Multimodal

Question 1

4 types of pain stimulus:

Answer 1

• mechanical
• thermal
• chemical
• sensitizing hormones (prostaglandins & substance P)

Question 2

Alpha and delta fibers transmit (fast/slow) pain signals

Answer 2

fast

Question 3

C fibers transmit (fast/slow) pain signals

Answer 3

slow

Question 4

Define multimodal pain management:

Answer 4

• multiple classes
• different receptors
• enhance analgesia
• reduce side effects

Question 5

4 elements of pain processing:

Answer 5

1) transduction
2) transmission
3) modulation
4) perception

Question 6

Pathway of pain signals:

Answer 6

• peripheral nerve
• a delta & C fibers
• afferent pathway
• spinothalamic tract
• periaqueductal gray
• thalamus
• sensory cortex
• efferent pathway

Question 7

What type of receptors are opioid receptors and where are they located?

Answer 7

• G-protein coupled receptors
• brain, spine, periphery

Question 8

Define biased agonism:

Answer 8

distinct ligands can bind to G-protein coupled receptor activating differential signaling pathways
- goal is to activate analgesic action w/o the SE

Question 9

Primary effect of NSAIDs:

Answer 9

inhibition of COX preventing transformation of arachidonic acid to prostaglandins

Question 10

List the factors that influence local anesthetic activity

Answer 10

• dosage
• additives
• site of injection
• combination with other LA
• pregnancy

Question 11

A neuraxial blockade affecting the following tissues would correlate to which spine level:
Peripheral
Cardiac
Splanchnic

Answer 11

peripheral = T1-L2
cardiac = T1-T4
splanchnic = T6-L1

Question 12

Contraindications to regional/neuraxial anesthesia:

Answer 12

• pt refusal
• sepsis
• allergy to meds
• inability to position
• neuropathy
• spinal stenosis
• hx of spine sx
• MS
• spina bifida
• aortic stenosis
• coagulopathy

Question 13

2 NMDA antagonists:

Answer 13

1) Magnesium
2) Ketamine

Question 14

What increases the potency of a2-adrenergic agonists?

Answer 14

concomitant opioid therapy

Question 15

MOA of cannabinoid receptor agonists:

Answer 15

endogenous/exogenous compounds bind to inhibitory cannabinoid receptors, decreasing NT release

Question 16

Locations of CB1 receptors:

Answer 16

in the CNS at nerve terminals mediating inhibition of NT
- brain (cerebral cortex, hippocampus, cerebellum, brainstem)

Question 17

Locations of CB2 receptors:

Answer 17

immune cells modulating cytokine release (reducing inflammation)
- spleen, tonsils, thymus, tissues that produce immune cells

Question 18

SE of cannabinoid receptor agonists

Answer 18

• sedation
• dizziness
• dry mouth
• dysphoria
• cognitive impairment
• anxiety
• orthostatic hypotension
• tachycardia
• bronchodilation
• impairment in attention
• decreased body temp
• psychosis