Exam 5 - Pain Barker Flashcards by Rehman Hameed

Q

chronic pain lasts > ____ months

A

> 3 months

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Q

which of these peripheral receptors/channels are temperature sensitive? SELECT ALL THAT APPLY

a. TRPV
b. TRPM
c. ASIC
d. Histamine
e. Bradykinin

A

a. TRPV (vanniloid) = heat
b. TRPM (melastatin) = cold

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Q

which of these peripheral receptors/channels are acid sensitive?

a. TRPV
b. TRPM
c. ASIC
d. Histamine
e. Bradykinin

A

c. ASIC (acid sensing ion channel)

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Q

which of the following are chemical irritant sensitive? SELECT ALL THAT APPLY

a. TRPV
b. TRPM
c. ASIC
d. Histamine
e. Bradykinin

A

d. Histamine
e. Bradykinin

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Q

3 different pain fibers

A

A beta-fibers
A delta-fibers
C-fibers

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Q

which is the fastest pain fiber?

a. A beta-fibers
b. A delta-fibers
c. C-fibers

A

a. A beta-fibers (35-75 m/s)

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Q

which is the slowest pain fiber?

a. A beta-fibers
b. A delta-fibers
c. C-fibers

A

c. C-fibers (0.5-2 m/s)

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Q

which pain fiber innervates the skin and detects touch, pressure?

a. A beta-fibers
b. A delta-fibers
c. C-fibers

A

a. A beta-fibers

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Q

which pain fiber is myelinated and detects “first pain” and cold?

a. A beta-fibers
b. A delta-fibers
c. C-fibers

A

b. A delta-fibers

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Q

which pain fibers are unmyelinated and detects “second pain”?

a. A beta-fibers
b. A delta-fibers
c. C-fibers

A

c. C-fibers

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Q

which pain fibers senses pain, temp, touch, pressure, and itch?

a. A beta-fibers
b. A delta-fibers
c. C-fibers

A

c. C-fibers

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Q

4 actions of Substance P in peripheral sensitization (slide 14)

A

-vasodilation
-degranulation of mast cells
-release of histamine
-inflammation and prostaglandins

(it also inc expression of pain receptors i.e. sensitization)

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Q

what is “referred pain”?

A

when you have injury in one area of body but you feel pain somewhere else

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Q

example of referred pain from the lecture

A

myocardial ischemia (there is a usual distribution of pain for this, but other less common sites can be affected)

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Q

throbbing, pulsating pain

a. inflammatory
b. neuropathic
c. visceral

A

a. inflammatory

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Q

stabbing, shooting, burning, tingling pain

a. inflammatory
b. neuropathic
c. visceral

A

b. neuropathic

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Q

squeezing pain

a. inflammatory
b. neuropathic
c. visceral

A

c. visceral

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Q

morphine, codeine, thebaine

a. phenanthrenes
b. non-phenanthrenes

A

a. phenanthrenes

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Q

tramadol, fentanyl, meperidine

a. phenanthrenes
b. non-phenanthrenes

A

b. non-phenanthrenes

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Q

T or F: methadone is a partial mu opioid agonist and also a NMDA antagonist

A

F (full mu agonist)

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Q

endogenous opioid at mu receptor

a. endorphin
b. dynorphin
c. enkephalin
d. nociceptin

A

a. endorphin

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Q

endogenous opioid of kappa receptor

a. endorphin
b. dynorphin
c. enkephalin
d. nociceptin

A

b. dynorphin

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Q

endogenous opioid at delta receptor

a. endorphin
b. dynorphin
c. enkephalin
d. nociceptin

A

c. enkephalin

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Q

endogenous opioid at nociceptin, orphanin FQ receptor

a. endorphin
b. dynorphin
c. enkephalin
d. nociceptin

A

c. nociceptin

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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