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Herbal Studies > Cannabanoids and Pain control > Flashcards

Cannabanoids and Pain control Flashcards

1
Q

Name the three categories of pain

A
  1. Accute physiological pain
  2. Accute inflammatory pain
  3. Chronic Pain
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2
Q

What is accute physiological pain?

A

Pain that results from sudden physical trauma, such as touching a hot stove or pricking the finger on a needle. This activates the ‘withdraw’ reflex, helping the body avoid pain. In this way pain is a defensive mechanism aimed at preventing harm.

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3
Q

What is accute inflammatory pain?

A

Pain that result from the bodies inflammatory response. The body responds to injury with inflamation that is aimed at healing the tissue. Inflammatory pain can an be important way to alert us to problems withing the body, as in appendicitis.

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4
Q

What is chronic pain?

A

Pain that lost for more than 3 months. Nerve damage almost always result in chronic pain. Chronic pain loses it’s defensive value

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5
Q

What is Allodynia?

A

Super sensitization to otherwise non painful stimuli

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6
Q

What problems are caused by chronic pain?

A

Can interfere with activities of daily livining
Can lead to depression, dispair, hopeless
Can lead to a decrease in quality of life
Can deteriate relationships
Can lead to a loss of income
Can lead to addiction (Oppiodes)

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7
Q

Anually, Chronic pain costs the economy more than the combined cost of …?

A

Diabetes, heart disease, and cancer

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8
Q

How are pain signals generated.

A

nociceptors (pain receptors) around the body is activated through transduction, when a certain threshold is reached, generating a pains signal which is transported from the peripheral nervous sytem to the central nervous system.

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9
Q

Was Descartes correct in assuming that their is a single pain center in the brain responsible for the perception of pain?

A

No. There is no ‘single’ center in the brain that is responsible for pain perception. Pain pathways terminate in multiple areas of the brain. Some are responsible for perceiving different kinds of pain, others are responsible for our motor response to the pain and still others are responsible for our emotive response to pain.

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10
Q

How do nerve blocks stop the experience of accute pain?

A

By interfering with the conduction of the pain signal

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11
Q

How does tissue damage cause inflamation

A

The contents of damaged cells spills into the interstitial spaces where it irritates the nociceptors, which attracts inflammatory immune cells. These cells release hestimine which activates the bodies inflammatory response (increase in circulation and swelling)

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12
Q

How does tissue damage cause inflamation and pain?

A

The contents of damaged cells spills into the interstitial spaces where it irritates the nociceptors, which attracts immune cells. These cells release hestimine which activates the bodies inflammatory response (increase in circulation and swelling). The inflamatory chemicals and response in turn continues to agrivate the nociceptors, producing more pain through averactive transduction untill inflamation subsides

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13
Q

What is Hyperalgesia?

A

A condition that results in a drop of the threshold that activates nociceptors. This usualy occurs during inflamation and is why even a light touch to an inflamed area can be painful.

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14
Q

What is Neuropathic pain?

A

Pain not activated by transduction, but by ectopic pain signals produced by damage or disease process along the pain pathway. Patients with neuropathic pain report often report spontanious experience of pain and hyperalgesia.

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15
Q

What is stress induced analgesia?

A

A mechanism that modulates or reduces pain during extreme or life threatening situations, allowing us to preserve life by escaping the situation.

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16
Q

What is the role of the body’s pain modulating systems?

A

To regulate our sensitivity to pain

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17
Q

Why is the body’s pain modulating sytem called a “top down” system?

A

because they originate in the brain and terminate in the synaps between the central and peripheral junction.

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18
Q

How can the body’s pain modulation system be ‘activated’ in order to decrease sensitivity to pain.

A 
Drugs
Manual stimulation
Hypnosis
Acupuncture
Relaxation
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19
Q

How do canabanoids relieve pain

A
  1. By interfering with transduction of nocireceptors
  2. By decreasing the sensitivity of nocireceptors
  3. By enhancing pain modulation
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20
Q

Name the 4 pain processes involved in the experience of pain

A

Transduction, Conduction, Synaptic Transmission, Perception

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21
Q

Name the 6 classes of pain killers

A
  1. simple analgesics:
    - weak
    - used for weak pain (paracetamol)
  2. NSAID’s:
    - reduce inflamation
    - inhibit cox(cyclooxygenase and enzyme that mediates
    inflamatory response)
  3. Opioide analgesics:
    - moderate to severe pain
    - effective for accute and cancer related pain
  4. Adjuvent drugs
    - Drugs that do not primarily treat pain, but are useful in
    the relieving of pain
    - Antidepressants, Anticonvulsants
    - useful for headache prophalaxis
    - reduce neuropathic pain
  5. Local Anesthetics
    - used for the management of accute pain during and
    after surgery, neuropathic pain and for intractable
    migraines
    - nerve and epidural blocks
  6. Heterogenus drugs
    - used for migraines
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22
Q

What are non-selective NSAID’s

A

NSAID’s that block both cox1 and cox2

Ibuprofen
Naproxen
Diclofenac

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23
Q

What is the difference between cox enzymes 1 and 2?

A

type 1 protects the stomach membrane, kidneys and blood clotting during inflamation

type 2 induces inflamation

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24
Q

What are selective NSAID’s

A

NSAID’s that block cox2 enzymes

Etoricoxib
Celecoxib

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25
Q

What are the advantages of selective NSAIDs over non-selective NSAIDs

A

Non selective NSAIDs inhibits cox1 enzymes responsible for protecting the stomach lining, which can lead to gastric problems such as ulcers, whereas selective NSAIDS only inhibits the cox2 enzyme responsible for inflamation

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26
Q

What are the risks associated with NSAIDS?

A

both selective and non-selective: increase risk of thrombobolic effects (heart attack, stroke)

non-selective: Gastric ulcers

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27
Q

Why should NSAIDS not be use for chronic pain?

A

Because long term use increase risk of heart attack and stroke.

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28
Q

What are the adverse effects of using opioides?

A

High potential for abuse, addiciton and overdose, fatality, nausea, sedation, unsteadiness.

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29
Q

What two catagories are opioides devided into?

A

Weak:

  • Codeine
  • Tramadol

Strong:

  • Morpine
  • Oxycodone
  • Fentanyl
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30
Q

What are the side effects of adjuvent drugs used to treat pain?

A

constipation, drowsiness, sexual dysfunction, sedation

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31
Q

What is the main problem with using local anesthetics?

A

Short duration

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32
Q

Which heterogenus drugs are often used for migraines?

A

Triptans

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33
Q

In regards to pain, what should be considered before prescribing pain killers

A
  1. Type (neuropathic, inflamatory, headache, spasms)
  2. Context (cause of the pain)
  3. Intensity (mild, moderate, severe)
  4. Background
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34
Q

When prescribing pain killers, what should be considered?

A
  1. Type
  2. Dose
  3. Duration
  4. Adjustments for patient background.
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35
Q

What is ischemic pain?

A

pain caused by reduce blood flow

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36
Q

What is the principle objective in the treatment of chronic pain?

A

To improve quality of life, by reducing pain and increasing function

37
Q

When pain reduction is no longer possible, what is the next step?

A

Pain management: Teaching the patient to manage their pain and improve quality of life and function despite residual pain.

38
Q

How long is the growing season for canabis?

A

3 to 6 months

39
Q

How tall do canabis plants get within their growing season?

A

up to 5 meters

40
Q

What are the 3 main categories of cannabis?

A

sativa
indica
ruderalis

41
Q

Differences between indica, sativa, ruderalis and hemp?

A

indica is shorter, darker leaves with fatter and fewer fingers (rarely more than 5). The buds tend to be wide, dense and bulky, flowering time is 6 - 8 weeks. Indica is more sedative, calming in its effects. It gets you stoned. (body high)

Sativa is taller, lighter in color and the leaves have longer thinner fingers often with many more fingers than indica. buds are longer and almost sausage shaped. flowering time is aobut 10 to 16 weeks. Sativa is more uplifting, energising and hallucinogenic in it’s effects. It gets you high (head high)

ruderalis is the short, and leaves often have only 3 fingers and the plant has a very short flowering cycle. They also tend to grow in low light. Is most often used by growers to create hybrids.

Hemp is a species of sativa that is grown for the industrial uses of it’s derived products, such as paper, oil, cbd oil, fiber, biofuel, etc. It has a low thc content

42
Q

Of the more than 500 compounds found in cannabis, which 3 are considered to the therapuetic agents?

A

Cannabinoids
Terpenoids : flavour and fragrance
Flavanoids

43
Q

What are the most common terpenoids found in cannabis?

A

Limonene, Myrcene, Alpha-pinene, Linalool, Beta-Caraphyllene, Caryophyllene

44
Q

What are terpenes?

A 
Hydrocarbons
Isoprene C5H8
Monoterpene C10H16
Sesquiterpene C15H24
Diterpene C20H32
Triterpene C30H48
45
Q

Which family of plants do canabis belong to

A

canabiceae

46
Q

What are flavanoids?

A

polycyclic aromatic phenols

47
Q

Of the 23 different kinds of flavanoids identified in cannabis, which ones are unique to cannabis?

A

cannflavin A, cannflavin B

48
Q

What are some of the medicinal propperties of flavanoids in cannabis?

A

anti-inflammatory
anti-cancer
neuro-protective

49
Q

Which receptors do cannabinoids act on?

A

cb1 and cb2

50
Q

Which disorders are cannabinoids useful for?

A 
anorexia
pain
inflammation
MS
Epilepsy
Glaucoma
Osteoperosis
Cancer
obesity
Parkinsons
51
Q

What are the 11 subclasses of cannabinoids?

A 
CBG -cannabigerol
^9-THC  -^9 Tetrahydrocannabinol
^8-THC - ^8 Tetrahydrocannabinol
CBD - cannabidiol
CBC - cannabichromene
CBN - cannabinol
CBL - cannabicyclol
CBND - cannabinodial
CBE - cannabielsoin
CBT - cannabitriol
Other
52
Q

From which cannabidoid are the other subclasses derived from

A

CBG - cannabigerol

53
Q

Which for classes of cannabinoids are biosynthesized in the cannabis plant?

A

CBC, CBD, CBG, ^9-THC,

The other classes of cannabinoids are the result of decomposition in the plant and/or storage conditions

54
Q

Why does canabinoids need to be decarboxylated?

A

because the plant synthesizes cannabinoids as acids THCA, CBDA which has a low bio-availabillity. In order to make it useable for the human body the carboxyl group needs to be removed through heat.

55
Q

What tempreture is required for decarboxylation?

A

approx 93 to 180 degrees celsius for about 60 - 90 minutes

56
Q

What are some of the benefits of undecarboxylated cbd’s or cbda’s?

A 
Prevents nausea and vomiting
Anxiolytic (anti-anxiety) effects
Antibacterial properties
Inhibits breast cancer cell migration
Potential to reduce seizures associated with epilepsy
Pain and inflammation reduction
57
Q

True or False: There is a specificity between the type or strain of cannabis and the type of cancer it can treat.

A

TRUE. The strain that treats prostate cancer might not be effect against other types of cancer such as breast cancer.

58
Q

What are the different methdos of consumption

A

Inhalation
Sub-lingual
Oral
Topical

59
Q

How long does it take for orally ingested cannabis to take effect?

A

approx 90 minutes

60
Q

How is sub-lingual cannabis absorbed into circulation?

A

through the oral mucosa

61
Q

What does bioavailabillity mean?

A

the percentage or amount of a substance found in the body of the total amount administered.

62
Q

What is the bioavailabillity of cannabis when smoked and what factors influences the bioavailabillity?

A

2 - 56%

depth
volume
holding time
frequency 
time between puffs
63
Q

How long before THC can be detected in plasma after smoking?

A

Almost immediately. Plasma levels of thc peaks about 20 minutes after smoking and then slowly declines untill it is completely gone 2 hours after smoking.

64
Q

What is the bioavailabillity of cannabis when ingested orally and what is it influenced by?

A

5 - 20%

Dose
Vehicle of ingested
physiological factors

65
Q

When do peak plasma levels of thc appear during oral ingestion of cannabis?

A

1 - 5 hours after ingestion

66
Q

When do peak plasma levels of thc appear during sub-lingual ingestion of cannabis?

A

1:30 to 4 hours after administration

and is completely eliminated from plama btween 12 to 24 hours after dosing

67
Q

how many days after smoking can thc be detected in low concetration in the blood of chronic smokers?

A

4 days.

Some thc is absorbed by lipids or fat cells in the body and then slowly released back into circulation

68
Q

How is thc metabolized in the body

A

thc is metabolized into two motabolites by enzyme cyp 450239:

active: 11 hydroxy thc (11-oh-thc)
inactive: 9 carboxy thc (9-cooh-thc)

Cannabinol (CBN) was also mainly metabolized to 11-hydroxy-CBN and 8-hydroxy-CBN by the microsomes

69
Q

What is the bioavailabillity of sub-lingually administered thc

A

13 to 35%

70
Q

What is the bioavailabillity of rectal administration of thc?

A

approx 13,5 %

71
Q

What happens to thc when enzyme cyp450239 is reduced by toxins or other medictions?

A

Causes an accumulation of THC in the body

72
Q

How is THC eliminated from the body?

A

Mainly through urine, with up to 90% eliminated within 5 days

73
Q

How long can THC be detected within the urine after administration?

A

2 to 4 weeks

74
Q

Where in the body are CB1 receptors found?

A 
Typically in the central nervous system:
Cortex
Hippocampus (memory)
Limbic system (emotion)
Brainstem and spinal cord (pain processing)
75
Q

What happend when cb1 receptors were blocked in animal studies?

A

Induced Hyperanalgesia or hyper sensitivity to pain

76
Q

Where are cb2 receptors found?

A

Typically in the peripheral nervous system

77
Q

What happens to the analgesic effect of cannabis over time?

A

It deminishes due to the down regulation of cb1 receptors in the CNS, which leads to an increase in tollerance

78
Q

What happens to the analgesic effect of cannabis over time?

A

It deminishes due to the down regulation of cb1 receptors in the CNS, which leads to an increase in tollerance

studies in animals have also shown a down regulation of cb2 receptors

79
Q

How does the activation of cb2 receptors reduce pain

A

cb2 receptors are found on immune cells, which when activated reduce inflamation

cb2 receptor are also found on nociceptors, when activated reduce the sensitivity of nociceptors

release of opiodes from skin cells, which further reduce pain.

80
Q

How does the activation of cb2 receptors reduce pain?

A

cb2 receptors are found on immune cells, which when activated reduce inflamation

cb2 receptor are also found on nociceptors, when activated reduce the sensitivity of nociceptors

activation of peripheral cb2 receptors, initiate the release of opiodes from skin cells, which further reduce pain.

This means that cannabis exert a local effect on pain through topical application

cb2 receptors are also found in the central nervous system on astrocytes and microglia which are heavily involved in pain processing

81
Q

How does the activation of cb1 receptor reduce pain?

A

cb1 receptors are found in the brian stem and spinal cour in areas associated with pain processing. activation of these receptors can interfere with pain processing.

cb1 receptors are also found near but outside the spinal cord, where there activation interferes with the pain processing in the peripheral nervous system.

82
Q

What are FFAH inhibitors?

A

drugs that inhibit the degradation of endocanabinoids and therefore increase the level of canabinioids in the brain

83
Q

Which kind of cannabis oil will be more effective in treating conditions with over inflamation?

A

Oils high in CBD, as CBD is anti-inflamatory

84
Q

What kinds of pain benefits from cannabis?

A 
accute pain
inflamatory pain
Headaches
Joint pain
Neuropathic pain
Cancer pain
Chronic pain

(important to note, that research is limited and seems to suggest that specificity exist, between strain used and type of pain treated)

85
Q

Which psychiatric conditions can benefit from cannabis?

A

PTSD -reduced symptoms of anxiety and insomnia and increased abillity to cope.

86
Q

Which psychiatric conditions can benefit from cannabis?

A

PTSD -improved mood, reduced symptoms of anxiety and insomnia and increased abillity to cope. (Stopping cannabis use can agravate PTSD symptoms due to withdrawel)

Depression -possitive effect on mood

87
Q

Which neurological conditions can benefit from cannabis?

A 
MS
Parkinsons
Epilepsy
Spasticity
Tourettes
88
Q

What is the hallmark symptom of cannabis withdrawel?

A

difficulty sleeping

  • night sweats
  • nightmares
  • strange dreams
  • difficulty falling asleep

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