Acute Pain

Front 1

How long does acute pain last?

Back 1

1 month or less

Front 2

What tracts do pain axons from both A-delta and C fibers ascend in the spinal cord? (2)

Back 2

- Medial lemniscus

- Anterior lateral spinothalamic tract

Front 3

What is the difference between hyperalgesia and allodynia?

Back 3

Hyperalgesia = exaggerated pain response

Allodynia = pain from non-painful stimuli

Front 4

What nerve types are ramped up as a result of cytokine release to lead to primary hyperalgesia? (2)

Back 4

C-fibers and high-threshold mechanoceptors

Front 5

Name 4 excitatory neurotransmitters that signal pain.

Back 5

- Substance P

- Glutamate

- Aspartate

- Neurokinin A

Front 6

Name 2 inhibitory neurotransmitters that dampen pain signals.

Back 6

- GABA

- Glycine

Front 7

Name 4 specific pain receptor types.

Back 7

- NMDA

- AMPA

- Kainate

- Metabotropic

Front 8

Which 2 pain receptors are fastest?

Which ion do they gate?

Back 8

- AMPA and Kainate --> use Sodium

Front 9

Which pain receptor is slow to react and what ion does it use?

Back 9

NMDA --> uses Calcium

Front 10

What does Substance P do to an NMDA receptor?

Back 10

Removes a Magnesium block

Front 11

Name 3 catabolic hormones released after surgery.

Back 11

- Glucagon

- GH

- Catecholamines

Front 12

What 3 substances are suppressed after surgery?

Back 12

- Insulin

- Anabolic hormones

- Testosterone

Front 13

How does neuropathic pain feel? (3)

Back 13

Burning, electric, or shooting

Front 14

How is nociceptive post-Op pain treated? (3)

Back 14

- Opioids

- NSAIDs

- Acetaminophen

Front 15

How is neuropathic pain treated post-Op? (3)

Back 15

- NMDA antagonists

- Alpha blockers

- Alpha-2-delta Ca2+ channel agonists

Front 16

Which gender experiences more pain post-Op?

Back 16

Women

Front 17

What are the 3 sub-types of opioid receptors?

Back 17

- Mu

- Kappa

- Delta

Front 18

Besides opioid activation, what other MoA's does methadone have? (2)

Back 18

- NMDA antagonist

- SE & NE reuptake inhibition

Front 19

What are 4 common side effects of opioid medications?

Back 19

- Sedation

- Nausea/vomiting

- Respiratory depression

- Constipation

Front 20

What are 4 less common side-effects of opioid medications?

Back 20

- Dizziness

- Confusion

- Myoclonus

- Urinary retention

Front 21

What drug dampens opioid induced constipation?

What is its MoA?

Back 21

Alvimopan: peripheral mu-opioid antagonist

Front 22

What is morphine's half-life?

Back 22

4-5 hours

Front 23

How is morphine cleared from the body?

Back 23

Glucoronidated in liver and cleared by kidney

Front 24

How many times more potent is hydromorphone (Dilautid) than morphine?

Back 24

~5x

Front 25

How many times more potent is Fentanyl than morphine?

Back 25

~80x

Front 26

How is Fentanyl cleared from the body?

Back 26

Liver and kidneys

Front 27

How many times more potent is Sufentanyl to morphine?

Back 27

1000x

Front 28

How many times more potent is Alfentanyl to morphine?

Back 28

~10x

Front 29

How many times more potent is Remifentanyl to morphine?

Back 29

~80x just like fentanyl

Front 30

Why use Remifentanyl over Fentanyl ever?

Back 30

Remi has an ultra-short half-life (~15 minutes)

Front 31

What are side-effects of meperidine? (3)

Back 31

- Tremulousness

- Myoclonus

- Seizures

Front 32

With what psych med is meperidine completely contraindicated?

Back 32

MAOi

Front 33

What is the half-life of methadone once it has accumulated in fat?

Back 33

128 hours

Front 34

What is the conversion ratio of morphine to methadone for <100mg/d?

>1000mg/d?

Back 34

<100mg/d = 300:1

>1000mg/d = 20:1

Front 35

What is the MoA of buprenorphine?

Back 35

Mixed opioid agonist-antagonist & partial mu-agonist

Front 36

What is the analgesic potency of buprenorphine to morphine?

Back 36

25-50x

Front 37

What does cyclooxygenase do?

Back 37

Converts arachidonic acid to prostaglandins

Front 38

Between COX-1 & COX-2, which is more important to pain?

Back 38

COX-2

Front 39

What do prostaglandins do peripherally?

Back 39

- contribute to hyperalgesia and inflammation

Front 40

What do prostaglandins do centrally? (3)

Back 40

Enhance pain transmission via Substance P & glutamate, increase 2nd neuron sensitivity, and inhibit descending modulators

Front 41

What are risks associated with NSAID use? (3)

Back 41

- Platelet dysfunction

- Gastrointestinal ulceration

- Nephrotoxicity

Front 42

Name 3 selective COX-2 inhibitors.

Which is still on the market?

Back 42

1) Celecoxib <--still on market

2) Rofecoxib

3) Valdecoxib

Front 43

Why must COX inhibitors not be used in excess after bone fusion surgery?

Back 43

Prevent bone healing

Front 44

Which drug inhibits COX-3 centrally?

Back 44

Para-aminophenol

(derivative of acetaminophen)

Front 45

Name 2 NMDA antagonists?

Back 45

- Ketamine

- Dextromethorphan

Front 46

When is ketamine indicated for use in pain relief?

Back 46

When opioids don't work or cause hyperalgesia/allodynia

Front 47

Which drug can be prescribed post-operatively to induce analgesia, sedation, and anxiolysis?

Back 47

Clonidine

Front 48

What is the MoA of clonidine?

Back 48

Alpha-2 agonist

Front 49

What is the MoA of dexmedetomodine?

Back 49

Alpha-2 agonist

Front 50

What opioids are recommended in place of morphine for patients with renal failure? (2)

Back 50

Hydromorphone or Fentanyl

Front 51

What are 5 variables associated with patient-controlled analgesia (PCA)?

Back 51

1) Bolus dose

2) Incremental (demand) dose
3) Lockout time
4) Background infusion rate
5) 1 & 4 hour dose limit

Front 52

When should background PCA infusion be used?

Back 52

only in opioid tolerant patients

Front 53

Between hydrophilic and lipophilic anesthetics, which has slow uptake and longer duration?

Back 53

Hydrophilic

Front 54

What other drug class can be mixed with opioid medications to modulate the effect of epidurals?

Back 54

Local anesthetics

Front 55

What adjuvants to opioids and local anesthetics can further enhance analgesia of epidurals? (2)

Back 55

- Clonidine

- Ketamine

Front 56

What nerve block is appropriate for surgery on the shoulder or upper arm?

Back 56

Interscalene block

Front 57

Between what two muscles must a needle go for an interscalene block? (2)

Back 57

Middle and Anterior scalene muscles

Front 58

What kind of nerve block is appropriate for forearm or hand surgery?

Back 58

Infraclavicular block

Front 59

What nerve block is appropriate for surgery on the buttocks?

Back 59

Lumbar nerve block

Front 60

What 2 nerve blocks can allow virtually any surgery on the leg from the knee down? (2)

Back 60

- Femoral nerve block

- Sciatic nerve block

Front 61

Name the branches of the sciatic nerve down to the foot.

Back 61

Sciatic nerve --> Tibial and Common peroneal nerves

Front 62

What nerve links the common peroneal and tibial below the knee?

Back 62

Sural communicating branch

Front 63

What nerve block is appropriate for surgery in the front of the thigh?

Back 63

Femoral nerve block

Front 64

What is the only nerve from the lumbar plexus below the knee?

Back 64

Saphenous nerve

Front 65

Which nerve roots supply the sciatic nerve?

Back 65

L4-S3

Front 66

Which nerve comes off the sciatic nerve to supply the medial and posterior aspect of the thigh?

Back 66

Posterior femoral cutanenous nerve

Front 67

Addition of what drug can prolong a paravertebral blockade?

Back 67

Epinephrine

Front 68

What type of nerve block can be used in place of epidural if a patient is getting an ex-lap and has a spinal stimulator device in place?

Back 68

Rectus sheath block

Front 69

How is physical dependence to opioids different from addiction?

Back 69

Physical dependence suggests only withdrawal Sx experienced while addiction includes subversive behavior to continue the drug habit

Front 70

How do PCAs of opioid dependence differ from those of opioid-naive patients?

Back 70

PCA may require basal infusion