Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology > Introduction to pain and analgesics > Flashcards

Introduction to pain and analgesics Flashcards

1
Q

IASP definition of pain

A

pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms as such damage. Pain is perceived

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the 3 pain fibers

A

1) Ab fiber
2) Ad fiber
3) C fiber

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Ab pain fiber

A
  • myelinated
  • triggered with non-noxious stimuluses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ad pain fiber

A
  • myelinated
  • triggered with noxious stimuluses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

C pain fiber

A
  • non myelinated
  • dull achey pain
  • triggered with noxious heat and chemical stimuli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

where are the 3 areas that you can modulate pain CNS

A

1) dorsal horn
2) cortex
3) PAG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the two pathways

A

1) spinothalamic tract (ascending)
2) spinobulbar tract (descending)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

where does the spinothalamic relay

A

conveys discriminative/localization aspects of pain by projection to the thalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

where does the spinobulbar tract relay too

A

convays the affective/intensity aspects of pain and is able to recruit descending controls via the periaqueductal gray, pontine locus coeruleus and rostroventriomedial medulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the types of chronic pain

A
  • nocicpetive
  • neuropathic
  • mixed (nociceptive and neuropathic)
  • visceral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

examples of nociceptive chronic pain

A

OA and RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

examples of neuropathic pain

A

Central
- post-stoke
- MS
- SCI
- Phantom pain
Peripheral
- Post-herpetic neuralgia
- Diabetic neuropathy
- HIV related neuropathic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

examples of mixed chronic pain

A
  • Low back
  • Cancer
  • Fibromyalgia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

examples of visceral chronic pain

A
  • Internal organs
  • Pancreatitis
  • Inflammatory bowel syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Physical sensations of neuropathic pain

A
  • numbness
  • tingling
  • burning
  • paresthetic
  • paroxysmal
  • lancinating
  • electric like
  • raw skin
  • shooting
  • deep, dull, bone like ache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Allodynia

A

Pain from a stimulus that does not normally provoke pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hyperalgesia

A

exaggerated response to a painful stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Hyperesthesias

A

exaggerated response to touch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

hyperpathy

A

persistant pain event after the cause of pain has been removed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what an analgesic

A

painkiller
is divided into 2 categories: nonopioid analgestics and opioid analgesics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

nonopioid analgestics

A

are comprised of drugs such as acetaminophen, aspirin, ibubrofen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

opioid analgestics

A

naturally occuring semisynthetic and synthetic agests are are characterized by their ability to relieve moderate to severe pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what analgestics modulate at the brain

A
  • opioids
  • NSAIDs
  • Ketamine
  • TCA
  • Gabapentionoids
  • Benzodiazepines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what analgestics modulate at the SC

A
  • opioids
  • neuraxial local anesthetics
  • ketamine
  • alpha- agonist
  • TCA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what analgestics modulate at the peripheral nerve

A
  • opioids
  • TCA
  • alpha agonist
  • ketamine
  • nerve block with local anaesthetic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what analgestics modulate at the tissue

A
  • opioids
  • NSAIDs
  • local anesthetic infiltration
  • corticosteroid
  • cooling, immobilization, elevation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what conditions are muscle relaxants able to treat

A

hyper excitable skeletal muscle such as spasticity and muscle spasms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

where are the 3 areas that muscle relaxants can block at

A

1) SC level
2) neuromuscular junction
3) directly within the muscle fiber

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what are some common symptoms of spasticity

A
  • muscle stiffness
  • muscle spasms
  • rapid muscle contractions (clonus)
  • fixed joints (contractures)
  • exaggerated muscle jerks
  • pain or tightness around joints
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what is the primary goals for muscle relaxants?

A

1) decrease in skeletal muscle excitability
2) decrease pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what are the 2 types of skeletal muscle relaxants

A

anti-spasticity or antispasmodic agents

32
Q

what is labeled for use only in epilepsy and postherpetic neuralgia but is also used as a muscle relaxant?

A

Gabapentin

33
Q

what is labeled only for the use of ALS but is also used as a muscle relaxant?

A

Riluzole

34
Q

what are the most common anti-spasticity drugs

A

1) Baclofen
2) Dantrolene
3) Tizanidine
4) Botulinum toxin

35
Q

what does Baclofen act on

A

Gaba-B receptors in the SC to inhibit reflexes and decrease spasticity

36
Q

what does Dantrolene act on

A

directly on the skeletal muscles inhibiting Ca2+ release

37
Q

what does Tizanidine act on

A

an alpha 2 adrenergic agonist that produces pre synaptic inhibition (CNS)

38
Q

what does Botulinum Toxin work at

A

the neuromuscular junction inhibiting acetylcholine release

39
Q

what are spasmolytics

A

muscle relaxants that inhibit muscle spasms (more for peripheral conditions)

40
Q

what are common spasmolytics?

A

1) Carisoprodol (soma)
2) Cyclobenzaprine (flexeril)
3) Methocarbamol (robaxin)
4) Orphenadrine (norflex)

41
Q

Carisoprodol (soma) acts on

A

believed to alter interneuronal activity in the SC and descending reticular formation.

42
Q

Cyclobenzaprine (Flexeril) acts on

A

the CNS by decreasing the activity in the brainstem

43
Q

Methocarbamol (Robaxin) acts on

A

the CNS

44
Q

Orphenadrine (Norflex) acts on

A

has anticholinergic properties but unsure of direct effect

45
Q

what are the key differences between anti-spasticity and spasmolytics?

A
  • anti-spasticity: for CNS conditions with increased muscle tone, have more specific targets, more chronic in nature
  • Spasmolytics: more PNS conditions, less clear targets, often used for acute conditions
46
Q

what are polysynaptic inhibitors

A

same as spasmolytics; theorized to work on the reflex arc decreasing alpha motor neuron excitability and therefore cause muscle relaxation

47
Q

what are the uses of polysynaptic inhibitors

A
  • Adjunts to rest and PT for releif of muscle spasms associated with acute painful MSK injuries
  • sometimes incorporated into the same tabel with an analgestic
48
Q

what are the adverse affects of polysynaptic inhibitors

A
  • drowsiness, dizziness
  • nauseas, lightheadesness, vertigo, ataxia, headache
  • tolerace and physical dependance
49
Q

what are agents that are used to treat spasticity

A

1) Baclofen
2) Ticanidine
3) Dantrolene
4) Botulinum toxin
5) Gabapentin
6) Diazepam (benzodiazepines)

50
Q

Diazepam (Valium) definition and what it works on

A
  • benzodiazepine agent
  • works by increasing the inhibitory effects at the CNS/SC synapses that use GABA. Less excited alpha motor neuron
51
Q

what are the 6 intrinsic benzoduazepine effects

A

1) anxiolysis
2) anterograde
3) amnesia
4) sedation/hypnosis
5) anticonvulsant
6) antiemesis and muscle relaxation

52
Q

what are the therapeutic uses of Diazepam (Valium)

A
  • treating muscle spasms
  • associated with inhibiting spasms of the larynx with the tentanus toxin
53
Q

what are the adverse effects of Diazepam (Valium)

A
  • sedation and reduction of psychomotor ability
  • long term use can lead to tolerance and dependance
  • sudden withdraw can lead to seizures, anxiety, agitation, tachycardia, and even death/coma
54
Q

what is a drug that can be used to reduce the effects of Diazepam (Valium) overdose

A

Flumazenil

55
Q

Baclofen (Lioresal) what is it and where does it effect

A
  • Derivative of the central inhibitory GABA
  • binds to GABA B receptors in the SC producing a less excited alpha motor neuron
56
Q

what are the uses of Baclofen

A
  • used to treat spasticity in SC lesions (paraplegia, quadriplegia, SC demyelination from MS)
  • does not cause as much generalized muscle weakness
57
Q

what are the adverse effects of Baclofen (Lioresal)

A
  • drowsiness
  • confusion and hallucinations
  • nausea, muscular weakness, headache
58
Q

what are the uses for Baclofen intrathecal (spinal) injections

A
  • used for severe spasticity
  • may decrease spasticity with a smaller dose with fewer systemic effects
59
Q

what are the uses for intrathecal baclofen pump

A

able to adjust to deliver the drug at a slow continuous rate. achieves best clinical reduction in spasticity

60
Q

intrathecal baclofen adverse effects

A
  • pump malfunction can cause withdrawal symptoms
  • increased delivery can cause overdose
  • pt can build up tolerance to drug
61
Q

what is the primary agent for adrenergic alpha 2 receptor agonists

A

Trizanidine (zanaflex)

62
Q

what do adrenergic alpha-2 receptor agonists? Tizanidine (Zanaflex) work to do

A
  • stimulate alpha 2 receptors in the spinal interneurons causing inhibition of the interneurons causing decrease in excitatory input to the alpha motor neurons
  • decreases excitability at both the pre and post synaptic inhibition
63
Q

what are the uses of Alpha-2 Agonists

A
  • control spasticity from UMN lesions
  • generally has milder side effects and produces less weakness
  • Tizanidine better then Clonidine due to less side effects
64
Q

what are the adverse effects of alpha-2 Agonists

A
  • sedation, dizziness, dry mouth
  • less generalized weakness
65
Q

Gabapentin (Neurontin)

A
  • developed as an anti-seizure med
  • Enhances GABA effect in the SC
66
Q

Uses of Gabapentin (Neurotin)

A
  • decrease spasticity with SCI and MS
  • best used in combo with other anti- spasticity agents
  • might be helpful in reducing chronic pain
67
Q

what are the adverse effects of Gabapentin (Neurotin)

A

sedation, fatigue, dizziness, ataxia

68
Q

Dantrolene Sodium (Dantrium)

A

only direct muscle relaxant

69
Q

what does Dantrolene Sodium (Dantrium) react on

A

inhibits the release of Ca2+ working directly on the sarcoplasmic reticulum

70
Q

what are the uses in Dantrolene Sodium (Dantrium)

A

treating severe spasticity (UMN lesions)

71
Q

what are the adverse effects of Dantrolene Sodium (Dantrium)

A
  • generalized muscle weakness
  • severe hepatotoxicity and fatal hepatitis
72
Q

Botulinum toxin (Botox)

A

muscle paralytic injected locally

73
Q

what are the serotypes of botulinum toxin

A

Type A (Botox) and Type B (Myobloc)

74
Q

what are the limitations of botulinum toxin

A
  • local irritation at injection
  • have a limit of total dose
75
Q

what is the mechanism of botox

A

inhibits Ach release at the NMJ causing paralysis within 3-7 days lasting 2-3 mo.

76
Q

what are the effects of botox injection wearoff

A

a new presynaptic terminal sprouts with new source of Ach, need a new injection again

Pharmacology (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions