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18 Cards in this Set
- Front
- Back
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What does nociception mean?
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Unwanted stimulus
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Through nociception, two types of pain fibers with freely branching nerve endings are activated. What are the two types?
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Large A-Delta Fibers, Smaller C-Fiber
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What are the characteristics of the Large A-Delta Fibers?
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6-8 microns in dm, thinly myelinated, conduct fast impulse (12-30 m/s), specialized for several types of info (mechanical distortion, touch, temp, chemicals, etc), indicate intensity and location, some polymodal, but most are not.
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What are the characteristics of Small C-Fibers?
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Unmyelinated, 0.3-1microns in dm, conduct slow impulse (0.4-1 m/s), most polymodal, cutaneous area of each nociception neuron overlaps with other neurons -> sophisticated peripheral alarm system to damage
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Where does most of the sensory input go to in the brain?
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Thalamus
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How many layers of different nerve input comprises the dorsal horn?
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6 specialized layers
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What secretes Enkephalin?
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Interneurons
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What does enkephalin do?
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It is a neuromodulator. Binds on mu receptor on C-Fiber synaptic knobs. It induces local depolarization and inhibits Ca++ influx of synaptic knobs of C fibers. Modulates the synaptic terminals of C-fiber which limits glutamate/Substance P release.
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How does morphine works?
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Mimics the process of Enkephalins. Functions as a neuromodulator (changes the environment)
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What are the endogenous opioids (peptides)?
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Enkephalins, endorphins, dynorphins
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What do opiates do?
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They mimic actions of endogenous opioids (enkephalins, endorphins, dynorphins). Effect mu receptor in CNS (morphine, codeine, fentanyl)
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How does diacetylmorphine HCL (heroin) work in contrast to morphine?
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Has increased hydrophobicity, crosses blood brain barrier faster than morphine and produces more rapid and intense euphoria.
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How does tolerance to morphine-like compounds work?
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Down regulation of the mu receptors. Morphine can cause the receptors to move blow the surface. The only way to create analgesia is by a higher dose.
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What is the Narcotic Addict Treatment Act?
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Implemented in 1974, strictly controlled methadone therapy by federally specified centers
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What is the Drug Abuse Treatment Act?
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Implemented in 2000. Addicts can be managed by out-patient basis by private physicians who must be properly trained.
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What is the treatment for opioid addiction?
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Managing withdrawl, managing dependence.
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How is withdrawal managed in patients with opioid addiction?
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Clonidine (alpha-2 agonis) diminishes NE actions during withdrawal; NSAIDs antiemetics and antacids also used.
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How is dependence manged in patients with opioid addiction?
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Buprenorphine (subutex), a partial opioid agonist in combination with naloxone (narcan) - inhibitor of opioids
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