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DDT > Pain > Flashcards

Pain Flashcards

1
Q

Define analgesia

A

Inability to feel pain, without removing all feeling or ability to move muscles

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2
Q

Define analgesic

A

Drug used to achieve analgesia

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3
Q

Define anaesthetic

A

Drug used to eliminate all sensation, including pain

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4
Q

What is a neuromuscular blockade?

A

Also known as muscle relaxant

Works by blocking the neuromuscular junction

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5
Q

What is a perineural blockade?

A

Injection to selectively block a nerve root

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6
Q

What is radicular pain?

A

Pain that radiates into a lower extremity

e.g. sciatica

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7
Q

What are the 5 types of sensory receptors?

A 
Mechanoreceptor
Nociceptors
Chemoreceptors
Thermoreceptors
Photoreceptors
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8
Q

What is the pathway of a pain signal?

A

Afferent peripheral nerve (nociceptor)
Synapses with interneuron in spinal cord in dorsal horn
Releases glutamate which binds to AMPA and NMDA receptors
Thalamus
Cortex

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9
Q

What is nociceptive pain?

A

Sensation of pain in response to detection of potentially damaging stimuli

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10
Q

What is neuropathic pain?

A

Pained caused by damage to the sensory nervous system

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11
Q

What is pain wind-up?

A

Perceived increase in pain intensity over time when the stimulus is applied repeatedly
Caused by repeated stimulation of group C nerve fibres and priming of the NMDA receptor response

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12
Q

What is Ketamine and how does it work?

A

Used as an IV anaesthetic
NMDA receptor antagonist
Leads to inhibition of CNS

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13
Q

How does Nitrous Oxide work as an anaesthetic (and what is it also known by)?

A

Antagonist of NMDA, AMPA and Kainate receptors

Also known as Entonox

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14
Q

What are the 4 types of receptor that opioids bind to?

A

Mu
Kappa
Delta
ORL1

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15
Q

What type of receptor are opioid receptors?

A

GPCR - coupled to Gi/o

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16
Q

What are the downstream effects if the Go receptor?

A

Potassium channels open
Potassium efflux
Hyperpolarisation
Less likely to reach action potential threshold

Also inactivates VOCCs, preventing neurotransmitter release

17
Q

What 5 receptors are coupled to a Gi/o protein?

A 
a2-adrenoreceptors
M2 and M4 receptors
All opioid receptors 
5-HT1 receptor
GABA-b receptor
18
Q

How does the GABA-a receptor work?

A

It is a ligand-gated chloride channel
Allows chloride ion influx
Hyperpolarisation
Less likely to reach action potential threshold

19
Q

Is Glycine an excitatory or inhibitory neurotransmitter?

A

Inhibitory

Also works on ligand gated chloride channels

20
Q

What are the two types of neuromuscular blockade?

A

Depolarising

Non-depolarising

21
Q

How do depolarising neuromuscular blockades work?

A

Agonist of nAchRs
Causes persistent refractory depolarisation
Motor endplate becomes inexcitable
(Ach normally released in brief spurts and rapidly hydrolysed)

22
Q

Example of a depolarising neuromuscular blockade

  • administration
  • structure
  • how is it broken down
A

Succinylcholine

  • Administered by IV
  • Looks like two Ach joined together
  • Broken down by plasma cholinesterase
23
Q

How do non-depolarising neuromuscular blockades work?

A

They are competitive reversible antagonists of nAchRs

24
Q

How does botox work?

A

Botox targets proteins in the SNARE complex

Prevents exocytosis of Ach

25
Q

How does Neostigmine work?

A

Inhibits acetylcholine esterase
Prevents breakdown of Ach
Used to treat Alzheimers and Parkinson’s

26
Q

How is Ach recycled?

A

Acetylcholine esterase breaks it down into acetate and choline
Choline reuptaken into presynaptic membrane by cotransportation with sodium ions
Choline + Acteyl Coa makes more Ach
Repackaged into vesicles

27
Q

What 3 things can anticonvulsant drugs be used to treat?

A

Seizures
Mood disorders/stabilisers
Neuropathic pain

28
Q

How do anticonvulsant drugs work?

A

Block sodium channels
Block calcium channels
Enhance GABA function

29
Q

By what 3 ways can GABA neurotransmission be enhanced?

A

Positive allosteric modulation of GABA-a receptors e.g. by benzodiazepines
Inhibition of GABA transaminase (preventing GABA breakdown)
Inhibition of the GAT1 reuptake transporter

30
Q

Example of a drug that inhibits sodium channels

A

Carbamazepine

Specifically Na1.8 channels

31
Q

Examples of 2 drugs that inhibits calcium channels

How do they work?

A

Gabapentin and Pregabalin
Block t-type calcium channels
Also prevent insertion of calcium channels into the membrane
Reduce expression of a2-delta subunits in calcium channels

32
Q

How does neuropathic pain after injury arise?

A

Injury causes inflammation
Release of inflammatory mediators
Inflammatory mediates upregulate a-adrenoreceptors on the sensory nerve and upregulate NMDA receptors on the spinal cord synapse
Lowers nerve activation threshold

33
Q

What is a nociceptor?

A

Sensory neuron that responds to potentially damaging stimuli
Detection of noxious stimuli transduced into electrical energy

34
Q

What are the two types of nociceptor axon?

A

A-delta fiber axons

C fiber axons

35
Q

What is the difference between A-delta fiber axons and C fiber axons?

A

A-delta fiber axons are myelinated and cause feeling of sharp pain. Action potentials are initiated through specific TRP channels
C fiber axons are non myelinated and cause feeling of dull, prolonged pain. They are polymodal - response to a range of stimuli

36
Q

How do thermoTRP channels work?

A

Ion channel, opens in response to extreme heat

The TRPV1 channel opens in response to 42 degrees, also vanilloids present in chilli

37
Q

What is hyperalgesia?

A

Increased sensitivity to pain, usually caused by inflammatory mediators

38
Q

What are A-beta fibers?

A

Detect non-noxious, mechanical stimuli

39
Q

What are 3 possible causes of phantom pain?

A
  1. Neuroma (tumour on a nerve sheath cell), causing abnormal firing of action potentials
  2. Degeneration of C fiber axons due to injury. A fibers branch into same lamina, so A fiber input becomes reported as noxious stimuli
  3. Cortical remapping following amputation

DDT (10 decks)

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