PAIN Flashcards
What are opioids used for?
reduce pain-defense mech to retract from danger/injurious agents
What system does opioid act on?
CNS; thalamus, basal ganglia, anterior cingulate, insula–most consistently activated in acute pain
How does the brainstem come into play?
BS and the descending pain modulatory system play a role in the ANTICIPATION and perception of pain. (can occur quickly)
Clinical chronic pain
causes increasing activation of the pre-frontal cortical region which implies that chronic pain disturbs the cognitive and emotion perception and processing of everyday experience.
At what levels can pain come into play?
..
What does the interaction between pre-frontal cortex, basal ganglia, and amygdala correlate to?
hypervigilence…
In what area does the opioid take action?
..
What immediately happens when tissue is damaged?
Immediate release of inflamm chemicals (excitatory NT)-eg histamine and bradykinin
What does bradykinin stimulate?
the release of
What are the two types of transmission?
chemical..mechanical (order?)
What are the steps of perception?
..
What two groups are pain divided into?
Acute and chronic pain
Examples of acute pain
- *heart attack
- acute appendicitis
- *bone fracture
- muscle sprain
- prolapsed disc
Examples of chronic pain
- cancer
- neuropathy
- inflammation
- distensions
- eruptions
Notes of Acute Pain
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Notes of Chronic Pain
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Acute pain management
reduce pain–>treat cause
Chronic pain management
focused on reducing the pain
A&C Pain management
- minimize pain, limit disability, maximize person’s fxn
- MULTIDISCIPLINARY-blends physical, emotional, intellectual and social variables
4 main effects of chronic pain on the patient
- physical functioning
- ability to perform activities of daily living
- sleep disturbances - psychological morbidity
- depression
- anxiety
- anger
- loss of self-esteem - social consequences
- relationship with family/friends
- intimacy/sexual activity
- social isolation - societal consequences
- healthcare cost
- disability
- lost workdays
What is the most successful pain treatment?
OPIOIDS
Important figures
Hippocrates, Marcus Aurelius, Galen of Pergamum, Solomon Snyder, Candace Pert
Ways to make/get OPIOID
- extraction
- Synthesis
- endogenous (endorphins)
What receptor do opioids use?
the OPIOID RECEPTOR! in the nervous system
What are the different types of receptors?
*Delta
Kappa
Mu
Nociceptin
Function of Delta Receptors
- analgesia
- antidepressant effects
- physical dependence
Function of Kappa Receptors
- spinal analgesia
- sedation
- miosis
- inhibition of ADH release
- dysphoria
Define analgesis
absence of pain without loss of consciousness; pain consists of BOTH sensory and affective (emotional) components. Opioids analgesic are unique in that they reduce both aspects of the pain experience
Define antidepressant
alleviate mood disorder (some are related to euphoria..recreation drugs)
Define physical dependence
chronic use of a drug that has produced tolerance
Define sedation
.
Define dysphoria
.
how do opioid induce analgesia?
by reducing the amount of information
LOCATION, LOCATION, LOCATION
(**Where are which receptors expressed???)
- presynpatic: mu, kappa, delta
- reduce calcium and increase potassium=decrease/inhibit transmitter release (hyperpolarize=reduce amt of AP)
- postsynaptic: mu
- increase/stimulate potassium–>IPSP
At which two sites do opiod act?
pre and post synaptic opioid receptors
Review p 22 diagram
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Acute effects of Opiates
inhibit LC neurons by activating K+ channels and inhibiting Na-dependent inward current
-via G-proteins AND regulation of Na current via inhibition of cAMP pathway
Chronic effects of Opiates
cAMP, PKA, TF
CNS effects-Euphoria
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CNS effects-Sedation
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CNS effects-Cough Suppression
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CNS effects-Respiratory Depression (** major prob with OD)
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CNS effects-Miosis
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CNS effects-Temperature
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STRONG Opiods
MORPHINE, METHADONE, MERPERDINE
Moderately STRONG Opioids
CODEINE, OXYCODONE
Receptor agonist-ANTagonist Opioids
PENTAZOCINE, BUPRENORPHINE
ANTagonist Opioids**
NALOXONE**
Why not automatically use STRONG opiods?
dependence=no bueno
MORPHINE
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MEPERIDINE
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HYDROCODONE
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CODEINE
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Euphoria Diagram ..online ppt
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PENTAZOCINE
+(delta agonist)/-(kappa agnist, mu ANTagonist)–TWO enantiomers
Indication:
Side Effects:
Withdrawal:
NALOXONE
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Signs!!!
- blue lips
- unresponsive to pain stimuli
Naloxone (narcan) if effective, but….
Opiod is still around, after injection in ~2hrs high (and OD) will return.
OD-Nervous system
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OD-Heart, blood and circulation
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OD-Stomach
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OD-sexual organs
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METHADONE
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