Multimodal Flashcards
4 types of pain stimulus:
- mechanical
- thermal
- chemical
- sensitizing hormones (prostaglandins & substance P)
Alpha and delta fibers transmit (fast/slow) pain signals
fast
C fibers transmit (fast/slow) pain signals
slow
Define multimodal pain management:
- multiple classes
- different receptors
- enhance analgesia
- reduce side effects
4 elements of pain processing:
1) transduction
2) transmission
3) modulation
4) perception
Pathway of pain signals:
- peripheral nerve
- a delta & C fibers
- afferent pathway
- spinothalamic tract
- periaqueductal gray
- thalamus
- sensory cortex
- efferent pathway
What type of receptors are opioid receptors and where are they located?
- G-protein coupled receptors
- brain, spine, periphery
Define biased agonism:
distinct ligands can bind to G-protein coupled receptor activating differential signaling pathways
- goal is to activate analgesic action w/o the SE
Primary effect of NSAIDs:
inhibition of COX preventing transformation of arachidonic acid to prostaglandins
List the factors that influence local anesthetic activity
- dosage
- additives
- site of injection
- combination with other LA
- pregnancy
A neuraxial blockade affecting the following tissues would correlate to which spine level:
Peripheral
Cardiac
Splanchnic
peripheral = T1-L2
cardiac = T1-T4
splanchnic = T6-L1
Contraindications to regional/neuraxial anesthesia:
- pt refusal
- sepsis
- allergy to meds
- inability to position
- neuropathy
- spinal stenosis
- hx of spine sx
- MS
- spina bifida
- aortic stenosis
- coagulopathy
2 NMDA antagonists:
1) Magnesium
2) Ketamine
What increases the potency of a2-adrenergic agonists?
concomitant opioid therapy
MOA of cannabinoid receptor agonists:
endogenous/exogenous compounds bind to inhibitory cannabinoid receptors, decreasing NT release
