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Integrated Physiology and Pharmacology > Pain and analgesia > Flashcards

Pain and analgesia Flashcards

1
Q

What is 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 are the two terminals of the DRG?

A

Primary sensory neuron

Second order neurons

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3
Q

What do peripheral nociceptors detect?

A

A noxious stimuli

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4
Q

Are spinal reflexes pain?

A

No - These simply make you move away from a certain stimuli

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5
Q

What is the reflex pathway?

A

1) Sensory receptors in skin detect a noxious stimuli
2) Sensory information goes via the afferent pathway to the dorsal root ganglia
3) The information is processed at an integrating center
4) Information goes out via the ventral root through the efferent pathway
5) Effector organs affected = response of the reflex

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6
Q

What is primary erythermalgia?

A

Pain by walking/ physical activity

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7
Q

What is Paroxysmal extreme pain disorder?

A

Pain when chewing or passing stool

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8
Q

What is acute pain?

A

Alerts the body to chemical, mechanical or thermal stimuli that has the potential to damage body tissues
Has a protective role

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9
Q

What is chronic pain?

A

Accompanies chronic inflammatory diseases eg arthritis
Neuropathic pain results from damage to nerves
Can be causes by trauma, diabetes, cancer treatment and herpetic infection

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10
Q

What is the total cost of pain annually to the US?

A

600 billion dollars (50% healthcare costs, 50% loss in productivity

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11
Q

What is analgesia?

A

The absence of pain without loosing consciousness

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12
Q

What are analgesias all aimed at?

A

The pain circuit; DRG and spinal horn neurons and pain processing parts of the brain

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13
Q

What are some current analgesics?

A

NSAIDS and opiods

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14
Q

List current problems with NSAIDs

A

Cardiovascular risk - Increases risk of thrombotic events, myocardial infarction and stroke
GI risk - bleeding, ulceration and perforation of the stomach or intestines, which can be fatal (elderly patients at greater risk)

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15
Q

List current problems with Opiods

A

Sedation - apathy and cognitive impairment
Depression of respiration - Main cause of intoxication related death in USA is from opioid overdose, Combination with alcohol is very dangerous
Inhibition of the GI tract
Addiction

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16
Q

What are the four classes of opioids?

A

Natural
Semi-synthetic
Fully synthetic
Endogenous opioid peptides

17
Q

Give examples of natural opioids

A

Morphine, codeine and dermorphine

18
Q

Give examples of semi-synthetic opioids

A

Heroin, hydromorphine, hydrocodone, oxycodone and oxymorphone

19
Q

Give examples of fully synthetic opioids

A

Fentanyl, pethidine, methadone, tramadol and propoxythene

20
Q

Give examples of endogenous opioid peptides

A

Endorphin, enkephalin, dynorphin and endomorphins

21
Q

What is opium and who isolated its active ingredient?

A

Opium is the dried juice of the seed head in a poppy flower

Its principal active ingredient, morphine, was isolated by Frederic Serturner in 1806

22
Q

What does morphine bind to?

A

Opioid receptors

These are GPCRs which lead to the inhibition of calcium influx

23
Q

What are the three types of opioid receptors

A

Mu, Keppa and delta

24
Q

Where are Mu opioid receptors concentrated?

A

At the dorsal horn area receiving input from DRG neurons

25
Q

What is demamorphin?

A

A hepta-peptide first isolated from the skin of the South American leaf frog
It is about 30 to 40 times more potent than morphine in Mu receptors
Stable due to non-natural amino acids (hence longer acting)

26
Q

What is the molecular structure of heroin?

A

It is morphine with an added acetate group - It is a boiled acetic acid

27
Q

Why can heroin penetrate into the brain easily?

A

It is hydrophobic

28
Q

What is fentanyl?

A

100 times more potent than morphine
Fast acting opioid
Used during surgery

29
Q

Where are opioid peptides mainly found in the CNS?

A

The midbrain, brainstem and spinal cord (areas associated with pain processing

30
Q

When are opioid peptides released?

A

During stress

31
Q

Why do opioid peptides have only a short pain release?

A

The are quickly degraded by extracellular proteases

32
Q

Met-enkaphalins prefer which receptors?

A

All opioid receptors

33
Q

Dynorphins prefer which receptors?

A

Kappa opioid receptors

34
Q

Endorphins prefer which receptors?

A

Mu-opiod receptors

35
Q

Loss of function mutations cause no pain in what channel?

A

NaV1.7

36
Q

Monoclonal antibodies against what help with lower back pain?

A

NGF

37
Q

Why can the botulinum neurotoxin be used to treat pain?

A

It blocks neurotransmitter release for several months by cleaving the SNAP25 protein

38
Q

What can the botulinum toxin be used to treat?

A

Migraines

Integrated Physiology and Pharmacology (17 decks)

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