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POS 2 > Pain and Analgesia > Flashcards

Pain and Analgesia Flashcards

1
Q

define chronic pain

A

lasting longer than 1 month,a ssociated with a p wide range of often subtle behaviourl disturbance

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2
Q

What are the 3 separate processes assocated with pain?

A
  1. nociception (sensory stimulus transmitted to the brain)
  2. perception (in CNS)
  3. behavioural reponse (varies according to species)
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3
Q

Define pain in animals

A
  • aversive sensory and emotional experince
  • awareness by the animal of demage or threat to the integrity of isssues
  • changes the animals physiology and behaviour to reduce/avoid damage, v lieklihood of recurrence and promote recovery
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4
Q

What is hyperalgesia? Allodynia?

A
  • increased sensitivity to nociceptive stimuli

- nociceptive sensatino of a NONPAINFUL stimulus

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5
Q

Clinical implicationd of hypersensitisation? What is this also known as? Which receptor is invovled and which drug can combat this?

A
  • level of pain percieved is more severe
  • anagesia less effective if given once pain present
  • one type of analgesia may not be effectiveo nits own
    = “wind up” d/t NMDA receptor involvement (ketmaine antagonist here)
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6
Q

Egs. of pain assessment

A
  • NRS
  • VAS
  • SDS (no pain -> worst imaginable)
  • Composite SS
  • multidimensional scoring system
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7
Q

What is pre-emptive analgesia?

A
  • administration of analgesics prior to onset of noxious stimuli (premed etc.)
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8
Q

Outline neural pathway of pain

A
  • nociception
  • mediated by substance P and glutamate
  • synapse dorsal horn
  • decussate
  • travel in spinothalamic tract -> thalamus
    [modulation within SC]
  • thalamocoritcal projections to the cortex
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9
Q

egs. of systeic analgesia

A
  • opiods
  • NSAIDs
  • ketamine
  • lidocaine
  • a2 agonists
  • tramadol (cheap, oral, lic)
  • gabapentin/pregabalin
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10
Q

egs. local analgesia

A
  • local anaesthetics
  • opioids
  • a2 agonists
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11
Q

define opium

A
  • mixture of alkaloids from the poppy plant
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12
Q

define opioid

A

any natural occouring, semi-sythetic or synthetic compound that binds to opioid receptros and shares the properties of the natural ocourring endogenous opioids

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13
Q

Define opiate

A
  • any naturally occourring opioid, derived rom opium eg. morphine, codeine
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14
Q

define narcotic

A

“to numb”

- was ued to deonte opioid, also describes non-opioid drugs of addictino

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15
Q

3 classifications of opioids?

A 
> naturally occourring ocmpounds
- morphine
- codeine
> semi-sythetic compounds 
- dimorphine (heroin) 
- dihydromorphone
- buprenorphine
- hydro-morphone
> synthetic
- pethidine
- methadone
- fentanyl, alfentanil, remifentanil
- butorphanol, tramadol
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16
Q

What effects are mediated by each opioid receptors? LOOK UP and print table

A

delta: (DOP)
- spinal and supraspinal analgesia
- reduce gastric motility
kappa: KOP)
- spinal analgesia
- diuresis
- dysphoria
- species dependant (birds ^ no)
mu:
- analgesia, sedation, bradycardia , resp depression
- inhibition of GI transit, opioid tolerance…
n:

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17
Q

What is the only validated pain scale fro use in dogs?

A

Glasgow pain scale

18
Q

What is an intervention score?

A

Pain scale sscore above which pain releif is administered

19
Q

Which opioids are full m-agonists?

A
  • morphine
  • methadone
  • pethidine (LIC)
  • fentanyl/remifentanil
  • etorphine (immobilon)
  • papaveretum (omnopon)
20
Q

Which drug is a partial m-agonist?

A

buprenorphine (LIC)

21
Q

Which drug i a mixed agonist and antagonist?

A
  • butorphanol (LIC)
22
Q

Which pain scals have been validated in horses?

A
  • composite orthopeadic pain cale

- PASPAS

23
Q

Which drug are opioid antagonists?

A
  • naloxone

- diprenorphine (revivon)

24
Q

What is a partial agonist? eg?

A
  • same overal actions of an agonist
  • does NOT Produce maximal effect
  • eg. buprenorphine
  • partial m agonist
  • analgesia, not as profound as full agonist
  • (use milkd - mod pain)
25
Q

What is a mixed ant/ag? eg?

A
  • agonist at some recpetors
  • antagonsit at others
  • eg. butorphanol
  • antagonist @mu, relatively poor analgesia
  • agonist at K - some analgesia, sedation and dysphoria
26
Q

Which levels can drugs work at? egs? LOOK UP

A 
> transduction (nociceptors)
- local analgesia
- opioids
- NSAIDs 
- steroids
> transmission (peripheral nerves)
- local anaesthetics
> modulation (SC grey matter) 
- inhibit central sensitisation 
- local 
-opoids
- a2s
- NSAIDs
- ketamine
> projection (SC white matter) 
> perception (brain)
- opioids
- a2 ags
27
Q

egs. routes of administration

A

> IV (NOT PETHIDINE)

  • IM
  • SC (variable absorption, not recommedned)
  • oral (high 1st pass metabolism cf. humans, poorly absorbed)
  • oral transmucosal (cats buprenorphine)
  • spinal/epidural
  • intra-articular
  • transdermal (fentanyl patch or new LIC liquid fenanyl spoton)
28
Q

Side effects of opioid analgesics

A

> arousal ^ or V
- CNS depression -> sedative effect (dogs, monkeys and people)
- CNS stimulation -> euphoria/dysphoria (exceitement and locomotor activity, cats, horses and ruminants)
- differences d/t interspecies differences in receptor distribution, presence of pain, dose and ROA, specific opoid
nausea and vomitiing
variation inupillary diamter
- cats mydriasis ( ^ catecholamine release, makes them light sensitive and aggressive)
- dogs miosis
thermoregulation
- v in dogs d/t thermal set point
- ^ cats, horses, swine and ruminants d/t muscular acitivty
resp depression
- m mediated effects (v responsivenesss to CO2)
- esp if coadministered with sedative
bradycadia
- vagal stim
- pethidine exeption
(eg. in GA, may need to give anti-cholinergic at the same time to avoid - or may be resp?? look up )

29
Q

What act is involved in controlled drugs legislation?

A

1971 misuse of drugs act
> schedule 2 (pure agonists, controlled drugs)
- must be kept in locked cupboard
- records kpt of purchase and use
- special prescription requirements
- must be disposed of according to legislationi
> scedule 3 (partial agonist: bupreorphine)
- should be kept in locked cupboard with schedule 2, no record of use necesary

30
Q

What is bupreorphine trade names?

A

vetergesic, bupracare

31
Q

Which drug is currently exept from drug resitrcutions?

A

butorphanol

32
Q

Indications and mode of action of ketamine? What schedule is it?

A
  • schedule 4 currently ( no recording needed, going to be rescheduled -> schedule 2 d/t lots of abuse)
  • adjuvant to pain managements
  • sub-anaesthetic doses to prevent windup
  • blocks NMDA R
    > indications
  • skin grafts and burns orthopeadics and spinal surgery
  • neurogenic pain (amputation)
33
Q

Which analgesic canont be given IV?

A

KETAMINE

-> severe anaphylaxis

34
Q

Tramadol - uses? What is it composed of? Mode of action?

A
  • minimal evidence on effeciveness
  • used because its cheap and not controlled
  • can not be reversed by opioid antagonisits
    > mixtuer of 2 stereoisomers with different effects and each metabolite will have different effects (complex drug ef. morphine etc.!)
  • 5HT and noradrenaline reuptake mediating == TCAs (amitryptaline etc.)
35
Q

What are euphoria and dysphoria?

A

> euphoria
- kneading
dysphoria
- bad trip!

36
Q

How can you treat dysphoria d/t opioids?

A
  • partial agonist administration (buprenorphine)
37
Q

Which opioid common causes vomiting?

A

Morphine

- methadone less commmon

38
Q

What are schedule 1 drugs?

A

Vets cant use huan only

39
Q

Actions of NSAIDs?

A
  • anti-inflammatory (except paracetamol)
  • analgesic
  • anti-pyretic
  • acute and chornic use
40
Q

What are the 2 types of pain?

A 
> adaptive (protecitve) 
- protective function 
- nociceptive pain 
- inflammatory pain 
> maladaptive (pathological) pain 
- serves no protective function 
- neuropathic pain (abnormal)

POS 2 (28 decks)

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