Term
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Definition
allodynia: ordinarily non-painful stimulus is painful
Hyperalgesia: increased response to a painful simulus |
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Term
| What are TRP receptors and what are the common ones |
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Definition
Transient Receptor Potential channels non-selective for Cations(Ca, Mg, Na)
TRPV1: >42 C, low pH, vanilloids(capsaicin)
TRPV2: >50 C
TRPV8: <25 C, menthol |
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Term
| What are some chemical receptors that can produce a painful response |
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Definition
ASIC: Acid Sensitive Ion Channels
P2Y, P2X: ATP Sensing
B1, B2: Bradykinin |
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Term
| What lamina in the spinal cord is the termination of Adelta and C fibers? What information is carried by each and which are myelinated |
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Definition
Adelta: Lamina I&V, sharp pain, myelinated
C fibers: Lamina II, Burning Pain, unmyelinated |
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Term
| What are the neurotransmitters of fast and slow pain responses and which requires a stronger stimulus? |
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Definition
Fast: NMDA Glutamate Receptor transmission
Slow: Substance P(High Threshold) |
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Term
| How is central sensitization caused and how can surgeons prevent it in limb amputation? |
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Definition
Process involving NMDA glutamate receptors
Surgeons use spinal anesthesia in addition to general anesthesisa |
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Term
| What are the ascending pathways for pain and where are these pathways perceived? |
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Definition
Spinothalamic: Thalamus
Spinoreticular
Spinomesencephalic: Periaqueductal gray
Perceived in the Somatosensory Cortex and Amygdala |
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Term
| What is a primary descending pathways inhibiting nociception |
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Definition
PAG->Raphe Nucleus->Dorsal Horn
Locus Coeruleus-> Dorsal Horn
Direct and Interneuron inhibition of 2nd order nociceptive pathways |
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Term
| What are the four families of endogenous opiods |
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Definition
Proenkephalin
POMC
Prodynorphin (produce A and B)
Endomorphins 1 and 2 |
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Term
| What is similar about the structure of many opiods? |
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Definition
| -Tyrosine-(Gly)-(Gly)-Phe- |
|
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Term
| What type of receptor are opiod receptors |
|
Definition
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Term
| Where are opiod receptors located on neurons and what are the effects by location site |
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Definition
Presynaptic neuron: Inhibit Ca channels
Post-synaptic neuron: Hyperpolarize with potassium
Also, decrease cAMP |
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Term
| What are the effects of morphine beyond its anesthetic properties? |
|
Definition
CNS: Miosis, Respiratory depression, nausea/vomiting
Biliary: Biliary colic
GI: Constipation
Endocrine: Decreased GnRH(less LH), CRF(less cortisol) |
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Term
| What is the triad of symptoms for opiod poisoning |
|
Definition
Miosis
Low Respiratory Rate
Coma |
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Term
| What effects of opiods show no tolerance in long term use |
|
Definition
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Term
| What is the mechanism and use of meperidine |
|
Definition
Weak mu opiod agonist
Childbirth Analgesia |
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Term
| What is the mechanism and use of Codeine and what is it commonly combined with |
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Definition
Mech: Prodrug-> Morphine and Codeine-6-glucuronide
Use: Anti-tussive and mild pain
Combined with NSAIDS sometimes |
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Term
| Mechanism and use of oxycodone? |
|
Definition
Weak mu agonist
NSAID combo for Analgesia
Percodan: Aspirin+Oxycondone
Percocet: Acetomenophen+Oxycodone |
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Term
| What is the mechanism of Fentanyl and how is it administered? |
|
Definition
Powerful Opiod Agonist
Oral and Transdermal |
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Term
| What is the mechanism of loperamide and what is it used for? |
|
Definition
Retained in GI and actively exported by P-gycoprotein from the brain
Anti-diarrheal |
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Term
| What is the mechanism of Buprenorphine and Suboxone? When are these drugs used |
|
Definition
Partial Mu agonist, Kappa antagonist
Suboxone: Buprenorphine and Naloxone
Use: Before anesthesia and chronic pain
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|
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Term
| What is the mechanism of Tapentadol |
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Definition
| Mu agonist and Norepi reuptake inhibitor |
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Term
| What is the mechanism of Nalbuphine and what are its uses |
|
Definition
Kappa Agonist and mu antagonist more effective in women
Uses:Anesthesia supplement, Labor
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Term
| What is the mechanism of Butorphanol |
|
Definition
| Kappa agonist and Mu antagonist |
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Term
| What is the mechanism of Pentazocine and how is it typically used |
|
Definition
Kappa Agoinst and Mu antagonist
Used in Dental extractions |
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Term
| What is the advantages and disadvantages to pentazocine |
|
Definition
Advan: Ceiling effect on respiratory depression
Disadv: CV effects-not good in MI |
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Term
| What are the opiod antagonists, which is the longest acting and what is their main uses? |
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Definition
Naloxone
Naltrexone
Nalmefene: longest-acting
Opiod poisoning and alcoholism |
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Term
| What is the mechanism of tramadol |
|
Definition
| weak mu agonist, NE and 5HT reuptake inhibitor |
|
|
Term
| What is gate control theory |
|
Definition
| increase myelined afferent stimulation to inhibit C fiber input |
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Term
| What are some surgical techniques to alleviate pain |
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Definition
Cordotomy
Nerve block
Surgical Ablation |
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Term
| What are the mixed opiod agonist-antagonists |
|
Definition
Nalbuphine
Butorphanol
Pentazocine |
|
|
Term
| What are the steps in the process of pain processing |
|
Definition
Transduction
Transmission
Modulation
Perception |
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|
Term
| Describe the cross-tolerance between the different opiod agonists |
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Definition
| Incomplete cross-tolerance becaus a rise in effect is still present when the drug is changed |
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