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W09 Pain/Pharmacology
Pain/Pharmacology Exam 2
58
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Professional
02/20/2009

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Term
peripheral
Definition
ASA and NSAIDs are (peripherally/centrally)-acting analgesics.
Term
central
Definition
Acetaminophen and opiods are (peripherally/centrally)-acting analgesics.
Term
afferent, efferentEnter away message text here.
Definition
___ neurons arrive at the brain. ___ neurons exit the brain.
Term
intracellular = high [K], low [Na/Cl]; extracellular = low [K], high [Na/Cl]
Definition
(Intra/extra)cellularl fluid contains high [K+] and low {Na+/Cl-]. (Intra/extra)cellular fluid contains low [K+] and high [Na+Cl-].
Term
1st false (intracellular is highly negative), 2nd true
Definition
T/F: The inside of a neuron is highly positive relative to the extracellular fluid. This different in electrical potential across the nerve cell is known as the resting potential.
Term
rapid depolarization followed by slow repolarization
Definition
The initial rapid positive rise in in the resting potential is ___ followed by ___ in which the neuron slowly becomes more negative.
Term
depolarization
Definition
___ phase is rapid when the nerve becomes less negative. This is a result of the influx of sodium ions via sodium channels.
Term
local anesthetics
Definition
What blocks sodium channels?
Term
sodium conductance
Definition
__ __ is the influx of sodium ions during depolarization.
Term
repolarization
Definition
___ phase is a slower process where the nerve becomes more negative as a result of the efflux of potassium ions via potassium channels.
Term
potassium conductance
Definition
___ ___ is the efflux of potassium ions.
Term
recovery phase
Definition
The __ phase is a slow process when the sodium-potassium ATP pump continues to exchange sodium and potassium and return the nerve to its resting potential.
Term
excitability
Definition
___ is the ability of a nerve cell to produce an action potential.
Term
threshold stimulus
Definition
___ stimulus is the minimum stimulus intensity needed to evoke an action potential. It is the "all-or-none-" stimulus.
Term
Nodes of Ranvier
Definition
___ ___ ___ are areas along a mylelinated nerve where there is no myelin.
Term
saltatory conduction
Definition
___ ___ is the movement of an impulse along the axons from the node of ranvier to another.
Term
Claudalis, a-delta and c-fibers
Definition
____ is the main relay site in the pathways responsible for pain from the face and mouth. Small diameter pain fibers (___ and ___ fibers) afferents terminate here.
Term
thalamus and limbic
Definition
Different parts of the brain (___ and ___) process the information and then send their responses to the periaqueductal gray matter.
Term
Periaqueductal gray matter
Definition
The ___ ___ ___ integrates the information sent and aggregates a response back to the oral tissue or spinal cord. These nerve from the brain carry information that can modify/inhibit the pain information being transmitted into the brain.
Term
PeriAqueductal Gray matter
Definition
The ___ ___ ___ modulates the pain sensation.
Term
a delta
Definition
A __ fibers are the smallest of the A fibers. It is lightly myelinated and part of the ascending pathway. They transmit intense, sharp and stinging pain.
Term
C fibers
Definition
___ fibers are slow, unmyelinated and are the smallest of all pain fibers. They transmit dull, burning and aching pain.
Term
a delta fibers
Definition
___ fibers have projections to reticular formation, thalamus and sensory cortex.
Term
C fibers
Definition
___ fibers have projections to the thalamus, PAG and limbic structures
Term
Pain!
Definition
Clinically, which sensation is lost first and last to recover?
Term
pain, cold, warmth, touch and deep pressure
Definition
Explain the order in which sensations are lost.
Term
Sodium channels opening in the depolarization stage
Definition
Local anesthetics block which step of the action potential?
Term
False! It does not!
Definition
T/F: Local anesthetics significantly alter the resting potential of the nerve membrane.
Term
local anesthetics
Definition
___ ___ blocks the influence of stimulation on Na+ conductance.
Term
amides
Definition
Lidocaine, prilocaine, articaine, bupivacaine, etidocaine and mepivacaine are all ____ local anesthetics.
Term
esters
Definition
Tetracaine, propoxycaine and benzocaine, ___ local anesthetics, are not commonly used in infiltration.
Term
False!
Definition
T/F: Cocaine is an ester local anesthetic.
Term
benzonatate
Definition
___ is a local anesthetic used for cough suppression.
Term
lipid solubility --> potency, protein binding --> duration of action, pka --> rate of onset
Definition
Lipid solubility of a local anesthetic affects the ____. ___ ___ affects the duration of action. ____ affects the rate of onset.
Term
constricts
Definition
Cocaine is the only local anesthetic that (dilates/constricts) blood vessels.
Term
procaine
Definition
___ is the least lipid soluble local anesthetic and is therefore the least potent.
Term
procaine
Definition
___ is poorly bound to proteins and therefore has a relatively short duration of action.
Term
pH 2-3
Definition
Inflammation (pH ___-___) interferes with efficacy of local anesthetics.
Term
pKa
Definition
___ defines the proportion of drug that is non-ionized and can easily diffuse nerve sheaths and membranes.
Term
decreases
Definition
When pH falls in a tissue, the amount of non-ionized species (increases/decreases).
Term
Pain fibers are the thinnest sensory fibers, whereas those conveying deep pressure sensation are the thickest
Definition
Why is pain sensation usually the first to disappear?
Term
3, internodal distance is great in larger nerve fibers
Definition
A minimum of __ consecutive nodes of nerve must be covered by the anesthetic solution to ensure thorough blockage.
Term
True! This is because more channels are open.
Definition
T/F: Nerve axons become more sensitive to local anesthetics' action as nerve activity increases.
Term
metabisulfate
Definition
___ is a preservative used in local anesthetics with epinephrine.
Term
cell body
Definition
The __ __ of a sensory/afferent neuron consists of a nucleus and possessing one to several dozens of fibers of varying lengths.
Term
dendrites
Definition
The ___ of an afferent neuron are branching processes that receive stimuli and conduct impulse generated toward the nerve cell body.
Term
axon
Definition
the ___ of an afferent neuron is a single nerve fiber connecting to other nerve cells, gland or muscle
Term
enkephalins
Definition
Peripheral Alpha-beta sensory fibers can inhibit the spinothalamic neurons via the release of ____.
Term
primary
Definition
Noxious stimulus activates (primary/secondary) afferent neurons which then evokes action potentials, conducted to dorsal horn of the spinal cord which then releases neurotransmitters.
Term
neurokinins (substance P), calcitonin gene-related peptide (CGRP) and excitatory amino acids (EEA --> glutamate)
Definition
What neurontransmitters are released from the dorsal horn of the spinal cord?
Term
interneurons
Definition
___ activate contralateral spinothalamic neurons which transmit impulses via ascending pain pathways to the reticular formation, medulla, thalamus, limbic structures and cortex.
Term
ascending, reticular formation, medulla, thalamus, limbic structures and cortex
Definition
Contralateral spinothalamic neurons transmit pain impulses via the (ascending/descending) pain pathway to the ___ ___, ___, ___, ___ __ and ___.
Term
a-delta and c fibers
Definition
Stimulation of ___ and ___ fibers activate spinal reflexes so you withdraw from a noxious stimulus before pain is recognized by higher structures.
Term
projections to the sensory cortex
Definition
What alerts an individual to the presence/anatomic location of pain?
Term
projections to the limbic structures (amygdala)
Definition
What enables an individual to experience discomfort, suffering and other emotional reactions to pain?
Term
located in the midbrain, receives inputs from hypothalamus, cortex and thalamus
Definition
PAG is located in the ___ as a small gray matter surrounding the central canal. It receives inputs from other brain regions including ___, ___ and ___. It is one of the gating mechanisms that control impulse trasmission into the dorsal horn.
Term
serotoninergic nerves
Definition
Medullary neurons, ___ nerves, arising in the nucleus magnus raphae (NMR) are fibers running in the dorsolateral funiculus of the spinal cord which form synaptic connections on dorsal horn interneurons --> inhibit discharge of spinothalamic neurons.
Term
noradrenergic
Definition
Medullary neurons, ____, arising from the locus ceruleus form synaptic connections on dorsal horn interneurons --> discharge spinothalamic neurons.
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