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34 Cards in this Set
- Front
- Back
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what are the primary nociceptive neurons (sensory) in newborns
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C and myelinated A-delta fibers
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originate as free nerve endings for sensing stimuli such as heat, pressure, and pain
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myelinated A-delta and unmyelinated C fibers
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what fibers are "faster" and transmit "first pain"
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A-delta
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Is characterized as sharp/isolated pain and last as long as the stimuli is present
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first pain
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What fibers are "slow" and carry mechanothermal and chemical stimuli
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Unmyelinated C fibers (referred to as 2nd pain
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what are the 3 neurons in the pain pathway
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primary, secondary, and tertiary neurons
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these types of neurons carry pain from periphery to the lateral dorsal horn of spinal cord
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primary
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where do A-delta fibers terminate
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terminate in laminae I, II, V and X (faster)
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where do C fibers terminate
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terminate in laminae I, II, and V (slower)
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Primary afferent neurons stimulate the release of?
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excitatory amino acids (glutamate/aspartate) or peptide neurotransmitters (sub P, somatostatin)
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what neurons trigger the secondary neurons and cross at level of the spinal cord
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primary afferent neurons
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what neurons can be activated at several dermatome levels above and below primary level thus leading to "wind up"
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second order neurons
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what are the two types of "second order neurons"
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-nociceptive specific and wide dynamic range neurons
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A type of second order neuron that is A-delta and C fiber specific
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nociceptive
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type of second order neuron that responds to nociceptive and non painful stimuli
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WDR - wide dynamic range neurons
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where is response to pain mediated?
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primary sensory cortex
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where do secondary neurons terminate
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at thalamus
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where do tertiary neurons terminate
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primary sensory cortex
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what can happen if a patient has prolonged exposure to untreated painful stimuli
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can lead to "rewiring" or nerve pathways that lead to an increased perception of pain in the future
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these mediators are fully functional at birth despite absence of fully myelinated pathways
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inflammatory mediators
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name 9 inflammatory mediators
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-hydrogen
-Kcl ions -histamine -leukotrienes -prostaglandins, cytokines, serotonin, bradykinins and nerve-growth factors |
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what are the pro's and con's to using Non-opioid analgesics
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-do not produce resp. depression
-limited by ceiling effect |
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this drug is believed to antagonize NMDA and sub P within the SC
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acetaminophen
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what two drugs decrease sympathetic response by inhibiting nor-epi at pre-synaptic sites in the periphery and post-synaptic sites centrally
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precidex and scopalamine
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opioid receptor that provides supra spinal analgesia
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Mu-1
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opioid receptors that are spinal mediated and case addictive dependency along with respiratory depression and decreased GI motility
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Mu-2
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opioid receptors that have anti-inflammatory characteristics and alter leukocytes
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Mu-3
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B/c the blood-brain barrier in not intact at birth certain drugs can cross. What kind?
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IV hydrophilic ( like morphine)
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what type of opioids have "back door" effect by directly bathing receptor sites with lower doses needed
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intrathecal/epidural
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what type of opioids diffuse across dura slower providing longer therapeutic effects
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hydrophilic
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discuss liver fx and the P450 in newborns
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immature until 2 months - can lead to prolonged clearance
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what 3 conditions can inhibit clearance and prolong duration
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cirrhosis, septic shock and renal failure
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why is there more free drug circulating in the newborn
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b/c of decreased circulating proteins
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Infants less than ______ have high circulating "free" drug and also have decreased clearance leading to higher circulating serum levels
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less than 2 months
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