Wk 5: Acute and chronic pain

Question 1

Excitatory neurostransmitters

Answer 1

Substance P
Glutamate

Question 2

Inhibitory neurotransmitters

Answer 2

Glycine
GABA
Enkephalin
Serotonin
Norepinephrine

Question 3

When can kids use standard adult pain assessment?

Answer 3

Children 7-8 years old

Question 4

Substance P

Answer 4

Excitatory neurotransmitter

Question 5

Glutamate

Answer 5

Excitatory neurotransmitter

Question 6

Bradykinin

Answer 6

Excitatory modulator of pain

Question 7

Histamine

Answer 7

Excitatory modulator of pain

Question 8

Prostaglandins

Answer 8

Excitatory modulator of pain

Question 9

Cytokines

Answer 9

Excitatory modulator of pain

Question 10

Calcitonin gene-related peptide (CGRP)

Answer 10

Excitatory modulator of pain

Question 11

Glycine

Answer 11

Inhibitory neurotransmitter

Question 12

GABA

Answer 12

Inhibitory neurotransmitter

Question 13

Enkephalin

Answer 13

Inhibitory neurotransmitter

Opioid dependent (mu, delta)

Question 14

Serotonin

Answer 14

Inhibitory neurotransmitter

Question 15

Norepinephrine

Answer 15

Inhibitory neurotransmitter

Question 16

Endorphins

Answer 16

Inhibitory neurotransmitter

Opioid dependent (mu)

Question 17

Dynorphins

Answer 17

Inhibitory neurotransmitter

Opioid dependent (kappa)

Question 18

Opioid dependent neurotransmitters

Answer 18

Endorphins (mu)
Enkephalins (mu, delta)
Dynorphins (kappa)

Question 19

Excitatory neurotransmitter, glutamate, primarily found where?

Answer 19

Released in the CNS from A Delta and C fibers

Instantaneous effects, producing initial, fast, sharp pain

Question 20

Excitatory neurotransmitter, Substance P, primarily found where?

Answer 20

Found and released from peripheral afferent C fibers

Involved in slow, chronic pain

Question 21

Glutamate receptors

Answer 21

NMDA
AMPA
Kainite
mGluRs (metabolic glutamate receptors)

Question 22

Substance P receptors

Answer 22

Neurokinin-1
Neurokinin-2

(G-protein linked)

Vasodilation, extravasation of plasma proteins, degranulation of mast cells, sensitization of the stimulated sensory nerve

Question 23

Where does pain modulation occur in the spinal cord

Answer 23

Dorsal horn

Particularly in lamina II of Rexed laminae in the substantia gelatinosa

Question 24

Gabapentin MOA

Answer 24

Blocks alpha-2 delta subunit of presynaptic voltage-gated calcium channels in the CNS, thereby preventing excitatory neurotransmitter release

Question 25

Should you keep a patient on gabapentin for surgery?

Answer 25

Yes, keep on before and after surgery Patients can withdraw from gabapentin (especially on chronic gabapentin)

Question 26

Precedex MOA

Answer 26

Selective alpha-2 adrenergic agonist in CNS Binds to alpha-2 receptor (a G-protein coupled receptor) in the CNS This inhibits adenyl cyclase and decreases cAMP Activates postsynaptic potassium channels = potassium efflux = hyperpolarization of cell/less likely to fire AP (SEDATION, ANALGESIA, ANXIOLYSIS) Inhibits presynaptic voltage gated calcium channels = reduces influx of calcium = decreased release NE, Substance P, Glutamate = REDUCED SYMPATHETIC NEUROTRANSMISSION