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Biochemistry Final Exam > Pain, Analgesia, and Anesthesia > Flashcards

Pain, Analgesia, and Anesthesia Flashcards

1
Q

What is an unpleasant sensory or emotional experience associated with actual or potential tissue damage?

A

pain

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2
Q

What happens when we experience pain of moderate to high intensity?

A

it is accompanied by anxiety and urge to escape or terminate the feeling

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3
Q

What unconscious activity is induced by a harmful stimulus applied to sense receptors?

A

nociception

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4
Q

_____ are harmful, poisonous, or very unpleasant stimuli.

A

Noxious stimuli

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5
Q

____ is an exaggerated response to a noxious stimulus.

A

Hyperalgesia

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6
Q

____ is the sensation of pain in response to a normally innocuous stimulus (e.g. painful sensation of a warm shower from damaged skin).

A

Allodynia

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7
Q

Is all pain accompanied with an emotional experience?

A

YES

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8
Q

_____ is when intense, repeated, or prolonged stimuli are applied to inflamed tissues and the threshold for activating primary afferent nociceptors is lowered and the frequency of firing is higher for all stimulus intensities.

A

Sensitization

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9
Q

What happens when the primary afferent nociceptors’ threshold is lowered?

A

the frequency of firing for all stimulus intensities is HIGHER, which means the area is more sensitized

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10
Q

Which inflammatory mediators contribute to the process of sensitization?

A

bradykinin (BK)
nerve-growth factor (NGF)
prostaglandins (PGs)
leukotrienes (LTs)

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11
Q

What do hyperalgesia and allodynia signify?

A

increased sensitivity of nociceptive afferent fibers (nociception)

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12
Q

Over time, does sensitization enhance or diminish the pain response?

A

enhance

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13
Q

What is the inability or reduced ability to feel pain without the loss of consciousness or other sensations?

A

analgesia

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14
Q

____ are substances that reduce the ability to feel pain (e.g. opioids, aspirin, etc.).

A

Analgesics

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15
Q

What is the insensitivity to pain?

A

anesthesia

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16
Q

What are the substances called that produce a general insensitivity to pain?

A

anesthetics

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17
Q

_____ anesthetics depress the CNS to a sufficient degree to permit the performance of surgery and unpleasant procedures.

A

General

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18
Q

____ anesthetics are substances that, when in contact with a nerve trunk, can cause both sensory and motor paralysis in the area innervated.

A

Local

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19
Q

Isoflurane, halothane, nitrous oxide, and propofol are all _____.

A

general anesthetics

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20
Q

Cocaine, lidocaine, and bupivacaine are all ____.

A

local anesthetics

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21
Q

What are the 3 receptors by which biochemical and molecular bases of pain occur?

A

mechanoreceptors
thermoreceptors
chemoreceptors

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22
Q

Which pain receptors mediate responses to touch and pressure?

A

mechanoreceptors

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23
Q

Which pain receptors detect the sensations of warmth and cold?

A

thermoreceptors

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24
Q

Which pain receptors are stimulated by a change in the chemical composition of the local environment?

A

chemoreceptors

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25
_____ are mechanical nociceptors that respond to strong pressure.
Mechanoreceptors
26
When are thermoreceptors activated?
activated by skin temperatures that are more than 45*C or severe cold (<20*C)
27
Taste and smell receptors are _____.
chemoreceptors
28
Visceral receptors that are sensitive to plasma levels of oxygen, pH, and osmolality are ____.
chemoreceptors
29
Chemicals such as bradykinin, histamine, acidity, acidity, and chemical irritants all trigger ____.
chemically sensitive nociceptors
30
A variety of receptors on the endings of _____ nerves/neurons respond to noxious thermal, mechanical, or chemical stimuli.
nociceptive sensory
31
Which ganglion do nociceptive sensory nerves send signals to the brain through?
trigeminal
32
Which channels are activated by intense heat, acids, and chemicals?
TRP channels
33
____ receptors are activated by intense heat, acids, and chemicals such as capsaicin.
TRPV1
34
Capsaicin is found in hot peppers and is an example of a _____.
vanilloid
35
____ receptors are activated by noxious mechanical, cold, and chemical stimuli.
TRPA1
36
What protein attaches transmembrane receptors to internal cytoskeleton proteins?
ankyrin
37
Which receptors are activated by pH changes within a physiologic range and may be the dominant receptors mediating acid-induced pain?
acid-sensing ion channel (ASIC) receptors
38
TRP receptors are classically associated with _____.
thermoreceptors
39
Can the TRP channels be directly activated by different stimuli in the post-synaptic membrane?
YES - cold, heat, H+, etc.
40
What are some of the intermediate signaling molecules that can activate the receptors on the nerve ending?
- ATP - molecules that act on G-protein coupled receptors - NGF
41
What acts on purinergic receptors to open channels on the nerve ending?
ATP
42
What are some molecules in pain reception that can act on G-protein coupled receptors?
- bradykinin - histamine - prostaglandins - serotonin - substance P - calcitonin gene-related protein
43
____ acts on tyrosine receptor kinase A (TrkA) receptors.
NGF
44
P2X, an ionotrpic receptor, and P2Y, a G-protein coupled receptor are acted upon by ____ to open their channels.
ATP
45
Does NGF signal through G-protein coupled receptors?
NO - it signals through tyrosine kinase A receptors
46
Tissue injury releases ____ and ____ that sensitize or activate nociceptors that release substance P and CGRP.
bradykinin; prostaglandins
47
Do mast cells produce additional pain response?
YES - by their degranulation
48
What happens when NGF acts on the TRK receptor?
it elicits a variety of cellular responses: - pro-apoptotic genes - anti-apoptotic genes - decrease cell growth - promote cell survival - outgrowth of neurites - cell growth + survival - rapid responses (ion channels)
49
Does NGF acting on the TRK receptor cause rapid or slow responses?
BOTH - rapid - slower transcriptional regulation
50
How does NGF acting on the TRK receptor elicit its effects?
- rapid protein kinase actions | - slower transcriptional regulation
51
In the inflammatory response at the neuron level, ___ can quickly activate the neuron to produce a painful sensory reception and produce sustained changes in the neuron that may lead to heightened sensitization.
NGF
52
NGF is an intermediary molecule in pain signaling that works through _____ receptors and can produce rapid and sustained responses.
tyrosine kinase
53
ATP can act on _____ receptors, leading to cellular depolarization.
ionotropic
54
Bradykinin, histamine, prostaglandins, serotonin, substance P, and CGRP are all ____ of G-protein coupled receptors.
agonists
55
Intermediate signaling molecules can all produce ____ of nociceptive neurons, leading to immediate or prolonged changes in neuronal responsiveness.
sensitization
56
What part of the brain receives pain transmission signals and then interprets them?
cerebral cortex
57
What are the two major types of fibers that carry pain?
A-delta | C axons
58
A-beta fibers carry signals related to _____.
proprioception
59
What fibers are present in nerves that innervate the skin and respond primarily to light touch or moving stimuli?
A-beta
60
Which fibers are present in nerves that respond to intense or painful stimuli?
A-delta | C axons
61
Which horn of the spinal cord do fibers from nociceptors and thermoreceptors synapse on?
dorsal horn
62
Which ganglion do fibers from nociceptors and thermoreceptors synapse on if coming from the head?
trigeminal ganglion
63
How do pain fibers ascend the spinal cord to signal to the brain?
via the ventrolateral spinothalmic pathway
64
Pain in your right hand would be perceived in your ____ cerebral cortex.
left
65
The nerves that are carrying pain pass through to the _____ side to transmit the pain signals to the opposite side of the brain.
contralateral
66
The ventrolateral spinothalmic tract mediates ____ and ____.
pain; temperature
67
The pain sensory fibers terminate in the dorsal horn, projections cross the midline, ascend in the ventrolateral quadrant of the spinal cord and reach which structures of the brain?
thalamus, and into the cerebral cortex
68
Pain from the head and face will come in from cell bodies residing in the _____.
trigeminal ganglion
69
The thalamic projections to the somatosensory cortex mediates the purely ____ aspects of pain.
sensory
70
The thalamic projections that project to the cortical regions are linked to the _____ responses.
emotional; unpleasant emotional dimension
71
The thalamic projections to the somatosensory cortex tell you the ____, ____, and ____ of pain.
location; intensity; quality
72
What are the cortical regions of the brain linked to emotional pain responses?
frontal cortex cingulate gyrus insular cortex
73
Noxious stimuli activate the peripheral ending of the primary afferent nociceptor by the process of ____.
transduction
74
What is the basis for referred pain?
convergence of somatic and visceral pain fibers in the dorsal horn
75
Why do we rub our knee when we bang it on a piece of furniture in the middle of the night?
because transmission in nociceptive pathways can be interrupted by actions that transmit sensation to the dorsal horn (AKA simultaneous activation)
76
Activation of the post-synaptic opioid receptors _____ the dorsal horn interneuron by causing an increase in K+.
hyperpolarize
77
The activation of the pre-synaptic opioid receptors leads to a decrease in ___ influx, resulting in decreased glutamate and substance P release.
Ca2+
78
The actions of the opioid receptors on K+ and Ca2+ reduce the duration of the excitatory post-synaptic potential (EPSP) in the _____.
dorsal horn
79
What happens when enkephalin and dynorphin activate opioid receptors?
the EPSP is reduced in the dorsal horn neuron
80
Activation of opioid receptors in dorsal root ganglia cell bodies ____ the transmission from nociceptive afferents.
reduce
81
Opioids _____ Ca2+ influx, decreasing the duration of the invoked action potential and reduce neurotransmitter release from the nociceptive neuron.
decrease
82
Opioids ____ the membrane of the dorsal horn neuron by increasing intracellular ___.
hyperpolarize; K+
83
What are the mechanisms of action of opioid analgesics?
- decrease intracellular Ca2+ | - increase intracellular K+
84
Opioids decrease intracellular Ca2+. Decreasing intracellular calcium causes _____.
decreased neurotransmitter secretion
85
Opioids increase intracellular K+. Increasing intracellular potassium does what to the cell?
hyperpolarizes the cell, disallowing depolarization and causing reduced action potential propogation
86
Opioid receptors are linked to what kind of membrane proteins?
G-coupled
87
What happens to Ca2+ and K+ concentrations intracellularly after morphine binds to an opioid receptor?
- increased concentration of K+ | - decreased concentration of Ca2+
88
Ibuprofen, naproxen, ketorolac, and celecoxib are all ____.
NSAIDs
89
Ibuprofen, naproxen, ketorolac, and celecoxib inhibit ____ and ____.
cyclooxygenase; production of prostaglandins
90
NSAIDs _____ inflammatory-mediated pain signaling and ____ sensitization of nociceptors.
reduce; reduce
91
What ion channels does lidocaine block?
Na+ channels
92
How would you administer halothane, isoflurane, and nitrous oxide?
inhalation
93
How would you administer propofol or midazolam?
intravenously
94
What is the mechanism of action for most general anesthetics?
increase the sensitivity of the GABA receptor, thus inhibiting excitatory neurotransmission and depressing nervous system activity
95
What is the mechanism of action for inhalational anesthetics?
they enhance the capacity of glycine to activate glycine receptors, which cause inhibitory effects in the brain
96
What ion channels do halogenated inhalational anesthetics activate?
K+ channels; hyperpolarize neurons and make them unsusceptible to depolarization

Biochemistry Final Exam (8 decks)

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