Chapter 14 - Pain And Inflammation Flashcards
in which free nerve endings do pain sensations arise
Nociceptors
Why does pain sensation arise
Nerve endings may be activated through mechanical, thermal, chemical stimulation
Where are nociceptors located
Skin, joints, blood vessel walls, periosteum, hollow organs, parietal surfaces of thorax and abdomen
What is superficial pain
Paid that arises in subcutaneous tissue.
What is deep pain
Associated with skeletal muscles, tendons, bones, joints. Visceral pain
Why can pain be harmful
Because it leads to stress and related problems such as gastrointestinal lesions, immunosuppression, delayed healing, hypertension, potential dysrhythmias
What is the first step in the pain pathway
Transduction or stimulation
What is the second step in the pain pathway
Spinal cord transmission
What is the third step in the pain pathway
Modulation
What is the fourth step in the pain pathway
Perception of pain
What are type C unmyelinated fibers responsible for
Dull, poorly localized pain in humans
What are type a Delta fibers responsible for
Sharp, localized pain
Where do type a and type C fibers carry impulses to
To the dorsal horn of the spinal cord
What are the responses to pain
Increased heart rate, increased respiratory rate, mydriasis, salvation, vocalization, changes in facial expression, guarding of the painful site, restlessness, unresponsiveness, failure to groom, abnormal gait, abnormal stands, rolling
How is the perception of pain enhanced
Hyperalgesia and central sensitization.
What is central sensitization
The idea that pain control is enhanced if analgesia is given before pain is generated. It is a preemptive pain medication
What are analgesics
Drugs used to control pain include NSAIDs and narcotics.
What are the bodies own opiate like analgesics
Endorphins
How can you pharmacologically intervene with pain
By targeting a single or multiple points of the pain process
What can transduction be inhibited by
Opioids and nsaids
What can transmission of nerve impulses be inhibited by
Local anesthetics and alpha 2 agonists
How can you modulate pain impulses in the spinal cord
Through the effects of local anesthetic, opioids, Alpha 2 agonists, tricyclic antidepressant, nsaid, anticonvulsant
How can pain perception in the cortex be inhibited
By use of anesthetic, opioid, benzodiazepine and alpha 2 agonist
What does damage to cells result in
Release of several chemical mediators that may initiate or prolong the inflammatory response
What are the chemical mediators of inflammation
Prostaglandins, leukotrienes, histamine, cytokines
What do the mediators of inflammation do
Exacerbate a pain response
What happens if you reduce inflammation
You reduce ️pain
How do NSAIDs work
Inhibit an enzyme called cyclooxygenase. Cox. Two forms: Cox 1 and Cox 2 exist
What is cox 1
Maintains physiologic functions such as modulation of renal bloodflow and synthesis of gastric mucosal
What does cox 2 do
Promotes the formation of prostaglandins from cell membrane arachodonic acid.
Which NSAIDs are less harsh: cox 1 or cox 2 inhibitors ?
Cox 2 inhibitors. Produce fewer gastrointestinal side effects
What is the short term use of NSAIDs
Preoperative/preemptive pain control
What is the long term use of NSAIDs
Older dogs with osteoarthritis
What does cox 1 do with the stomach mucus
Plays an important role in causing the secretion of stomach protective mucus, maintaining blood supply to the stomach and decreasing acid production
What does cox 1 do with the kidney
Cox 1 prostaglandins counteracted vasoconstriction and allowed vasodilation of the renal blood supply
What are glucocorticoids
Exert their effects by blocking Phospholipase an enzyme necessary for the production of both prostaglandins and leukotrienes. Intervention is provided earlier in the sequence of the formation of inflammatory mediators. Because the inflammatory reaction is blocked earlier by glucocorticoids they are more effective anti inflammatory agents than NSAIDs
What are the common side effects of NSAIDs
Most common side effects are gastrointestinal ulceration and bleeding. Other side effects may include hepatotoxicity, nephrotoxicity, inhibition of cartilage metabolism, bone marrow suppression, bleeding tendencies
What should dogs and cats on prolonged and nsaid use have
Routine biochemistry done before the start of nsaids and every six months while on NSAIDs to check for liver and kidney function
What are the precautions for nsaids
Do not give more than one type of nsaid at a time, prevent accidental ingestion, always give with food, stop if vomiting or diarrhea, always check if animal seems not well
What does aspirin do
Causes ulcerations and bleeding out. Relief of mild to moderate pain caused by musculoskeletal conditions such as arthritis and hip dysplasia
What is special about cats with aspirin
They’re highly susceptible to aspirin overdose because of their inability to metabolize it rapidly.
What is phenylbutazone
Banamine. Anti-inflammatory medication for horses
What is DMSO
It is an anti-inflammatory and has the ability to act as a carrier of other agents through the skin. It is not a nsaid.
What is special about tylenol with cats
Cat lacks liver enzymes to metabolize the drug safely. Produces metabolites that are toxic to the liver
What is carprofen
Propionic acid derivative nsaid that has been approved for oral use in dogs. Carprofen has been approved for oral and injectable use in dogs and cats.
How long is the rimadyl-carprofen half life
8 hours.
How does rimadyl work
By inhibiting cox 2 and doesn’t cause ulcers.
What is the clinical use of rimadyl
Relief of pain associate.d with degenerative joint disease and postoperative pain resulting from soft tissue or orthopaedic repair.
What is the dosage form of rimadyl
Available in tablets etc
What are the adverse side effects of carprofen
Side effects such as gastrointestinal ulceration and bleeding are apparently rare with this agent
What does ibuprofen cause
Ulcers and gastric bleeding
What is deramax
An analgesic and a nsaid against the coxib. Control of pain and inflammation
What is previcox
NSAID that belongs to coxib class. Used for the treatment of pain and inflammation associated with osteoarthritis
What is metacam
Cox 2 receptor nsaid. It has aninflammatory, analgesia and antipyretic. Used to control pain associated with surgical procedures and arthritis t
What are the adverse side effects of metacam
Similar to other NSAIDs
