Term
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Definition
| nociceptive (noxious) stimuli |
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Term
| Lamina II also is known as... |
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Definition
| substantia gelatinosa, MAJOR SITE OF OPOID ACTION |
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Term
| Lamina III and IV deals with... |
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Definition
| non-nociceptive sensory input (epicritic pathways) |
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Term
| Which lamina integrates somatic and visceral input, and is a key player on referred pain? |
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Definition
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Term
| alpha delta fibers synapse with which layers of the lamina? |
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Definition
| primarily lamina I and V, lesser with II, III, IV, and X |
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Term
| Which nerve fibers synapse with lamina I and II, and to a lesser extent with V? |
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Definition
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Term
| What area of the brain is the major relay station between the second order neurons and the third order neurons? |
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Definition
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Term
| Decribe the pathway of pain through the spinothalamic tract |
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Definition
| impulse travels down dorsal root ganglia to dorsal horn, synapse with the 2nd order nerve (or interneuron if reflex arc), 2nd order travels to contralateral side then acends up mylenated fibers that lie anterolaterally, up to the thalamus, thalamus relays it to the somatosensory cortex |
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Term
| name the differences between the lateral STT and the medial STT |
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Definition
| lateral carries discriminative info (laocation, intensity, duration) to the ventral posteriolateral nucleus of the thalamus; the medial STT (also known as the paleospinalthalmic tract)carries autonomic and emotional perception of pain to the medial thalamus |
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Term
| what nerve tract location intervenes with motor function? |
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Definition
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Term
| what are the reticular activation system (RAS) and the hypothalamus responsible for in pain |
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Definition
| the arousal response (wakefulness) |
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Term
| i am a third order neuron, where do i begin and end? |
|
Definition
| thalamus to the somatosensory cortex |
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|
Term
| feet are medial, hands midline, and face/belly/pharynx are lateral on what map? |
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Definition
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Term
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Definition
| primary excitatory CNS neurotransmitter, acts on NMDA receptors, and ketamine antagonizes (sits on the NMDA receptor to reduce pain) |
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Term
| acetylcholine, enkephalins(endorphins), and noreip are all inhibitory neurotransmitters in the CNS, which receptors do they effect? |
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Definition
| acetyl-muscarinic, enkephalins-mu (act like morphine, cause euphoria), norepi- alpha 2 (clonidine and precedex agonize and inhibit pain here) |
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Term
| Which neurotransmitter is the primary inhibitory one? |
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Definition
| gamma amino buteric acid (GABA), also deals with wakefulness (propofol and etomidate enhance this (neurotransmitter) |
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Term
| which neurotransmitter excites mu receptors and is the target of narcs? |
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Definition
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Term
| what is the order of nerve blockade for spinal/epidurals? |
|
Definition
| autonomic, temp, pain, touch, pressure, motor, vibration, propriception (ATP TP MVP) |
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|
Term
| what are the divisions of the spine and numbers of vertebrae? |
|
Definition
| cervicle (7), thoracic (12), lumbar (5), sacrum (5), coccyx (4 fused) |
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Term
| which areas of the spine are concave? convex? |
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Definition
| thoracic is concave, convex at the lumbar/cervical |
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|
Term
| when the pt is supine, what are the highest points of the spine? lowest? |
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Definition
| highest-C5 L5, lowest-T5 S2 |
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Term
|
Definition
| exaggerated thoracic curve |
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|
Term
|
Definition
| exaggerated lumbar or cervical curve |
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Term
|
Definition
| abnormal lateral (s) curve |
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|
Term
| are abnormal curvatures contraindications for SAB or epidurals? |
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Definition
| nope, however they may effect how the drug behaves in the spinal column (level) |
|
|
Term
| name the six components of your vertebral anatomy......and point them out on your partner |
|
Definition
| spinous process (spine), lamina, transverse process, superior articular process, pedicle, vertebral foramen |
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|
Term
| local anesthetics work by... |
|
Definition
| binding to the voltage gated Na channel, blocking the influx, inhibiting the propagation of depolarization |
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|
Term
| what part of the structure of the local anesthetic drug determines how it is classified? |
|
Definition
| the linkage chain, which is either an amide or an ester chain |
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Term
| by adding groups and lengthing/shortining the chain of locals, what will happen |
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Definition
| increase/decrease duration, solubility, and potency |
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|
Term
| are locals mostly acidic or basic? |
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Definition
|
|
Term
| what determines the duration of action in local anesthetics? |
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Definition
|
|
Term
| where and how are esters metabolized? what is the derivative? |
|
Definition
| in the plasma, hydrolized by plasma cholinesterase, breaks down into PABA |
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Term
| amides are metabolized by....... |
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Definition
| microsomal enzymes in the liver |
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Term
| which ester does not metabolize like the others |
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Definition
| cocaine (metabolized in the liver), metabolites are active |
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Term
| rank these esters in order from metabolized fastest to slowest.....tetracaine, chloroprocaine, procaine, yomomma-aine |
|
Definition
| chloroprocaine, procaine, tetracaine |
|
|
Term
| what are most local anesthetic allergies due to? |
|
Definition
| ester class production of PABA |
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|
Term
| what is the shortcut to convert % solution to mg/ml? |
|
Definition
| decimal point one place to the right |
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Term
|
Definition
| ph at which 50% of the drug is ionized and 50% is unionized |
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|
Term
| what does the pKa determine in the action of local anesthetics |
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Definition
|
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Term
| adding bicarb to your local, what will happen? |
|
Definition
| speed up the onset due to more unionized drug |
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|
Term
| if i am basic local with a pKa of 9 and i am injected into opra's gluteus maximus (ph of 7.3), will more of me be ionized or unionized? |
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Definition
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|
Term
| if i am an acidic local with a pKa of 5.9 and i am injected into the scrotum of ozzy ozborne (ph 2) will more of me be ionized or unionized? |
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Definition
|
|
Term
| what three things should you know when doing pKa problems? |
|
Definition
| pKa of drug, if drug is an acid or base, ph of the solution where drug is injected |
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|
Term
| what form (ionized or unionized) of the local binds to the fast Na channels? What does the other form do? |
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Definition
| ionized binds to the Na channels, unionized crosses membranes |
|
|
Term
| explain ion trapping in the fetus |
|
Definition
| fetus ph is lower than mom, unionized drug crosses placenta, in the lower ph the drug becomes more ionized and unable to return to the mom, therfore it is trapped |
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|
Term
| in which situation would ion trapping be of benefit? |
|
Definition
|
|
Term
| what is the potency of local anesthetics dependent (mostly) upon? |
|
Definition
|
|
Term
| what two properties of the local determines duration |
|
Definition
| amount of protein binding (the more binding the longer the action) and lipid soulbility (lipids serve as a storage reservoir, the higher the solubility the longer the duration) |
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|
Term
| what main characteristic would a local with a high potency and long duration have? |
|
Definition
| a high oil:water partition coefficient |
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|
Term
| how does a vasopressor effect our locals? |
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Definition
| it produces local vasoconstriction, which reduces blood flow, which reduces the amount of drug absorbed into the local capillaries, which prolongs duration of action and reduces chance of toxicity |
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Term
| rank the tissues in order of highest blood flow to lowest |
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Definition
| trach, intercostal muscle, caudal, paracervical, epidural, brachial plexus, subarachnoid/sciatic/femoral, subQ |
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|
Term
| is risk of toxicity higher in low blood flow areas? |
|
Definition
| nope, it is higher in high blood flow areas |
|
|
Term
| what is tissue toxicity of locals usually related to? |
|
Definition
|
|
Term
| what is systemic toxicity of locals related to? |
|
Definition
| blood levels secondary to absorbtion from site of injection |
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|
Term
| what are signs/symptoms of systemic toxicity of locals? |
|
Definition
| lightheadedness, tinnitus, seizures, CNS/cardiovascular collapse |
|
|
Term
| what does cocaine do that would cause sympathamometic effects (like HTN, tachy) |
|
Definition
| blocks the uptake of norepinepherine |
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Term
| toxic levels of locals.....lidocaine, bupivicaine, tetracaine, chloroprocaine, and cocaine are? |
|
Definition
| lido (4mg/kg, 7mg/kg with epi), bup (2.5mg/kg, 3mg/kg with epi), tetra (1.5mg/kg), chloro (9-14mg/kg), coke (3mg/kg) |
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|
Term
| what do i have to watch for when i am spraying a shitload of cetacaine spray and then my surgeon is going to block with a normal dose of tetracaine? |
|
Definition
|
|
Term
|
Definition
| 10mcg/kg in peds, 200-250mcg in adults |
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|
Term
| should i mix my local with epi if i am going to do a penis block? |
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Definition
| no way man, dont mix epi with locals for blocks in poor circulation areas (penis/fingers/toes) or in IV blocks (beir blocks) |
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