Review 3

Question 1

Capsaicin

Answer 1

VR-1 agonist

Repeated application thought to deplete substance P from primary afferent pain neurons (cream)

Adverse Reactions: Burning, stinging, and erythema at the site of application

Question 2

Ketamine

Answer 2

Glutamate antagonist at NMDA receptors in ascending pain pathway blocking acute nociceptive pain

Prevents central sensitization process in chronic pain

Question 3

Low back pain

Answer 3

TCADs

Question 4

Fibromyalgia

Answer 4

SNRIs

Question 5

Topical local anesthetic

Answer 5

lidocaine

Question 6

VSCC α2δ ligands

Answer 6

pregabalin - gabapentin

Question 7

Nonopioid analgesics

Answer 7

NSAIDs, acetaminophen, COX-2 selective, aspirin

Question 8

Acute neuropathic pain

Neuropathic cancer pain

Episodic exacerbations of severe pain

Answer 8

Opioid analgesics may be used

Question 9

Chronic Mild pain

Answer 9

non-opioid, adjuvants useful

↓ central sense, perf sense, ↑ descending inhibition

Question 10

Nothing works better than ____ for inflamtions

Answer 10

glucocorticoids

Question 11

Nothing works better than____ for pain

Answer 11

Opioids

Question 12

Multimodal spare:

Answer 12

Opioid sparing

Question 13

What is Multimodal Analgesia?

Answer 13

Use of multiple classes of analgesics acting via different pathways

Opioid monotherapy remains a cornerstone of treatment for severe postoperative pain  BUT idiosyncratic and dose-limiting side effects curtail practical efficacy

Benefits of combining other agents with opioids

Greater analgesic efficacy from synergistic actions of agents with different mechanisms

Synergism between agents allows use of lower doses (“opioid-sparing”) limiting dose-related side effects

Question 14

Agonists at u-opioid receptors modulate

Answer 14

Transmission of pain (dorsal horn)

Perception - reaction to pain (cortex -limbic system)

Question 15

Mainstay of therapy for moderate-to-severe acute pain

Answer 15

Opiods

NOTE: Use of non-opioid and adjuvant medications is emphasized for treatment of chronic-persistent pain

Question 16

Opioids - Side Effects

Answer 16

NV
Constipation
Pruritus

resp depression serious, reverse with naloxone
monitor sedation

Question 17

Opioids - Side Effects Constipation

Answer 17

Tolerance to constipation does not develop to same level as to analgesia or respiratory depression

Question 18

Local Anesthetic Molecule INtermediate chain

Answer 18

Determines metabolic pathway and allergenicity

Question 19

Local Anesthetic Molecule lipophilic ring

Answer 19

Penetration of bio membrane

Question 20

Local Anesthetic Molecule hydrophilic R group

Answer 20

Ionizable amine - pH determines % of charged vs uncharged

Question 21

Local Anesthetic- Influence of pH on Distribution

Answer 21

Equilibrium reaction between bases and protons (H+ ions) is written as acid dissociations (loss of proton)

R-NH3+ (blocking) R-NH2 (soluble) + H+

Nonionized form (R-NH2) predominates at higher pHs and more readily crosses neuronal membranes

Question 22

Sodium Channel and Sites of LA Action

Answer 22

Use-dependent block [preferential binding to open and inactivated states] of Na+ channel by LA prevents propagation of action potential and transmission of pain impulses

Question 23

Local Anesthetics Side effects

Answer 23

Neurotoxicity, hypotension, dizziness, drowsiness

Question 24

NSAIDs – COX-2 Inhibitors

side affects

Answer 24

Side Effects:

GI ulceration (esp. ketorolac used in the elderly)

Increased bleeding risk

Renal dysfunction

COX-2 selective agents may increase CVS complications  increased thrombotic risk

Question 25

NON-Opioids are first line for everything

Answer 25

Ibuprofen is safest for GIIIII tract

Question 26

Acetaminophen Side Effects

Answer 26

Relative to NSAIDs: Little or no effects on peripheral COX-2: GI tract, platelets, kidneys, uterus

Hepatotoxicity major concern