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Pharmacology & Anesthesiology > Analgesia and Pain > Flashcards

Analgesia and Pain Flashcards

1
Q

what two drugs completely block both A-delta and C fibers

A

local blocks and ketamine

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2
Q

what is pain

A

an unpleasant sensory and emotional experience associated with actual or potential tissue damage

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3
Q

T/F the pain pathway involves decussation at the grey matter of the spinal cord

A

T

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4
Q

what starts the signal transduction pathway

A

thermal, mechanical and chemical signals (ex. inflammatory molecules)

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5
Q

what are the 4 overarching body responses to pain and why do we need to know about them from a pharmacology/anesthesiology pov

A
  • increase in hr/bp
  • increase in metabolism
  • increase in coagulability
  • decrease in immune function

We need to be aware that some of our drugs will modify the responses to pain

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6
Q

T/F the more chronic the stimulus, the more the effects of pain

A

T

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7
Q

what is nociception

A

the event of sensing mechanical, chemical and thermal stimuli by nociceptors (neuronal structures)

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8
Q

what is the difference between pain and nociception

A

pain includes nociception as well as the emotional and psychological consequences

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9
Q

describe the relationship of pain, perception and nociception

A

pain includes nociception and perception

nociception does not include perception

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10
Q

what are the types of pain

A

pain can be physiologic or pathologic. physiologic pain is called nociceptive/inflammatory. pathologic pain can be neuropathic or nociplastic

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11
Q

acute pain:
- type of fibers

chronic pain:
- type of fibers

A

acute: large diameter, myelinated, Aδ fibers

chronic: small diameter, unmyelinated, C fibers

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12
Q

somatic pain involves what systems and what fibers?

visceral pain involves what systems and what fibers?

A

somatic: skin and musculoskeletal; Aδ fibers

visceral: organs; C fibers

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13
Q

somatic pain is ______ pain and visceral pain is ____ pain

A

fast; slow

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14
Q

transmission of pain goes from _________ to the ______

A

nociceptors; brain

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15
Q

where are first order neurons

A

from nociceptors to the spinal cord

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16
Q

fast pain is activated by __________ stimuli whereas slow pain is activated by ___________

A

thermal and mechanical; thermal, mechanical and chemical

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17
Q

does Aδ or C fibers transmit signals with a faster velocity

A

Aδ (because they are large and myelinated)

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18
Q

what are the nociceptive fibers

A

Aδ and C fibers

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19
Q

what is the neurotransmitter for A-delta fibers

A

glutamate

20
Q

what is the neurotransmitter for C fibers

A

substance P and glutamate

21
Q

where do Aδ and C fibers go in the spinal cord

A

dorsal horn

22
Q

what laminae in the spinal cord to the following go to:

Aβ (touch):
Aδ (fast pain):
C (slow pain):

A

Aβ: laminae II and IV
Aδ: laminae I (II also mentioned)
C: laminae I and II

23
Q

what is important about wide dynamic range neurons and what is this pain called

A

can convert touch sensation to pain; nociplastic pain

24
Q

what is alodynia

A

pain due to a stimulus which does not normally result in pain

25
Q

what is hyperalgesia

A

increased response to a stimulus that usually results in pain

26
Q

glutamate and substance P are both excitatory or inhibitory

A

excitatory

27
Q

what are the characteristics of glutamate

A
  • excitatory
  • lasts for a few milliseconds
  • acts rapidly
28
Q

what are the characteristics of substance P

A
  • excitatory
  • released over a period of seconds or minutes
29
Q

how does the DOUBLE PAIN sensation work

A

glutamate gives the faster pain sensation, followed by the lagging pain sensation of substance P

30
Q

what fibers are involved in the following tracts:
- neospinal thalmic
- paleospinal thalmic
- archispinal thamlic

A
  • neospinal thalmic: Aδ (fast pain)
  • paleospinal thalmic: C (slow pain)
  • archispinal thalmic: C (slow pain)
31
Q

what type of tract is visceral pain

A

involves C fibers: paleospinothalmic and archispinothalmic

32
Q

what type of tract is somatic pain

A

can be sharp (Aδ, neospinothalmic) or dull/aching (C fibers, paleospinothalmic and archispinothalmic)

33
Q

what type of tract is the trigeminal system

A

neospinothalmic tract

34
Q

what ganglion does the trigeminal system synapse in

A

the trigeminal ganglion

35
Q

what responses to pain are mediated by the paleospinalthamic tract? what about the archispinalthamic tract?

A

paleo: emotional and visceral response to pain
archi: emotional, visceral and autonomic response to pain

36
Q

what is the pathway from nociceptors to the somatosensory cortex (5 main words)

A

transduction -> transmission -> modulation -> projection -> perception

37
Q

T/F transduction involves a signal threshold, and the strength and duration of the stimulus will affect the action potential that is ultimately created

A

T

38
Q

T/F nociceptors express a good ability to adapt

A

F; adapt very little or not at all

39
Q

what is the important implication of the non-adapting nature of nociceptors

A

the excitation of pain fibers becomes progressively greater as the pain stimulus continues (it wont calm itself down), leading to hyperalgesia or allodynia

40
Q

T/F Aδ and C fibers are carried by both sympathetic and parasympathetic nerves

A

T

41
Q

what is a key location of the brain involved in:
- perception
- integration
- modulation

A

perception: cortex
integration: thalamus
modulation: periaqueductal gray (PAG)

42
Q

T/F the thalamus is physically located close to systems involved in fear, anxiety and memory

A

T

43
Q

what causes peripheral sensitization

A

tissue damage and inflammation

44
Q

what causes central sensitization

A

frequent or severe peripheral nociceptor input

45
Q

wind-up involves what receptors and build-up of what

A

AMPA -> NMDA; build up of Ca2+ in pre-synaptic terminal

46
Q

T/F neuropathic pain involves stimulating the nociceptive system without specifically stimulating the receptors

A

T

Pharmacology & Anesthesiology (22 decks)

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