Exam 5 - Pain Barker Flashcards
chronic pain lasts > ____ months
> 3 months
which of these peripheral receptors/channels are temperature sensitive? SELECT ALL THAT APPLY
a. TRPV
b. TRPM
c. ASIC
d. Histamine
e. Bradykinin
a. TRPV (vanniloid) = heat
b. TRPM (melastatin) = cold
which of these peripheral receptors/channels are acid sensitive?
a. TRPV
b. TRPM
c. ASIC
d. Histamine
e. Bradykinin
c. ASIC (acid sensing ion channel)
which of the following are chemical irritant sensitive? SELECT ALL THAT APPLY
a. TRPV
b. TRPM
c. ASIC
d. Histamine
e. Bradykinin
d. Histamine
e. Bradykinin
3 different pain fibers
A beta-fibers
A delta-fibers
C-fibers
which is the fastest pain fiber?
a. A beta-fibers
b. A delta-fibers
c. C-fibers
a. A beta-fibers (35-75 m/s)
which is the slowest pain fiber?
a. A beta-fibers
b. A delta-fibers
c. C-fibers
c. C-fibers (0.5-2 m/s)
which pain fiber innervates the skin and detects touch, pressure?
a. A beta-fibers
b. A delta-fibers
c. C-fibers
a. A beta-fibers
which pain fiber is myelinated and detects “first pain” and cold?
a. A beta-fibers
b. A delta-fibers
c. C-fibers
b. A delta-fibers
which pain fibers are unmyelinated and detects “second pain”?
a. A beta-fibers
b. A delta-fibers
c. C-fibers
c. C-fibers
which pain fibers senses pain, temp, touch, pressure, and itch?
a. A beta-fibers
b. A delta-fibers
c. C-fibers
c. C-fibers
4 actions of Substance P in peripheral sensitization (slide 14)
-vasodilation
-degranulation of mast cells
-release of histamine
-inflammation and prostaglandins
(it also inc expression of pain receptors i.e. sensitization)
what is “referred pain”?
when you have injury in one area of body but you feel pain somewhere else
example of referred pain from the lecture
myocardial ischemia (there is a usual distribution of pain for this, but other less common sites can be affected)
throbbing, pulsating pain
a. inflammatory
b. neuropathic
c. visceral
a. inflammatory
stabbing, shooting, burning, tingling pain
a. inflammatory
b. neuropathic
c. visceral
b. neuropathic
squeezing pain
a. inflammatory
b. neuropathic
c. visceral
c. visceral
morphine, codeine, thebaine
a. phenanthrenes
b. non-phenanthrenes
a. phenanthrenes
tramadol, fentanyl, meperidine
a. phenanthrenes
b. non-phenanthrenes
b. non-phenanthrenes
T or F: methadone is a partial mu opioid agonist and also a NMDA antagonist
F (full mu agonist)
endogenous opioid at mu receptor
a. endorphin
b. dynorphin
c. enkephalin
d. nociceptin
a. endorphin
endogenous opioid of kappa receptor
a. endorphin
b. dynorphin
c. enkephalin
d. nociceptin
b. dynorphin
endogenous opioid at delta receptor
a. endorphin
b. dynorphin
c. enkephalin
d. nociceptin
c. enkephalin
endogenous opioid at nociceptin, orphanin FQ receptor
a. endorphin
b. dynorphin
c. enkephalin
d. nociceptin
c. nociceptin
the kappa opioid receptor has potential use for tx of ______ due to reduced dopamine release
addiction
has role in hypoxia/ischemia/stroke
a. mu receptor
b. kappa receptor
c. delta receptor
c. delta receptor
T or F: there are several FDA-approved delta opioids on the market
F (none)
SE of blocking delta opioid receptor
seizures
morphine bioavailability due to first pass metabolism
25%
what two CYPs metabolize morphine/phenanthrenes?
2D6, 3A4
3 opioids that are prodrugs
heroin, codeine, tramadol
T or F: fentanyl and methadone do NOT produce active metabolites
T
which opioids used in the hospital are broken down by plasma esterases due to ester linkage?
a. sufentanil, remifentanil, alfentanil
b. fentanyl
c. hydromorphone
d. hydrocodone
e. morphine
a. sufentanil, remifentanil, alfentanil
T or F: tramadol has SNRI properties
T
which opioid is used for cough?
a. diphenoxylate with atropine
b. loperamide
c. eluxadoline
d. nalbuphine
e. codeine
e. codeine
can cause colonic contractions
a. PEG
b. Senna
c. Docusate
b. Senna
which of the following is TRUE about methadone?
a. fast-acting (2-4 minutes)
b. partial agonist
c. accumulates with repeated dose
d. the (-) enantiomer = NMDA antagonist
c. accumulates with repeated dose
(a is slow acting 2-4 hours; b is full; d is (+)
which formulation of buprenorphine has abuse potential?
subutex
naloxone (Narcan) half-life range
a. 2-5 min
b. 10-20 min
c. 30-90 min
d. 4-8 hours
c. 30-90 min
what is neonatal abstinence syndrome?
group of conditions caused when a baby withdraws from certain drugs (opioids) they are exposed to in the womb before birth
nonpharm tx for neonatal abstinence syndrome (5)
swaddling
hypercaloric formula
frequent feedings
observation
rehydration
pharmacological tx for neonatal abstinence syndrome (4)
morphine sulfate
SL buprenorphine
methadone
clonidine
T or F: for neonatal abstinence syndrome, morphine and buprenorphine are linked with longer hospital stay than methadone
F (shorter)
what do rubor, tumor, calor, dolor mean in the inflammatory response to pain?
redness, swelling, heat, pain
three phases of inflammatory response to pain
acute -> vasodilation
subacute -> infiltration
chronic -> proliferation
eicosanoids are _______ acid metabolites
arachidonic
aspirin
a. reversible COX 1 inhibitor
b. irreversible COX 1 inhibitor
c. reversible COX1/2 inhibitor
d. irreversible COX1/2 inhibitor
d. irreversible COX1/2 inhibitor
what does acetylation of COX2 do?
changes catalytic activity, turns off ability to generate prostaglandins
aspirin, unlike other NSAIDs, _______ inhibits COX enzymes
irreversibly
acetaminophen can cause dose-dependent, potentially fatal _____ _____
hepatic necrosis
lidocaine, bupivacaine, and benzocaine are _____ channel blockers
sodium
lidocaine’s structure has a ____ group while benzocaine has a _____ group
amide; ester (esters have higher allergy risk)
off label peripheral neuropathy, migraine
a. lamotrigine
b. carbamazepine
c. amitriptyline
d. duloxetine
e. venlafaxine
f. milnacipran
a. lamotrigine
trigeminal neuralgia
a. lamotrigine
b. carbamazepine
c. amitriptyline
d. duloxetine
e. venlafaxine
f. milnacipran
b. carbamazepine
Post-herpetic neuralgia, polyneuropathy, fibromyalgia, visceral pain
a. lamotrigine
b. carbamazepine
c. amitriptyline
d. duloxetine
e. venlafaxine
f. milnacipran
c. amitriptyline
diabetic pain, fibromyalgia, peripheral neuropathy
a. lamotrigine
b. carbamazepine
c. amitriptyline
d. duloxetine
e. venlafaxine
f. milnacipran
d. duloxetine
off label diabetic neuropathic pain; also has non-selective opioid effects and cardiac toxicity
a. lamotrigine
b. carbamazepine
c. amitriptyline
d. duloxetine
e. venlafaxine
f. milnacipran
e. venlafaxine
which 3 drugs can be used for fibromyalgia?
a. lamotrigine
b. carbamazepine
c. amitriptyline
d. duloxetine
e. venlafaxine
f. milnacipran
c. amitriptyline
d. duloxetine
f. milnacipran
two SNRIs that lack sodium channel functionality
milnacipran
tapentadol
tapentadol use
diabetic neuropathic pain
SNRIs can increase _____ levels and act on _____ receptors in spinal cord
NE; alpha 2 adrenergic
how do CCBs work as an analgesic?
reduced calcium influx will reduce glutamate release and reduced firing and depolarization of the neuron
which of the following are CaV1,2 selective and have no drug-drug interactions? SELECT ALL THAT APPLY
a. levetiracetam
b. ziconotide
c. gabapentin
d. pregabalin
c, d
half-life of gabapentin and pregabalin (range)
4-8 hours
which CCB for pain is derived from snail toxin and used in opioid intolerant patients?
a. ziconotide
b. gabapentin
c. pregabalin
d. levetiracetam
a. ziconotide
which CCB for pain may cause mood symptoms?
a. levetiracetam
b. ziconotide
c. gabapentin
d. pregabalin
a. levetiracetam
opioids, cannabis, GHB
a. stimulants
b. depressants
c. psychedelics
b. depressants
alcohol, inhalants
a. stimulants
b. depressants
c. psychedelics
b. depressants
cocaine, amphetamine, meth
a. stimulants
b. depressants
c. psychedelics
a. stimulants
bath salts, ecstasy, nicotine
a. stimulants
b. depressants
c. psychedelics
a. stimulants
LSD, psilocybin, PCP, mescaline, ketamine
a. stimulants
b. depressants
c. psychedelics
c. psychedelics
morphine
a. stimulants
b. depressants
c. psychedelics
b. depressants
which of the following do NOT act DIRECTLY on GPCRs? SELECT ALL THAT APPLY
a. opioids
b. LSD
c. cocaine
d. alcohol
e. caffeine
f. marijuana
g. psilocybin
h. MDMA
i. GHB
j. amphetamine
c. cocaine
d. alcohol
h. MDMA
j. amphetamine
what does incentive salience mean in regards to addiction? (from internet)
it’s an unconscious desire for a reward that triggers intense motivation; ex. If a recovering drug user has a cognitive desire to abstain from drugs, but still “wants” drugs. These cravings/desires can be triggered by “cues” such as smelling a drug or being around drug paraphernalia
salience = state or quality of an item that stands out relative to neighboring items
how many criteria must be met for mild, moderate, and severe substance use disorder?
mild 2-3
moderate 4-5
severe > 6
goose bumps and muscle spasms are examples of what kind of withdrawal sx?
a. emotional
b. physical
c. dangerous
b. physical
headaches, anxiety, and insomnia are examples of what kind of withdrawal sx?
a. emotional
b. physical
c. dangerous
a. emotional
know the diff between positive and negative reinforcement
ok
what does LTP mean?
long term potentiation -> persistent inc in synaptic strength following intense stimulation
rewarding substances cause relative inc in glutamatergic _____ receptors
AMPA
“cold turkey” refers to what physical sx of withdrawal?
goose bumps
“kicking the habit” refers to what physical withdrawal sx?
muscle spasms
