Physiology

Question 1

Pain types

Answer 1

nociception 
types are: 
1. tranduction 
2. transmission 
3. modulation 
4. perception

Question 2

Transduction pain

Answer 2

tx: NSAIDS inhibits prostaglandins 
noxious stimulus (mechanical/thermal/chemical) ==> electrical activity at the sensory nerves ==> inflammation

Question 3

Transmission

Answer 3

tx: Local anesthetics act on ion channels of neurons and prevent depolarisatio nand prevent transmission of sigal to dorsal horn
patho: pain travels along two fibers. usually sharp pain followed by slow burning pain
A fibers: acute, sharp pain, fast transmission
C fibers: slow, chronic pain, slow transmision

Question 4

Modulation

Answer 4

Tx: Transcutaneous electrical nerve stimulation which works via pain gating
Patho: stimulation of mechanoreceptors will inhibit stimuation and activation of large A fibers

Question 5

Perception

Answer 5

treated with opiods
patho: occurs in thalamus and sensory cortex
viscera have sensory receptors which detect pain caused by ischemia, smooth muscle spasm, distension or chemical damage

Question 6

NICE guidelines for pain

Answer 6

1. paracetamaol
2. ibuprofen or weak opiod like codeine
3. paracetamol + ibuprofen+ codeine
4. paracetamol + alternative NSAID
5. para+ NSAID + weak opiod

Question 7

Factors increasing pain

Answer 7

anger 
boredom 
insominia/fatigue
anxiety/fear/grief 
depression 
social isolation 
discomfort
lack of understanding

Question 8

factors decreasing pain

Answer 8

acceptance
creative activities
sleep
relaxation 
elevation of mood
companionship and understanding 
relief of other symptoms 
understanding the condition

Question 9

WHO Pain ladder

Answer 9

1. non-opioid + adjuvant
2. mild opioid + non-opioid+ adjuvant
3. moderate opioid + non-opioid + adjuvant

Question 10

Calculate Breakthough dose

Answer 10

total daily dose of opiate / 6

Question 11

Adjuvants for pain

Answer 11

TCA==> neuropathic pain
Hyoscine butylbromide ==> anti-spasmodic
Diazepam/Baclofen ==> muscle spasm
Dexamethasome ==> ICP/ Swelling

Question 12

Control and action of PTH

Answer 12

Low Calcium causes increased PTH
pth causes
- kidney: increased calcium resorption/ increased phsphate ecvretion
increased vitamin D
- bone: osteoclastic resorption which releases calcium and phosphate into blood
high calcium shuts off PTH