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Anesthesia and Analgesia > Ch1 BB AALA > Flashcards

Ch1 BB AALA Flashcards

1
Q
  1. What is the IASP?
A

International Association for the Study of Pain

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2
Q
  1. What is the IASP definition of pain?
A
  1. “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”
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3
Q
  1. What is a more animal specific definition of pain?
A
  1. “an aversive sensory, emotional experience representing an awareness by the animal of damage or threat to the integrity of its tissues; it changes the animal’s physiology and behavior to reduce or avoid damage, reduce the likelihood of recurrence, and to promote recovery; non-functional pain occurs when the intensity or duration of the experience is not appropriate for the damage sustained and when physiological and behavioral responses are unsuccessful in alleviating it.”
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4
Q
  1. What is acute pain?
A
  1. Acute pain- has proximate cause, often serves as an essential protective function by associating potentially damaging noxious stimuli with an unpleasant sensation
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5
Q
  1. Acute pain can be further characterized as _________ or __________.
A
  1. physiologic or clinical
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6
Q
  1. Differentiate between the two classifications of acute pain.
A
  1. physiologic- early-warning system that aids in protecting body from tissue damage by physical, thermal, or chemical threats, initiated by activation of high-threshold nociceptive neurons, highly localized, transient, initiates physiologic and avoidance behaviors accompanied by protective reflexes; clinical- prolonged unpleasant sensations arising from significant tissue damage, induces augmented or abnormal signal processing, may be spontaneous, may be characterized by hypersensitivity, hyperalgesia, & allodynia, & pain surrounding noninjured tissues
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7
Q
  1. What is chronic pain?
A
  1. “pain which persists past the normal time of healing”, pain continues beyond the stage where it is useful to protect the region, or is persistent and may not have a clearly identifiable cause
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8
Q
  1. The IASP regards _____ months of pain as the most expedient point at which transition from acute to nonmalignant pain can be defined.
A

3 months

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9
Q
  1. What is pain threshold?
A
  1. least experience of pain an individual can recognize
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10
Q
  1. True or False: Sex has been demonstrated to influence pain thresholds in animals.
A
  1. False- has not been conclusively demonstrated
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11
Q

What is pain tolerance?

A
  1. the greatest level of pain an individual is willing to tolerate
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12
Q
  1. _____________ is an exaggerated response to a stimulus that would normally be painful.
A
  1. hyperalgesia
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13
Q
  1. _____________ refers to reduced threshold to noxious stimuli.
A
  1. hypersensitivity
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14
Q
  1. What is allodynia?
A
  1. pain induced by a non-noxious stimulus
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15
Q
  1. What is analgesia?
A
  1. absence of pain in response to stimulation that would normally be painful
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16
Q
  1. _____________ is the sensation of noxious stimuli.
A

nociception

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17
Q
  1. What is the important distinction between nociception and pain?
A
  1. nociception includes neurobiological processes by which noxious stimuli are encoded as neural impulses and sent to the brain; pain is the cognitive and emotive interpretation of the sensation as a hurtful or unpleasant experience
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18
Q
  1. ___________ is the process of converting noxious thermal, mechanical, or chemical stimuli into an action potential
A

transduction

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19
Q
  1. True or False: The frequency and duration of the action potential is proportional to the intensity and duration of the stimulus.
A

True

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20
Q
  1. True or False: Most nociceptors are unimodal.
A
  1. False- polymodal
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21
Q
  1. What are “silent” nociceptors?
A
  1. nociceptors that express transducers with such high activation thresholds that they are only activated when sensitized by tissue injury
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22
Q
  1. List the major transducer types.
A
  1. transient receptor potential ion channels, ATP-gated ion channels, and acid-sensing ion channels
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23
Q
  1. _______ respond to thermal, chemical, and possibly mechanical stimuli.
A

transient receptor potential ion channels

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24
Q
  1. _________ are released in response to mechanical forces, inflammation, and nerve damage.
A

ATP-gated ion channels

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25
Q
  1. _________ transduce innocuous mechanical stimuli such as touch.
A

acid-sending ion channels

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26
Q
  1. What is transmission?
A
  1. the process by which primary afferent sensory neurons propagate action potentials to the spinal cord
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27
Q
  1. What 5 things are nociceptive neurons characterized by?
A
  1. size, myelination, peptide content, receptive characteristics, and site of termination in the spinal cord
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28
Q
  1. _______ fibers are thinly myelinated, have intermediate velocities, punctate receptive fields, and respond to thermal and mechanical stimuli.
A
  1. Aδ
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29
Q
  1. _______ fibers constitute the majority of peripheral nociceptive fibers, have small unmyelinated axons, wide receptive fields, and are polymodal.
A

C

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30
Q
  1. ______ fibers are large, myelinated, and have fast conduction velocities.
A
  1. Aβ
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31
Q
  1. True or False: All neurons express voltage-gated sodium ion channels.
A

True

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32
Q
  1. What is projection, and where does it start?
A
  1. process of conveying information through the spinal cord to the brain, starts in the dorsal horn
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33
Q
  1. Primary afferent nociceptive neurons connect with interneurons where in the dorsal spinal cord?
    a. lamina I
    b. substantia gelatinosa (II, IIa)
    c. lamina V
    d. all of the above
    e. none of the above
A
  1. d- all of the above
34
Q
  1. What type of neurons do dorsal horn projections code into?
A

nociceptive-specific
wide dynamic range
non-nociceptive

35
Q
  1. ____________ neurons are innervated by Aδ and C fibers and code localizing and qualitative information about noxious stimuli.
A
  1. nociceptive-specific
36
Q
  1. __________ neurons are innervated by C, Aδ, and Aβ fibers and convey the intensity of noxious and innocuous mechanical, thermal, and chemical stimuli.
A
  1. wide dynamic range
37
Q
  1. ________ fibers code innocuous thermal and mechanical information from Aβ and Aδ fibers.
A
  1. non-nociceptive
38
Q
  1. What may be the four most important spinal tracts involved in pain?
A
  1. spinothalamic, spinoreticular, spinomesencephalic, and spinohypothalamic tracts
39
Q
  1. True or False: In contrast to humans and NHP, other animals do not have a bilateral, diffuse and multisynaptic nociceptive pathway in the spinal cord.
A
  1. False- other animals DO have bilateral, diffuse, multisynaptic pathway in contrast to humans and NHP
40
Q
  1. The ________ has long been considered the key relay for receiving and integrating spinal nociceptive input and projecting that information to cortical and subcortical areas of the brain.
41
Q
  1. What is modulation?
A
  1. the process by which nociceptive information from primary afferents is inhibited or augmented
42
Q
  1. True or False: Most dorsal horn neurons are inhibitory interneurons.
43
Q
  1. What happens when inhibitory interneurons are activated?
44
Q
  1. What is the primary excitatory neurotransmitter release by nociceptive terminals?
45
Q
  1. Glutamate preferentially binds to what receptor(s)?
A

kainate
AMPA
NMDA

46
Q
  1. What is the principal inhibitory neurotransmitter in the nervous system?
47
Q
  1. GABA’s actions are mediated by _______ and _______ receptor subtypes.
48
Q
  1. What happens when these receptors are activated?
A
  1. GABAA- hyperpolarizes cell, decreasing excitation; GABAB- reduces release of glutamate, substance P, and calcitonin gene-related product
49
Q
  1. What neurotransmitter(s) is/are most critical to descending antinociception?
A

Serotonin
Norepinephrine

50
Q
  1. True or False: Norepinephrine stimulates the release of GABA and glycine, reduces glutmate release from primary afferents and reduces excitation of projection neurons.
51
Q
  1. True or False: Both noxious and non-noxious stimuli elicit the same type of unlocalized body responses in altricial rats.
52
Q
  1. True or False: In rats, the descending inhibitory systems that help fine-tune responses are mature and functional at birth.
A
  1. False- immature at birth and not functional until 3 wks after birth
53
Q
  1. The _______________ is the primary system affecting the neuroendocrine response to pain.
A
  1. hypothalamic-pituitary-adrenal axis
54
Q
  1. True or False: Responses to pain are the mirror images of those elicited by restraint or other stressors.
A
  1. False- are not mirror image
55
Q
  1. The neuroendocrine and sympathetic nervous system responses to pain are initiated by:
    a. neuronal stimulation through direct and indirect connection with nociceptive pathways
    b. IL-1
    c. TNF
    d. All of the above
    e. None of the above
A
  1. d- all of the above
56
Q
  1. Activation of the hypothalamic-pituitary-adrenal axis by acute pain results in the release of:
A

corticotrophin-releasing hormone
antidiuretic hormone
prolactin & adrenocorticoropic hormone
β-endorphins
glucocorticoids

57
Q
  1. True or False: Pain causes increased heart rate, blood pressure, cardiac output, and systemic vascular resistance.
58
Q
  1. True or False: Pain in human thoracic surgery patients, has been shown to decrease tidal volume, functional residual capacity, and cause ventilation-perfusion mismatch.
59
Q
  1. Name 3 miscellaneous effects of pain
A

glucose intolerance

ileus

sleep disturbance

60
Q
  1. What does neural plasticity refer to?
A
  1. when neurons alter their structure/function in response to stimulation or activation
61
Q
  1. True or False: Prostaglandin E2, Histamine, and Nerve growth factor are algogens and cause sensitization.
A
  1. False- sensitization, not algogens
62
Q
  1. What is “wind-up”?
A
  1. progressive increase in action potential frequency generated by closely repeated constant pulses of electricity
63
Q
  1. True or False: Wind-up is necessary and sufficient for central sensitization to occur.
64
Q
  1. ________________ contributes to primary hyperalgesia, and is the only mechanism by which secondary hyperalgesia and secondary allodynia occur.
65
Q
  1. Central sensitization is not a completely neuronal event, and may depend upon _____________ activation.
A
  1. glial cell
66
Q
  1. The glial model of central sensitization suggests that the CNS synapses have a tetrapartite structure, comprised of:
A

microglia
astrocytes
pre-synaptic neurons
post-synaptic neurons

67
Q
  1. True or False: Over a period of hours-days, central sensitization switches from transcription-and-translation-dependent processes to activity-dependant processes.
A
  1. False- switches from activity-dependent to transcription-and-translation dependent
68
Q
  1. What are the cardinal signs of chronic pain?
A
  1. allodynia, hyperalgesia, and spontaneous pain
69
Q
  1. True or False: Once astrocytes are activated, inhibiting microglial cells has no effect on pain.
70
Q
  1. Which voltage-gated sodium channels have been implicated in the pathogenesis of both neuropathic and inflammatory chronic pain?
A

1.3, 1.7, and 1.8

71
Q
  1. Altered expression and distribution of sodium ion channels leads to the generation of _________________ in the absence of stimuli.
A
  1. spontaneous (ectopic) impulses
72
Q
  1. Voltage gated _______________ (sodium or calcium, choose one) channels appear to regulate neurotransmitter release.
73
Q
  1. True or False: Loss of inhibitory interneurons appears to be mediated by glutamate receptor 5 and caspase-3 activity.
74
Q
  1. What is phenotypic switching?
A

induced expression of nociceptive-related ion channels, molecules, and receptors not normally found in non-nociceptive sensory neurons, and novel up-or down regulation of similar molecules in nociceptive neurons

75
Q
  1. True of False: Most chronic pain encountered in veterinary medicine is likely neuropathic, inflammatory, or neoplastic in origin
76
Q

What are definitions of neuropathic pain?

A
  1. “pain initiated or caused by a primary lesion or dysfunction of the nervous system”, “pain caused by a lesion of the peripheral or central nervous system (or both) manifesting with sensory symptoms and signs”
77
Q
  1. Which of the following is NOT an etiology responsible for neuropathic pain?
    a. chemotherapy induced polyneuropathy
    b. diabetes
    c. herpes virus
    d. multiple sclerosis
    e. osteoarthritis
A
  1. e- osteoarthritis
78
Q
  1. How does chronic inflammatory pain develop?
A
  1. from chemicals (algogens, sensitizers, immunomodulators) released by immunocytes infiltrating injured or diseased tissue
79
Q
  1. Which of the following is NOT an example of a disease associated with chronic inflammatory pain?
    a. herpes virus
    b. osteoarthritis
    c. endometriosis
    d. feline lower urinary tract disease
    e. ulcerative dermatitis
A
  1. a- herpes virus

Anesthesia and Analgesia (6 decks)

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