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PPT > GI mc 2 > Flashcards

GI mc 2 Flashcards

1
Q

hyperalgesia

A

increased sensitivity to stimuli

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2
Q

allodynia

A

misperception of pain to non-noxious stimuli

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3
Q

peripheral pain receptors and prolonged pain

A

can become sensitised

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4
Q

transmission of incoming nociceptive impulses is modulated by…

A

dorsal horn

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5
Q

where is pain transmitted

A

dorsal horn of the spinal cord

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6
Q

what do pain impulses do in the dorsal horn

A

decussate

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7
Q

where do pain impulses go when they have decussated

A

ascend via the spinothalamic tract to the reticular activating system (RAS) and thalamus

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8
Q

hyperalgesia

A

increased sensitivity to stimuli

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9
Q

allodynia

A

misperception of pain to non-noxious stimuli

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10
Q

what does dorsal horn recieve impulses from

A

peripheral touch receptors and from descending pathways that involve the limbic cortical systems

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11
Q

limbic cortical systems examples

A

orbital frontal cortex, amygdala, and hypothalamus

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12
Q

after morphine is given what is released

A

histamine

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13
Q

what does histamine do

A

flushing, tachycardia, hypotension, pruritus and bronchospasm

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14
Q

common side effects of opiods

A

constipation, nausea, confusion, hallucinations, flushing, dry mouth, difficulty peeing, hypotension

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15
Q

rare side effects of opiods

A

urinary retention, pruritus, delerium, myoclonus, hyperalgesia, resp depression, sexual dysfunction, biliary spasm and visual disturbance

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16
Q

what to give for opiod toxicity

A

naloxone

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17
Q

what is naloxone

A

opioid competitive antagonist

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18
Q

who has a longer half life opiod or naloxone

A

opiods

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19
Q

what does naloxone decrease

A

ED50

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20
Q

what is a common long term complication of opoids

A

constipation

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21
Q

what to give with opiods to avoid side effects

A

large bowel stimulant

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22
Q

what laxatives not to give with opiods

A

bulk forming laxatives

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23
Q

describe methylnaltrexone

A

opioid antagonist that does not cross the blood-brain barrier

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24
Q

how do you give methylnaltrexone

A

comes as infection only

25
Q

whats good about methylnaltrexone

A

diminish the peripherally mediated side effects of opioids while maintaining central analgesic effects

26
Q

who is methylnaltrexone approved in

A

OIC in patients with chronic pain
patients with advanced illness receiving palliative care who have had an inadequate response to traditional laxatives and here it can be used as an adjunct

27
Q

Pain receptor activity can be directly blocked by

A

lidocaine

28
Q

how can NSAIDs work for post op pain

A

diminish local hormonal response

29
Q

neurotransmitter targets for analgesia

A

substance P, calcitonin gene-related peptide, aspartate, glutamate and GABA

30
Q

how does paracetamol result in analgesia

A

action on spinal receptors through NAPQI acting on the TPRA1 receptor blocking pain signal transmission

31
Q

what is Bupivacaine

A

local anaesthetic

32
Q

Bupivacaine binds to

A

sodium channels makes them inactive so that no depolarisation can occur

33
Q

2 sites of action of opiods

A 
presynaptic= inhibit neurotransmitter release 
postsynaptic= inhibitory
34
Q

morphine acts on what receptors

A

m

35
Q

what does action on m receptors do

A

inhibits release of several different neurotransmitters incl NE, acetylcholine, substance P

36
Q

where is vomitting controlled

A

vom centre in the brain stem

37
Q

where do afferent stimuli arrive at the CTZ from

A

chemoreceptors and pressure receptors in the gut and CNS, as well as peripheral pain receptors

38
Q

Ondansetron

A

selective serotonin receptor (5-HT3) antagonist

39
Q

good about ondasteron

A

not sleepy

can give IV

40
Q

Hyoscine

A

anticholinergic

41
Q

cyclizine

A

antihistamine, H1 receptor antagonist

42
Q

if an antihistamine cant cross BBB how does it work as an antiemetic

A

it cant

43
Q

dexamethasone

A

glucocorticoid

44
Q

what is dexamethasone used for

A

chemo N and V

45
Q

prochlorperazine

A

antipsychotic, also antiemetic

46
Q

Metoclopramide

A

dopamine receptor antagonist

47
Q

Metoclopramide and prochlorperazine side efefcts

A

extrapyramidal

48
Q

does domperidone cross BBB

A

no

49
Q

how to treat dystonic reaction

A

procyclidine

50
Q

how long does Procyclidine take to work

A

5-20 mins

51
Q

Aprepitant

A

really bad chemotherapy treatment -needs to be given before nausea develops

52
Q

Opioids have 3 potentially emetogenic mechanisms:

A

a direct effect on chemoreceptor trigger zone
enhanced vestibular sensitivity
delayed gastric emptying

53
Q

nausea and opiods

A

tollerance builds quickly

54
Q

chronic nausea and opiod use..

A

dopamine antagonist such as prochlorperazine or metoclopramide

55
Q

metoclopramide affect on the bowel

A

prokinetic

56
Q

what might you use haliperidol for

A

effective in opiate induced vomiting

57
Q

Ondansetron and opiate nausea

A

can help as opiods work on the CTZ

can cause constipation

58
Q

how often to give oramorph and why

A

every 4 hours - lasts 4-6 hours avoid break through pain

59
Q

what is the rescue dose of oraporph

A

⅙ of the total 34 hour dose

PPT (8 decks)

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