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178 Cards in this Set
- Front
- Back
nociception is the
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transduction/modulation/transmission of pain
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pain threshold is the point when
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stimuli is perceived as pain
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pain tolerance is the point when
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the max point a person endures before intervention is required
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response to acute pain
chronic pain |
acute-stress response
chronic-depression |
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nociceptive pain can be classifed (2)
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visceral-organ
somatic-skin w/an identifiable point |
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neuropathic pain is caused by
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abnormal processing of a painful stimuli or a painful excitation w/ no stimuli
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Gen acute pain is nocioceptive and the response is proportional to the stimulus whereas chronic pain is neuropathic and generally persists ....
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beyond the usual course of an injury or a disease.
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two nerve fibers that transmit painful stimuli
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a delta
c |
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bigger nerve fibers will...
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conduct faster
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carrier of fast/first pain
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a delta-biggest
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the stimulus carried by a delta fibers results in a response for
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the duration of the stimulus
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slow/second pain is carried by
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c fibers
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activation of c fibers can result in pain that
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outlasts the stimulus
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acute pain is carried by..
chronic pain is carried by... |
acute is- a
chronic is c |
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nerve sprouting is a feature of
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chronic pain
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the stimulus carried by a delta fibers results in a response for
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the duration of the stimulus
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the stimulus carried by a delta fibers results in a response for
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the duration of the stimulus
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slow/second pain is carried by
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c fibers
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the stimulus carried by a delta fibers results in a response for
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the duration of the stimulus
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enkaphalin/endorphins/opiates are contained in
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interneurons
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the stimulus carried by a delta fibers results in a response for
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the duration of the stimulus
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in chronic pain pathways, c fibers synapse with
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interneurons that contain enkaphalin
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the stimulus carried by a delta fibers results in a response for
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the duration of the stimulus
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the stimulus carried by a delta fibers results in a response for
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the duration of the stimulus
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slow/second pain is carried by
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c fibers
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the stimulus carried by a delta fibers results in a response for
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the duration of the stimulus
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slow/second pain is carried by
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c fibers
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nociception is the
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transduction/modulation/transmission of pain
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slow/second pain is carried by
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c fibers
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slow/second pain is carried by
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c fibers
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major neurotransmitter that is released by c fibers is
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substance p
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pain threshold is the point when
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stimuli is perceived as pain
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activation of c fibers can result in pain that
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outlasts the stimulus
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activation of c fibers can result in pain that
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outlasts the stimulus
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slow/second pain is carried by
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c fibers
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slow/second pain is carried by
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c fibers
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activation of c fibers can result in pain that
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outlasts the stimulus
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activation of c fibers can result in pain that
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outlasts the stimulus
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activation of c fibers can result in pain that
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outlasts the stimulus
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how can morphine act in the subarachnoid space
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c fibers release substance p but enkaphalin release causes a decrease in substance p
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acute pain is carried by..
chronic pain is carried by... |
acute is- a
chronic is c |
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acute pain is carried by..
chronic pain is carried by... |
acute is- a
chronic is c |
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activation of c fibers can result in pain that
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outlasts the stimulus
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pain tolerance is the point when
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the max point a person endures before intervention is required
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activation of c fibers can result in pain that
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outlasts the stimulus
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acute pain is carried by..
chronic pain is carried by... |
acute is- a
chronic is c |
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acute pain is carried by..
chronic pain is carried by... |
acute is- a
chronic is c |
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acute pain is carried by..
chronic pain is carried by... |
acute is- a
chronic is c |
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nerve sprouting is a feature of
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chronic pain
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major transmitter of a fibers is
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glutamate
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acute pain is carried by..
chronic pain is carried by... |
acute is- a
chronic is c |
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nerve sprouting is a feature of
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chronic pain
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nerve sprouting is a feature of
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chronic pain
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response to acute pain
chronic pain |
acute-stress response
chronic-depression |
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acute pain is carried by..
chronic pain is carried by... |
acute is- a
chronic is c |
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enkaphalin/endorphins/opiates are contained in
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interneurons
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nerve sprouting is a feature of
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chronic pain
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nerve sprouting is a feature of
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chronic pain
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nerve sprouting is a feature of
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chronic pain
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enkaphalin/endorphins/opiates are contained in
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interneurons
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in chronic pain pathways, c fibers synapse with
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interneurons that contain enkaphalin
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nociceptive pain can be classifed (2)
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visceral-organ
somatic-skin w/an identifiable point |
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enkaphalin/endorphins/opiates are contained in
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interneurons
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enkaphalin/endorphins/opiates are contained in
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interneurons
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enkaphalin/endorphins/opiates are contained in
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interneurons
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enkaphalin/endorphins/opiates are contained in
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interneurons
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nerve sprouting is a feature of
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chronic pain
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major neurotransmitter that is released by c fibers is
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substance p
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in chronic pain pathways, c fibers synapse with
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interneurons that contain enkaphalin
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in chronic pain pathways, c fibers synapse with
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interneurons that contain enkaphalin
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in chronic pain pathways, c fibers synapse with
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interneurons that contain enkaphalin
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in chronic pain pathways, c fibers synapse with
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interneurons that contain enkaphalin
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in chronic pain pathways, c fibers synapse with
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interneurons that contain enkaphalin
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how can morphine act in the subarachnoid space
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c fibers release substance p but enkaphalin release causes a decrease in substance p
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enkaphalin/endorphins/opiates are contained in
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interneurons
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major neurotransmitter that is released by c fibers is
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substance p
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major neurotransmitter that is released by c fibers is
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substance p
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how can morphine act in the subarachnoid space
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c fibers release substance p but enkaphalin release causes a decrease in substance p
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major neurotransmitter that is released by c fibers is
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substance p
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major transmitter of a fibers is
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glutamate
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how can morphine act in the subarachnoid space
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c fibers release substance p but enkaphalin release causes a decrease in substance p
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in chronic pain pathways, c fibers synapse with
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interneurons that contain enkaphalin
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how can morphine act in the subarachnoid space
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c fibers release substance p but enkaphalin release causes a decrease in substance p
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major neurotransmitter that is released by c fibers is
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substance p
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major neurotransmitter that is released by c fibers is
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substance p
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major transmitter of a fibers is
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glutamate
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major neurotransmitter that is released by c fibers is
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substance p
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major transmitter of a fibers is
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glutamate
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how can morphine act in the subarachnoid space
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c fibers release substance p but enkaphalin release causes a decrease in substance p
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major transmitter of a fibers is
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glutamate
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how can morphine act in the subarachnoid space
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c fibers release substance p but enkaphalin release causes a decrease in substance p
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major transmitter of a fibers is
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glutamate
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major transmitter of a fibers is
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glutamate
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how can morphine act in the subarachnoid space
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c fibers release substance p but enkaphalin release causes a decrease in substance p
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major transmitter of a fibers is
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glutamate
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fast/first pain is conducted by
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a detla fibers
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the pain sensation equals the duration of the pain stimulus in..pain with transmission by..
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acute pain with transmission by a delta fibers
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second/slow pain or... pain is transmitted by
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c fibers
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pain that extends beyond the painful stimulus is..pain and is carried by...
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chronic pain and is carried by c fibers
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nerve sprouting is a feature of
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chronic pain
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physiologic aka..pain
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chronic
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..pain is caused by abnormal processing of painful stimulus
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neuropathic ( can also result from spontaneous excitation of nerves w/no painful stimulus)
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nociceptive pain is classified as
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visceral-organ
somatic-skin |
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pain, temp and touch are conducted by..fibers
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a-delta
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both fast and slow fibers synapse in the
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dorsal horn of the spinal cord
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a delta fibers synapse in
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lamina 1/5 of the dorsal horn
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c fibers synaps in the
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lamina 2/3 of the dorsal horn
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lamina 2 where the..fibers synapse is also called the
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substantia gellatinosa
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spinal and epidural opiates work in the..portion of the spinal cord in lamina... where..fibers innervate
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substantia gellatinosa, lamina 2 , c fibers
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both a and c fibers cross over the ..and travel up the
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tract of lisseur..spinothalmic tract
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spinothalmic tract other wise called
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anterior later
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tract before the synapse are called..after are called
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first order befor
second order after |
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two types of second order neurons are
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wide range and nocioceptive
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wide range neurons are capable of
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wind up
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wind up
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increase in firing of second order neurons even with the same intensity
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second order neurons synapse with third order neurons in the
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thalmus
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pain is perceived in the
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cerebral cortex
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afferent is ...
efferent is... |
afferent is sensory
efferent is motor |
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area of the cortex that sensory info is perceived in
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pareaqueductal grey matter in the mibrain.
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iv narcotics work in the...where
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paraequeductual grey matter in the midbrain where modulating factors are formed
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c fibers synapse with second order neurons resulting in
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release of substance P
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substance P is modulated by
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release of enkaphalins from second order synapse with c fibers
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morphine acts in the subarachnoid space by
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modulating the release of enkapahlins from synapses with second order neurons with c fibers
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the NDMA receptor is modultated by release of and is a feature of ..pain
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glutamate acute pain
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alpha 2 agonist
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clonidine, dextomidine
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..is a gabba agonist that inhibits pain and is very helpful in the treatment of trigeminal neurolgia
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baclofen
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adenosine is an...neurotransmitter
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inhibitory
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nitric oxide is considered to be a
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analgesic through inhibition of ndma an an alpha 2 agonist
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endorphins and enkaphalins are neurotransmitters for...receptors
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mu, delta kappa
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substance P is teh neurotransmitter for the,,,receptor
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NK-1
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gaba is a..and is a nuerotransmitter for the..receptor
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inhibitory ...A/B
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NDMA and AMPA are
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excitatory
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depolarization causes..influx
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calcium
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caclium influx following depolarization causes
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phospholipase 2 activation and release of arachodonic acid
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spinal analgesia is mediated primarily by the
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mu2 receptors
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supraspinal (IV) analgesia is mediated primarily by
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mu1 receptors
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respiratory depression is mediated by activation of
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mu 2 receptors
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decreased hear rate and euphoria is seen with activation of
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mu 1 receptors
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pruritus is featured with activation of
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mu 1 receptors
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physical dependance occurs most likely with activation of...receptors
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mu 2
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dysphoria and sedation occurs with activation of..receptors
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kappa
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supraspinal analgesia dose not occur with the activation of...receptor
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mu 2
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opiods in spinals work by activation of the...receptors in the
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mu2 in the substantia gellatinosa
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IV opiods work in the...through activation of the...receptors
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paraequduactal grey area of the thalmus/limbic system..mu 1
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primary hypergesia
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release of substances from damaged tissues such as phospholipase 2 and arachodonic acid
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secondary hypergesia is due to the release of .....which..
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substance P which degranulates mast cells, releases histamine and there is tissue edema
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peripheral modulation is compromised of
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primary and secondary hypergesia
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central modulation involves
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three mechanisms of central sensitization of the spinal cord
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with central modulation, there is ..of wide range neurons
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wind up
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features of central modulation (3)
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wind up, receptor field expansion (so that adjacent neurons are receptive to stimuli), hyperexcitatbility of flexion reflexes
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conversion of phospholips to arachodonic acid is inhibited by
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corticosteroids
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formation of oxygen radicals from conversion of cyclooxygenase to endoperoxides occurs is prevented by
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NSAIDS
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leukotrines formed by lipoxygenase from achochodonic acid cause
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bronchoconstriction and chemotaxis
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thromboxane causes
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vasoconstriction and thrombocyte aggregation
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cell membranes/phosopholipids use..to form achochodinic acid
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phospholipase A
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5 Prostoglandins
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prostocyclin A
Thromboxane PGE 2 PGD 2 PGF 2a |
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bradykynin, potassium, oxygen radicals cause
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pain inflammation edema
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two pathways of the archochodinic acid cascade are
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cyclooxygenase, lipooxygenase
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thoracic epidurals would improve myocardial oxygen supply by
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dilitation by sympathetic block/dilation of coronary arteries/
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lumbar epidural would not
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dilate coronary arteries since epidurals are segmental and can lower perfusion pressure
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clonidine can reduce...outflow
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sympathetic
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are spinals or epidurals most likely to cause urinary retention
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spinals (50%)
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are spinals or epidurals most likely to cause N/v
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equally 20-30%
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are spinals or epidurals more likely to cause respiratory depression
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spinals 5-7 vs .1-2.0 %
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incidence of pruritus with spinals and epidurals
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spinals is 60. epidurals 1-100
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why is fentanyl less likely to cause delayed respiratory depression
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because it is lipophilic and is more likely to stick to neural tissue and nto to go up the spinal cord to brain with more systemic absorption and early vs late respiratory depression
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why dose morphine cause early respiratory depression
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because it is hydrophilic and is likely to be absorbed into the epidural space, veins and stays in csf so there is rosteral spread to brain
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complex regional pain syndrome 1 is otherwise called
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reflex sympathetic dystrophy
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complex regional pain syndrome 2 is formerly called
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causalgia
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complex regional pain syndrome is
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pain that outlasts stimulus
1. extremities involving minor trauma 2. gunshot wounds |
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low dose antidepressants help modulate pain by
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modulate sympathetically driven pain by nhibiting uptake of norepinephrine and seratonin
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amount of local anesthetic for a lumbar block
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1-2 ml
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SSRI, tryciclics block
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NDMA synaptic activity
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clonazepam and valproic acid work by alteration of the
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ion channels along the nerve fiber
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mixaline, a....drug causes pain modulation by
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sodium channel blocker, prevents glutamate release
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anticonvusants are categorized as
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membrane stabalizers
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membrane stabalizers prevent the
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firing of traumatized neurons
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morphine is...x more potent than fentanyl
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100
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