Term
| Pain Definitions (Three). |
|
Definition
| It is what the patient says it is. |
|
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Term
|
Definition
| Decreased pain threshold. |
|
|
Term
|
Definition
| Synaptic potentials increase with amplitude with each repeated stimulus. Pain gets greater with each stimulus causing the pain. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Pain evoked by a non-noxious stimulus. A stimulus that normally does not cause pain. |
|
|
Term
| What is preemptive analgesia? |
|
Definition
| Analgesic given prior to stimulus. |
|
|
Term
| Define Acute Pain (4 things). |
|
Definition
| Rapid, defined onset with limited duration. |
|
|
Term
| What are the two types of acute pain? |
|
Definition
| monophasic - one time cause, surgery. |
|
|
Term
|
Definition
| Delayed, poorly defined onset. |
|
|
Term
| What is associated with chronic pain? |
|
Definition
|
|
Term
| What may be associated with chronic pain? |
|
Definition
| Allodynia and hyperagesia may be associated. |
|
|
Term
|
Definition
| Pain caused by muscle spasm stimulating pain receptors. |
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|
Term
|
Definition
| Short, well localized. Matched to type of stimulus. |
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|
Term
|
Definition
| Throbbing, burning, or aching pain. |
|
|
Term
| Characteristics of temperature sensation? |
|
Definition
| Follows same path as slow pain. |
|
|
Term
| What are the two types of visceral pain? |
|
Definition
|
|
Term
|
Definition
| Assoicated with cramping pain caused by ischemia caused by stretching, distension, and spasm. |
|
|
Term
| What kinds of organs is cramping pain specific to? |
|
Definition
| Visceral pain to the hollow organs such as bowel, bladder, gastric, and uterine. |
|
|
Term
| What kind of organs is a sharp pain specific to? |
|
Definition
| Visceral pain to the solid organs such as liver. |
|
|
Term
|
Definition
| A sharp stabbing pain, well localized. |
|
|
Term
| Describe Neuropathic Pain. |
|
Definition
| Peripheral or central stimulation. |
|
|
Term
| Perception of pain is a subjective experience. What three areas that compose this subjective perception? |
|
Definition
| Sensory - Intensity, location and duration. |
|
|
Term
| What influences pain response? |
|
Definition
|
|
Term
| What kind of activity is provoked by pain in the anatomic nervous system? |
|
Definition
| Efferent activity. Motor response to avoid or correct painful stimuli. |
|
|
Term
| Spontaneous firing can occur from the reusult of? |
|
Definition
|
|
Term
| Describe complex regional pain syndrom. (long) |
|
Definition
| First described in civil war "causalgia". |
|
|
Term
| What does the increased sympathetic response in complex regional pain syndrome eventually lead to? |
|
Definition
| Changes at all neuraxial levels leading to sensitization of pain pathways maintaining chronic neuropathy. |
|
|
Term
| What is the primary receptor that is activated in the sensitization of the dorsal horn? What drug has the potential to be a antagonist to this? |
|
Definition
| N-methyl-D-Asparate (NMDA). |
|
|
Term
| What does the pathophysiology of pain involve? (four things) |
|
Definition
|
|
Term
|
Definition
| Noxious stimuli translated into electrical activity. |
|
|
Term
| Describe transduction as it relates to nociceptor activation. |
|
Definition
| Injury stimulates Protaglandin, serotonin, and bradykinins to activate pain fibers. |
|
|
Term
| During transduction what do the peripheral neurons release? |
|
Definition
| Substance P and other mediators. |
|
|
Term
| Describe nociceptors in terms of their nerve endings. |
|
Definition
| Nociceptors have open affernet nerve endings of myelinated A-delta and C-delta fibers. |
|
|
Term
| What are the two types of A-delta neruons? |
|
Definition
| Mechanosensitive and Mechanothermal. |
|
|
Term
| What kind of stimuli are polynodal C sensitive to? |
|
Definition
| Heat, mechanical and chemical stimuli. |
|
|
Term
| What can stimulate polynodal C type nociceptors? |
|
Definition
| Acetylcholine, bradykinin, histamine, prostaglandins, and K+. |
|
|
Term
|
Definition
| No, they act as a protective mechanism that allows for constant awareness of injury. |
|
|
Term
| Describe Transmission (periphery to spinal cord). |
|
Definition
| Impulse travels via axons of the primary afferent neurons to the dorsal horn of the spinal cord. |
|
|
Term
| What are the tracts called that the dorsal horn projects to the brain? |
|
Definition
|
|
Term
| How are pain signals transmitted to the thalmus? |
|
Definition
| Via the spinothalmic tract (ascending trat). |
|
|
Term
| What transmits pain informaion to reticular formation, mesencephalon, and hypothalamus? |
|
Definition
| spinoreticular, spinomesenecephalic, and spinohypothalamic tracts. |
|
|
Term
| How do opioids block the flow of information? |
|
Definition
| Opioids can inhibit sensations at the dorsal horn and can bind to sites in the brain to activate descending pathways to further inhibit. |
|
|
Term
| What drug mimics GABA to inhibit nociceptive transmission? |
|
Definition
|
|
Term
| Where do the afferent A-Delta fibers enter and terminate in the spinal cord? |
|
Definition
| Enter - dorsal nerve roots. |
|
|
Term
| After termination in 1 and 5 in the dorsal horn, what do the fibers of afferent A-Delta do? |
|
Definition
| Excite second order neurons of the spinothalamic tract then give rise to long fibers which cross to the opposite side of the spinal cord and up to the brain via the neospinalthalmic pathway. |
|
|
Term
|
Definition
|
|
Term
| Glutamate from A Delta fibers binds to what? |
|
Definition
| AMPA receptors postsynaptically. |
|
|
Term
|
Definition
| Large, heavily myelinated. |
|
|
Term
| What kind of fibers are present for slow transmission? |
|
Definition
|
|
Term
| Describe the path of Type C Afferent fibers. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| How do pain impulses travel in the brain? |
|
Definition
| Thalamus to somatosensory area of cortex. |
|
|
Term
| Where do afferent C fibers end? |
|
Definition
|
|
Term
| Describe how pain is modulated. |
|
Definition
| Spinal interneurons release inhibitory amino acids (GABA) and neuropeptides (endogenous opioids) that bind to afferent primary and dorsal horn neurons and inhibit pain. |
|
|
Term
| Describe the Gate Control Theory. |
|
Definition
| Dorsal horn functions as a gate. |
|
|
Term
| What do the spinothalmic and the medullary fibers release to inhibit pain responses? |
|
Definition
|
|
Term
| What effect do MAO and Tricyclics have on pain inhibition. |
|
Definition
| Block the reuptake of norepi and cause an increase in concentration leading to inhibited pain responses. Ie, ANS compensation. |
|
|
Term
| Where does clonidine have its greatest effect? |
|
Definition
| Clonidine works best supraspinal. |
|
|
Term
| What kind of agonist is Clonidine? |
|
Definition
| Conidine is Alpha 2 agonist. |
|
|
Term
| When are analgesia properties seen? |
|
Definition
| Analgesic properties seen after one dose. Useful in augementing morphine or local blocks. |
|
|
Term
| WHat are the side effects of clonidine? |
|
Definition
| Sedation (alpha 2 agonist). |
|
|
Term
| How does Ketamine effect the NMDA receptor? |
|
Definition
| Ketamine is an antagonist at NMDA receptor sites. NDMA is an excitatory neuro transmitter for pain. |
|
|
Term
| What receptors does Klonidine function at other than NMDA? |
|
Definition
| Ketamine functions at opiate and muscarinic receptors. |
|
|
Term
| Describe effect that ketamine has on patient? |
|
Definition
|
|
Term
| General Description of an NSAID. |
|
Definition
| Decrease pain receptor actiavtion from prostaglandin. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Mainly found in inflamatory cells. |
|
|
Term
| What NSAID is the safest for renal impairment? |
|
Definition
|
|
Term
| What are the limits for both children and adult for acetaminophen? |
|
Definition
|
|
Term
| Acetaminophen IV for analgesia DOA and onset? |
|
Definition
|
|
Term
| Acetaminophen IV for Antipyretic DOA and onset? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| How fast is IV infusion given? |
|
Definition
| Concentration: 100ml amp, 10mg/ml. |
|
|
Term
| What are the effects of using a non-selective NSAID? |
|
Definition
| Renal impairment, blocks prostaglandin in stomach, and platelet inhibition. |
|
|
Term
| What are the concerns related to toradol? |
|
Definition
| GI bleeding > than aspirin. |
|
|
Term
| What may be a relative contraindication to a patient getting toradol? |
|
Definition
|
|
Term
| What is the max dose of toradol for an adult. |
|
Definition
|
|
Term
| WHat are the potential side effects of NSAIDS? |
|
Definition
|
|
Term
| What kind of receptor is an opiate receptor? |
|
Definition
|
|
Term
| Activation of the opiate receptor causes the inhibition of |
|
Definition
| Adenylyl Cyclase, which in turn causes a decrease in CAMP. |
|
|
Term
| Where are opiate receptors located? |
|
Definition
|
|
Term
| How is classification opioid receptors accomplished? |
|
Definition
| Classified by receptor affinity for opioid peptides. |
|
|
Term
| Activation of a Mu1 receptor causes? |
|
Definition
|
|
Term
| Activation of a Mu2 receptor causes? |
|
Definition
|
|
Term
| What kind of agonist are highly specific to Mu receptors? |
|
Definition
|
|
Term
| Spinal anesthesia is mediated by primarily what receptor? |
|
Definition
|
|
Term
| Supraspinal anesthesia is mediated by what receptors? |
|
Definition
|
|
Term
| What receptors cause respiratory depression? |
|
Definition
|
|
Term
| What receptors causes dependence? |
|
Definition
|
|
Term
| Supraspinal analgesia is primarily mediated by what receptor? |
|
Definition
|
|
Term
| What receptor causes Euphoria? |
|
Definition
|
|
Term
| What receptor causes dysphoria? |
|
Definition
|
|
Term
| What receptor is most important for peripheral pain? |
|
Definition
|
|
Term
| What receptors cause sedation? |
|
Definition
|
|
Term
| What does the term neuraxial analgesia refer to? What is it based on? |
|
Definition
| Epidural and suarachoid opiates. Based on opioid receptors in the spinal cord. |
|
|
Term
| What results in systemic absorption in regards to spinal anesthesia. |
|
Definition
|
|
Term
| What complication can be caused by cephalad migration of a drug interacting with the trigeminal nucleus? |
|
Definition
|
|
Term
| What accounts for differences in synthetic opioids? |
|
Definition
| Receptor affinity, potency, duration. |
|
|
Term
| Is there a ceiling affect with opioids? |
|
Definition
| No ceiling affect with opioids. |
|
|
Term
| Is there a celing affect with NSAIDS? |
|
Definition
| Yes, there is a ceiling affect with NSAIDs. |
|
|
Term
| Where do synthetic opioids act? |
|
Definition
| At the opiate receptor pre and post and at primary afferent neurons. |
|
|
Term
| What are the CNS effects of morphine like drugs? |
|
Definition
| decreased stress respons to surgical stimulation, decreased MAC of volatile agents, analgesia, euphoria (in presence of pain), dysphoria (when not in pain), sedation, respiratory depression. |
|
|
Term
| What are the GI effects of morphine like drugs? |
|
Definition
| Biliary tract-spasm of sphincter of Odi, pancreatic ducts (reversible by: |
|
|
Term
| What are the Gu effects of morphine like drugs? |
|
Definition
| Urinary retention, urgency, difficulty voiding (increase tone of ureter. |
|
|
Term
| What are the cutaneous effects of morphine like drugs? |
|
Definition
| Vessel dilation, localized histamine release (rarely IgE mediated), pruitis, erythema. |
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| 1/10 potency of morphine. |
|
|
Term
| What is the active metabolite in Meperidine? What is it responsible for? |
|
Definition
| Normeperidine. It is responsible for CNS effects ie. Seizures. |
|
|
Term
| When is Meperidine contraindicated? |
|
Definition
| If patient taking MAO inhibitors. |
|
|
Term
| What receptors does Meperidine work at? |
|
Definition
| Mu and Kappa opiate receptors. |
|
|
Term
| What are two common side effects of Meperidine? |
|
Definition
| Hyperpyrexia and Dysphoria. |
|
|
Term
| What is the typical use for meperidine? |
|
Definition
|
|
Term
| What is the max dose for 24 hours? What is the max length of time meperidine should be use for? |
|
Definition
| Should not exceed 600mg in 24 hours. Should not be used greater than 48 hours. |
|
|
Term
|
Definition
| 1 milligrams/kg (said to induce surgical anesthesia). |
|
|
Term
|
Definition
| 2 to 15 milligrams titratd to effect 1-2 milligrams doses. |
|
|
Term
|
Definition
| 1 to 5 minutes. IM More towards 5min. |
|
|
Term
|
Definition
| 5 to 20 minutes IV 30-60min IM. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Mainly kidney. 7 to 10% billiary. |
|
|
Term
| How does the CSF effect differ from the effect of drug in plasma? |
|
Definition
| CSF peak take lags behind plasma, but last longer than plasma |
|
|
Term
| What are active metabolites of morphine |
|
Definition
| Morphine 3 etheral sulfate, morephine 3 glucoronide, morephine 6 glucuronide. |
|
|
Term
| What is metabolized to morphine as well as other metabolites |
|
Definition
|
|
Term
| Why does PO morphine not work well? |
|
Definition
|
|
Term
| What does morphine cause the release of that causes it to not be a good choice for an asmatic |
|
Definition
|
|
Term
|
Definition
| 50mcg/ml. (epidural 5mcg/ml. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Liver: N-demethylation to norfentanyl. |
|
|
Term
|
Definition
| Kidney. Present in urine for 72 hours. |
|
|
Term
| What are you synthetic opiates (phenylpiperidines)? |
|
Definition
| Meperidein, Fentaynyl, Sufentanil, Alfentanil, Remifentanil. |
|
|
Term
| How much stronger is Fentanyl than morphine |
|
Definition
|
|
Term
| How does duration of action and elmination time differ from morphine? |
|
Definition
| Morphine has a longer duration of action, but fentanyl takes longer to elminate due to a greater lipid solubility. |
|
|
Term
| How does onset differ between fentanyl and morphine? |
|
Definition
| Morphine has a slower onset 1-5min, Fentanyl 30 seconds. Due to greater greater lipid solubility allowing for rapid passage through blood brain barrier. |
|
|
Term
| First pass pulmonary effect? |
|
Definition
|
|
Term
| How does fentanyl effect cardiac tissue? |
|
Definition
| Minimal effect on cardiac output, minimal cardiac depression, but may cause bradycardia due to carotid sinus reflex. |
|
|
Term
| If Fentanyl is given at a high rate of speed, what can it cause? |
|
Definition
|
|
Term
| How does fentanyl cause an increase in ICP? |
|
Definition
| Due to an increase in CO2 due to respiratory depression. |
|
|
Term
| Sufentanil Concentration. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| 2.48 (smaller than fent). |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| 10x Stronger than Fentanyl. |
|
|
Term
|
Definition
|
|
Term
| How does the elmination half life and context sensitive half time differ from fentanyl? |
|
Definition
| Elimination half life and contect sensitive half life of sufentanil is shorter due to a higher protein binding and smaller volume of distribution. |
|
|
Term
| How does respiratory depression differ from fentanyl. |
|
Definition
| Sufentanil has a greater respiratory depression. |
|
|
Term
|
Definition
| Bradycardia dose dependent, increased ICP only with increased CO2 |
|
|
Term
|
Definition
| 10-15 min. 1/3 that of fentanyl. |
|
|
Term
|
Definition
| 1 minute. 5x faster than fentanyl. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Low volume of distribution. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Remifentanyl Concentration. |
|
Definition
| Abailable 3, 5, and 10mg powder for recontitution. |
|
|
Term
|
Definition
| 0.5 to 1mcg/kg. over 30 seconds. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Less than 1 min. (ultra short acting). |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Context sensitive half time. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Ester hydrolysis to inactive metabolite. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| 15-20x stronger than alfentanyl or 2x as potent as fentanyl. |
|
|
Term
| Why is remifentanil not recommended as a sole agent? |
|
Definition
| Due chest rigidity and uncertain loss of conciousness. Should be supplemented with N2O, forane, or propofol. |
|
|
Term
| What might you want to give with remifentanyl? How do you want to infuse? |
|
Definition
| Infuse slow and give a non depolarizing muscle relaxant for chest rigidity |
|
|
Term
| What differs in chemical make up of remifentanil compared to fentanyl? What does this allow for? |
|
Definition
| Remifentanyl has a ester linkage. This allows for ultrashort duration and with no cumulative effects. Rapid on and rapid off. |
|
|
Term
| Why is remifentanil cleared so quickly? What is its clearance rate compared to fentanyl? |
|
Definition
| Ester Hydrolysis by plasma/tissue esterase causes fast clearance. Remifentanil clears 8 times faster than fentanyl. |
|
|
Term
| How are renal and hepatic functions effected with remifentanyl? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| 0.2 to 0.6mg q2-q3 hours. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| 0.4mg/ml amp. Draw up with 3cc NS for a .1mg per ml concentration |
|
|
Term
|
Definition
| 0.05 to .1 mg increments to effect. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Liver, undergoes first pass effect 1/5 oral potency. |
|
|
Term
| What kind of antagonist is it? What sites does it affect? |
|
Definition
| Pure opiod agonist at mu, delta, and kappa sites. |
|
|
Term
| What are the side effects of Naloxone? |
|
Definition
| Potential reversal of hypotension. Nausea and vomiting related to rapid infusion. |
|
|
Term
| What should be watched for after giving? |
|
Definition
|
|
Term
| How should Naloxone be given? |
|
Definition
| Slowly in 0.5 to .1mg increments. Repeat 2 to 3 min. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| How is drug compared to Narcan? |
|
Definition
| Equal potency. Longer duration due to slow metabolism by the liver. |
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|
