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Advanced Principles 2 > Pain lecture part 1 > Flashcards

Pain lecture part 1 Flashcards

1
Q

Common chronic pain conditions include

A

lumbar radiculopathy
facet arthropathy
SI joint dysfunction
occipital neuritis

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2
Q

The following material is released after trauma and is thought to enhance afferent transmission

A 
potassium 
plasma
red and white blood cells
clotting factors
peptides 
prostaglandins
inflammatory cells
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3
Q

Release of substance P & calcitonin gene related peptide causes

A

vascular leaking leading to swelling

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4
Q

Release of materials enhance activation of

A

membrane channels (Na+, Ca++)

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5
Q

Pain response without tissue injury includes

A

“escape” response consistent with intensity of stimulation

removal of stimulation terminates the sensation & response

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6
Q

The sensation of a pain response without tissue injury is specific to

A

a site of potential injury

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7
Q

The initial sensation to pain response without tissue injury is

A

sharp, followed by dull sensation

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8
Q

Pain response with tissue injury includes

A

pain persists after removal of stimulus

stimulating injured tissue cause an intense response (hyperalgesia)

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9
Q

Pain response with tissue injury has both

A

localized sensation and referred sensation

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10
Q

______ of stimulation is required to elicit an adverse response in pain response with tissue injury

A

lower threshold

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11
Q

Allodynia is defined as

A

increased pain sensation with light touch

-pain that should not be

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12
Q

Pain response with nerve injury is an ongoing unpleasant pain sensation usually referred to

A

the dermatome innervated by the injured nerve (hyperalgesia)

-pain greater than expected)

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13
Q

The evolution of chronic pain is

A 
associated with nerve injury response
failure to treat nerve & tissue injury effectively 
occult inflammation 
failure of tissue healing 
persistent inflammation
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14
Q

Windup is defined as

A

when normal pain responses become abnormal

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15
Q

Chronic pain results in

A

despair, poverty, homelessness, divorce, suicide

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16
Q

The pathway to windup includes

A

repetitive stimulation releases glutamate, neurokinin, substance P** overwhelming the Mg block
channels are opened, proteins couple with receptors producing long lasting Ca++ release
glial cell dysfunction (dorsal horn)
loss of central inhibition mechanisms

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17
Q

Loss of central inhibition mechanisms include

A 
increased intracellular Ca++
release of arachidonic acid (irritant)
creation of cylooxygenase (Cox)
Cox synthesizes prostaglandins
which reduce glycine and GABA mediated inhibition 
negative impact on NMDA receptors 
promote dorsal horn excitability
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18
Q

Goals of pain treatment include

A

improve mobility and activities of daily living
ensure compliance with treatment plan
address emotional/social components
decrease pain sensation

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19
Q

Nonsteroidal anti-inflammatory drugs have the following activities:

A

antipyretic
anti-inflammatory
analgesia
acetaminophen has little anti-inflammatory activity

20
Q

MOA of NSAIDS include

A

inhibits prostaglandin production from arachidonic acid by acetylation of COX

21
Q

COX1 is responsible for

A

contributes to hemostasis & platelet aggregation

protects the gastric mucosa via prostacyclin production

22
Q

Cox2 is responsible for

A

producing inflammation
contribute to fever
stimulates pain sensation
supports prostacyclin anti-coagulation activity
both are present peripherally and in the CNS

23
Q

Absorption of NSAIDs includes

A

orally in the stomach and small intestines
peak concentration in 1-4 hours
food delays absorption
IV admin may not reduce negative gastric effects
topical absorption has advantages of local targeted effect

24
Q

Distribution of NSAIDs include

A

weakly acidic
highly plasma bound
liphophilic
only unbound portion is effective

25
Q

Elimination of NSAIDs include

A

hepatic oxidation & conjugation
less than 10% renal elimination
some active metabolites

26
Q

Examples of propionic acid include

A

Naproxen (aleve)- non-selective COX

ibuprofen- non-selective COX

27
Q

Anthranilic acid includes

A

meloxicam (Mobic)- cox 2

-cox 2 selective at lower doses <15 mg

28
Q

Acetic acid drugs include

A

diclofenic
indomethacin- non-selective- high GI side effects
toradol- non-selective- can impair renal function, limit doses to 3-5 days

29
Q

Describe issues with diclofenic.

A

hepatic toxicity
transdermal use is effective without systemic toxicity
increased risk of thrombotic event

30
Q

Pure cox 2 inhibitor includes

A

celecoxib (celebrex)

31
Q

Celebrex may be used in treatment of

A

colon polyps, cancer, mental illness

32
Q

IV tylenol may be used to

A

reduce post-operative narcotic consumption

33
Q

Tylenol works by

A

inhibiting central prostaglandin synthesis
poor cox inhibition
no effect on platelet function or gastric mucosa

34
Q

Salicylates include

A

aspirin
-nonselective cox inhibitor
long term antipyretic and anti-inflammatory properties

35
Q

Long term effects of aspirin include

A

bleeding
ulcers
Reye’s syndrome (children)

36
Q

NSAID side effects include

A

gastric mucosa
dyspepsia
decreased renal function
hepatic side effects
acetaminophen hepatotoxicity
increased platelet aggregation at high doses
decreased platelet aggregation at low doses (ASA)

37
Q

Opioid receptors include

A

Mu, Kappa, & Delta

38
Q

Effects of stimulating the Mu receptors include

A 
analgesia
respiratory depression 
euphoria
sedation 
decreased GI motility 
dependence
39
Q

Effects of stimulating the kappa receptors include

A 
spinal analgesia
sedation 
dyspnea
dependence
dysphoria 
respiratory depression
40
Q

Effects of stimulating the delta receptors include

A

psychomimetic effects**
dysphoria
increased release of dopamine stimulating pleasure centers
insignificant analgesic effects

41
Q

Most effects and side effects of opioids can be traced to

A

metabolites

higher metabolite activity usually means more side effects

42
Q

Metabolites can produce

A

hyperalgesia

43
Q

Opioid side effects include

A

constipation - does not resolve over time
nausea
pruritus
sedation- transient
respiratory depression- long term use leads to sleap apnea
endocrine- low testosterone, amenorrha, immunologic, inhibition of cellular response

44
Q

The solution to opioid side effects is to

A

reduce opioid use

45
Q

The primary action of oxycodone is

A

kappa (dysphoria)

metabolites have anti-sedative effects

Advanced Principles 2 (42 decks)

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