Pain Management Flashcards
More than ___% of overdose deaths involve an opiate.
60
What percent of people without cancer who receive a long-term opioid prescription will struggle with addiction?
25%
What type of neuron senses non-noxious mechanical stimuli?
A beta
The _________ neurons sense “noxious mechanical stimuli” such as crush/pressure injuries.
A delta
C fibers sense ______________.
heat or capsacin
Because local anesthetics are weak bases, they have faster onset of effect after _________ is given.
NaHCO3 (or any other substance that will raise serum alkalinity and make the -NH3 form of the molecule predominate)
Why is memantine given to those with Alzheimer’s?
Because there is often up-regulation of glutamate in those with Alzheimer’s
The lifetime prevalence of severe chronic pain is ________.
1/3
The amount of opioids prescribed has ________ in the last fifteen years.
qudrupled
Severe pain is characterized by what nonverbal behavior?
Crying out (same as excruciating but with more intensity)
Differentiate neuropathic, functional, and nociceptive chronic pain.
Nociceptive: related to a chronic disease
Functional: no identifiable cause
Neuropathic: pain from an acute injury that lasts well beyond healing
The 5HT3 receptor is involved in the _________ response.
chronic pain (hence serotonergic drugs that treat chronic pain)
True or false: even partial agonists of the mu-opioid receptor can have respiratory suppressive effects at therapeutic doses.
True –happens with buprenorphine and tramadol
Describe the arousability scale.
1: no able to arouse
2: difficult to arouse
3: sleeping but arousable
4: drowsy
5: wide awake
What agents can be given to those with opioid constipation?
Naltrexone Naloxegol Methylnaltrexone Docusate-senna Milk of magnesia Polyethylene glycol (miralax) Bisacodyl-senna
Local anesthetics can block signals from which fibers?
All fibers, but happens first with A-delta and C
Why do nerve blocks cause vasodilation when given without epinephrine?
Because they block sympathetic input to the blood vessels, leading to vasodilation
Titrating up local anesthetic, what order will non-pain sensations be lost in?
Pressure -> vibration -> proprioception -> motor
Naproxen works by ______________.
reversibly inhibiting COX-1 and COX-2
True or false: there is no renal difference between inhibiting COX-1 and COX-2.
True
Why is memantine given to those with Alzheimer’s?
Because Alzheimer’s presents with excessive glutamate activity. Memantine is a non-competitive antagonist of the Mg site within NMDA channels.
What molecule is involved in peripheral sensitization and is a common target of managing chronic pain?
Prostaglandins
Which neurotransmitter is the main one involved in central sensitization?
Glutamate
Why are calcium-channel blockers given to those with chronic pain?
Because calcium channels are involved in central sensitization
How do opioids in the PAG work?
They inhibit release of GABA, thereby removing the static inhibition that prevents PAG from firing –they inhibit the inhibitor.
