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Neurology Year 3 > Analgesia > Flashcards

Analgesia Flashcards

1
Q

Drugs that reduce pain at the site of injury do so how?

A

Decreases sensitisation by blocking’s prostaglandin synthesis

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2
Q

Give a example of a drug that reduces pain at the site of injury?

A

NSAIDs

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3
Q

Drugs that reduce nerve conduction of pain do so how?

A

Block of voltage gates Na+ channels

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4
Q

Give an example of drugs that reduce the nerve conduction to reduce the perception of pain?

A

Lignocaine

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5
Q

List some drugs that reduce the synaptic transmission in the dorsal horn.

A

Opiods

Some antidepressants

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6
Q

List drugs which activate the descending inhibitory controls.

A

Opiods

Select tri-cyclic antidepressants

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7
Q

Which drugs target the ion channels that are unregulated in nerve damage?

A

Antiepileptics e.g. GABA pentinoids

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8
Q

List some common NSAIDs

A

Aspirin
Diclofenac
Ibuprofen
Naproxene

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9
Q

List some weak opiods

A

codeine
tramadol
dextropropoxyphene

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10
Q

List some strong opiods

A

Morphine
oxycodone
fentanyl
heroin

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11
Q

In supra spinal antinociception where do the neurones arise from?

A

Peraqueductal grey mater
Locus coeruleus
Nucleus Raphe Magnus

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12
Q

Where do neurones of the supra spinal anti-nociception project down to?

A

Posterior horn to the area where the 1st and 2nd order neurones of the spinothalamic tract synapse.

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13
Q

The supra spinal antinociception neurones release what into the synapse?

A 
Noradrenaline 
5 HT (Seretonin)
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14
Q

Noradrenaline and 5 HT have what affect of the spinothalamic tract?

A

Inhibits the release of Substance P from presynaptic build.

Prevents Depolarisation on the Second order neurone.

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15
Q

What affect does Noradrenaline and 5HT have on the interneurone located by the synaptic cleft of the 1st and 2nd order neurone?

A

Interneurone is activated and releases Enkephalin (Opiod)

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16
Q

What is the affect of Enkephalin?

A

Prevents depolarisation of the presynaptic bulb and the sport synaptic neurone.

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17
Q

What kind of receptors do opioids work on?

A

G protein Coupled Receptors

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18
Q

What is the affect of activating a opioid G protein coupled receptor?

A

Beta unit - Inhibition of Ca2+ channels suppress excitatory neurotransmitter release.
- opening K+ channels suppressing excitation by hyper-polarising the neurones.
Inhibiting adenyl cyclase - long term suppression

19
Q

What are the different types of opioid receptors and what are there functions?

A

μ - most analgesic action and major sideaffects
δ - activation can be proconvulsant
k - Sedation dysphoria and hallucination

20
Q

List the major respiratory side effects of Opioids.

A

Apnoea - medullary respiratory system becomes desensitised to CO2 levels

21
Q

List the major cardiovascular side effects of Opioids

A

Orthostatic hypotension - reduced sympathetic tone and bradycardia
Histamine mediated dilation

22
Q

List the major GI side effects of Opioids.

A

Nausea Vomiting Constipation

-acts on the CTZ

23
Q

List the major CNS side effects of Opioids.

A

Confusion Euphoria Dysphoria hallucinations Dizziness Myoclonus Hyperalgesia

24
Q

Morphine

A

Acute and Severe pain
Metaboised in liver
IV IM SC or oral

25
Q

Diamorphine

A

Severe post operative pain
More lipophilic than morphine
Rapid onset when IV
Heroin

26
Q

Codeine

A

Mild moderate pain
Anti diarrhoea Antitussive (prevent cough)
Oral

27
Q

Fentanyl

A

75x more potent than morphine
IV to provide analgesia in maintenance anaesthesia
Transdermal or buccal in chronic pain

28
Q

Pethidine

A

Acute pain especially labour
Rapid onset IV IM or SC - short duration
Should be given with MAO inhibitors

29
Q

Buprenophine

A

Useful in chronic pain with patient controlled injection system
Slow onset but long duration of action

30
Q

Tramadol

A

Weak μ agonist
Oral
Avoid in patients with epilepsy

31
Q

Methadone

A

Chronic pain and cancer
Assisted withdrawal from heroine
Long duration of action

32
Q

What is the purpose of Antagonist to Opioid receptors?

A

Used to reverse opioid toxicity

33
Q

List some opioid antagonists

A

Naloxene
Naltrexone
Alvimopan

34
Q

Naloxene

A

Incrementally IV IM or SC
Short half life - careful monitoring
Can induce acute withdrawal symptoms
Used in new borns with opioid toxicity

35
Q

Naltrexone

A

Oral availability and longer half life

36
Q

Alvimopan

A

No affect of CNS

Reduced GI affects of chronic opioid use.

37
Q

NSAIDs

A

Prevent prostaglandin build up by inhibition of COX enzyme.

38
Q

What drugs are used for neuropathic pain

A

Gabapentin

Pregablin

39
Q

What is the action of gabapentin an pregablin?

A

Reduced voltage gated Ca2+ channel expression

Decreases neurotransmitter release

40
Q

What is gabapentin used for?

A

Migraine prophylaxis

41
Q

What is pregablin used for?

A

Useful in painful diabetic neuropathy

42
Q

How do Tricyclic antidepressants like Amitriptyline work?

A

Decrease the re uptake of neurotransmitter noradrenaline

43
Q

What is the first line drug for trigeminal neuralgia?

A

Carbamezapine

44
Q

How does Carbamezapine work?

A

Block Na+ voltage gated ion channels

Neurology Year 3 (29 decks)

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