Pain Analgesia (Arthur ****)

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Sensory system function
Transmit sensory information into the spinal cord and to sensory areas of the brain
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types of sensory receptors
mechanoreceptors
thermoreceptors
chemoreceptors
Proprioceptors
nociceptors
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/Pain is what
subjective response
to a noxious stimulus
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Sensation is what
nociception
Nociceptors
free nerve endings
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Types of pain
Acute (physiological)
Inflammatory (pathological)
Neuropathic
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what's acute pain
Acute pain is a physiological response that warns us of danger.
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nocioception
normal processing of pain and the responses to noxious stimuli that are damaging or potentially damaging to normal tissue.
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in inflammatory pain, during tissue damage, there's a release of inflammatory mediators such as what?
prostaglandins and bradykinin
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what does this increase the sensitivity of?
nocipetors to noxious stimuli
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name 2 types of Sensitization in the pain pathway
hyperalgesia
allodynia
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hyperalgesia -
hypersensitivity to a noxious stimulus (hypersensitive nociceptors)
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allodynia
pain that results from a non-noxious stimulus (low-threshold mechanoreceptors and thermoreceptors)
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what reduce production of prostaglandins
NSAIDs
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how is Neuropathic Pain is caused
by damage or injury to the nociceptive nerves – peripherally or centrally.
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what's the pain usually described as
burning sensation and affected areas are often sensitive to the touch.
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what are nociceptors
free nerve endings in the skin
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Many stimuli have been found to activate what on nociceptor terminals?
ion channels
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Nociiceptors Act as what to depolarize these neurons
molecular transducers
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what does this set off along the pain pathways
nociceptive impulse
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this can be blocked by Blocked by local anaesthetics, e.g. what
lidocaine
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TRPV1 cation channel, activation results in what
sodium influx
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TRPV1 activated by what
noxious heat and low pH
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TRPV1 sensitised by?
inflammatory agents
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what blocks TRPV1?
antagonists
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what sensation does TRPV1 lead to?
painful, burning sensation
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TRPM8 has a sodium influx in response to what?
cold
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TRPM8 unregulated in patients w what syndrome
painful bladder syndrome
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TRPM8 may be target for what
prostate cancer
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ENaC/DEG activated by what
mechanical stimuli
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ASIC (mamba venom) (acid sensing ion channel) sodium channel activated by what?
protons- acid
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what decrease pain by modulating descending pain pathway?
Opiates
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nociceptive axons synapse with what in lamina I,ii and v of dorsal horn in spinal cord
second order neutrons
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for moderate pain, axons release what with fast action transmission
glutamate
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for stronger pain, axons release what with slower action transmission
glutamate and substance P (and ATP)
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what's the conotoxin from cone snail
ziconotide
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pain transmission in spinal cord, Local inhibitory interneurons release
GABA and glycine
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Descending pain control fibres release what to inhibit pain
opioids
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name a type of antidepressant (treatment of neurotic pain)
tricyclics
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name some antidepressants
amitriptyline, doxepin, imipramine
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what do tricyclics inhibit the reuptake of?
norepinephrine and serotonin
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Step 1 of analgesic ladder?
tissue damage releases NSAIDs
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Step 2 of analgesic ladder?
mild opioids (eg codeine)
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Step 3 of analgesic ladder?
strong opioids
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how do opioids inhibit transmission of pain in DH (dorsal horn)
presynaptic inhibition of afferent impulses
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how do opioids activate the descending pathway
by inhibiting GABA release from INs in the PAG
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name some receptor antagonists that decrease excitation
5-HT, NMDA, AMPA,P2X
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the angelic ladder mirrors what
pain pathway
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NSAIDs such as ibuprofen, naproxen and diclofenac are COX inhibit inhibiting what
prostaglandins
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drugs to treat analgesia descending control include
paracetamol, codeine based co-codamol, tramadol
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drugs to treat neuropathic pain (spinal cord)
Amitriptyline, gabapentin, Pregabalin
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opioids v opiates difference
opioids are drugs acting on opioid receptors (synthetic and semi-synthetic), opiates are opiods derived directly from poppies
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Endogenous Opioids are
dynorphins, enkephalins, endorphins, endomorphins and nociceptin
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name 3 G protein-coupled receptors with opioids as ligands
MOR,DOR,KOR
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opening k+ channels of opioid receptors makes neurons what
less excitable
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inhibiting Ca2+ channels in opioids receptors does what
decreases neurotransmitter release
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opioids peripheral effects on GI motility
decreased peristaltic waves and increased tone of anal sphincter
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name 4 opioids
diamorphine, naloxone, codine, nalorphine
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Other cards in this set

Card 2

Front

types of sensory receptors

Back

mechanoreceptors
thermoreceptors
chemoreceptors
Proprioceptors
nociceptors

Card 3

Front

/Pain is what

Back

Preview of the front of card 3

Card 4

Front

Sensation is what

Back

Preview of the front of card 4

Card 5

Front

Types of pain

Back

Preview of the front of card 5
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