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Pharmacology > Pain (Chapter 7) > Flashcards

Pain (Chapter 7) Flashcards

1
Q

how can fast pain be described ?

A

sharp, prickling, acute, electric

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2
Q

how can slow pain be described ?

A

burning, aching, throbbing, nauseous, chronic

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3
Q

how is pain initiated ? where can it be found ?

A

initiated by free nerve endings in superficial layer of the skin
also found in internal tissues (periosteum, arterial walls, joint surfaces, falx, tentorium of the cranial vault)

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4
Q

explain pain in deep tissues

A

they dont have pain nerves, but overall pain can give the impression of pain in these areas

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5
Q

what is periosteum ?

A

the membrane that lines the outer surface of bones

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6
Q

what is falx

A

part of the dura mater of the cranium

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7
Q

what is the tentorium cerebelli ?

A

extension of dura mater separating the cerebellum from the inf portion of occ lobes

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8
Q

what are the 3 types of stimuli that pain is initiated by ?

A

mechanical, thermal, chemical

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9
Q

what is fast pain initiated by? which type of stimuli

A

mechanical and thermal

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10
Q

which type of stimuli initiates slow pain ?

A

mechanical, thermal, chemical

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11
Q

name seven causes of chemical pain

A 
bradykinin
serotonin
histamine
potassium ions
acids
ach
proteolytic enzymes
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12
Q

what is pain enhanced by ? how ?

A

prostaglandins and substance P

they make the nerve endings more sensitive

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13
Q

explain the adaptation mechanism of pain receptors

A

they are non-adaptable

continue to deliver pain signals and may in fact lead to greater pain sensitivity called hyperalgesia

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14
Q

what is the correlation between pain and tissue damage?

A

positive

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15
Q

what degree celsius is when tissues start to be damaged ?

A

45

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16
Q

following tissue damage, what is the number one responsible chemical for pain ?

A

bradykinin

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17
Q

in a painful area, what will you find local increases of ?

A

potassium ions and proteolytic enzymes because they directly attack nerve endings due to increased ion permeability

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18
Q

what is ischemia ? how does it cause pain

A

blocked flow

causes pain through buildup of lactic acid from anaerobic metabolism + bradykinins and proteolytic enzymes

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19
Q

what is bradykinin ?

A

a small peptide that is a physiologic mediator of pain

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20
Q

what is the neospinothalamic tract ?

A

fast pain transmitted from peripheral nerves to spinal cord by small type A delta fibers
velocity of 6-30 m/s
terminates in brain stem and somatosensory cortex

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21
Q

what is the paleospinothalamic tract ?

A

slow pain transmitted to spinal cord by C fibers at 0.5-2m/s terminating in spinal cord

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22
Q

explain the dual system of pain

A

the two tracts, slow and fast, work together
initial fast response makes person react quickly
second slow response makes person respond over time to alleviate the situation

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23
Q

how many pain tracts are there ?

A

2 except 3 in higher mammals

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24
Q

what are 5 non-drug ways of dealing with pain ?

A

1- transcutaneous electrical nerve stimulation
2- manual acupressure
3- endogenous opioids (innate)
4- surgical interruption (cutting of pain nervous pathways by cordotomy in thoracic region of spinal cord) spinal cord on side opposite to pain is partially cut in anterolateral quadrant to interrupt the anterolateral sensory pathway
5- acupuncture

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25
Q

does acupuncture work ?

A

small analgesic effect, but cannot clearly be distinguished from bias

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26
Q

what is the idea behind acupuncture ?

A

penetration of skin results in release of endogenous opioids

27
Q

what is a drug that treats pain called ?

A

analgesic

28
Q

what are analgesics to treat mild pain ?

A

tylenol, NSAIDs, caffein mixtures (OTC)

29
Q

what are analgesics to treat severe pain ?

A

prescription opioids

30
Q

what are the three most important opioid receptors in the CNS ?

A

mu
kappa
delta

31
Q

what do opioid receptors do ?

A

mediate natural analgesic effects in response to endogenous b-endorphins

32
Q

how do opioid drugs work ?

A

inhibit synaptic transmission in CNS

also decrease substance P transmission across cleft

33
Q

where is the mu opioid receptor found ?

A

in pre- and post-synaptic membranes of pain

34
Q

explain how opiods inhibit substance P

A

hyperpolarization occurs, harder to get AP
need more substance P to depolarize the nociceptor
reduces conduction along afferent nociceptor

35
Q

what is morphine ?

A

strongest opioid analgesic

decreases pain through opioid receptors and decreases perception of pain

36
Q

how is morphine most effective ?

A

parenterally because GI absorption unreliable

37
Q

what is codeine ?

A

metabolizes into morphine, decreasing pain through opioid receptors

38
Q

what can codeine be used with ?

A

aspirin, acetaminophen, caffeine

39
Q

what is hydrocodone ?

A

stronger derivative of codein

40
Q

what is vicodin ?

A

hydrocodone acetaminophen mixture

41
Q

what happens mixing hydrocodone with caffeine ?

A

becomes pain and sinus medication, clearing nasal passage

42
Q

what is oxycodone (oxycontin)

A

not as strong as morphine
has controlled release
has an abuse potential

43
Q

what is methadone ?

A

mildest type of opioid, treating cancer patients and addictions

44
Q

is caffeine an analgesic ?

A

not by itself, but makes opioid effects last longer (synergist)

45
Q

how do opioids effect cough ?

A

suppresses cough center in medulla , which is why codeine used in cough medicine

46
Q

how do opioids affect the GI tract ?

A

decreased GI mobility,constipation

47
Q

how do opioids affect pupils ?

A

myeosis (pupil constriction)

48
Q

how do opioids affect peeing ?

A

urinary tension, feeling of wanting to pee but can’t

49
Q

how do opioids make you dizzy ?

A

orthostatic hypotension

50
Q

how do opioids change state of mind ?

A

a side effect could be dysphoria

51
Q

what are contraindications to opioids ?

A

monoamine oxidase inhibitors (antidepressants)

can lead to death

52
Q

what are the advantages of local anesthetics ?

A

do not cause loss of consciousness even with parenteral administration

53
Q

how can local anesthetics lead to coma ?

A

CNS depression

54
Q

how are local anesthetics often used ?

A

parenterally by infiltration anesthesia (injection at area where anesthesia is desired) or nerve block anesthesia (injection near nerves supplying a specific area)

55
Q

what does the duration of anesthesia depend on ?

A

the lipid solubility of anesthetic, amount of blood flow at site of injection

more blood flow carries the drug away from the site quicker

56
Q

what do anesthetic names end with ?

A

-caine

57
Q

what are examples of topical anesthetics ? what are they used for

A

pain relief on skin surface or mucous membranes

sprays, gels, lozenges, suppositories

58
Q

what is special about topical anesthetic ethyl chloride ?

A

effectiveness as the result of a cooling effect (like ice but much quicker)
spray on skin until skin turns white in 5 seconds
duration of response seconds to a minute

59
Q

what is the only local anesthetic that is a controlled substance ?

A

cocaine

60
Q

what is cocaine used for and how ?

A

topically got anesthesia of ear, nose, and throat

61
Q

how is cocaine unique ?

A

causes constriction of local vasculature and eliminates the need for using epinephrine
absorbed by mucous membranes and has more pronounced CNS effects, stimulatory effects first and then depressant effects

62
Q

how does cocaine affect HR and BP

A

small doses: bradycardia

big doses: tachycardia and hypertension

63
Q

what are the two main groups of analgesics ?

A

NSAIDs/ acetaminophen

opioids

64
Q

what is the main concern when prescribing opioids as analgesics ?

A

constipation

recommend laxatives

Pharmacology (15 decks)

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