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130 Cards in this Set
- Front
- Back
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the discriminative pathway
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aka dorasal column-medial lemniscal pathway
-use for rapid transmission of sensory information such as descriminatory touch -info on this pathway can be discretely localized and discriminated in terms of intensity |
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one of the distinct features of the discrimitive pathway is that it relays ______ information regarding ______ orientation
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precise
spacial |
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why do people say men can park cars better then women?
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because their descrimativory pathway is more developed!
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astereognosis
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ability to describe an object but not call out its name
discriminative somatosensory pathway functional but parietal association cortex is not |
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anterolateral pathway transmit what
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pain
thermal sensations crude touch pressure |
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sensory homonculus reflects..
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the density of cortical neurons devoted to sensory input from afferents in corresponding peripheral areas
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modalities is a term used for ______, ______ distinctions between sensations
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qualitative
subjective |
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acuity referes to the ability to discriminate the ______ of somesthetic stimulation
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location
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the tactile system relays sensory information reagarding t______, p______, and v______
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touch pressure and vibration
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thermal sensation is discriminated by three types of receptors...
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cold, wamrth, pain
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conduction of thermal information through peripheral nerves is fast/slow
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slow
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what is a nerve test that covers a lot of basis
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pricking sole of foot
is the patient able to recognize/describe/locate pain? |
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specificity theory of pain
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regars pain as a separate sensory modality evoked by the activity of specific receptors that transmit info to pain centers in brain
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pattern theory of pain
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pain receptors share endings with other sensory modalities but different patters of activity or the same neurons can be used to signal painful/non painful stimuli
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acute pain is due to i______ causes and is of ______ term duration
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identifiable
short |
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chronic pain is of ______ term duration and the patient a______ to pain
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long
adapts |
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referred pain originates at a v______stie but is perceived as o______ in a part of the body that is i______ by neurons entering the ______ segment of the nervous system
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viceral
originating innervated same |
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what is the cause of psychogenic pain?
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no organic cause
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nociceptive pain is a n______ process, trasmitting information about tissue d______
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normal
damange |
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somatic pain is l______, t______, d______, a______
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localized
throbbing dull achy |
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somatic pain is treated with 4 meds
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nsaids
opioids apap anesthesia |
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visceral pain is p______ localized, r______ and treated with o______
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poorly
referred opioids |
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neuropathic pain is the a______ transmission of information about stimuli or change to the n______ due to an i______
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abnormal
nerve injury |
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your patient says she has pain in her foot. you ask her what the quality of the pain is. she responds "it feels burning and knife like. sort of like someone is stabbing me all over the foot" what kind of pain is this?
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neuropathic.
also can be described as shooting and can be continuous or sudden |
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you call the doctor about your patients "burning, knife like pain in her foot." the doctor orders MSO4 q4hr prn. is this OK?
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no.
MSO4 is morphine which is an opioid. and she is having neuropathic pain which does not respond well to opioids |
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as you politely inform the doctor that you think it is neuropathic pain that your patient is experiencing, which class of drugs would you expect him to perscribe?
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tricyclic antidepressants and anticonvulsants
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what do affarent pathways do on a fundamental level?
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carry nerve impulses from receptors or sense organs toward the central nervous system.
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nociceptors are apart affarent/effarent pathways
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afferent
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A delta fibers are unmyelinated/myelinated
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myelinated
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C fibers are myelinated/unmyelinated
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unmyelinated
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efferent pathways...
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carry nerve impulses away from the central nervous system to effectors such as muscles or glands
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what are the 6 higher brain systems that pain reaches via nerves
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limbic
reticular thalamus hypothalamus medulla cortex |
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chemial pain stimulants, stimulate type _____ receptors. and are apart of the i_____ process
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C
inflammatory |
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mechanical pain stimuli are from problems like l_____ or f_____
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lacerations
fractures |
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mechanical pain stimuli stimulate type _____ receptors
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A
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thermal pain stimuli stimulate type _____ receptors
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A
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the inflammatory response n_____ invading agents, l_____ the spread of agents, and begins to p_____ tissue for r_____
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neutralizes invading agents
limites spread of invading agents preparing tissue for repair! |
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during the initial stages of the inflammatory response, the vessels _____ but later they _____
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constrict
dilate |
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3 stages of cellular response to inflammations
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pavementing
emigration phagocytosis |
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what is "pavementing" in the inflam response?
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neutrophils line the blood vessel endothelium
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what is "emigration" refere to in the cellular response to inflammatory
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neutrophils traveling to the damaged tissue
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what does "phagocytosis" refere to in the cellular response to inflam process
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damage tissue is removed
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there are a lot of chemical mediators active in the inflam process. try and name them all... DO IT
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histamine
prostaglandins bradykinin leukotrienes cytokines 02 radicals proteolytic enzymes substancce P serotonin/K+ ions actylcholine ATP COME ON YOU WIMP!! |
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substance P is a modulator of n_____ and involved in signaling the i_____ of noxious or a_____ stimuli
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nociception
intensity adverse |
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what would activate the nociceptors in the skin?
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cuts burns cold
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what would activate the nociceptors in the gi tract
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inflam, distension, spasm
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NEVER, NEVER, NEVER, NEVER, EVER
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GIVE UP
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activation of nociceptors in the skeletal muscle can be caused by..
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inschemia
injuries of connective tissue necrosis hemorrhage |
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what would activate the nociceptors of joints
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inflammation
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what would activate the nociceptors of the arteries
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inflammation
piercing |
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what would cause the activiation of nociceptors in the head (aka headache... like jackie is having tonight)
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traction and displacement of arteries/meningeal structures
pulsation |
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pain tolerance is the _____ intensity or _____ an individual can or will endure before _____ help
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maximum
duration seeking |
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how does your SNS respond to pain?
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activates fight/flight
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what does the body do with catecholamines in response to pain?
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releases them
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what does the release of catecholamines do to the body?
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^HR
^BP ^resp dcrease GI possible NV |
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PAG, aka _____ _____ region, when stimulated causes _____
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periaqueductal grey region
causes analgesia |
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endorphins and enkephalins. what are they?
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endogenous pain relief.
opioid substances |
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endorphins are found in the _____ structure
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brainstem structure
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enkephalins are found in the _____, l_____ system and _____ horn
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PAG
limbic system dorsal horn |
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Mu receptors modulate a_____, b_____, and b_____
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analgesia
bradycardia bradypnea |
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the kappa receptors modulate s_____ anesthesia
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spinal
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the sigma receptors modulate d_____ and hallucinations
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dysphoria
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what does the delta and upsilon receptors modulate?
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dunno.
look it up you bum! |
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you can do this
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you are driven!
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what does ABCDE stand for in the clincal approach to pain management
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ask/assess
believe choose deliver empower/enable |
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analgesics releive pain without loss of _____
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concsiousness
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opiods are derived from _____
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opium
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what are the three opioid receptors
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MU
kappa Delta |
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Cows are pure opioid agonist. Why?
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because they Muuuuu
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morphine sulfate is a _____ receptor agonist and is the mainstay for control of ______ and ______ pain
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Mu receptor
acute pain cancer pain |
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opioids have 4 functions
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control pain
sedation cough suppression diarrhea suppression |
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what are the main effects of opioid analgesisc. hint: there are 7 of them
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analgesia
euphoria sedation resp depress miosis cough supression emesis |
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what are the 4 CNS effects of an opioid
hint: some overlap from "main effects" |
impaired reasoning
resp depress cough supress NV |
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what are the peripheral effects of an opioid?
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mild histamine release
reduction of pre/afterload |
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you have a patient come into ER with renal failure, cycstic fibrosis, a head injury, and a severed limb. MSO4 is perscribed for pain, what respiratory issue should you be conserned about other than depression
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supression of cough reflex. cystic fibrosis produces a lot of mucus and if cough is supressed by mso4 then they might not clear their airway effeciently. risk for pneumonia
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your patient is taking mso4 and begins to itch all over after 3 days of treatment. GET THE EPIPEN ...right?
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no. MS04 causes a mild release of histamine. this rxn is probably related to that and may be able to be controlled with benedryl. an immediate rxn of itching/sweling/hive would indicate an allergic rxn and maybe warrent epi pen use
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what are 7 common adverse effects of opioid usage
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resp depress
constipation orthostatic hypotension urinary retention cough supressino emisis increased ICP miosis |
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what is miosis?
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constriction of pupil
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you give your pt the perscribed 10mg dose of ms04. their respirations decrease from 12-8 breaths per minute.
what gas does hypoventilation ^ in the blood? what could this ^ do to the brain and why? |
CO2
increased ICP because CO2 dilates cerebral blood vessels |
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7 commonly perscribed drugs that will interact with opioids.
this might be a tough one. |
ETOH
anxiolytic phenothiazines sedatives barbiturates anesthetics MAOIs |
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what is a common class of anxiolytics?
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benzodiazepines
common examples: klonopin, valume, clonozepam |
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ms04 can fuck with what common respiratory disorder
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asthma
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tolerance means one must ______ doses to obtain ______ response
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increase
same |
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abstinence syndrome occurs if drug is ______ d/c'ed
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abruptly
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abstinence syndrome is dependant upon ______ ______ of drug and th degree of ______ ______
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half life of drug
degree of phsyical dependences/ |
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s/s of abstinence syndrome are similar to which nervous system function in hyperdrive?
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SNS
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what is the classic triad of opioid overdose?
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resp depress
miosis coma |
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what is the tx for opioid over dose?
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narcan
supplement with vent |
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your patient is given ms04. she ends up comotos, miopic, and breathing very slow. the MD orders narcan 20 mg iv push. you do it and nothing happens. the MD orders another 20 mg iv push. why should this make you nervous
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it is likely that the patient will get "kicked out of bed" and pain modulator (ms04) is completely gone. now they are in a lot of pain.
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so after the MD ordered you to give 3 rounds of narcan the pt is finally awake and breathing. but they are also writhing in pain. the md oders 10 mg ms04 iv push to get pain under control. after 30 mins the pt is still writhing. the md orders another 10 mg of ms04. why does this make you nervous?
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because the narcan is currently stuck to the Mu receptors so the morphine cannot attatch. this means the mso4 is circulating, but not being excreted. once the narcan leaves the mu site, then the ms04 will rush in.
if you load their circulatory system up with ms04, eventually the body will kick off the narcan and make it rain ms04 again. now we are coma tose again |
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5 things to do before giving pain med (revised slide)
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evaluate pain
vitals b&b consent for procedures bed in low pos |
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how many days should uncomplicated inflammation last?
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8-10
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how long does chronic pain last?
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weeks
months years |
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prostaglandins contribute to v______, p______, and s______
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vasodilation
pain swelling |
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prostaglandins are p______ compunds
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phospholipid
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prostaglandins ______ gastric acids
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suppress
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prostaglandins ______ renal blood flow
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increase
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functions of prostaglandins
good luck! there are 8 of them! |
MEDIATE inflam response
INCREASE response to pain PROMOTE fever, secretion of mucus, renal dilation SUPPRESS gastric acid SUPPORT sub mucosal blood flow STIMULATE platelete aggregation |
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What did one saggy tit say to the other saggy tit?
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If we don't get some support soon, people will think we're nuts!
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what are normal prostiglandin functions
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mediate inflam
^sensativity to pain promote fever decrease gastric acid ^ sub muosal blood flow stimulate platelet aggregation ^renal bloodflow |
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what happens if prostaglandins are inhibited?
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supresses inflam
decreases sensativity to pain reduces fever ^gastric acids decreases submucosal blood flow ^platelet aggregation decrease renal blood flow |
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NSAIDS and APAP are ______ inhibitors
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cyclooxygenase
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NSAIDS and apap are used to supress _______, relieve _______, and reduce _______
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supress inflam
releive pain reduce fever |
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3 common adverse effects of NSAIDS are..
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gastric ulceration
bleeding acute renal failure |
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asa is apart of which group of drugs?
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NSAID
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glucocorticoids are apart of which drug class?
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steroidal anti inflam agents
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APAP is/is not an NSAID
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is not
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APA is an anti_______ and a_______
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antipyretic
analgesic |
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what are 4 advantages of using APAP?
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minimal GI effects
no effect on bleeding time no effect on uric acid levels no effect on respirations |
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bronch/o
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bronchial tubes
(two tubes, one right and one left, that branch from the trachea to enter the lungs) |
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what the 2 major adverse effects of APAP
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hepatotoxicity
hepatic necrosis |
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acute hepatic necrosis can occur with doses of _______ to _______ grams and the risk increases when pt is _______ or using _______
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10-15 grams
fasting using ETOH |
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apap w/ coedine is perscribed for
milld, moderate, severe pain? |
moderate
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apap w/codein is a schedual _______ drug
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III
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asa is a _______ _______ cox inhibitor
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non selective
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asa is an a_______, anti_______, and anti_______
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analgesic
antipyretic antiinflammatory |
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asa causes a supression of _______ aggregation
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platelet
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get up and stretch for 1 full minute.
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seriously get up. you'll feel better and learn more efficently.
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2 major risks of asa use
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bleeding
gastric ulceration |
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your patient is scheduled to have a surgery in 3 weeks. they currently take 81 mg of asa qd. when should they stop taking this for the sx?
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1 wk prior.
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your patient is taking ms04, omeprazole, asa, glucophage, and vitamen E.
they are experiencing tinnitus, sweating, headache and dizziness. what is happening? |
asa adverse effect
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what syndrome could occur with children who recieve asa
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reyes.
common happening to children who get asa with a viral infection |
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ibprofen is _______ to asa
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similar
this means it: gi ulceration, bleeding, are problems |
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ibprofen is indicated in what type of disorders
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inflammatory disorders
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what are the indications for 2nd generaton cox 2 ihnibitors?
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osteoarthritis
RA |
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3 common adverse effects of cox 2 inhibitors are...
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dyspepsia
abd pain renal toxicity |
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cortisone is an anti_______. it also has i_______ actions, _______ retention/_______loss
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antiinflam
immunosupressive actions sodium retention potassium loss |
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cortisone is used in 5 common disorders. what are they?
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RA
lupus IBS prevention of allograft rejection |
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what are cortisones laundry list of adverse effects?
12 of them!! good luck chump! |
adrenal insufic
osteoporosis infxn glucose intolerance myopathy cushings fluid imbalance growth retardation psychologic disturbance cataracts glaucoma peptic ulcers |
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your patient is to stop taking her glucocorticoid. how long should this span over?
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7 days.
switch from multi dose to single dosing |
