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Clin Med Final Material 5 > Pain- Ross > Flashcards

Pain- Ross Flashcards

1
Q

Nociceptor is the ________ receptor detecting the stimulus of heat/cold, Ph, mechanical disruption (bringing pain into the spinal cord _______ the brain via __________ tract)

A

afferent

towards

spinothalamic tract

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2
Q

A-alpha and A-beta carry, these three things to Medulla

A

vibration, stretch, proprioception

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3
Q

2nd order neuron bring signals from the _____ to _______

A

medulla to thalamus

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4
Q

2nd order neuron bring signals from the _____ to _______

A

thalamus to somatosensory cortex

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5
Q

T/F: A-delta and C fibers carry nociceptor sense to the medulla then thalamus then cortex

A

True

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6
Q

A –alpha and A-beta Dorsal column is the _______ ________ pathway

A

Medial lemniscus pathway meaning: system that conveys sensations of fine touch, vibration, two-point discrimination, and proprioception (position) from the skin and joints to the brain

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7
Q

pain receptors are called _______

A

nocireceptors

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8
Q

What type of pain?

A-beta & A-alpha:

A

fast, light touch

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9
Q

What type of pain?

A-delta

A

sharp pain because they are myelinated

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10
Q

What type of pain?

c fibers

A

(unmyelinated) slower, dull burn pain

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11
Q

1st order neuron resides in _______ _____ _______; 2 arms one in the periphery and the other goes into SC at dorsal columns it goes up then _______ over, continues through the dorsal column to medulla where synapse at dorsal column nuclei

A

dorsal root ganglion

crosses over

(crosses from one side to the other so pain on R side of body is processed on the L side of the body)

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12
Q

2nd order neuron carries info to the _______

A

thalamus

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13
Q

3rd order neuron goes from thalamus to __________ _____ (location of pain), cingulate cortex: interpretation of pain and or insular cortex (limbic brain) emotional reaction to pain

A

somatosensory cortex

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14
Q

________ decreases activation and makes it easier to feel pain while serotonin

A

prostaglandin

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15
Q

what three things make the pain threshold go up and hard to feel pain

A

serotonin, thromboxane and endorphins

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16
Q

What is the convergence theory?

A

Convergence theory is when a visceral and somatic afferent converge on the same are of dorsal horn, the brain can not distinguish between the 2 and pain can be felt in a different location

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17
Q

What are some local effects nociceptors can have?

A

edema, vasodilation and hyperalgesia (enhanced sensitivity to pain)

18
Q

What is the cortex influence of pain?

A

The cortex probably influences pain via several mechanisms. It has been proposed that the cortex may reduce pain by interrupting the transmission of noxious information from the spinal cord level by activating descending pain modulatory systems located in the brainstem

19
Q

It’s the ________ that sends signals to somatosensory cortex, cingulate cortex and insular cortex. The ______ interprets the signal of pain (emotional/rational input) and modulates it.

A

thalamus

Cortex

20
Q

What is the purpose of endorphins?

A

Endorphins turn on/off cells that inhibit (green) or facilitate control of nociceptive signals (red)

21
Q

Where are the four places we can influence pain?

A
  1. at nociceptor
  2. in dorsal horn
  3. PAG
  4. thalamus
22
Q

What happens at the PAG?

A

At baseline the cortical influence on pain is blocked by an inhibitory neuron. So initially when you hit your arm there is no cortical modulation of the pain, only when the hypothamus , insular cortex or cingulate cortex signal to an inhibitory neuro to inhibit the baseline blockage of signal (inhibitory neuron) do cortical influence take effect. This is mediated by endorphins.

23
Q

At the dorsal horn, the modulation of pain is from the:

A

Modulation of pain is from serotonin, norepi, opioids, gaba receptors

24
Q

If there is a local issue with pain detection what can we use to help?

A

NSAIDS, nerve blocks and local anesthesia can be helpful

25
Q

If there is a transmission issue with pain transmission what can we use to help?

A

Opioids acetaminophen, gabapentin and tricyclic anti-depressants can help

26
Q

If there is an issue with pain expression, what can be helpful?

A

Opioids, benzo, sedative, hypnosis, and distraction can be helpful

27
Q

T/F: Placebo effect is real, the brain will produce endogenous opioids to modulate pain.

A

T

28
Q

**What is a major side effect of morphine?

A

hypotension and nausea and histamine release

29
Q

What is the IV dose or morphine and PO?

A

IV: 0.1 mg/kg
PO: 0.3 mg/kg

Short acting 10-30 min

30
Q

What is a major side effect of hydromorphone (diludid)?

A

EUPHORIA *makes people feel high

31
Q

What is the IV dose for hydromorphone and IM?

A

IV: 0.015 mg/kg
IM: 1-2 mg/kg

Longer acting about 2-4 hr for IM, shorter for IV

32
Q

**What is a major side effect of fentanyl?

A

> 5 mcg can cause chest wall ridigity

**used for breakthrough pain; opioid tolerant cancer - wait 2 hrs before treating another episode

33
Q

What can you increase the fentanyl dose by per episode?

A

100 micrograms per episode

34
Q

What is the IV dose for hydromorphone and nose spray?

A

IV: 1 mcg/kg lasts about 60 min

Nostril Spray: highly addictive

35
Q

**Oxycodone side effects?

A

Possible inadvertend acetaminophen overdose with combination agents

**same as the side effects for hydrocodone

36
Q

What is the dosing for oxycodone?

A

5-10 mg PO
OR
30 mg PR

37
Q

Side effects of codeine (natural alkaloid)?

A

High incidence of GIside effects

Some patients cannot metabolize it

38
Q

What is Ross’s fav pain med?

A

Oxycodone

39
Q

This as an alternative to a narcotic for acute pain especially neuropathic similar to gabapentin

A

ketamine

40
Q

What are two topical meds that can be used in back pain?

A

lidocaine, capsacin

41
Q

What are some HA meds?

A

Headache: phenothiazines (Compazine, ergotomines (sumatriptan), anti-psycotics (Haldol), anti-seizre (valproate)

Clin Med Final Material 5 (18 decks)

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