Patho Neuro Part 2

Front 1

What is the definition of pain?

Back 1

-unpleasant sensory and emotional experience with actual or potential tissue damage
-pain is what the patient says it is and when the patient says it is occuring

Front 2

Somatic pain can be broken down into what to subtypes?

Back 2

Superficial and deep

Front 3

Superficial pain is from the _____ and is well localized, sharp and (clearly/poorly) located

Back 3

-skin
-clearly

Front 4

Deep pain is from the _____ (many) and is dull, aching, throbbing, cramping and (clearly/poorly) localized?

Back 4

-bone, ligaments, blood vessels and muscles
-poorly

Front 5

Visceral pain is located where and results from what?

Back 5

location: deep tissues or organs and surrounding structures
results from: stretching or ischemia

Front 6

Visceral pain characteristics?

Back 6

-deep, boring, diffuse, poorly defined, referred to a distant location
-associated with ANS

Front 7

Neuropathic pain comes from?

Back 7

peripheral receptors, afferent fibers in periphery or CNS

Front 8

Neuropathic pain characteristics?

Back 8

-shooting, burning, stabbing, cutting, tingling
-hard to treat, phantom pain

Front 9

What is acute pain?

Back 9

a biologically necessary physiologic response that provokes an escape/ protection reaction

Front 10

Chronic pain has no useful ______ purpose and it lasts longer than ___ months

Back 10

biological
6

Front 11

Cancer pain can be _____, ____ or a combo of both.

Back 11

acute, chronic

Front 12

Referred pain originates at a visceral site but is perceived as originating in a part of the body wall that is innervated by ____ entering the same segments of the nervous system.

Back 12

neurons

Front 13

Pain threshold is defined as?

Back 13

the point at which a stimulus is perceived as painful
*almost equal from person to person

Front 14

What is pain tolerance defined as?

Back 14

max intensity or duration of pain that a person is willing to endure before the person wants something done about the pain
-caries a lot depending on genetic, cultural, psychological and familial factors

Front 15

What are the 3 basic stimuli that activate specific pain receptors?

Back 15

-mechanical
-thermal
-chemical

Front 16

some examples of mechanical stimuli are?

Back 16

-pressure
-brushing
-pinch
-prick

Front 17

Examples of thermal stimuli are?

Back 17

-hot
-cold

Front 18

examples of chemical stimuli are?

Back 18

-exogenous
-endogenous
-tissue damage
-inflammation
-vascular epithelial cells
-immune cells

Front 19

Nociceptors are?

Back 19

pain receptors

Front 20

the two peripheral afferents are?

Back 20

-A delta fibers
-c fibers

Front 21

A delta fibers are _____ making them fast and responsible for ____ pain.

Back 21

-myelinated
-acute

Front 22

C fibers are _____ and responsible for _____ pain.

Back 22

-unmyelinated
-chronic

Front 23

Chemicals released in response to pain are?

Back 23

-glutamate
-NE
-substance P

Front 24

pain pathways to the cortex involve?

Back 24

-second-order neurons
-third- order neurons

Front 25

Second order neurons process _____ info and communicate with various reflex networks and sensory pathways in the spinal cord and travel to the ______.

Back 25

-nociceptive
-thalamus

Front 26

third order neurons ____ pain info to the cortex where is is perceived. both _____ and _____ areas.

Back 26

-project
-primary and associative

Front 27

The central processing of pain information includes the __________ cortex, the ________________ ____________, and the ____________ stem centers

Back 27

The central processing of pain information includes the SOMATOSENSORY cortex, the LIMBIC SYSTEM, and the BRAIN stem centers

Front 28

Pain information is perceived and interpreted in this part of the brain

Back 28

-somatosensory cortex

Front 29

Pain is transmitted to the ________________ cortex

Back 29

-SOMATOSENSORY cortex

Front 30

The ____________ ____________ experiences the components of pain

Back 30

-limbic system

Front 31

This part of the central processing of pain information in the brain recruits autonomic nervous system responses

Back 31

-brain stem centers

Front 32

The somatosensory cortex, the limbic system, and the brain stem centers are all part of the ____________ ____________ ___________.

Back 32

-all part of the TOTAL PAIN EXPERIENCE

Front 33

The endogenous analgesic center is located in the _____ __________

Back 33

mid brain

Front 34

__________________ __________________ _______________ in the medulla sends inhibitory signals to __________ horn neurons in the spinal cord

Back 34

-Nucleus raphe Magnus

-dorsal horn

Front 35

Signals from the PAG area sends signals to the spinal cord which goes to the ___________ horn

Back 35

posterior horn

Front 36

Pain signals from the PAG area go to the spinal cord then to the posterior horn that increase or decrease the amount of ___________ __________ from nociceptors

Back 36

***action potentials

--therefore OPENING or CLOSING the gate

Front 37

If the "gate" is opened....

Back 37

-more action potentials from nociceptors
-more pain

Front 38

If the gate is closed...

Back 38

-less action potentials
-feel less pain

Front 39

PAG

Back 39

serotonin tricyclics

Front 40

Prostaglandins _______________ the pain signal

Back 40

INCREASE

Front 41

Opioids ____________ the pain signal

Back 41

DECREASE

Front 42

Opioids ________ the gate at the posterior horn

Back 42

**close

Front 43

Substances that will stimulate pain receptors mainly are these

Back 43

Prostaglandins

Front 44

Prostaglandins formed from this pathway

Back 44

Arachidonic Acid

Front 45

NSAIDs block _____ __ receptors

Back 45

COX 1

Front 46

Vioxx (rarely used now due to s/e) and Celebrex block these receptors

Back 46

COX II

Front 47

Morphine like drugs are derived from _______ and can be __________ or synthetic

Back 47

-opium
-natural or synthetic

Front 48

Morphine acts on receptors in spinal cord and causes

Back 48

-epidural analgesia

Front 49

Morphine acts on receptors in brain stem and causes

Back 49

respiratory depression

Front 50

Morphine acts on receptors in the GI tract and causes

Back 50

constipation

Front 51

Morphine acts on receptors in the brain directly and/or releasing ___________ which are ____________ ____________ like substances

Back 51

-endorphins
-endogenous morphine like substances

Front 52

Amitriptyline is in this drug class

Back 52

tricyclic antidepressant

Front 53

Tricyclic antidepressants increase the amount of ______________ in PAG

Back 53

serotonin

Front 54

TCAs are great for this type of pain

Back 54

neuropathic pain

Front 55

Neurontin is this type of medication

Back 55

antiseizure medication

Front 56

Neurontin suppresses the spontaneous ____________ of __________

Back 56

-firing of neurons

Front 57

Three dosing schedules for pain

Back 57

1. PCA
2. fixed
3. PRN

Front 58

Best way to treat pain

Back 58

PCA

Front 59

2nd best way to treat pain

Back 59

Fixed

Front 60

Why is PRN a problem in treating pain?

Back 60

-experience pain, need more drugs, more prone to side effects

Front 61

Pain and Clinical Sequelae: Ventilation

Splinting >>> altered respiratory pattern and effort >> _________ lung capacity >> ________ airway clearance >> retention of secretions >> (develop this airway disease) >> DECREASE PaO2

Back 61

-splinting >> altered resp pattern and effort >> DECREASED lung capacity >> INEFFECTIVE airway clearance >> retention of secretions >> DEVELOP PNA

Front 62

Splinting >> altered respiratory pattern and effort >> decreased lung capacity >> __/__ abnormalities >> shunt >> __/__ mismatch >> atelectasis >> decrease Pa O2

Back 62

V/Q abnormalities
V/Q mismatch

Front 63

Pain increases vasopressin, _______, aldosterone, and _________ which leads to fluid retention in the __________ and ___________ in preload, this eventually leads to tachycardia

Back 63

renin, angiotensin

in the kidneys

increase in preload

Front 64

Pain and Perfusion....

Pain activates the _______________ nervous system and causes increase afterload and tachycardia.....this increases ____________ demand leading to myocardial ischemia

Back 64

SNS

myocardial demand

Front 65

Pain and Perfusion...

Pain activates the SNS which vaso-_________ and ______________ regional blood flow and ____________ wound healing

Back 65

vasoconstricts

decreases

decreases

Front 66

Pain and Perfusion..

Pain may make a person immobile leading to venous ________ place the patient at and ___________ risk of DVT

Back 66

stasis

increased

Front 67

T/F Chronic pain requires it's own form of treatment

Back 67

True

Front 68

T/F does chronic pain has a significance

Back 68

False-no significance

Front 69

Phantom pain

Back 69

"original tissue injury may resolve but the pain lingers"

Front 70

The ANS controls __________________ body functions

Back 70

involuntary

Front 71

What is the main center for the control of the ANS

Back 71

hypothalamus

Front 72

PNS

Back 72

-conserve, restore energy, "feed and breed"

Front 73

SNS

Back 73

mobilizes when the organism is being threatened, "fight or flight"

Front 74

Humans are Homeotherms what does this mean?

Back 74

As part of homeostasis we keep a constant temp: 36.0°C - 37.5 °C (97 °F - 99.5 °F )

Front 75

_________________in general is the purposeful maintenance of a stable internal environment by coordinated physiologic processes that oppose change

Back 75

Homeostasis

Front 76

The way by which the organism opposes the change is the ___________________________. This includes: (3)

Back 76

the feedback mechanism:
1. Sensors that detect a change
2. Center that compares the data to a set point
3. Mechanisms that return the parameter within the values of the set point

Front 77

Thermoregulatory Control Loop involves (3)

Back 77

Receptors
Hypothalamus
Effector mechanisms

Front 78

Thermoregulatory Control Loop Receptors

Back 78

Temperature-sensitive ion channels thru-out body, receive/integrate thermal inputs from internal/external sensors

Front 79

In relation to thermoregulation, where would deviations be detected around a set point?

Back 79

Hypothalamus: The processing center; “thermostatic comparer”

Front 80

Thermoregulatory Control Loop Effector mechanisms

Back 80

Initiate compensatory responses to correct deviation; also voluntary mechanisms
Core temps > 41° C (105.8° F) or < 34° C (93.2° F) -> impaired thermoregulation

Front 81

Temperature is regulated by ____________ ____________mechanisms and is a balance between: (two things)

Back 81

nervous feedback;

1. Increased heat production and heat conservation
2. Decreased heat production and increased elimination

Front 82

Name 2 Mechanisms of Heat Production

Back 82

Hypothalamic stimulation of shivering
SNS stimulation

Front 83

Heat production and SNS stimulation

Back 83

Epi, NE shift body metabolism to heat production from energy generation (brown fat) especially important in infants

Front 84

________________stimulation of shivering: physiology and effectiveness

Back 84

Hypothalamic stimulation of shivering
Gradual increase in muscle tone
Rapid muscle oscillations (shivering)
Increases heat production 4 to 5 times the norm

Front 85

Three Mechanisms of Heat Conservation; and how they work

Back 85

1. SNS activation: Intense skin vasoconstriction conserves the heat in the core
2. Abolition of sweating: Decreases evaporation at skin level
3. Behavioral control: Physical activity, Dressing, Moving close to a heat source

Front 86

Mechanisms of Heat Loss: (5) and explain each

Back 86

1. Radiation: Loss through infrared rays to cooler surfaces nearby; turn the temp down in the room.
2. Conduction; Loss through contact with cooler surfaces: cooling blankets.
3. Convection: Loss through air movement around the body
4. Evaporation: 0.5 calorie is lost for each mL of water evaporate; Important in hot temperatures
5. Behavioral control: turn on the AC, turn on fan etc.

Front 87

Fever is elevation in body temperature that is caused by ____________-induced (upward/downward) displacement of the _____ ______ of the ________________ thermoregulatory center

Back 87

Elevation in body temperature that is caused by cytokine-induced upward displacement of the set point of the hypothalamic thermoregulatory center

Front 88

Fever is Caused by a number of ____________and substances called, __________ _____________

Back 88

Fever is Caused by a number of microorganisms and substances, “exogenous pyrogens”

Front 89

Exogenous pyrogens induce ____cells to produce _____-producing mediators, called “endogenous pyrogens.” Interleukins (IL-1, IL-6), TNF-α (tumor necrosis factor) act on the ______________.
This causes: ______________.

Back 89

Exogenous pyrogens induce host cells to produce fever-producing mediators, “endogenous pyrogens” - Interleukins (IL-1, IL-6), TNF-α act on hypothalamus
This causes fever.

Front 90

exogenous pyogens include:

Back 90

bacteria, viruses, exotoxins etc.

Front 91

Describe the fever mechanism in relation to set point:

Back 91

We have a normal set point ie: 37 C. First, exogenous pyrogens affect host cells... (at this point we are infected and experience prodromal symptoms, but do not have fever)... these infected host cells (macrophages, endotheilial cells) then produce endogenous pyrogens... these endogenous pyrogens then act on the hypothalamus and change the set point... This causes shivering because our current temp (37) is much lower than the new set point: 38+, so we shiver so we can get our core temp all the way up to our new set point of 38+.