Term
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Definition
| It is described as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. |
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Term
| What specialized receptors perceive pain and where? |
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Definition
*Dorsal horn by A-delta and C-fibers
*Dorsal horn contains complex circuitry of neurons
*6 Laminae (Rexed's)
*Substantia Gelatinosa (Lamina II)
*Interneurons or 2nd neurons
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Term
| Where is the first and second neurons in the pain pathway located? |
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Definition
*1st is located in the spinal ganglia or ganglia of CNs
*2nd is located in dorsal horn or the rhombencephalon |
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Term
| What effect does pain have on perfusion? |
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Definition
| *Direct activation of autonomic sympathetic neurons by the processing of nociceptive information of the segmental spinal level can lead to immediate changes in the perfusion of defined areas. |
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Term
| Where are the high concentrations of opioid receptors in the spinal cord? |
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Definition
*In the dorsal horn in the periaqueductal gray area
*Greatest abundance is substantia gelatinosa |
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Term
| Where do opioid receptors have the highest affinity for opioids but do not have the greatest number? |
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Definition
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Term
| What is the endogenous pathway for pain? |
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Definition
| Periaquaductal gray matter-->Nucleus raphe magnus--> substantia gelatinosa-->APs stimulate enkephalin release OR exogenous given ligands-->Decreases APs to lateral spinothalamic tract |
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Term
| What is the exogenous pathway for pain? |
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Definition
| *AP stimulate enkephalin neurons-->enkephalin released or exogenous given-->decreases action potentials to lateral spinothalamic tract. |
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Term
| How do opioids effect presynaptic receptors? |
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Definition
| *Presynaptic receptors inhibit th release of substance P, glutamate and other neurotransmitters and postsynaptic receptros decrease the evoked excitatory postsynaptic potential (EPSP). |
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Term
| Where are first order and second order receptors found? |
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Definition
*First order found outside of the cell
*second order found on the inside of the cell |
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Term
| What are the natural ligands for opioid receptors? |
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Definition
*Enkephalins
*Endorphins
*Dynorphins |
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Term
| What are the most clinically relevant pharmacodynamic measures? |
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Definition
*Potency
*Speed of Onset
*Duration of Action |
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Term
| What is used as the benchmark analgesic opioid? |
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Definition
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Term
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Definition
*Fentanyl
*Sulfentanyl
*Alfentanil
*Remifentanil
*Methadone |
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Term
| What are important pharmacologic characteristics? |
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Definition
*Metaboism
*Bioavailability
*Protein binding
*Lipid solubility |
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Term
| What do all opioid receptors have common? |
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Definition
| They all are G-protein coupled receptors |
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Term
| What are the MOA when G-protein coupled opioid receptors are activated? |
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Definition
*Potassium ion channels open causing hyperpolarization and decreased neuronal firing
*Reduction of calcium ion influx and subsequent neurotransmitter release
*Glutamine and substance P release is inhibited |
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Term
| Why can muscle rigidity result with opioid use? |
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Definition
| *Inhibition of dopamine release and GABA pathways in the striatum and substantia nigra. |
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Term
| How can muscle rigidity be treated |
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Definition
| With a partial antagonist such as Nubain or Stadol. Allows delta and kappa receptors to have opioid agonist on board but removes Mu agonist only. |
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Term
| What nerve fibers and neurotransmitters are associated with acute pain? |
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Definition
*A-delta nerve fibers
*Glutamate |
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Term
| What nerve fibers and neurotransmitter are associated with chronic pain? |
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Definition
*Unmyelinated C fibers at the dorsal roots and free nerve endings
*Substance P |
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Term
| What does substance P do to vessels? |
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Definition
| It increases vasodilation and permeability |
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Term
| Describe Superficial somatic pain, where receptors are located, and what to use for treatment |
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Definition
*Superficial Somatic pain is characterized by sharp, throbbing, pricking and is well localized
*Nociceptive receptors in skin, sub Q tissue, mucous membranes
*Treat with opioids |
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Term
| Describe deep somatic pain, location of receptors and treatment |
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Definition
*Deep somatic pain is characterised by dull, aching, quality more diffuse
*Arises from muscle, tendon, joints, and bones
*NSAIDS such as Torodol, good drug |
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Term
| What is radicular pain caused by? |
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Definition
| *Irritation of nerve roots ie disc herniation |
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Term
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Definition
| *Weakness, numbness, tingling or loss of reflexes in the distribution of the nerve. |
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Term
| What does neuropathic pain result from? |
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Definition
*Injury to the nervous system either central or peripheral.
*Occurs after trauma and many disease |
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Term
| What is the first line therapy in cancer pain treatment? |
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Definition
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Term
| Why does cancer pain arise? |
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Definition
*Arises when a tumor presses on bone, nerves, or body organs.
*Tumor cells lie between capillary and nerve causing inflammation when the chemo destroys the cells. |
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