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Pharmacology II > Lecture 26: Pain Physiology > Flashcards

Lecture 26: Pain Physiology Flashcards

1
Q

What pain scale do we use in the clinic

A

Glasgow composite pain scale

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2
Q

When do you intervene on glascow pain scale

A

5/20 or 6/24

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3
Q

How often do you assess pain until patient is recovered from anesthesia

A

Every 15-30 minutes

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4
Q

How often do you assess pain in first 24hrs post-op

A

Every 1-4hrs

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5
Q

After analgesic intervention, how long after do you asses pain

A

15 minutes

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6
Q

Based on ear position, assign pain scale left to right

A

left: 0- absent
Middle: 1 moderately present
Right: 2- markedly present

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7
Q

Based on orbital tightening assign pain scale

A

Left: absent (eyes open)
Middle: 1- moderately present (eyes partially closed)
Right: 2- markedly present (squinted eyes)

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8
Q

Assign pain based on muzzle tension

A

left: 0-absent
Middle- 1- moderately present
Right: 2- markedly present- tense (elliptical shape)

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9
Q

Assign pain based on whisker change

A

Left: 0-absent
Middle: 1- moderately present (slightly curved or straight)
Right: 2-markedly present- straight or moving forward away from face

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10
Q

Assign pain based on head position

A

left- 0 absent
Middle: 1-moderately present- head aligned with shoulders
Right: 2-markedly present- head below shoulders or tilted down

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11
Q

What is wrong here that would indicate pain

A

Ears out- 2
Head down- 2
Eyes- squinted- 1

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12
Q

Assign pain based on ear position

A

left- 0
Middle: 1- ears to side
Right: 2- backwards

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13
Q

Assign pain based on orbital tightening

A

left- 0
Middle-1- slightly closed
Right: 2- squinting

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14
Q

Assign pain based on tension above eye

A

Left- 0
Middle-1
Right- 2- bone surfaces very obvious

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15
Q

assign pain based on prominent strained chewing muscles

A

Left- 0
Middle-1
Right-2

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16
Q

Score the following in chart and total pain score

A

Ears backwards- 1
Orbital tightening-0
Tension above eyes-0
Prominent strained chewing muscles-0
Mouth strained and pronounced chin- 0
Strained nostrils and flattening-0
Total-1

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17
Q

Score following chart and total pain score

A

ears backwards- 0
Orbital tightening-0
Tension above eyes- 1
Prominent strained chewing muscles- 0
Mouth strained and pronounced chin- 0
Strained nostrils and flattening- 0
Total-1

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18
Q

Score the following chart and total score

A

Ears back-2
Orbital tightening- 2
Tension above eye-0
Prominent strained chewing muscles- 2
Mouth strained and pronounced chin-1
Strained nostrils and flattening-1
Total-8

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19
Q

Score the following chart and total score

A

ears back-0
Orbital tightening-0
Tension above eye-1
Prominent strained chewing muscles- 0
Mouth strained and pronounced chin- 0
Strained nostrils and flattening- 0
Total-1

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20
Q

How can you tell if horse shows typical pain signs if just asleep vs actual pain

A

If you stimulate horse they should change their facial expressions if not painful

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21
Q

What can be used to block transduction

A
  1. Local anesthetics
  2. Opioids
  3. Alpha 2 agonists
  4. NSAIDS
  5. Corticosteroids
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22
Q

What can be used to block transmission

A
  1. GA
  2. Opioids
  3. Alpha 2 antagonists
  4. Benzodiazepines
  5. Acepromazine
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23
Q

What can be used to block modulation

A
  1. Local anesthetics
  2. Opioids
  3. Alpha 2 agonists
  4. NSAIDS
  5. NMDA antagonist (ketamine)
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24
Q

What can be used to block perception

A
  1. Local anesthesia
  2. Opioids
  3. Alpha 2 agonists
  4. Benzodiazepines
  5. Acepromazine
  6. NMDA antagonists
  7. GABA agonists
  8. Inhalant anesthesia
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25
Q

What would be a good pre-op protocol for neuter

A
  1. Opioids- buprenorphine, hydromorphone
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26
Q

What would be could intra-op pain control for neuter

A

Intratesticular block with lidocaine

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27
Q

What would be good post-op pain control for neuter

A

NSAIDS, buprenorphine

28
Q

What would be good pre-op pain protocol for femoral fracture

A
  1. Fentanyl and lidocaine CRI’s
  2. NSAIDS
  3. Hydromorphone, morphine, methadone (full mu’s)
29
Q

What would be good intra-op pain control for femoral fracture

A
  1. Epidural
  2. Sciatic/ femoral nerve block
30
Q

What would be good post-op pain protocol for femoral fracture

A
  1. If epidural effective may not need a lot
  2. If not effective- fentanyl CRI, morphine, hydromorphone q4-6hrs
31
Q

What is the space for lumbosacral epidural

A

Between L7 and S1

32
Q

If epidural failed what are good post-op pain controls

A

Ketamine, fentanyl, lidocaine

33
Q

What would be a good pre-op pain control for sx involving opening chest cavity

A

Hydromorphone, morphine, methadone (full mu)

34
Q

What would be good intra-op pain protocol for sx involving opening chest cavity

A
  1. Intercostal nerve block
35
Q

What would be good post-op pain protocol for sx involving opening chest cavity

A

Fentanyl and lidocaine CRI

36
Q

Where is an intercostal nerve block done in relation to surgical incision

A

1 space cranial to incision and 2 spaces caudal to incision

37
Q

How does interpleural regional anesthesia work

A

Place catheter and leave in to inject bupivicaine or lidocaine every so often

38
Q

What is good pre-op pain protocol for mandibular fracture

A
  1. Methadone, hydromorphone, morphine
  2. NSAIDS
39
Q

What is good intra-op pain protocol for mandibular fracture

A
  1. Mandibular nerve block
  2. Fentanyl, ketamine and/or lidocaine
40
Q

What is good post-op pain control for mandibular fracture

A

Hydromorphone, buprenorphine

41
Q

What drugs are standard of care for treatment of pain

A

Opioids and NSAIDS

42
Q

You can’t give lidocaine IV to what species

A

Cats

43
Q

Local anesthesia blocks __

A

Transmission of signal along nerve

44
Q

Regional and local anesthesia blocks transmission up the nerve to the spinal cord and therefore there is no ___ or __

A

Modulation or perception

45
Q

What can you combine local anesthetics with for synergistic effect

A

Opioids or alpha 2 agonists

46
Q

What is commonly used to tx mild to severe pain

A

Opioids

47
Q

___inhibits the action potential of nociceptive neurons

A

Opioids

48
Q

Where do opioids act

A

Midbrain, spinal cord, peripheral nociceptors

49
Q

The distribution of opioid receptors and response to treatment is ___dependent

A

Species

50
Q

Activation of alpha 2 receptors in CNS and spinal cord causes ___

A

Decreased sympathetic discharge leading to sedation and analgesia

51
Q

Alpha 2 agonists inhibit ___release from nociceptor neurons

A

Neurotransmitter

52
Q

NSAIDS block__

A

COX pathway

53
Q

__is standard use for inflammatory pain and acute pain unless contraindicated for medical reasons

A

NSAIDS

54
Q

__return threshold of nociceptors to normal range

A

NSAIDS

55
Q

What are some examples of NMDA antagonists

A

Ketamine, methadone

56
Q

NMDA antagonists are __transmission inhibitors

A

Nociceptive

57
Q

NMDA receptors are unregulated in ___pain and should be considered in these cases

A

Wind up pain

58
Q

What do benzodiazepines contribute to a pain protocol

A

Alter conscious state which may alter perception of pain

59
Q

T or F: benzodiazepines are analgesic

A

False

60
Q

What do tricyclic antidepressants do you pain pathway and what is an example

A

Ex: amtriptyline
Alter 5-HT and NE reputable

61
Q

What kind of pain is gabapentin useful in

A

Neuropathic pain, decreased development of chronic pain

62
Q

How do corticosteroids work in pain pathway

A

Inhibit PLA2 and arachidonic acid pathway

63
Q

T or F: you should use corticosteroids with NSAIDS

A

False

64
Q

What is the endogenous ligand for maropitant and how might this be helpful with pain

A

Substance P is endogenous ligand and it may inhibit/prevent transmission of signal

65
Q

CRI”s provide __ concentration and ___

A

Consistent plasma concentration and efficacy

66
Q

CRI’s are used with what kind of drugs

A

Potent, short acting (ex: fentanyl)

Pharmacology II (34 decks)

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