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IDT Fall > Pain Management > Flashcards

Pain Management Flashcards

1
Q

define somatic pain

A

localized aching or throbbing

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2
Q

define visceral pain

A

pain in organs

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3
Q

define central pain

A

non-nerve related, pain that cannot be identified physically

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4
Q

fibromyalgia is categorized under what type of pain?

A

central pain

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5
Q

what is the purpose of the JCAHO accreditation?

A

inform patients rights to pain assessment and management

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6
Q

define nociception

A

sensation of pain

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7
Q

define proprioception

A

perception of the body/placement of limbs

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8
Q

define allodynia or hyperalgesia

A

hypersensitivity and pain response to normal tactile stimuli. such as a sunburn

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9
Q

define analgesia

A

blocking only of nociception

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10
Q

define anesthesia

A

blocking all sensation

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11
Q

where does initiation of pain occur?

A

from stimulus in periphery

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12
Q

where does transmission of pain occur?

A

in spinal cord

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13
Q

where does perception of pain occur?

A

in brain

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14
Q

where does reaction of pain occur?
what is the reaction?

A

in brainstem-reflex motor
inhibition or sensitization outputs

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15
Q

what do Mu opioid receptors do on pre-synaptic neuron?

A

blunt pain and block calcium channels to decrease NT release

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16
Q

Mu opioid receptors are inhibitory or non-inhibitory?
G-protein coupled or non-G protein coupled

A

inhibitory and G-protein couplred

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17
Q

what do the free nerve endings in the dermis of skin sense?

A

light touch, pressure, or pain perception

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18
Q

where is the first stop once a pain signal is initiated?

A

the spinal cord dorsal horn

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19
Q

what do Mu opioid receptors do on post-synaptic neuron?

A

cause hyperpolarization by increasing k+ out of neuron and desensitize

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20
Q

what part of the brain is the primary site for distribution of pain signals?

A

thalamus

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21
Q

projections to _____________ localize pain

A

somatosensory cortex

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22
Q

projections to ________ and _______ shape emotional and cognitive responses and reactions

A

prefrontal cortex, limbic areas

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23
Q

which parts of the brain carry out descending modulation of pain?

A

rostral ventromedial medulla
periaqueductal gray

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24
Q

which parts of the brain influence motivational information (to prevent future pain)?

A

Ventral tegmental area
Thalamus

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25
Q

which parts of the brain process your emotional response to pain?

A

Anterior cingulate cortex
Insula
Nucleus accumbens
Amygdala
Parabrachial nucleus

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26
Q

how do opioids interact with GABA?

A

they inhibit GABA inhibition of descending inhibitory pathways
Explanation: they block the inhibition caused by GABA in descending inhibitory pathways to allow activation of the descending inhibitory pathways to block pain

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27
Q

which two NTs do descending inhibitory pathways utilize to activate inhibitory interneurons in the dorsal horn?
Given what these two NTs are, what drug class has analgesic action?

A

5-HT and NE
SNRIs

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28
Q

what are the 3 sites of opioid action? (PAG, RVM, and DH)

A

periaqueductal gray, rostral ventromedial medulla, and dorsal horn

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29
Q

define a narcotic

A

anything that dulls the senses, relieves pain and induces sleep

30
Q

define opioid

A

anything that binds to opioid receptors

31
Q

preproopiomelanocortin, preproenkephalin, prepordynorphin, and preproorphanin are all classified as?

A

opioid receptor agonists

32
Q

Beta-Endorphin, Met-enkephalin, and Leu-enkephalin all have high affinity for which types of opioid receptors?

A

mu and delta

33
Q

dynorphin A and B have high affinity for which opioid receptor type?

A

kappa

34
Q

what effects would you expect from drugs that target mu opioid receptors?

A

analgesia, sedation, euphoria, respiratory depression, constipation and dependence

35
Q

what effects would you expect from drugs that target delta opioid receptors?

A

mild analgesia, less respiratory depression, less constipation (compared to mu)

36
Q

what effects would you expect from drugs that target kappa opioid receptors?

A

analgesia, less respiratory depression, dysphoria, less dependence, minimal constipation (compared to mu)

37
Q

how does respiratory depression occur when using CNS depressants?

A

The pons region of the brain has decreased sensitivity to pCO2 and therefore you don’t realize you need more oxygen in the brain

38
Q

how do opioids have antitussive effects?

A

inhibits cough center in the medulla

39
Q

why do opioids cause nausea and vomiting?

A

they stimulate the chemoreceptor trigger zone

40
Q

opioids cause miosis or mitosis?

A

miosis

41
Q

T/F opioids block the baroreflex

A

false, they blunt it, not completely block

42
Q

opioid effect on stomach:

A

decreased secretions and motility

43
Q

opioid effect on intestines:

A

decrease propulsion and water secretion

44
Q

opioid effect on sphincters:

A

contraction of smooth muscle

45
Q

what is the mechanism behind opioids decreasing stomach secretion/water secretion?

A

they decrease cAMP levels which are important for water secretion which is important for gut mobility

46
Q

what is the mechanism behind opioids causing sphincter smooth muscle contraction?

A

decreasing cAMP levels causes contraction of smooth muscle

47
Q

opioid effect on urinary tract:

A

contraction of smooth muscle - urinary retention

48
Q

opioid effect on uterine smooth muscle:

A

prolongation of labor

49
Q

opioid effect on bronchiole smooth muscle:

A

constriction, may be problematic in asthma

50
Q

opioid effect on vascular smooth muscle:

A

hypotension from release of histamine

51
Q

opioid effect on basal metabolic rate and temperature:

A

modest decrease

52
Q

opioid effect on immune system:

A

modest immunosuppression

53
Q

opioid effect on mast cells:

A

histamine release

54
Q

opioid effect on pituitary:

A

possible increase in prolactin and growth hormone

55
Q

opioids can cause hypogonadism which is a decrease in hormones such as estradiol and testosterone. what SEs would you expect?

A

decreased libido, menstrual irregularity

56
Q

what are the diagnostic triad signs of acute overdose of opioids?

A

pinpoint pupils, respiratory depression, and coma

57
Q

what is the indication of opioid-induced hyperalgesia?

A

increasing dose without relief

58
Q

You can build tolerance to opioid SEs except for which two SEs?

A

constipation and miosis

59
Q

why can NSAIDs, SNRIs, acetaminophen, local anesthetics, and alpha 2 agonists be helpful as combo therapy with opioids?

A

they reduce pain at lower opioid doses so you can dose less opioid

60
Q

list all of the withdrawal symptoms from opioids:
(T T S H P P I M D L N V H I)

A

tachypnea (rapid breathing)
tachycardia
sweating
hypertension
piloerection
pupillary dilation and photophobia
insomnia
myalgia
diarrhea
lacrimation
nausea
vomiting
hyperthermia
irratability

61
Q

what drug can be used to treat the autonomic hyperactivity and anxiety from opioid withdrawal?

A

clonidine

62
Q

what drugs can be used to treat myalgia from opioid withdrawal?

A

NSAIDs

63
Q

what drug can be used to treat diarrhea from opioid withdrawal?

A

loperamide

64
Q

what is the longest acting opioid agonist? what is it used for?

A

methadone: pain management of opioid use disorder as maintenance therapy

65
Q

what drug has a toxic metabolite and should be avoided?

A

meperidine

66
Q

codeine must be metabolized to ____ for efficacy, many people are _____ metabolizers

A

morphine, poor

67
Q

TRV130 has biased agonism, explain what this means

A

mu opioid receptors have two components - G protein and Beta-arrestin. G protein is normally blocked by Beta-arrestin which decreases respiration and GI function. TRV130 blocks Beta-arrestin, allowing G protein to stay active which will increase analgesic effects

68
Q

what drug formulations does Naloxone come in?

A

IM, IV, or nasal

69
Q

what is Naltrexone used for?

A

to treat opioid use disorder and alcoholism

70
Q

How do Naloxegol, Methylnatrexone, Naldemedine, and Alvimopan work for treating opioid-induced constipation?

A

they are opioid antagonists that have no CNS effects, so they can block opioid stimulation in periphery w/o blocking pain relief

71
Q

why would we prescribe oxycodone + naloxone, buprenorphine + naloxone, or pentazoxine + naloxone?

A

they prevent people from IV injecting opioids => naloxone blocks opioid actions if injected, but not if taken orally, so patient has to take med orally to have any pain relief

IDT Fall (29 decks)

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