Term
|
Definition
| A well-localized constant, achy area in skin and subcutaneous tissues and less well-localized in bone, connective tissues, blood vessels, and muscles |
|
|
Term
Incisional pain, bone fractures, bony metastasis, osteoarthritis and rheumatoid arthritis, peripheral vascular disease:
These cause what kind of pain? |
|
Definition
|
|
Term
|
Definition
| Poorly localized, crampy, diffuse, and deep sensation originating from an internal organ or a cavity lining. |
|
|
Term
Bladder distention and spasms, intestinal distention, inflammatory bowel disease, hiatal hernia, organ metastasis, and pericarditis:
These cause what kind of pain? |
|
Definition
|
|
Term
|
Definition
| A poorly localized, electric-shock-like, lancinating, shooting sensation originating from injury to a peripheral nerve, the spinal cord, or the brain |
|
|
Term
Diabetic neuropathy, radiculopathy, postherpetic neuralgia, phantom limb pain, and tumor-related nerve compression:
These cause what kind of pain? |
|
Definition
|
|
Term
| Characterize pain interms of the following: (7) |
|
Definition
1) Location
2) Mode and time of onset
3) Associated features, e.g., nausea, muscle spasm
4) Quality and time-intensity attributes
5) Duration
6) Severity (scale of 0-10)
7) Provoking and relieving factors |
|
|
Term
| What pain stimuli are specific to skin? |
|
Definition
| pricking, cutting, crushing, burning, and freezing |
|
|
Term
| What pain stimuli are specific to viscera? |
|
Definition
Inflamed mucosa, distention or spasm of smooth muscle, and traction on the mesenteric attachment.
(Insensitive to pricking, cutting, crushing, burning, and freezing) |
|
|
Term
| What pain stimuli are specific to skeletal and cardiac muscle? |
|
Definition
| ischemia (intermittent claudication/ angina), necrosis, hemorrhage, and injection of irritating solutions as well as by injuries of connective tissue sheaths. |
|
|
Term
| What pain stimuli are specific to joints? |
|
Definition
Synovial membrane inflammation, exposure to hypertonic saline.
(Insensitive to pricking, cutting, and cautery.) |
|
|
Term
| What pain stimuli are specific to ligaments? |
|
Definition
|
|
Term
| What pain stimuli are specific to periosteum? |
|
Definition
|
|
Term
| What pain stimuli are specific to blood vessels? |
|
Definition
| Piercing by a needle, inflammation, distension, traction |
|
|
Term
| What pain stimuli are specific to nerves? |
|
Definition
| Inflammation, compression of roots and sensory ganglia. |
|
|
Term
| 3 types of sensory receptors: |
|
Definition
1) neuroepithelial
2) epithelial
3) neuronal |
|
|
Term
| Example of neuro-epithelial sensory receptor? |
|
Definition
olfactory epithelium neurons
(the neuron itself replaces the epithelial tissue as a sensor) |
|
|
Term
Examples of epithelial sensory receptors:
(4) |
|
Definition
1) Epidermal Merkel cells (sustained pressure mechanosensors)
2) taste buds
3) auditory receptors
4) retinal photoreceptors |
|
|
Term
| examples of neuronal sensory receptors: (2) |
|
Definition
1) cutaneous sensors (except Merkel)
2) proprioceptors |
|
|
Term
| Nociceptors or pain sensors are _________ sensory receptors |
|
Definition
|
|
Term
| What neuron type is associated with nociception? |
|
Definition
|
|
Term
| Local anesthetics block nerve conduction at the _____________ ____________ . |
|
Definition
|
|
Term
| Fibers responsible for pain, temperature and touch? |
|
Definition
|
|
Term
| Fibers responsible for pain, temperature and some mechanoreception ? |
|
Definition
|
|
Term
| A-delta fibers synapse in? |
|
Definition
| Rexed's lamina I of the dorsal horn. |
|
|
Term
| C fibers synapse in the ? |
|
Definition
| substantia gelatinosa of the dorsal horn |
|
|
Term
| Pain comes in 2 forms: acute/sharp/highly localized and then chronic/slow/dull/aching. What determines this? |
|
Definition
| The conduction of the acute pain is on the A-δ fibers. In contrast the C fibers are slower, 2 m/s conduction. That is the neurological basis for different types of pain. |
|
|
Term
| The Neospinothalamic tract is for fast acute, pain and synapses where? |
|
Definition
| in the thalamus (it has one synapse) |
|
|
Term
| the Paleospinothalamic is for slow, chronic pain and synapses where? |
|
Definition
| Reticular nuclei of brainstem then thalamus (according to transcript) |
|
|
Term
| The periaqueductal grey is very important for the ___________________. |
|
Definition
| endogenous analgesic system |
|
|
Term
| T/F: pain can be generated in the absence of any stimulus |
|
Definition
| T (he referenced empathetic pain when parent watches child in pain) |
|
|
Term
| ______ _________ affect synaptic transmission in CNS structures. |
|
Definition
|
|
Term
| ________ __________ affects signal generation at the synapse. |
|
Definition
|
|
Term
| Morphine and meperidine are ___________ __________. |
|
Definition
|
|
Term
| aspirin is a _________ __________ |
|
Definition
|
|
Term
| site of action of morphine and meperidine? |
|
Definition
|
|
Term
| site of action of aspirin? |
|
Definition
|
|
Term
| codeine can be used for a pain level of ____ |
|
Definition
|
|
Term
| morphine and meperidine may be used for a pain level of ____ |
|
Definition
|
|
Term
| aspirin may be used for a pain level of _____ |
|
Definition
|
|
Term
| inflammation activates _______________ to release arachidonic acid from membrane phospholipids. |
|
Definition
|
|
Term
| PGH synthase is a ______________ enzyme |
|
Definition
|
|
Term
| 2 functions of PGH synhase: |
|
Definition
1) COX
2) hydroperoxidase |
|
|
Term
| what is the difference b/w COX I and II? |
|
Definition
I: endogenous/constitutive in most cells
II: inducible isoform (induced by inflammation) |
|
|
Term
| hydroperoxidases do what? |
|
Definition
| degrade hydrogen peroxide to PGH2 |
|
|
Term
| 5 bioactive prostaglandins from PGH2: |
|
Definition
1) TXA2 (platelets, lungs)
2) PGE2 (renal collecting tubule)
3) PGI2 (endothelial cells)
4) PGJ2 (brain)
5) PGF2-alpha (uterus, kinda like oxytocin) |
|
|
Term
| arachidonic acid is transformed to HETEs and leukotrienes by __________________. |
|
Definition
|
|
Term
| _________ ___________ is mediated by HETEs. |
|
Definition
|
|
Term
| leukocyte infiltration will not be blocked by ___________. |
|
Definition
| NSAIDs (obvious i know, but he said it was an important exam pt, that this is a totally diff enzyme than the COX enzymes which may be blocked by NSAIDs) |
|
|
Term
| montelukast/singulair directly blocks the production of ______________ |
|
Definition
| leukotrienes (not on test, but he said was very important to know) |
|
|
Term
|
Definition
1) thromboxane (TXA2)
2) leukotrienes |
|
|
Term
| PGE2 cause what for signs of inflammation: |
|
Definition
1) redness
2) heat
3) pain
4) swelling |
|
|
Term
| ____________ potentiate the effects of bradykinin and histamine on pain and fever |
|
Definition
|
|
Term
| _________________ (PGE2 analog) used to treat drug-induced ulcers in elderly |
|
Definition
|
|
Term
| actions of PGE2 concerning GIT: (3) |
|
Definition
1)inhibit acid secretion
2)increase mucous secretion
3)cytoprotective and prevents ulceration |
|
|
Term
| Actions of PGF concerning GIT (2): |
|
Definition
1) inhibit acid secretion
2) increase mucous secretion |
|
|
Term
| _______ & _________ cause contraction in uterine smooth muscle. |
|
Definition
|
|
Term
| _____________(PGE2 analog) contracts uterus and expels fetus |
|
Definition
|
|
Term
| Misoprostol + progesterone receptor blocker (mifepristone) is known as |
|
Definition
|
|
Term
| furosemide upregulates COX2 activity which increases ___________ |
|
Definition
|
|
Term
| PGE2 can block __________ reabsorption |
|
Definition
|
|
Term
| 4 positive effects of NSAIDs: |
|
Definition
1)anti-inflammatory
2)analgesic
3)antipyretic
4)antiaggregation |
|
|
Term
| tinnitus, dizziness and headache may be an adverse side effect of _____________. |
|
Definition
|
|
Term
| adverse effects of NSAIDs in CNS: (3) |
|
Definition
1)tinnitus
2)headaches
3)dizziness |
|
|
Term
| adverse effects of NSAIDs in CVS: (3) |
|
Definition
1)edema
2)hypertension
3)congestive heart failure |
|
|
Term
| adverse effects of NSAIDs in GI: (3) |
|
Definition
1)nausea
2)ulcers
3)bleeding |
|
|
Term
| adverse effects of NSAIDs in blood: (3) |
|
Definition
1)neutropenia
2)thrombocytopenia
3)anemia |
|
|
Term
| adverse effect of NSAIDs on liver: |
|
Definition
|
|
Term
| adverse effect of NSAIDs on lungs: |
|
Definition
|
|
Term
| 3 adverse effects of NSAIDs on kidneys: |
|
Definition
1)hyperkalemia
2)renal insufficiency
3)proteinuria |
|
|
Term
| which NSAID is safe for people with ulcers? |
|
Definition
|
|
Term
| Which drug is the only parenteral analgesic in the NSAID class? |
|
Definition
|
|
Term
List of ten NSAIDs (mild analgesics) non-selective COX-inhibitors:
(al-medhi suggested good idea to know all) |
|
Definition
1)aspirin
2)diclofenac
3)etodolac
4)ibuprofen
5)indomethacin
6)ketoprofen
7)ketorolac
8)naproxen
9)piroxicam
10)sulindac |
|
|
Term
| Name 1 drawback to acetaminophen: |
|
Definition
| It has no anti-inflammatory effect. It treats fever and pain but do not use for inflammation! |
|
|
Term
| Celecoxib and meloxicam are _____________ inhibitors. |
|
Definition
|
|
Term
| 2 pros to using a COX-2 selective inhibitor as opposed to non-selective COX inhibitor: |
|
Definition
1)No antiaggregation effects
2)less GI bleeding |
|
|
Term
| 2 examples of COX-2 selective inhibtors: |
|
Definition
|
|
Term
| COX-2 is the isoform of ____________ _________that resides in macrophages and in joint cells, the “synovialcytes.” |
|
Definition
|
|
Term
| 2 side effects of COX-2 specific inhibitors: |
|
Definition
1) higher thrombotic events
2) nephrotoxicity |
|
|
Term
| salicylic acid can be used as a ____________. |
|
Definition
|
|
Term
| Name 4 things salicylic acid may be used for: |
|
Definition
1)warts
2)corns
3)fungus
4)eczema |
|
|
Term
| A wart can be lysed with ____________ _______. |
|
Definition
|
|
Term
oil of wintergreen contains ___________ _________.
( i have no idea if this is relevant or not, al-medhi put lots of rando stuff on the slides) |
|
Definition
|
|
Term
| prostaglandins lower the required levels of _____________ to elicit a pain response. This is the mechanism of _______________. |
|
Definition
| substance P; hyperalgesia |
|
|
Term
| pyrogens, agents such as LPS of bacteria, viruses, and others, induce fever via _______________. |
|
Definition
|
|
Term
| How does aspirin (acetylsalicylic acid) prevent binding of arachidonic acid to PGH synthase? |
|
Definition
| by acetylating the PGH synthase |
|
|
Term
| ____________ prevents sensitization of receptors by prostaglandins, and thus hyperalgesia |
|
Definition
| aspirin (acetylsalicylic acid) |
|
|
Term
| ____________ Inhibits pyrogen-induced prostaglandin synthesis and resets hypothalamic thermostat |
|
Definition
| aspirin (acetylsalicylic acid) |
|
|
Term
| aspirin induces antipyresis by: (2) |
|
Definition
1)inhibiting pyrogen-induced prostagladin synthesis
2)vasodilation of skin vessels to dissipate more heat |
|
|
Term
| leukocyte infiltration cannot be blocked by NSAIDS or aspirin. It can only be blocked by ___________ ____________. |
|
Definition
|
|
Term
| Aspirin (acetylsalicylic acid) is antithrombotic b/c: (2) |
|
Definition
1) anucleate platelets are unable to synthesize new PGH (8-10 days to replace platelets)
2)loss of thromboxane inhibits platelet aggregation and increases bleeding time
*PGH synthase is replaced w/in 12 hrs in other tissues |
|
|
Term
| _____________ has a muco-protective effect |
|
Definition
|
|
Term
| Aspirin may cause gastric ulceration & bleeding due to inhibition of ______ synthesis locally |
|
Definition
|
|
Term
| chronic toxicity by aspirin is otherwise known as ? |
|
Definition
|
|
Term
| Salicylism may cause: (3) |
|
Definition
1)tinnitus
2)decreased hearing
3)vertigo |
|
|
Term
| 10-30 g single dose of aspirin may cause: |
|
Definition
| acute salicylate toxicity |
|
|
Term
| This diuretic can enhance the toxic effects of aspirin. |
|
Definition
|
|
Term
| _________ has a direct effect on the respiratory center to increase rate and depth of breathing |
|
Definition
|
|
Term
| ___________ increases GI bleeding induced by salicylates |
|
Definition
|
|
Term
| Treat overdose of acetominophen (tylenol) with __________________. |
|
Definition
| N–ACETYLCYSTEIN (MUCOMYST) |
|
|
Term
| Tylenol does not have an ____________ effect. |
|
Definition
|
|
Term
| Why is acetaminophen (tylenol) not anti-inflammatory ? |
|
Definition
| There is a high concentration of peroxides in inflamed tissue blocking the action. |
|
|
Term
|
Definition
|
|
Term
| Papaverine is a _________ _________ relaxant. |
|
Definition
|
|
Term
| 3 medically relevant alkaloids: (3) |
|
Definition
1)morphine
2)codeine
3)papaverine |
|
|
Term
| _________ are narcotic analgesics like morphine that produce analgesia without loss of consciousness. |
|
Definition
|
|
Term
| Drugs derived from opium are known as _______. |
|
Definition
|
|
Term
| Opioid drugs act mostly via the ________ _________. |
|
Definition
|
|
Term
| pinpoint pupil is a sign of _______ toxicity |
|
Definition
|
|
Term
| opioid receptors located in the ____________ effect neuroendocrine function. |
|
Definition
|
|
Term
| Opioid receptors located in the __________________ effect coughing, respiration, vomiting, & miosis. |
|
Definition
|
|
Term
| opioid receptors located in ___________________ effect mood & behavior. |
|
Definition
|
|
Term
| opioid receptors located in ____________, __________ & _____________ regulate pain sensation. |
|
Definition
| dorsal horn, periaqueductal grey & thalamus |
|
|
Term
| Respiratory depression is caused only by the _________ opioid receptor. |
|
Definition
|
|
Term
| Do not give opioids to pulmonary disease pts due to ________________ |
|
Definition
|
|
Term
| Drug historically used to treat diarrhea: |
|
Definition
|
|
Term
| Dyspnea and pain are greatly relieved by _________ in an MI pt. |
|
Definition
|
|
Term
| What kind of receptor are opioid receptors? |
|
Definition
| G-protein coupled receptors (Gi) |
|
|
Term
| activation of opioid GPCR does what 2 things to hyperpolarize the cell? |
|
Definition
1)open K channels (efflux of Ca)
2)close Ca channles (blocking Ca influx)
*hyperpolarization--this causes a blockade of Neurotransmitter Release
and Pain Transmission |
|
|
Term
| If you use morphine chronically,binding of _________ leads to internalization of morphine receptors |
|
Definition
|
|
Term
| acute tolerance of morphine is caused by _____________ activation |
|
Definition
|
|
Term
| B-arrestins cause internalization of ________________ |
|
Definition
|
|
Term
| T/F: all effects of morphine are subject to mechanism of tolerance |
|
Definition
|
|
Term
| 3 effects of morphine that are not affected by the mechanism of tolerance: |
|
Definition
1)miosis
2)constipation
3)convulsion |
|
|
Term
| High tolerance to ____________ can develop with long term morphine use. |
|
Definition
| analgesia (there is a long list of others but they are considered side-effects) |
|
|
Term
| Naloxone is a ______________________ |
|
Definition
|
|
Term
| T/F: humans have endogenous morphine-like substances |
|
Definition
|
|
Term
| name 3 families of endogenous opioid peptides: |
|
Definition
1)endorphins
2)enkephalins
3)dynorphins |
|
|
Term
| _____________ is the smallest endogenous opioid peptide that is synthesized by the body |
|
Definition
|
|
Term
| ___________ is the precursor for B-endorphins |
|
Definition
| Pro-opiomelanocortin (POMC) |
|
|
Term
|
Definition
|
|
Term
| 6 possible products of Pro-opiomelanocortin (POMC): |
|
Definition
1)MSH (alpha, gamma and beta)
2)ACTH
3)lipotropin (beta and gamma)
4)CLIP
5)B-endorphin
6)met-enkephalin |
|
|
Term
| enkephalin neurons of periaqueductal grey project into ___________________________. |
|
Definition
|
|
Term
| enkephail receptor activation blocks the release of ____________ or _______________ |
|
Definition
|
|
Term
| How does activation of enkephalin neuron cause analgesia? |
|
Definition
| by preventing the release of substance from primary nociceptor neuron in the dorsal horn. Therefore, it cannot depolarize the dorsal horn 2nd order neuron |
|
|
Term
| Which mu-receptor agonist is short acting and good for small procedures? |
|
Definition
|
|
Term
| Fentanyl may be used as a patch and is _______________ times more potent than morphine |
|
Definition
|
|
Term
| _______________ is 4 times more potent than morphine |
|
Definition
|
|
Term
| When you switch in a post-operative patient from IM form to a tablet form, you ____________ the dose of morphine |
|
Definition
|
|
Term
| 4 partial agonists of mu opioid receptors |
|
Definition
1)codeine
2)oxycodone
3)hydrocodone
4)propoxyphene |
|
|
Term
| How does the potency of codeine compare to that of morphine? |
|
Definition
it is not as potent (partial agonist).
Requires dosage of 130 mg vs. 30 mg of morphine |
|
|
Term
| How is codeine usually administered? |
|
Definition
|
|
Term
| Buprenorphine is a ________________ that acts on more than one opioid receptor. |
|
Definition
|
|
Term
| Mixed agonists of opioid receptors are sometimes used to treat opioid dependence. Why? |
|
Definition
| b/c the may act as antagonists or agonists on varying opioid receptors. This may help with treating withdrawal effects without completely removing the opioid ligand |
|
|
Term
| Name the most potent opioid receptor mixed agonist. |
|
Definition
|
|
Term
| Name 4 opioid receptor mixed agonists: |
|
Definition
1)buprenorphin
2)butorphanol
3)nalbuphine
4)pentazocine |
|
|
Term
| Why are opioids and NSAIDs synergistic? |
|
Definition
NSAIDs block COX which increases the availability of arachidonic acid to be acted on by lipoxygenase.
*lipoxygenase products facilitate opening of K+-channels by opioids. |
|
|
Term
| Due to ______________, morphine is 2 to 6-fold less potent orally than parenterally |
|
Definition
|
|
Term
| Methadone is used in place of morphine when? |
|
Definition
| (long acting drugs) when less frequent dosing required |
|
|
Term
| remifentanil is used in place of morphine when? |
|
Definition
| For short, painful procedures – quick acting, fast-dissipating drugs |
|
|
Term
| 7 additional routes of administration of opioid analgesics: |
|
Definition
1)rectal transmucosal
2)epidural
3)subarachnoid
4)oral transmucosal
5)transdermal patch
6)iontophoresis
7)inhalation |
|
|
Term
| subarachnoid administration of opioid analgesics allows direct access to ____________ & ____________. |
|
Definition
1)dorsal horn neurons
2)brain structures
*allows these drugs to act much longer than they do upon alternate administration routes |
|
|
Term
| 3 drugs which may be administered through the subarachnoid: (opioid analgesics) |
|
Definition
1)morphine
2)meperidine
3)fentanyl |
|
|
Term
| opioid analgesics administered as an epidural are usually introduced as an ______________. |
|
Definition
|
|
Term
| ____________ uses an electrical current to push the medicine through the skin |
|
Definition
|
|
Term
| In _____________________, Patient has limited control of dosing from infusion pump within tightly mandated parameters |
|
Definition
| PCA, patient controlled analgesia |
|
|
Term
| In ______________________, a catheter connected to a computer can monitor the opioid levels in the blood and can then maintain therapeutic levels of opioids in the blood. |
|
Definition
Computer-Assisted Continuous Infusion (CACI)
*only used for patients emerging from unconsciousness in the ICU |
|
|
Term
| Why is morphine helpful in treating dyspnea? (2) |
|
Definition
1)decreased peripheral resistance
2)increased capacity of peripheral vascular compartments |
|
|
Term
| Morphine is contraindicated in _____________________. |
|
Definition
| pulmonary edema due to respiratory disease |
|
|
Term
| 2 opioids used to suppress cough reflex: |
|
Definition
1)codeine
2)dextromethorphan (isomer of codeine analog methorphan; no analgesic or addictive properties) |
|
|
Term
| opioids directly inhibit __________ in the rhythm-generating respiratory center neurons in the Pre-Boetzinger complex |
|
Definition
| 5HT4 receptors (serotonin receptors) |
|
|
Term
| In respiratory depression caused by opioids, what happens to the body's sensitivity to O2? |
|
Definition
| its unaltered, this may cause apnea |
|
|
Term
|
Definition
|
|
Term
| 10 adverse affects of opioids |
|
Definition
1)sedation
2)depression of cough reflex
3)miosis
4)truncal rigidity (think highly lipid suloble opioids like fentanyl)
5)nausea & vomiting
6)euphoria
7)convulsion (due to inhibition of GABA release)
8)endocrine changes
9)constipation
10)reduced O2 consumption of myocardium |
|
|
Term
| 3 drugs in coma cocktail: |
|
Definition
1)Naloxone
2)thiamine
3)dextrose |
|
|
Term
| Naltrexone is an _______________ |
|
Definition
|
|
Term
| what drugs work against neuropathic pain? |
|
Definition
|
|
Term
| 5 examples of neuropathic pain: |
|
Definition
1)Polyneuropathy
2)Postherpetic neuralgia
3)Trigeminal neuralgia (Tic doloreaux)
4)Glossopharyngeal neuralgia
5)Myelitis |
|
|
Term
| these drugs block serotonin reuptake and facilitate the action of the endogenous opioid analgesic system. |
|
Definition
| tricyclic antidepressants |
|
|
Term
| Name 3 tricyclic antidepressants: |
|
Definition
1)IMIPRAMINE
2)AMITRIPTYLINE
3)DOXEPIN |
|
|
Term
|
Definition
1)PHENYTOIN
2)CARBAMAZEPINE
3)GABAPENTIN
4)LEVETIRACETAM |
|
|
Term
| These drugs block Na-channel and prevent neuronal firing |
|
Definition
|
|
Term
| family of drugs that are 5HT 1D/1B agonists |
|
Definition
|
|
Term
| 3 drug groups used to treat migraines |
|
Definition
1)triptans (5HT agonists)
2)ergot alkaloids
3)NSAIDs or combo NSAIDs + opioids |
|
|
