Pain Management

Question 1

More than ___% of overdose deaths involve an opiate.

Answer 1

60

Question 2

What percent of people without cancer who receive a long-term opioid prescription will struggle with addiction?

Answer 2

25%

Question 3

What type of neuron senses non-noxious mechanical stimuli?

Answer 3

A beta

Question 4

The _________ neurons sense “noxious mechanical stimuli” such as crush/pressure injuries.

Answer 4

A delta

Question 5

C fibers sense ______________.

Answer 5

heat or capsacin

Question 6

Because local anesthetics are weak bases, they have faster onset of effect after _________ is given.

Answer 6

NaHCO3 (or any other substance that will raise serum alkalinity and make the -NH3 form of the molecule predominate)

Question 7

Why is memantine given to those with Alzheimer’s?

Answer 7

Because there is often up-regulation of glutamate in those with Alzheimer’s

Question 8

The lifetime prevalence of severe chronic pain is ________.

Answer 8

1/3

Question 9

The amount of opioids prescribed has ________ in the last fifteen years.

Answer 9

qudrupled

Question 10

Severe pain is characterized by what nonverbal behavior?

Answer 10

Crying out (same as excruciating but with more intensity)

Question 11

Differentiate neuropathic, functional, and nociceptive chronic pain.

Answer 11

Nociceptive: related to a chronic disease
Functional: no identifiable cause
Neuropathic: pain from an acute injury that lasts well beyond healing

Question 12

The 5HT3 receptor is involved in the _________ response.

Answer 12

chronic pain (hence serotonergic drugs that treat chronic pain)

Question 13

True or false: even partial agonists of the mu-opioid receptor can have respiratory suppressive effects at therapeutic doses.

Answer 13

True –happens with buprenorphine and tramadol

Question 14

Describe the arousability scale.

Answer 14

1: no able to arouse
2: difficult to arouse
3: sleeping but arousable
4: drowsy
5: wide awake

Question 15

What agents can be given to those with opioid constipation?

Answer 15

Naltrexone
Naloxegol
Methylnaltrexone
Docusate-senna
Milk of magnesia
Polyethylene glycol (miralax) 
Bisacodyl-senna

Question 16

Local anesthetics can block signals from which fibers?

Answer 16

All fibers, but happens first with A-delta and C

Question 17

Why do nerve blocks cause vasodilation when given without epinephrine?

Answer 17

Because they block sympathetic input to the blood vessels, leading to vasodilation

Question 18

Titrating up local anesthetic, what order will non-pain sensations be lost in?

Answer 18

Pressure -> vibration -> proprioception -> motor

Question 19

Naproxen works by ______________.

Answer 19

reversibly inhibiting COX-1 and COX-2

Question 20

True or false: there is no renal difference between inhibiting COX-1 and COX-2.

Answer 20

True

Question 21

Why is memantine given to those with Alzheimer’s?

Answer 21

Because Alzheimer’s presents with excessive glutamate activity. Memantine is a non-competitive antagonist of the Mg site within NMDA channels.

Question 22

What molecule is involved in peripheral sensitization and is a common target of managing chronic pain?

Answer 22

Prostaglandins

Question 23

Which neurotransmitter is the main one involved in central sensitization?

Answer 23

Glutamate

Question 24

Why are calcium-channel blockers given to those with chronic pain?

Answer 24

Because calcium channels are involved in central sensitization

Question 25

How do opioids in the PAG work?

Answer 25

They inhibit release of GABA, thereby removing the static inhibition that prevents PAG from firing –they inhibit the inhibitor.