Module Test 3 Set 2

Front 1

4 basic types of nociceptors

Back 1

1)heat response
2)cold response
2)acid response
3)pressure response

Front 2

Chemical mediators of pain in tissues (3)

Back 2

1)PG
2)K+/H+
3)prostanoids

Front 3

Chemical mediators of pain in plasma

Back 3

bradykinin

Front 4

Chemical mediators of pain in nerve terminals (3)

Back 4

1)substance P
2)CGRP
3)glutamate

Front 5

Opoid receptor subtypes (4)

Back 5

1)mu (MOP)
2)delta (DOP)
3)kappa (KOP)
4)ORL1 (NOP)

Front 6

Mu agonists

Back 6

enkephalin

Front 7

Delta agonists (2)

Back 7

1)enkephalin
2)endorphin

Front 8

kappa agonists

Back 8

dynorphin

Front 9

ORL1/NOP agonists (2)

Back 9

1)orphanin FQ
2)nociceptin

Front 10

Mu receptor agents (3)

Back 10

1)morphine
2)fentanyl
3)oxycodone

Front 11

Kappa receptor agents (3)

Back 11

1)butorphanol
2)levorphanol
3)pentazocine

Front 12

Descending pain pathway is always off b/c of...

Back 12

GABA

Front 13

Opioid analgesics mechanism (4)

Back 13

1)directly inhibit release of NTs that activate ascending pain pathways
2)inhibit release of NTs that inhibit descending pain pathway
3)activate descending analgesic pathways (promoting release of opioid peptides)
4)stimulate descending inhibitory pathways (5-HT, NE)

Front 14

DXM properties (3)

Back 14

1)little addictive potential
2)less constipating than codeine***
3)NMDA receptor antagonist

Front 15

Anti-diarrheal effects of opioids (4)

Back 15

1)incr tone
2)decr gut motility
3)stim mu2/delta receptors in brain and GI nerve plexus
4)loperamide crosses BBB poorly

Front 16

Diphenoxylate
a)____ analog
b)_____ prevents abuse

Back 16

a)meperidine
b)anticholinergic SE's

Front 17

Opioids can also be used for...(2)

Back 17

1)dyspnea of acute pulmonary edema
2)anesthesia

Front 18

Dyspnea of acute pulmonary edema def (2)

Back 18

1)associated w/ MI
2)labored/difficult breathing associated w/ pain

Front 19

....(3) used as regional anesthetics b/c....

Back 19

1)morphine, fentanyl, lidocaine
2)produce spinal analgesia

Front 20

a)Nociception vs.
b)Hyperalgesia vs.
c)Allodynia

Back 20

a)normal response to noxious stimulus
b)enhanced response to a noxious stimulus
c)when a non-noxious stimulus is perceived as noxious

Front 21

Acute pain desc. (5)

Back 21

1)pain following an injury, stops when treated
2)important for survival
3)pt knows pain will end @ some point
4)clinical assessment correlates well w/ pt self-reporting
5)important to prevent it from becoming chronic pain

Front 22

Chronic pain characteristics (4)

Back 22

1)lasts for more than several weeks (episodic or continuous)
2)no survival benefit
3)more pronounced psychological harm
4)poor correlation b/w clinical assessment and pt assessment

Front 23

Plant that morpheine/codeine comes from and it is...

Back 23

papaver somniferum

gold standard for pain relief since 3rd century BC

Front 24

Morphine metabolized in liver to: and characteristics of them (2)

Back 24

1)morphine-6-glucuronide, active 100-800x more potent than morphine
2)morphine-3-glucuronide, no analgesia, may cause tremors

Front 25

Codeine is metabolized to...(2)

Back 25

1)5-10% to morphine-6G
2)80% to codeine-6G

Front 26

Genetic variability w/ codeine (3)

Back 26

a)coversion to morphine via CYP2D6
b)10% of whites don't have this so codeine is ineffective
c)chinese have lower CYP2D6 and produce less morphine-6G

Front 27

2 main ways to block pain

Back 27

1)block glutamate receptor
2)activate descending pain inhibitory tracts

Front 28

Semisynthetic opioids (3)

Back 28

1)hydrocodone
2)oxymorphone
3)oxycodone

Front 29

Oxycodone (Oxycontin) (4)

Back 29

1)mu agonist
2)8x more potent than codeine
3)active metabolites, but less potent
4)treat acute pain >> than chronic

Front 30

Methadone (dolophine) (5)

Back 30

1)mu agonist
2)effective orally w/ long half-life (so long time to SS)
3)less sedation than morphine
4)higher doses for addiction than pain
5)racemic mixtures activate mu and antagonize NMDA

Front 31

Methadone cautions (2) and interactions (3)

Back 31

1)will accumulate to toxic levels if dosed too freq.
2)may prolong Q-T

1/2)rifampin and phenytoin incr metabolism
3)cimetidine inhibits metabolism

Front 32

Meperidine (demerol) (5)

Back 32

1)normepiridine is antimuscarinic
2)don't use for more than 48hrs w/ doses >600mg/day
3)no antitussive
4)less constipation, spasm, retention than morphine
5)mu agonist

Front 33

Normeperidine properties (3)

Back 33

1)half as efficacious as meperidine w/ 2x greater half-life
2)decreases seizure threshold
3)increases CNS excitability

Front 34

Pentazocine
a)receptor
b)other (4)

Back 34

a)weak mu agonist/antagonist, kappa agonist

b1)can precipitate withdrawal
b2)w/ naloxone to prevent euphoria
b3)can't reverse MS respiratory depression
b4)no active metabolites

Front 35

Pentazocine
a)use
b)SE's (3)
c)avoid use in...

Back 35

a)pt w/ chronic pain or w/ former opioid addicts
b)less urinary retention, constipation, dysphoria @ high doses
c)CAD

Front 36

Butorphanol
a)receptor
b)other (2)

Back 36

a)mu ANTAgonist, kappa agonist
b1)ceiling effect on respiratory depression
b2)good for acute pain

Front 37

Butorphanol
a)approved for...
b)SE's (2)

Back 37

1)severe HA, post-labor, surgery
2)CV effects like pentazocine, sedation

Front 38

Nalbuphine (Nubain)
a)receptor
b)other (3)

Back 38

a)mu ANTAgonist, kappa agonist
b1)less dysphoria than pentazocine
b2)no CV effects (so good for MI)
b3)abstinence syndrome

Front 39

Dysphoria
a)cause

Back 39

a)kappa receptor agonists

Front 40

Respiratory depression
a)cause
b)other (3)

Back 40

a)mu2 agonist in brain
b1)primary cause of death
b2)dose dependent
b3)tolerance develops

Front 41

Miosis
a)cause
b)other (3)

Back 41

a)mu/kappa agonists
b1)dose dependent
b2)NO TOLERANCE DEVELOPS
b3)GOOD INDICATOR OF OPIOID O.D. IF pt unconscious

Front 42

Constipation
a)cause
b)other (2)

Back 42

a)mu2/delta receptors in brain and GI nerve plexus
b1)little/no tolerance
b2)initiate laxatives early

Front 43

Sensitivity rxns
a)cause
b)other (2)

Back 43

a)wheals @ site of injexn due to histamine
b1)urticaria, rashes
b2)anaphylaxis RARE

Front 44

Biliary Tract
a)what happens
b)prevented by...
c)reversed by...

Back 44

a)incr tone in sphincter of Oddi
b)atropine
c)opioid antagonists

Front 45

GU effects (2)

Back 45

1)decr renal fxn by decr renal blood flow
2)urinary retention

Front 46

Use of agonists w/ agonist/antagonist can lead to.... (2)

Back 46

1)diminished analgesia
2)precipitated withdrawal

Front 47

Use of opioids in pregnancy (2)

Back 47

1)fetus may become dependent
2)manifest withdrawal after delivery

Front 48

Use of opioids in pts w/ endocrine disease

Back 48

1)pts w/ addison's or myxedema may be more sensitivie

Front 49

Use of opioids in pts w/ impaired pulmonary fxn =

Back 49

acute respiratory failure

Front 50

Use morphine w/ care in asthmatics b/c...

Back 50

it may induce histamine release (fentanyl doesn't release histamine)

Front 51

Acute overdose of opioids characterized by... (4)

Back 51

1)coma
2)pinpoint pupils
3)respiratory depression
4)maybe needle marks

Front 52

Pure opioids antagonist...

Back 52

naloxone

Front 53

Naloxone (Narcan)
a)affinities
b)treat...
c)induces

Back 53

a)mu > kappa1 > delta > kappa3
b)acute opioid overdose
c)abstinence syndrome

Front 54

Naltrexone (Revia)
a)affinities
b)adv over Naloxone
c)treat...

Back 54

a)mu > kappa1 > delta > kappa3
b)longer half-life
c)chronic alcoholism/opioid addiction NOT overdose

Front 55

____ is not used for opioid induced constipation

Back 55

NO BULK LAXATIVES

Front 56

If you are switching opioids you must...

Back 56

make sure you are switching from mu agonist to mu agonist...etc.

Front 57

Thermoregulation def. (3)

Back 57

1)maintain normal body temp.
2)set pt is normal body temp (97-99F)
3)diurnal temp variations in set pt (lowest in morn, peak in late afternoon/early evening)

Front 58

Temp. regualtion center

Back 58

hypothalamus

Front 59

Thermoreceptors
a)where
b)fxn

Back 59

a)thruout body
b)transmit temp changes to hypothalamus so it can thermoregulate properly