GI mc 2

Question 1

hyperalgesia

Answer 1

increased sensitivity to stimuli

Question 2

allodynia

Answer 2

misperception of pain to non-noxious stimuli

Question 3

peripheral pain receptors and prolonged pain

Answer 3

can become sensitised

Question 4

transmission of incoming nociceptive impulses is modulated by…

Answer 4

dorsal horn

Question 5

where is pain transmitted

Answer 5

dorsal horn of the spinal cord

Question 6

what do pain impulses do in the dorsal horn

Answer 6

decussate

Question 7

where do pain impulses go when they have decussated

Answer 7

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

Question 8

hyperalgesia

Answer 8

increased sensitivity to stimuli

Question 9

allodynia

Answer 9

misperception of pain to non-noxious stimuli

Question 10

what does dorsal horn recieve impulses from

Answer 10

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

Question 11

limbic cortical systems examples

Answer 11

orbital frontal cortex, amygdala, and hypothalamus

Question 12

after morphine is given what is released

Answer 12

histamine

Question 13

what does histamine do

Answer 13

flushing, tachycardia, hypotension, pruritus and bronchospasm

Question 14

common side effects of opiods

Answer 14

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

Question 15

rare side effects of opiods

Answer 15

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

Question 16

what to give for opiod toxicity

Answer 16

naloxone

Question 17

what is naloxone

Answer 17

opioid competitive antagonist

Question 18

who has a longer half life opiod or naloxone

Answer 18

opiods

Question 19

what does naloxone decrease

Answer 19

ED50

Question 20

what is a common long term complication of opoids

Answer 20

constipation

Question 21

what to give with opiods to avoid side effects

Answer 21

large bowel stimulant

Question 22

what laxatives not to give with opiods

Answer 22

bulk forming laxatives

Question 23

describe methylnaltrexone

Answer 23

opioid antagonist that does not cross the blood-brain barrier

Question 24

how do you give methylnaltrexone

Answer 24

comes as infection only

Question 25

whats good about methylnaltrexone

Answer 25

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

Question 26

who is methylnaltrexone approved in

Answer 26

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

Question 27

Pain receptor activity can be directly blocked by

Answer 27

lidocaine

Question 28

how can NSAIDs work for post op pain

Answer 28

diminish local hormonal response

Question 29

neurotransmitter targets for analgesia

Answer 29

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

Question 30

how does paracetamol result in analgesia

Answer 30

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

Question 31

what is Bupivacaine

Answer 31

local anaesthetic

Question 32

Bupivacaine binds to

Answer 32

sodium channels makes them inactive so that no depolarisation can occur

Question 33

2 sites of action of opiods

Answer 33

``` presynaptic= inhibit neurotransmitter release postsynaptic= inhibitory ```

Question 34

morphine acts on what receptors

Answer 34

m

Question 35

what does action on m receptors do

Answer 35

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

Question 36

where is vomitting controlled

Answer 36

vom centre in the brain stem

Question 37

where do afferent stimuli arrive at the CTZ from

Answer 37

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

Question 38

Ondansetron

Answer 38

selective serotonin receptor (5-HT3) antagonist

Question 39

good about ondasteron

Answer 39

not sleepy | can give IV

Question 40

Hyoscine

Answer 40

anticholinergic

Question 41

cyclizine

Answer 41

antihistamine, H1 receptor antagonist

Question 42

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

Answer 42

it cant

Question 43

dexamethasone

Answer 43

glucocorticoid

Question 44

what is dexamethasone used for

Answer 44

chemo N and V

Question 45

prochlorperazine

Answer 45

antipsychotic, also antiemetic

Question 46

Metoclopramide

Answer 46

dopamine receptor antagonist

Question 47

Metoclopramide and prochlorperazine side efefcts

Answer 47

extrapyramidal

Question 48

does domperidone cross BBB

Answer 48

no

Question 49

how to treat dystonic reaction

Answer 49

procyclidine

Question 50

how long does Procyclidine take to work

Answer 50

5-20 mins

Question 51

Aprepitant

Answer 51

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

Question 52

Opioids have 3 potentially emetogenic mechanisms:

Answer 52

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

Question 53

nausea and opiods

Answer 53

tollerance builds quickly

Question 54

chronic nausea and opiod use..

Answer 54

dopamine antagonist such as prochlorperazine or metoclopramide

Question 55

metoclopramide affect on the bowel

Answer 55

prokinetic

Question 56

what might you use haliperidol for

Answer 56

effective in opiate induced vomiting

Question 57

Ondansetron and opiate nausea

Answer 57

can help as opiods work on the CTZ | can cause constipation

Question 58

how often to give oramorph and why

Answer 58

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

Question 59

what is the rescue dose of oraporph

Answer 59

⅙ of the total 34 hour dose