Final Flashcards
Enkephalins, endorphans and opioid receptors target what Laminae of Rexad?
2
Non-nociceptive example of WDR neurons
Type A beta
What part of modulation causes hyperalgesia?
Dorsolateral funiculus
Pt screams an asks for pain medicine when putting on EKG leads is an example of what?
allodynia
Manipulation of small intestine would involve what fibers?
Type C (0.5-2 m/s)
What NT is involved with an open wound on hand (picture)?
glutamate
NT for type C fibers
substance P
______ are alogenic substances and made from cyclooxygenase and can cause hyperalgesia
Prostaglandins
(picture of burned hand) 1. Where are primary afferent neurons (A Delta and C) cell bodies? 2. Where do fibers descend or ascend? 3. After leaving tract of lissauer, the axon (still primary neurons) enter gray matter (rexad’s laminae I, II, V) of dorsal horn of spinal cord where they synapse with what?
(Actual ? had to do with neurons ascending/descending or crossing tract of lissauer??)
- dorsal root ganglia of spinal cord
- Tract of Lissauer
- second-order neurons
Visceral pain is ____ (nociceptive or non-nociceptive)
Nociceptive. So is somatic
Non-nociceptive pain: neuropathic, idiopathic, and psychogenic
The three sensory neurons involved in transmission are:
- Primary (stimulus to rexed laminae I/II/V)
- Secondary (nociceptive and WDR, start in rexed laminae I, II, V- cross midline of spinal cord though anterior commissure and ascend anterolateral pathway of the spinothalmic tract to terminate in the lateral thalamus and intralaminar nuclei)
- Tertiary (thalamus to cerebral cortex)
Type A delta fibers NT and receptor
glutamate and NMDA
NT stimulate peripheral nociceptors causing an influx of ___ ions to enter the nerve fiber membranes (depolarization) and a subsequent efflux of ____ (depolarization). This is a pain impulse.
Sodium
Potassium
Third order/tertiary neurons terminate in the
cerebral cortex
Another name for descending pathway
modulation. Efferent pathway. descends axons from cerebral cortex, hypothalamus, thalamus, periaquaductal gray, nucleus, raphe magnus, and locus ceruleus, via the dorsolateral funiculis, synapse with and suppress pain transmission to the brainstem and spinal cord dorsal horn
Descending (afferent/efferent) fibers have to with modulation
efferent
NT released on surgical incision
glutamate
Pain is an unpleasant and ____ experience associated with actual or potential tissue damage or described in terms of such damage.
emotional
Acute pain may result in…
atelectasis
Prostaglandins enhance the release of
glutamate
A 19 y/o boy rates his pain a 3 on 1-10 scale and is anxious and wheezing. BEST analgesic for him…
tylenol
In the presence of inflammation, the administration of a non-selective cylclooxygenase inhibitor may result in
fever
Doses for IV orfirmev
adult: 1000 mg q6h, 650 mg q4h, MAX 4000 mg/day
peds: 15 mg/kg q6h, 12.5 mg/kg q4h, MAX 75 mg/kg/day
NSAIDS produce their therapeutic effects by inhibiting the conversion of arachidonic acid to:
prostoglandins
centrally, opioid receptors are primarily located in which Rexed’s Lamina?
two
Which agent should be prescribed with caution in a patient with renal insufficiency?
Morphine (has active metabolites)
Receptor that remains plugged by Magnesium
NMDA
T/F: Morphine 3 glucuronide is an active metabolite
False. (morphine 6 glucuronide)
In chronic pain states, ketamine is beneficial in reducing
allodynia
Common side effect of alpha 2 agonist
decreased heart rate
Fentanyl route that has the shortest duration of action
epidural
T/F: Hydromorphone is a safe choice for patients suffering from renal insufficiency.
true (no active metabolites)
The upper lockout interval for the majority of PCA prescribed opioids is
10 min
Which PCA variable is least prescribed?
basal rate
T/F: Inhibition of alpha 2 adrenoreceptors may result in supraspinal analgesia
false
T/F: celocoxib (a selective cox 2 inhibitor) should be avoided in patients with asthma
True
Which receptor is a known sympatholytic?
Alpha 2
Continuous stimulation of the nociceptor terminal by which NT can lead to chronic pain?
glutamate
____ plug in NMDA receptors renders them inactive
magnesium
A systemic effect of exogenous steroid administration is
depression
T/F: Medications for the treatment of chronic pain should be continue throughout the preoperative period
True
When prescribing an antidepressant as part of a multimodal approach to chronic pain management one would expect effects to take place in
1 week (4-10 days)
Methadone has a half life of
15-60 hours
Epileptics on phenytoin affect the metabolism of
methadone
A single epidural steroid injection can cause hypothalamic pituitary adrenal axis suppression lasting:
5 days- 5 weeks
What NT plays the greatest role in “wind-up”
glutamate
The preventative drug used in the treatment of neuropathic pain blocks the alpha 2 delta subunit of the presynaptic voltage gated calcium channels within the CNS is:
pregabalin (lyrica) or gabapentin (neurontin)
