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Principles of Pharmacology and Therapeutics > Pain and Analgesia > Flashcards

Pain and Analgesia Flashcards

1
Q

Define pain

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

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2
Q

What is pain?

A

Individual experience
Multidimensional
Protective function

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3
Q

What are the different types of pain?

A

Physiologic
Nociceptive/Inflammatory
Neuropathic

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4
Q

What are the characteristics of physiologic pain?

A

Short duration, preprogrammed responses, no tissue damage

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5
Q

What are the characteristics of nociceptive/inflammatory pain?

A

Tissue damage, allodynia, hyperalgesia etc

Pathologic forms

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6
Q

What are the characteristics of neuropathic pain?

A

Damage or dysfunction of peripheral nerves or CNS

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7
Q

Define acute pain

A

Obvious cause
Relatively short duration
Resolves with healing
Protective function

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8
Q

Define chronic pain

A

Multiple causes
Persist after healing
No adaptive function
Often refractory to treatment

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9
Q

What is the process of nociception?

A 
Transduction
Transmission
Modulation
Projection
Perception
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10
Q

What is the process of transduction of pain?

A

Peripheral nerves are extensions of CNS and free nerve endings transduce noxious stimuli into electrical signals and action potentials
Varied sensitivity to mechanical, thermal and chemical stimuli

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11
Q

What is peripheral sensitisation?

A

IMAGE

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12
Q

What is the process of transmission of pain?

A

First order neurons synapse in dorsal horn
Myelinated A-delta fibres = first pain
Unmyelinated C fibres = second pain, visceral pain

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13
Q

What is the process of modulation of pain?

A

Peripheral sensory nerve impulses are amplified or suppressed in the spinal cord
Dorsal horn has inter-neurons and ascending neurons

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14
Q

What is the gate theory of control?

A

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15
Q

What is the process of inhibitory neurotransmission in the dorsal horn?

A

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16
Q

What is the process of central sensitisation?

A

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17
Q

What are the ascending pathways for nociception? (process of projection)

A

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18
Q

What is the process of perception of pain?

A

Unpleasant sensation in the CNS resulting in a behavioural response to pain which varies according to species

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19
Q

What are the descending pathways of pain?

A

Originates in the brian (amygdala, hypothalamus)
Relayed via the brain stem, rostral ventral medulla
Spinal cord - release of inhibitory neurotransmitters (serotonin, norepinephrine, endogenous opioids)
Takes part in modulation

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20
Q

What are the consequences of pain?

A

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21
Q

Why is peripheral and central sensitisation important?

A

The level of pain perceived is more severe
Analgesic drugs may be less effective if given once pain is present
One type of analgesic may not be effective on its own

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22
Q

How is pain assessed in practice?

A 
Visual analogue scale
Numerical rating score
Simple descriptive scale
Composite scoring system
Multidimensional scoring system
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23
Q

What are the methods of pain scoring in equines?

A

Composite orthopedic pain scale
Equine acute abdominal pain scale
Complex numerical rating scale - postop colic
Post abdominal surgery pain assessment scale

24
Q

What drug groups can be used for pain management?

A 
NSAIDs
Opioids
Ketamine
Alpha-2-agonists
Local anaesthetics
25
What is pre-emptive analgesia?
The prevention or minimisation of pain by the administration of analgesics before the production of pain or the introduction of noxious stimulus if pain already exists
26
What is multi-modal analgesia?
The administration of multiple drugs that act by different mechanisms of action to produce the desired analgesic effect
27
What are the advantages of multi-modal analgesia?
Additive or synergistic effects Reduced side effects Reduced dose
28
What drugs can be used for systemic analgesia?
``` Opioids NSAIDs Ketamine Lidocaine MLK Alpha 2 agonists Tramadol Gabapentin/Pregabalin ```
29
What agents can be used for local analgesia?
Local anaesthetics Opioids Alpha 2 agonists
30
Define opium
Mixture of alkaloids from the poppy plant
31
Define opioid
Any natural occurring, semi-synthetic or synthetic compound that binds to opioid receptors and shares the properties of the natural occurring endogenous opioids
32
Define opiate
Any natural occurring opioid, derived from opium
33
Define narcotic
Used to denote an opioid but also to describe non-opioid drugs of addiction
34
What are the effects mediated by DOP opioid receptors?
Spinal and supraspinal analgesia, reduced gastric motility
35
What are the effects of KOP opioid receptors?
Spinal analgesia, diuresis, dysphoria
36
What are the effects caused by MOP opioid receptors?
Analgesia, sedation, bradycardia, respiratory depression, inhibition of GI tract, opioid tolerance and hyperalgesia endocrine effects and immunological effects
37
What are the effects of NOP opioid receptors?
Spinal analgesia, hyperalgesia and allodynia as well as supraspinal inhibition of opioid tone
38
What are some MOP selective agonists?
``` Morphine Pethidine Methadone Fentanyl Buprenorphine - partial ```
39
What are some KOP selective agonists?
Butorphanol | Nalbuphine
40
What are the location of MOP receptors?
``` Throughout pain pathways of CNS Spinal cord dorsal horn CTZ Basal ganglia Limbic centres Cortex and thalamus Myenterix plexus ```
41
Where are KOP receptors located?
``` Spinal cord dorsal horn Basal ganglia Limbic centres Cortex and thalamus Myenteric plexus ```
42
Where are the DOP receptors located?
Spinal cord dorsal horn Basal ganglia Cortex and thalamus
43
What are the selective actions of MOP receptors?
``` Analgesia (strong) Cough suppression Constipation Sedation Motor excitation in some species Respiratory depression Tolerance and dependence Vomiting ```
44
What are the selective actions of KOP receptors?
Analgesia (moderate) Sedation Dysphoria
45
What are the selective actions of DOP receptors?
Analgesia (mild) | Motor excitation?
46
What is a mixed opioid agonist-antagonist?
Butorphanol Antagonist of MOP receptors so relatively poor analgesia Agonist at some KOP receptors giving some analgesia, sedation and dysphoria
47
What are opioid antagonists?
Naloxone | Diprenorphine
48
What is a partial agonist?
Buprenorphine Has the same overall action as agonists but doesn't produce maximal effect giving analgesia but not as profound as full agonists
49
What are the possible routes of administration of opioids?
IV, IM, SC, oral, oral transmucosal, spinal/epidural, intra-articular, transdermal
50
What are the side effects of opioids?
Arousal Dysphoria Vomiting and nausea Variation in pupillary diameter (miosis dogs, mydriasis cats) Thermoregulaion (decrease in dogs, increase in others) Respiratory depression Bradycardia
51
What regulations cover use of pure opioid agonists?
Must be kept in a locked cupboard Records kept of purchase and use Special prescription requirements Must be disposed of according to legislation
52
What regulations cover use of partial opioid agonists?
Should be kept in a locked cupboard with pure opioids but no record of use is necessary
53
What is tramadol?
Weak MOP agonist Serotonin re-uptake inhibiting Norepinephine re-uptake inhibiting NMDA receptor antagonist
54
What are the actions of NSAIDs?
Anti-inflammatory Analgesic Anti-pyretic Acute and chronic use
55
What are the indications for ketamine?
Skin surgeries and neuropathic pain
56
How is ketamine used to manage pain?
Adjuvant to pain management at sub-anaesthetic doses blocks NMDA receptor

Principles of Pharmacology and Therapeutics (8 decks)

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