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Pharm exam 2 > Pharm Exam 2 > Flashcards

Pharm Exam 2 Flashcards

0
Q

Dorsal horn neurons can display “windup phenomenon” a after multiple stimuli. What is this?

A

Synaptic potentials increase in amplitude with each repeated stimulus. (pain gets worse with each stimuli)

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1
Q

What is hyperalgesia?

A

Decreased pain threshold in inflamed area, with a hyper-reactive response inappropriate to the level of stimulus

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2
Q

What is a nociceptor?

A

another name for pain receptor

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3
Q

What is allodynia?

A

Pain evoked by a non-noxious stimulus.

ex. weight of sheets in bed, or even pain from absence of stimuli

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4
Q

What is preemptive analgesia?

A

Analgesic given prior to stimulus which prevents establishment of altered central processing.

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5
Q

Describe the characteristics of Acute Pain?

A
  1. Rapid and has well defined onset with limited duration
  2. It is a protective mechanism
  3. It is associated with anxiety (sympathetic hyperactivity Tachy, HTN)
  4. Provoked from tissue injury
  5. Mono-phasic= surgery 1x cause or recurrent= headaches, dysmenorrhea, inflamed bowel
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6
Q

What are some characteristics of Chronic pain?

A
  1. Delayed, with ill defined onset (approx 6 weeks)
  2. unpredictable
  3. begins as acute pain
  4. Autonomous- independent of trigger stimulus
  5. Aberration of normal pain pathway (treatment not same)
  6. Associated with depression
  7. May be associated with hyperalgesia and allodynia
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7
Q

What is a skeletal muscle spasm?

A

Direct pain from effect of skeletal muscle spasm stimulating pain receptors

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8
Q

Describer Fast Pain?

A
  • Sensation carried by A-Delta nerve fibers that are myelinated
  • Fast,Short, well localized/pinpoint-able,
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9
Q

What are characteristics of Slow pain?

A
  • Carried by unmyelinated C Fibers
  • Throbbing, burning, aching
  • poorly localized (deep pain)
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10
Q

What path does temperature sensation follow?

A

Same as slow pain

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11
Q

Pain from heat and tissue damage occurs around what Temp?

A

43 degrees Celsius (threshold)

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12
Q

What type of pain is from peripheral stimulation of nociceptors in structures?

A

Nociceptive pain

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13
Q

What type of pain can be cause from peripheral or central stimulation that originates in the CNS?

A

Neuropathic pain

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14
Q

Nociceptive pain can be further divided into what two groups?

A

visceral and somatic

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15
Q

What is visceral pain?

A
  • Sharp, aching, or cramping pain from hollow organs
  • Caused from ischemia, stretching, or distention
  • poorly localized and radiates
  • Pain from organs such as lungs, brain, liver
  • Less dense distributed receptors when compared to skin receptor
  • Associated with N & V
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16
Q

What is somatic pain?

A
  • Arises from Skin and skeletal muscle (ex surgical incision)
  • Sharp stabbing well localized
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17
Q

What is neuropathic pain?

A
  • Originates in CNS or brain usually
  • often not responsive to opiates
  • Treated with adjuvant therapy (Lyrica, Gabbapentin)
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18
Q

Pain response can be influenced by what factors?

A 
Genetic
Chemical
gender
cultural
previous experience
19
Q

Is pain a subjective or objective experience?

A

Subjective

20
Q

Pain stimulus evokes efferent activity in which part of the autonomic nervous system?

A

Sympathetic

21
Q

What can cause spontaneous firing of nerves?

A
  1. peripheral nerve injury

2. In the dorsal root ganglia where peripheral projections have been interrupted (amputation, nerve transection)

22
Q

When was complex regional pain syndrome first described and what was it called then?

A

following civil war injuries and was called “causalgia”

23
Q

What is Complex Regional Pain Syndrome?

A
  • starts as acute pain but changes to chronic systemic disease after prolonged stimulation
  • characterized by severe pain, swelling, and changes in the skin. CRPS is expected to worsen over time. It often initially affects an arm or a leg and often spreads throughout the body
  • extreme hyperalgesia and allodynia is common
24
Q

Sympathetic nervous system stimulation from pain leads to what physiologic effects?

A
  • Vasoconstriction that causes acidosis and tissue ischemia and further chemical release of pain mediators (prostaglandins, substance P, bradykinin etc.)
  • Local anesthetics block Sympathetic transmission therefore block pain transmission and cascade that can lead to Complex Regional Pain syndrome.
25
Q

What is the name of the receptor that is activated in Complex Regional Pain Syndrome that is the primary mediator of sensitization in the dorsal horn?

A

N-methyl-D-Aspartate (NMDA)

26
Q

The pathophysiology of pain involves what 4 steps?

A
  1. Transduction
  2. Transmission
  3. Modulation
  4. Perception
27
Q

What is Transduction?

A

Process of activation of peripheral terminals of primary afferent sensory neurons where noxious stimuli are translated into electrical activity.

28
Q

So what does stimulus do to a neuron?

A

activates it

29
Q

When transduction occurs where does the action potential conducted to (or synapse)?

A

The dorsal horn of the spinal cord

30
Q

What are some substances that can activate pain fibers during injury or painful event?

A 
Prostaglandins
serotonin
bradykinins
glutamate
Substance P etc.
31
Q

During injury peripheral neurons will release substance P and other mediators that will activate what other things?

A

Mast cells
vasodilate vessels
recruit other receptors

32
Q

Where are pain receptors (nociceptors) found?

A

Skin
Skeletal Muscle
Viscera

33
Q

Do pain receptors adapt and stop accepting painful stimuli?

A

No, pain is a protective mechanism that allows awareness

34
Q

Some opioid analgesics bind to opioid receptors found (where) and mimic the inhibitory effects of endogenous opioids?

A

-inhibit nociception in the dorsal horn
-can also bind to opioid receptors in the brain and activate descending pathway to further inhibit Dorsal Horn nociceptive transmission
(binding in periaqueductal gray region brain will cause serotonin to be released in DH which causes enkephalin to be released to block Ca++)

35
Q

What does Baclofen do to prevent pain transmission?

A

It is a GABA agonist that binds to GABA receptors and mimics the inhibitory effects of GABA (ex Neurontin, Lyrica)

36
Q

At which laminae in the dorsal root do type A-Delta fibers (fast) nerve roots terminate (synapse)?

A

Laminae 1 & 5

37
Q

After A-Delta fibers synapse in the dorsal horn they then cross to the opposite side of the cord and pass to the brain via what tract?

A

The spinothalamic (anteriolateral pathway or column)

38
Q

Are A-Delta fibers mylinated?

A

yes lightly myelinated

39
Q

What is the name of the ascending pathway that is part of the spinothalamic tract that the A-delta fibers travel to the thalamus by?

A

Neospinothalmic tract

40
Q

What type of pain does A-delta fibers sense?

A

Intense, sharp, stinging pain that allows localization and withdraw reflex

41
Q

What is the major neurotransmitter released and where does it bind?

A 
NT= glutamate
Binds= AMPA receptor post-synaptic
42
Q

What are A-beta fibers?

A

Somatosensory fibers that inhibit the spinothalamic neurons via release of enkephalins which may mediate analgesic effects of tissue stimulation (gate control theory)

43
Q

How is the A-beta fibers different from A-delta fibers when considering size and myelination?

A 
Larger diameter 
Highly myelinated (so faster conductor than A-delta)
44
Q

Transcutaneous Electrical Nerve stimulation, acupuncture, and “rubbing the injury” are all associated with which nerve fiber?

A

A-beta

45
Q

Where does Type C (slow) pain terminate (synapse) in the dorsal horn?

A

Laminae 2 & 3 (aka substantia gelatinosa) and Laminae 5

46
Q

What can happen in the dorsal horn prevent pain?

A

Modulation through spinal interneurons release inhibitory amino acids (GABA) and neuropeptides (endogenous opioids) that bind to receptors on primary afferent and DH neurons to inhibit pain transmission

Pharm exam 2 (6 decks)

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