Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm & Dynamics of Anesthesia Agents > Analgesics, Pain Pathways and Pain Management > Flashcards

Analgesics, Pain Pathways and Pain Management Flashcards

1
Q

What is Nociception (Pain)?

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damange

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the three types of pain?

A

Nociceptive, inflammatory, and neuropathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is nociceptive pain activated?

A

Noxious stimuli
1) chemical
2) mechanical/ pressure
3) thermal (hot & cold)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is involved with inflammatory pain?

A

Macrophages
Mast cells (histamine release)
Neutrophil granulocytes
Release of all types of cytokines/ chemicals like prostaglandins (which can cause altered capillary permeability)

The chemical mediators make the nociceptors more sensitive to pain and lower pain thresholds (can cause allodynia and hyperalgesia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What type of pain is involved in acute to chronic pain?

A

Inflammatory pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What type of medication works really well to relieve inflammatory pain?

A

NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is neuropathic pain activated?

A

Results from damage to the neuron itself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Is neuropathic pain easy or difficult to treat?

A

Extremely difficult, the most resistant to pain therapy!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the hallmark of neuropathic pain?

A

Allodynia**
Hyperalgesia **

Also:
Hypoaesthesia (numbness)
Paraesthesia (pins and needles)
Summation (pain sensitization is increased more each time)
Thermal hypersensitivities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the four steps of nociception?

A

Traduction
Transmission
Modulation
Perception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What occurs during transduction?

A

Nociceptors transform painful stimuli (chemical, pressure/ mechanical, thermal) into a signal or action potential (electrical stimulus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Where are nociceptors mostly found?

A

Skin, joints, and muscles
On free nerve endings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Activation of nociceptors subsequently activates specific subtypes of ________ ion channels to general actional potentials called ________ and ________.

A

sodium

1) Nav 1.7
2) Nav 1.8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What nociceptor is stimulated by capsaicin?

A

TRPV1 (thermal nociceptor that can perceive noxious heat > 43C/ 110F)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Continuous stimulation of TRPV1 by capsaicin results in receptor _______________ and decrease in pain transmission.

A

Desensitization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the two main peripheral neurons/pain fibers involved in transduction?

A

A-delta fibers (myelinated)
C-fibers (unmyelinated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Neurons (like the A-delta fibers) are categorized by what three characteristics?

A

Whether they are myelinated or not, their diameter size, and their propagation speed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What type of pain do A-delta fibers transmit?

A

Fast pain that is sharp and well-localized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What type of pain do C-fibers transmit?

A

Slow pain that is dull, stabby, achy, and poorly localized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Compare A-delta fibers and C-fibers &
where do they synpase?

A

A-delta: “first pain” is fast, sharp, well-localized pain; myelinated; fast conduction speed 5-30 m/s; larger diameter
-Synapse at Lamina 1 and V

C-fibers: “second pain” is slow, longer-lasting dull, aching, diffuse pain; unmyelinated; slow conduction speed < 2 m/s; smaller diameter
-Synapse at Lamina 1 and II (substantial gelatinosa)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Approximately ____% of C-fibers send collaterals to the descending pathways

A

80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What occurs during transmission?

A

The process of transferring pain information from the peripheral to the central nervous system and up to the brain along neuronal axons. The reflex arc is included.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

During transmission, the pain signal is relayed through the ________________ while ascending up to the brain along the _________________ tract.

A

1) three-neuron afferent pain pathway
2) spinothalamic tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is another commonly used name for the spinothalamic tract?

A

The anterolateral system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

In the ascending, anterolateral system, what does the anterior portion sense?

A

Light touch & pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

In the ascending, anterolateral system, what does the lateral portion sense?

A

Pain & temperature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

During transmission, how does the first-order (presynaptic) neuron travel?

A

From periphery to dorsal horn (cell body in dorsal root ganglion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

During transmission, how does the second-order (post-synaptic) neuron travel?

A

From the dorsal horn to the thalamus (cell body in the dorsal horn). It crosses the contralateral side of the spinal cord and then ascends up to the brain via the spinothalamic tract.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

During transmission, how does the third-order neuron travel?

A

From the thalamus to the cerebral (somatosensory) cortex (cell body in the thalamus). Located in the parietal lobe. This is the main place where we perceive pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What two excitatory neurotransmitters are released from the 1st order neuron to the 2nd order neuron in the dorsal horn?

A

1) Glutamate (the most common and the main endogenous ligand for NMDA receptors)
2) Substance P

Also CGRP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Glutamate receptors are broken down into what two families?

A

1) Ionotropic (ion channels) - ex: NMDA receptor
2) Metabotropic (GPCRs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What occurs during modulation?

A

The up or downregulation of pain signals throughout the spinal cord and brain. Ex: descending pathways (that meet with ascending pathways) inhibit pain signaling; gate-control theory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

During modulation, the descending neuron stimulates a small neuron in the area called what?

A

Interneurons (opioid neurons)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

During modulation, the interneurons release what?

A

Endogenous opioids such as endorphins, enkephalins & dynorphins
*Also GABA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

During modulation, what do interneurons do to the ascending pathway in the substantial gelatinosa?

A

When stimulated, they release endogenous opioids that control or inhibit pain signals from transmitting from 1st-order neurons to 2nd-order neurons in the ascending pathway = stopping the continuation of impulse up to the thalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

The most important site of modulation is the ___________________ in the dorsal horn and is also called the Rexed Lamina II. It is where a lot of attenuation and modulation of pain occurs.

A

Substantia gelatinosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Per Rhea, during modulation, what is the most important section of the descending inhibitory pain pathway?

A

Periaqueductal gray matter (PAG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

In the descending inhibitory pain pathway, what is the area in the brain that consists of grey matter that goes from the 3rd ventricle to the 4th ventricle?

A

Periaqueductal gray matter (PAG)
*Is the beginning of the descending pain pathway

39
Q

During modulation, pain is inhibited when the descending pain pathway releases _______, _________, and _______ _______ that prevent the release of excitatory neurotransmitters (Glutamate, Substance P) in the dorsal horn from being released from the 1st order neuron to the 2nd order neuron in the ascending pathway.

A

1) NE
2) Serotonin (5-HT)
3) Endogenous opioids (ex: endorphins, enkephalin) *from interneurons??

*Also GABA

40
Q

During modulation, what part of the brainstem releases norepinephrine?

A

Locus coeruleus

41
Q

During modulation, what 3 parts of the brainstem release serotonin?

A

1) Reticular formation
2) Rostral ventromedial medulla
3) Raphe nucleus magnus

42
Q

During modulation, what part of the brainstem releases endogenous opioids (Enkephalin)?

A

Rostral ventromedial medulla

43
Q

What is the main inhibitory neurotransmitter in the body?

A

GABA

44
Q

What occurs during perception?

A

The awareness of pain associated with a specific area of the body. Pain processing is also influenced by environmental cues, cultural conditioning, and past experiences.

45
Q

During perception, the processing of afferent pain signals mainly occurs where?

A

1) Cerebral (somatosensory) cortex*
2) Limbic system

46
Q

What portion of the brain senses a lot of the sensitive nerve endings like the hands, lips, and face?

A

Homunculus

47
Q

What area of the brain is responsible for our emotional response and behavior regulation?

A

Limbic system (cingulate cortex)

48
Q

What area of the brain controls the ANS response (increased HR and BP)?

A

Hypothalamus

49
Q

What area of the brain senses fear?

A

Amygdala

50
Q

What two areas of the brain are responsible for learning, memory, and perception of pain?

A

The hippocampus and pre-frontal cortex

51
Q

What area of the brain is responsible for our motivation and reward system?

A

Accumbuns
& Ventral tegmental area

52
Q

What area of the brain processes painful experiences and drives learning from pain?

A

Insula

53
Q

What type of receptor is the opioid receptor?

A

G-protein coupled receptor

54
Q

What happens during stimulation of an opioid G-Protein Coupled Receptor?

A

Nothing crosses the cell membrane. A ligand (opioid) gets bound to the outside of the cell, and on the inside of the cell, a series of pathways are stimulated.

G-protein is activated

Adenylate cyclase is inhibited

Less intracellular concentration of cAMP (main 2nd messenger**) is produced

Presynaptic: Ca channel conductance is decreased/ inhibited (neurotransmitters can not be released)

Postsynaptic: Potassium channels are opened –> conductance increased –> outflux of potassium –> hyperpolarizes the neuron –> decreased RMP –> becomes more resistant to stimulation

55
Q

What are the receptors in the endocannabinoid system?

A

1) CB1* - mostly CNS
2) CB2 - peripheral NS and immune cells

56
Q

What are the endogenous ligands in the endocannabinoid system?

A

1) AEA: anandamide
2) 2-AG: 2-arachidonoyglyerol

57
Q

The theory that describes that nonpainful stimuli can override painful stimuli (the rubbing effect) is called the _____ _______ _______?

A

Gate Control Theory
Pain signals can be interrupted in the substantial gelitanosa of the spinal cord, which acts as a “gate.”

58
Q

What fibers are involved in the Gate Control Theory?

A

A-beta fibers (large-diameter, myelinated, deep pressure/ deep touch fibers). They are faster than A-delta fibers and C-fibers. Stops pain stimulus by inhibiting Ca channels and opening K channels.

59
Q

What is the reflex arc?

A

Interneurons between the sensory neuron and motor neuron activate or deactivate certain muscle fibers. This coordinates the correct flexion and relaxation of muscles to WITHDRAW from painful stimuli.

60
Q

What neurons are involved in the reflex arc?

A

A-alpha

61
Q

Pain from internal organs and blood vessels is known as what?

A

Visceral pain
Vague symptoms such as aching, squeezing and radiating pain

62
Q

Pain that occurs when pain receptors in tissues (including the skin, muscles, skeleton, joints, and connective tissues) are activated is known as what?

A

Somatic or Cutaneous pain
Also described as musculoskeletal pain

63
Q

Visceral pain is transmitted up to the brain via which spinal tract?

A

Doral column tract
**Somatic and cutaneous pain travel up the spinal cord via the spinothalamic tract

64
Q

The visceral pain tract sometimes shares second-order neurons with somatic pain tracts and can cause what kind of pain?

A

Referred pain - the brain can get confused

65
Q

If you have a spinal cord lesion on one side, how will the patient present?

A

They will have reduced pain sensation and temperature on the OPPOSITE side

66
Q

The viscera responds more to what kind of sensations?

A

Ischemia, stretching, compression, and distension

67
Q

In visceral pain, the dorsal column pathway does not synapse at the level of the spinal cord the way somatic and cutaneous fibers do. Where do the fibers synapse instead?

A

The medulla and it stays on the same side of the spinal cord.

68
Q

What is the midline myelotomy?

A

Dissect fibers in the spinal cord for relief of severe visceral pain as palliative treatment for cancer patients.

69
Q

What is analgesia?

A

Diminished or absence of pain without loss of consciousness

70
Q

What is allodynia?

A

Pain from stimuli that normally does not provoke pain (ex: light brushing of skin, feather across skin)

71
Q

What is hyperalgesia?

A

Exaggerated response to a usually painful stimuli

72
Q

What is dysesthesia?

A

An “abnormal sensation”; is a general term for cutaneous symptoms without a primary cutaneous condition (pruritus, burning, tingling (pins, needles), stinging, crawling, hypoesthesia (numbness)

73
Q

What is neuralgia?

A

Similar to dysesthesia but associated with a SPECIFIC condition (trigeminal neuralgia, post-herpetic neuralgia). Intense, intermittent pain, numbers & tingling along the nerve pathway.

74
Q

What is neuropathy?

A

Damage or dysfunction to one or more nerves resulting in numbness, tingling, and muscle weakness, usually in hands and feet

75
Q

What is paresthesia?

A

Tingling (pins, needles) or prickling sensations usually in hands or feet but can happen anywhere; COOL sensitivity

76
Q

In the five-ring structure of opioids, what has the analgesic activity?

A

N-methylpiperidine moiety

77
Q

Synthetic opioids only have ___ of the original 5 rings

A

2

78
Q

Where are opioid receptors located in the central nervous system?

A

Supraspinal: medulla & midbrain
Spinal: presynaptic opioid receptors

79
Q

Where are the opioid receptors located in the peripheral locations?

A

GI, vasculature, lungs, heart, immune system, PNS

80
Q

What are the 3 subtypes of opioid receptors?

A

Mu (1 & 2), Kappa, Delta

81
Q

How do GPCR receptors work?

A

Inhibit cAMP & interact with ion channels
Inhibit Ca channels, open K channels

82
Q

Stimulation of mu (1&2) receptors produces what main 3 effects?

A

1) supraspinal analgesia
2) euphoria
3) respiratory depression (Mu 2**)

83
Q

What symptoms are seen with stimulation of mu 1 receptors?

A

Supraspinal analgesia
Euphoria, Sedation
Prolactin release, catalepsy
LOW abuse potential
Miosis
Bradycardia
Hypothermia
Urinary retention
Pruritus

84
Q

What symptoms are seen with stimulation of mu 2 receptors?

A

Spinal analgesia
Respiratory depression**
Physical dependence
Constipation/ decreased peristalsis*
N/V, increased biliary pressure
Pruritus

85
Q

What symptoms are seen with the stimulation of kappa receptors?

A

Supraspinal AND spinal analgesia
Dysphoria, Sedation
Hallucinations, delirium
LOW abuse potential
Miosis
Diuresis - inhibition of vasopressin release
Anti-shivering

86
Q

What symptoms are seen with the stimulation of delta receptors?

A

Supraspinal AND spinal analgesia
Respiratory depression*
Physical dependence*
Constipation (minimal)
Urinary retention
Pruritus

87
Q

What endogenous ligand is associated with the mu receptor?

A

Endorphin

88
Q

What endogenous ligand is associated with the kappa receptor?

A

Dynorphin

89
Q

What endogenous ligand is associated with the delta receptor?

A

Enkephalin

90
Q

What two opioids have active metabolites that could cause toxicity, especially in renal failure or elderly patients?

A

Morphine and meperidine

91
Q

What areas of the brain are responsible for respiratory depression?

A

Pons and medulla

92
Q

The euphoria and reward part of the brain is in the nucleus accumbens and the ventral tegmental area. How do opioid receptors cause euphoria?

A

Opioid receptors inhibit GABA receptors, which then increases dopamine receptors. It is an indirect way of increasing dopamine.

93
Q

As set by the DEA, what schedule are most opioids?

A

II

Pharm & Dynamics of Anesthesia Agents (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions