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178 Cards in this Set

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