inhibit COX-1 and COX-2
• Inhibit Prostaglandin
  –> PGE2, PGF2(alpha)

Question 30

Prostaglandin Effects

Answer 30

Sensitize nerve terminals to pain effects of Bradykinin and 5-HT

Question 31

Acetaminophen effects

Answer 31

Generic Name: Paracetamol

Analgesic, Antipyretic
No Anti-Inflammatory Effects

Question 32

Acetaminophen Mechanism

Answer 32

Not fully understood

Inhibit a variant of COX-1 (COX-3?)
Activate and desensitize TRPA1/V1 channels in brain?

Question 33

Tricyclic Antidepressant Uses

Answer 33

Relieve neuropathic pain

Question 34

Tricyclic Antidepressant Mechanism of Action

Answer 34

Act within CNS
Inhibits Noradrenaline reuptake

Question 35

Antiepileptic Drugs Uses

Answer 35

Used to relieve neuropathic pain

Question 36

Antiepileptic Drugs Mechanism of Action

Answer 36

Blocks voltage gated Na+ Channels

Reduces expression of voltage gated Ca2+ channels on nerve membrane
- Reduces transmitter release