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neuroscience of pain > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

% of the population suffers from migranes, the majority being _ ().

A

14.7
female
after puberty, before menopause

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2
Q

Migraine

A

recurring headache disorder manifesting in attacks lasting 4-72 hours

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3
Q

Symptoms of a migraine

A

unilateral (sometimes bilateral) location
Pulsating quality
Moderate or severe intensity
Aggravation by routine physical intensity
Photo- and phono- phobia

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4
Q

In the US, one in _ households has one sufferer of migraines

A

four

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5
Q

Foods containing (5) are likely to trigger a migraine

A 
MSG
tyramine
nitrates
phenylethylamine
aspartame
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6
Q

Drugs containing (3) are likely to trigger a migraine

A

Estrogen (eg. OC)
Nitroglycerin
Excess analgesic use or withdrawal

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7
Q

Abortive migraine therapy

A

goal is to stop the migraine once it starts

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8
Q

Prophylactic migraine therapy

A

goal is to prevent migrains from occurring, drugs taken daily

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9
Q

Abortive therapy drugs

A

NSAIDS + caffeine
Ergotamine
Dihydroergotamine

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10
Q

Abortive therapy drug targets

A

AGONIST

5-HT1/1B/1D/1F, Alpha 1/2, D2

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11
Q

Triptans (are/are not) effective for most patients

A

are not

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12
Q

Abortive therapy CGRP drugs

A

Triptans
Olcegepant
Telcagepant

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13
Q 
criteria for prophylaxis
frequency
duration
severity
relief of drugs
A

2-3/mo
extreme severity
inadequate relief

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14
Q

What drug is FDA approved for chronic migraine?

A

BotoxA

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15
Q

Presynaptic effects of opioids

A

Blocks Ca2+ influx
K+ efflux
Decreases excitatory NT release

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16
Q

Postsynaptic effects of opioids

A

Opens K+ channels

Inhibits AP generation

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17
Q

morphine is a _

A

Mu agonist

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18
Q

Codeine is _ potent than morephine

A

less

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19
Q

Oxycodone has _ bioavailability

A

high

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20
Q

Fentanyl is _ times more potent than morphine

A

100

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21
Q

Methadone has a _ half-life

A

long

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22
Q

Buprenorphine is a _

A

partial mu agonist

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23
Q

Pentazocine is a _

A

mu and kappa agonist

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24
Q

action of opioid analgesics are _.

A

widespread in the brain, SC, and below

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25
Q

opioids _ off cells via _

A

activate

GABA

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26
Q

opioids _ on cells

A

inhibit

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27
Q

RVM on cells _ dorsal horn cells

A

excite

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28
Q

RVM off cells _ dorsal horn cells

A

inhibit

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29
Q

Morphine _ on-cells in the RVM

A

inhibits

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30
Q

Morphine _ off-cells in the RVM

A

excites

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31
Q

Neural circuits involved in addiction

A

DSM Th
VTA
LHyTh
VP

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32
Q

a selective _ receptor has been implicated in tolerance to opioids

A

CCK2

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33
Q

tolerance is probably mediated by _

A

desensitization of receptors and receptor downregulation

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34
Q

COX1 produces _

A

prostaglandins

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35
Q

COX2 becomes expressed in connection with _

A

inflammatory processes

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36
Q

Aspirin is toxic to the _

A

GI

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37
Q

Aspirin has a long duration effect on platelets that can effect _.

A

bleeding

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38
Q

Aspirin can cause _ in children under 10

A

Reye’s syndrome

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39
Q

Tylenol/_ can cause _.

A

paracetamol

hepatoxicity (liver failure)

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40
Q

prostaglandins are blocked by _, _, and _.

A

aspirin
indomethacin
common NSAIDs

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41
Q

Side effects of COX inhibitors include _ or _

A

GI bleeding

perforation of stomach lining

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42
Q

Relative risk of NSAIDs increases with _

A

age

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43
Q

second generation selective COX2 inhibitors are called _

A

coxib compounds

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44
Q

coxib compounds cause less _ and _

A

stomach bleeding/perforation

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45
Q

coxib compounds have serious risks of _ in patients with preexisting problems

A

cardiovascular disorders

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46
Q

coxib compounds are mostly used for _

A

arthritis

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47
Q

more than /day of acetaminophen() casues _

A

2,000mg
tylenol
liver failure

48
Q

IS rheumatoid arthritis more prevalent in older or younger people?

A

younger

49
Q

Disease modifying drugs are available (_) for OA or RA?

A

RA

50
Q

Is OA or is RA an autoimmune disease?

A

RA

51
Q

The most common form of persistent pain in the developed world is _

A

osteoarthritis

52
Q

in most cases, _ can eliminate pain in most cases of osteoarthritis

A

joint replacement

53
Q

Does osteoarthritis have central, peripheral, or both components?

A

both

54
Q

_ is the first line of treatment for osteoarthritis and rheumatoid arthritis

A

NSAIDs

55
Q

Osteoarthritis pain is _ in nature

A

nociceptive

56
Q

The most effective treatment for osteoarthritis is _ or _

A

local anesthetic injection

joint replacement

57
Q

NSAIDs often become (more/less) effective over time

A

less

58
Q

_ are almost always used in RA patients

A

TNF-alpha blocking therapies

59
Q

Postherpetic neuralgia is treated with _

A

Analgesics/opioids/gabapentin

60
Q

Diabetic neuropathy is treated with _

A

analgesics/opioids/carbamazepine /gabapentin

61
Q

Trigeminal neuralgia is treated with

A

Carbamazepine/lamotrigine

62
Q

Central poststroke pain is treated with _

A

amitriptyline/lamotrigine

63
Q

HIV polneuropathy is treated with

A

lamotrigine

64
Q

SCI/MS pain is treated with _

A

amitriptyline/lamotrigine

65
Q

Postherpetic neuralgia affects () and _

A 
nerve fibers (DRG)
skin
66
Q

postherpetic neuralgia is a complication of _

A

shingles

67
Q

The chickenpox virus can remain dormant in _.

A

DRG neurons

68
Q

The chickenpox virus (does/does not) have a vaccine

A

does

69
Q

PHN causes loss of _

A

epidermal nerve fibers

70
Q

_ is a glycation product and is an important factor in _

A

methylglyoxal

diabetic neuropathy

71
Q

daibetic neuropathy can lead to _ neuropathy.

A

peripheral

72
Q

CRPS

A

complex regional pain syndrome

73
Q

CRPS most often affects _

A

the distal extremities

74
Q

current evidence suggests that all CRPS cases are casued by _

A

nerve damage

75
Q

Type I CRPS

A

no identified nerve damage

76
Q

Type II CRPS

A

identified nerve damage

77
Q

CRPS results in _

A

loss of epidermal nerve fibers

78
Q

ectopic neural activity

A

spontaneous neural activity

79
Q

There is strong evidence that _ arises from a _ and is responsible for neuropathic pain

A

ectopic activity

neuroma

80
Q

input deprivation (nerve severance) can lead to _ in the PNS, like expression of _ or _

A

plastic changes
VGNa+ channels (^)
VGK+ channels (v)

81
Q

Anti-epileptics fall into either _ or _

A

gabapentinoids

VGNa+ channel inhibitors

82
Q

4 main anti-epileptic VGNa+ channel inhibitors

A

phentoin
valproic acid
amitriptyline
carbamazapine

83
Q

2 classes of anti-depressants to treat neuropathic pain

A

SNRIs

MAOIs

84
Q

Concept of SNRIs

A

SNRIs increase NE availability in the dorsal horn, mimicking descending inhibition

85
Q

Concept of MAOIs

A

increase NE availability in the dorsal horn, inhibit VGNa+ channels in some cases

86
Q

most widely used topical treatment

A

capsaicin

87
Q

concept of topical capsaicin

A

causes long-lasting desensitization of nociceptors, decreasing ectopic activity

88
Q

second most widely used topical treatment

A

lidocaine patches

89
Q

people with preexisting cancer pain are likely to be _.

A

sensitized to pain

90
Q

concept of cancer pain

A

bone destruction injures nerves, likely provoking neuropathic pain

91
Q

most common treatment for cancer pain

A

opioids

92
Q

dysfunctional pain

A

pain with no organic origin

93
Q

dysfunctional pain results in _ and _

A

decreased inhibition

increased facilitation

94
Q

damage to PNS leads to _ retraction

A

epidermal nerve fiber

95
Q

damage to PNS leads to _ activity

A

ectopic

96
Q

damage to PNS leads to _ of pain sensing neurons

A

sensitization

97
Q

chronic pain conditions are either a _ or develop after _

A

continuation of acute post-surgery pain

an asymptomatic period

98
Q

NNT

A

number needed to treat for pain reduction to be at 50%

99
Q

existing neuropathic pain therapeutics are _

A

ineffective

100
Q

The most promising current treatment for neuropathic pain is _

A

p2x3 antagonists

101
Q

Biologic drugs for pain therapy

A

Anti-NGF
Anti-CGRP
IL-10

102
Q

Side effect of anti-NGF therapy

A

avascular necrosis

103
Q

Anti-CGRP therapies are used to treat _ in clinical trials

A

migraines

104
Q

Concept of disease modifying therapies

A

target underlying molecular mechanisms to reverse pathological changes in gene expression

105
Q

translation of mRNA controls _

A

postsynaptic plasticity

106
Q

_ localizes to nerve fibers

A

P-mTOR

107
Q

Nerve injury, NGF, and IL-6 converge on the _ to control gene expression

A

eIF4F complex

108
Q

_ decrease mTOR and ERK activity

A

AMP Kinase activators

109
Q

salicylate (_) is a _

A

tylenol

AMPK activator

110
Q

AMPK activators reduce _

A

sensory neuron excitability

111
Q

metformin is a _

A

AMPK activator

112
Q

metformin treatment reverses _

A

neuropathic mechanical hypersensitivity

113
Q

daily treatment for _ days reverses neuropathic mechanical hypersensitivity to normal

A

7 days

114
Q

metformin treatment reverses nerve injury-induced _

A

microglial activation

115
Q

channelrhodopsin

A

an algae light operated ion channel that has been engineered to control neuronal activity

116
Q

halorhodopsin

A

a light activated chloride pump found in archaea

neuroscience of pain (2 decks)

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