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APA3 levi 2019 S.Horvath > Pain Management > Flashcards

Pain Management Flashcards

1
Q

Increased sensitivity to pain =

A

algesia

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2
Q

pain producing =

A

algogenic

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3
Q

a normally non-harmful stimulus perceived as painful =

A

allodynia

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4
Q

the absence of pain in the presence of a normally painful stimulus =

A

analgesia

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5
Q

an unpleasant painful abnormal sensation, whether evoked or spontaneous =

A

dysesthesia

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6
Q

a heightened response to a normally painful stimulus =

A

hyperalgesia

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7
Q

pain in the distribution of peripheral nerve

A

neuralgia

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8
Q

an abnormal disturbance in the function of a nerve =

A

neuropathy

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9
Q

an abnormal sensation, whether spontaneous or evoked =

A

paresthesia

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10
Q

acute pain occurs in what time frame?

A

<1 month

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11
Q

acute pain is associated with ___ or ___ tissue damage

A

actual or potential

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12
Q

chronic pain occurs in what time frame?

A

> 3mo

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13
Q

chronic pain = persistent pain associated with a distinct period of ____ pain of __ months or more that includes negative ___ and ___ experience

A

uninterrupted, 3, sensory, emotional

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14
Q

nociceptive pain is ___ and ____ in nature

A

somatic and visceral

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15
Q

non-nociceptive pain is ___ and ___ in nature

A

neuropathic, inflammatory

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16
Q

what type of pain is identifiable to focus, stems from tissue damage, is well localized, sharp, hurts at area?

A

somatic

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17
Q

what type of pain is diffuse, referred, dull, cramping, squeezing.

A

visceral

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18
Q

what type of pain is associated with autonomic reflexes such as nausea, vomiting, diarrhea

A

visceral

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19
Q

what type of pain results from damage to peripheral or central neural structures, resulting in abnormal processing of painful stimuli?

A

neuropathic

remember this is also non-nociceptive

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20
Q

what type of pain stems from sensitization of the nociceptive pathway from multiple mediators

A

inflammatory pain

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21
Q

_____ is the transformation of noxious stimuli (chemical, mechanical, thermal) to an action potential

A

transduction

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22
Q

which nerve fibers are fast, sharp, pain(6-30m/s) (reflex alert)

A

A delta

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23
Q

which nerve fibers are slow (0.5-2 m/s) dull burning throbbing aching

A

C fibers

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24
Q

Substance P is associated with which nerve fibers?

A

c

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25
Q

Substance P causes vaso____, extravasation of plasma proteins, degranulation of ___ cells, sensitization of stimulated sensory nerve

A

vasodilation.

mast

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26
Q

glutamate is associated with ____, ____, ____

A

CNS, A-delta, C fibers

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27
Q

T/F Glutamate transduction has an instantaneous effect and is associated with fast, sharp pain.

A

TRUE

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28
Q

Bradykinin : ____-algesic

A

peptide.

has a direct stimulating effect on peripheral nociceptors via bradykinin receptors

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29
Q

____ is an amine released from mast cells, basophils, and platelets via Substance P, causing edema and vasodilation

A

histamine

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30
Q

___ is an amine stored and released from platelets after tissue injury

A

serotonin

31
Q

what 3 substances are synthesized from cox1 and cox2, cause hyperalgesia

A

prostaglandins, leukotrienes, thromboxanes

PLT

32
Q

what substance is released in response to tissue injury and causes an increased production of prostaglandins

A

cytokines

33
Q

___ is a peptide released from afferent C fibers. causes local cutaneous vasodilation, plasma extravasation, and sensitization

A

Calcitonin gene-related peptide (CGRP)

34
Q

___ is the process by which action potential is conducted from the periphery to the CNS

A

transmission

example is spinothalmic anterolateral tract

35
Q

____ occurs once signal is recognized by various areas of brain

A

perception

36
Q

____ refers to altering neural afferent activity along pathway

A

modulation

37
Q

suppress = ____, enhance = ____

A

suppress = inhibatory, enhance = excitatory

SI-EE

38
Q

suppression works on descending ___ pathways

A

efferent

39
Q

___ inhibit COX, thereby stopping the conversion of arachidonic acid to prostaglandins

A

NSAIDs

40
Q

30mg of IM Ketorlac is equivalent to ___mg IM morphine

A

12

41
Q

dont administer toradol for >___ days

A

5

42
Q

contraindications to Ketorlac include

A

coagulopathies, renal failure, active PUD, GI bleeding, hypersensitivity to NSAIDS, surgery with high potential for post op bleeding

43
Q

MOA of toradol?

A

non-selective COX inhibitor

44
Q

acetaminophen reduces ___ synthesis

A

prostaglandin

45
Q

Opiods: CNS receptors are in the ____ horn, specifically ______

A

dorsal horn, specifically reed lamina II (substance gelatinosa)

46
Q

opioids: peripherally ___ sensory nerve fibers in GI tract, lungs, joints

A

afferent

47
Q

mu, delta, and kappa receptors: ___ channels are inhibited presynaptically, and ___ conductance is increased post-synaptically

A

ca, K

48
Q

how do opiates affect adenylate cyclase activity?

A

decrease pre-synapptically - thereby inhibiting calcium channels, which causes a dec in excitatory neurotransmitters

49
Q

what affect does increased potassium conduction postsynaptically on mu delta and kappa receptors have?

A

hyperpolarization, inhibits excitatory neurotransmission

50
Q

T/F Ketamine is an NMDA agonist.

A

FALSE - NMDA antagonist

51
Q

which receptor is associated with wind up?

A

NMDA

52
Q

how do clonidine and precedex work at alpha 2 receptors?

A
  • they inhibit adenyl cyclase and decrease cAMP

- activate postsynaptic K channels and inhibit presynaptic Ca channels which decrease neurotransmitter release

53
Q

Should the patient continue their gabapentin, pregabalin, antidepressants, corticosteroids , methadones?

A

absolutely.

54
Q

how do gapapentin and pregabalin (lyrica) work?

A

they are for neuropathic pain syndromes - inhibit neuronal excitation and stabilize nerve membranes.

55
Q

how do antidepressants work?

A

they block the reuptake of serotonin and norepinephrine in the CNS, increasing availability

56
Q

corticosteroids decrease ___ and ____ release

A

cytokine, prostaglandin

57
Q

methadone has synthetic ____, ____ , and ____ receptor action

A

synthetic opiod, opiod, and NMDA

58
Q

what are the 3 heuristic subdivisions of painful stimuli?

A

painful stimuli without tissue damage, tissue damage without nerve damage, and nerve damage

59
Q

what are the 3 anatomic regions associated with pain

A

peripheral, spinal , cerebral

60
Q

T/F Substance P and Substance P receptors are specifically associated with neuropathic and cancer pain.

A

FALSE. specifically associated with inflammatory pain, while diminished or absent in neuropathic and cancer pain

61
Q

Chronic Pain: inflammatory pain produces capillary vasodilation, smooth muscle contraction. promotes ____ transmission of pain impulses to ____. via which 3 mediators?

A

promotes synaptic transmission of pain impulses to CNS.

histamine, bradykinin, substance P

62
Q

neurpathic pain commonly leads to ____

A

allodynia

pain from stimuli that is normally not painful

63
Q

T/F Neuropathic pain is persistent, allodynia, and not managed well with NSAIDs

A

true

64
Q

____ is the cyclic response to pain that leads to abnormal pain response

A

windup

65
Q

neuropathic pain is thought to include the dysfunction of both ___ and ____ fibers

A

A (fast) and C (slow)

66
Q

NMDA receptors are stabilized by __

A

magnesium

67
Q

In the periphery, abnormal (chronic pain): magnesium displaced, _____ activated, ____ ions enter cells. exaggerated release of ____ and _____

A

NMDA. calcium.

exaggerated release of substance P and excitatory amino acids

68
Q

what is the low dose range of ketamine that has shown successful outcomes

A

0.25-.5mg/kg

69
Q

T/F Cyclobenzaprine (flexeril) is useful for maintenance of long term chronic pain.

A

FALSE - it becomes ineffective in a few weeks, and is only for short term symptomatic reliefs.

70
Q

what is the drawback of carisoprodol (Soma)?

A

it has the potential for dependence, tolerance, and mental impairment.

71
Q

how does withdrawal from Baclofen present?

A

resp failure, hemodynamic changes, seizure, delirium

72
Q

T/F Baclofen is NOT for use in chronic pain, rather it has specialized use for CP and MS.

A

TRUE

73
Q

T/F Baclofen can be used for muscle spasms related to acute pain.

A

FALSE - baclofen should NEVER be used for muscle spasms related to acute or chronic pain. it was designed for extreme spasmodic conditions (CP, tetanus, MS) (per nagelhout)

APA3 levi 2019 S.Horvath (16 decks)

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