H18:87-94-Pain

Question 1

3 fibers of the peripheral nerve,,,

Answer 1

Abeta
Adelta
C (unmyelinated)
and primary sensory, motor and sympathetic postgang. neurons

Question 2

Pain fibers (also only ones to innervate cornea)

Answer 2

Adelta and C fibers

Question 3

8 types of noxious stimuli

Answer 3

Cold, intense heat, intense mechanical distortion, ATP, serotoninc, bradykinin, histamine, acidic environment

Question 4

What is sensitization

Answer 4

when a prolonged and or frequent stimuli results in a lowering of the depolarization threshold of a primary afferent nerve.

Question 5

three peptides released by nociceptors

Answer 5

Substance P
Calcitonin gene-related peptide
glutamate (NT)

Question 6

What is referred pain ?

Answer 6

the convergence of sensory inputs on a single spinal pain-transmission neuron

Question 7

Two areas of the brain responsible for emotional response to pain

Answer 7

cingulate gyrus

insular cortex

Question 8

General pathway of spinothalamic tract

Answer 8

contralaterally through anterior white comissure then up the anterolateral white matter, lateral brainstem to the thalamus

Question 9

what is the duality of pain

Answer 9

sensation and emotion

Question 10

Three descriptors for neuropathic pain.

Answer 10

burning, electric,tingling

Question 11

When a patient is on opioids when should you have naloxone close by ?

Answer 11

High doses or if patient has pulmonary disease.

Question 12

4 frequent and bothersome ADRS of opioids.

Answer 12

N/V/constipation/pruritus

Question 13

What is a PCA device ?

Answer 13

Patient controlled analgesia - give loading dose then bolus dose is delivered (1 mg morphine, .2mg hydromorphone, 10 mcg fentanyl) with a lockout phase for 10 minutes and a limit on total dose in 1 hour.

Question 14

opioid that can be delivered rectally,transdermally, IV and orally

Answer 14

fentanyl

Question 15

What is Alvimopan (Entereg) and methylnaltrexone (Rellistor)

Answer 15

Peripheral opioid antagonist for ileus after abdominal surgery
same but for chronic constipation due to chronic opioid use

Question 16

How to ddx myofascial pain vs neuropathic pain

Answer 16

inject lidocaine at trigger point and myofascial pain will diminish

Question 17

Signs of neuropathic pain

Answer 17

atrophy, allodynia, weakness, decreased DTR

Question 18

8 conditions that TCAs have been shown to benefit and/or produce analgesia .

Answer 18

Chronic low back pain, cancer, dejerine syndrome,postherpetic,DM , tension and migraine HA, RA

Question 19

Anti-depressants that can be used for neuropathic pain (3)

Answer 19

Prozac (fluoxetine)
Cymbalta (duloxetine)
Effexor (venlafaxine)

Question 20

Anticonvulsants that can be used for neuropathic pain (3)

Answer 20

Gabapentin ( Neurontin)
Lyrica (pregabalin)
Tegretol ( crabamazapine)

Question 21

2 opioids that have mixed agonist-antagonist actions at the mew receptor

Answer 21

buprenorphine

butorphanol

Question 22

four long acting opioids used for long-term outpt. use

Answer 22

transdermal fentanyl, levorphanol, methadone, SR morphine

Question 23

What is Subutex
Suboxone
Vivitrol

Answer 23

Subutex (buprenorphine) which is an agonist-antagonist (full ag delta, antag at kappa,mew partial Ag)
Suboxone (buprenorphine + naloxone (Evzio/Narcan)–> opioid antagonist
Vivitrol = naltrexone opioid antagonist (longer t1/2 than nalox)