Analgesia Case application

Question 1

CARDIOPULMONARY PARAMETERS associated with pain are:

Answer 1

only blood pressure. NOT heart rate.

Question 2

Analgesic sites of action:

Answer 2

Peripheral: transduction, transmission
Spinal cord: modulation, projection
Brain: Perception

Question 3

What is the site of action of opioids?

Answer 3

Peripheral; transduction
Spinal cord; modulation, projection
Brain; perception

Question 4

what is the site of action of local anesthetics?

Answer 4

Peripheral; transduction, transmission
Spinal cord; modulation, projection

Question 5

what is the site of action of alpha2-agonists?

Answer 5

Spinal cord; modulation, projection
Brain; perception

Question 6

what is the site of action of NSAIDs?

Answer 6

Peripheral; transduction
Spinal cord; modulation, projection

Question 7

What are Amitriptyline and clomipramine? how do they work? Side effects?

Answer 7

antidepressants
– Serotonin and norepinephrine re-uptake inhibitors
– Direct and indirect opioid effects
– Inhibition at NMDA receptors
– Inhibition at ion channels

Side effects
* Sedation, excitement, agitation
* Ventricular arrhythmias, death

Question 8

what is Amantadine? What is it used for and what is its role in pain management? side effects?

Answer 8

• Antiviral for Influenza A
• Used for dyskinesia (sudden uncontrolled movements [e.g.,
  Parkinson’s]
• NMDA antagonist

Side effects rare
* Sedation or agitation in humans

Question 9

What is gabapentin? what is it used for and what is its role in pain management? side effects?

Answer 9

• Antiepileptic
• Relieves allodynia and hyperalgesia
  – Neuropathic pain
• Mechanism of action
  – Not known
  – Linked to Calcium ion channels on dorsal horn
  – Linked to NMDA receptor actions but no direct interaction with it

Side effects rare
* Sedation and fatigue