Peer SupportMCQs and SAQsPain and Pain Pharmacology

I thought some of you might like a few practice questions. The answers are just a guideline.If you play as a presentation the answers and some explanation will come up

What is hyperalgesia? [1]

Exaggerated pain response to a noxious stimuli

What is allodynia? [1]Pain resulting from a stimulus which would not normally cause pain

Which of the following can be used to treat neuropathic pain?a. Morphine

b. Amytriptylinec. Gabapentin d. Both a and ce. Both b and c

First order neurones in the pain pathway can travel

between spinal segments in which tracts?

a. Rubrospinal b. Lissaursc. Thalamicd. Vestibulospinale. Corticospinal

Explain why syringomyelia can lead

to loss of pain sensation? [2]Expansion of the spinal canal

Compression of the 2nd order neurones of the pain pathway as they decussate in front of the spinal canalLeads to bilateral loss of sensation

Pain from the face is detected by which

nerve?a. Trigeminalb. Facialc. Glossopharyngeald. Accessorye. Hypoglossal

Nociceptors are present on the free endings of sensory neurones. In what system

are they not found? a. Respiratory systemb. Gastrointestinal Systemc. Musculoskeletal Systemd. Central Nervous Systeme. Cardiovascular system

Explain how prostaglandin release

causes pain? [3]Arachidonic acid released due to injuryConverted by cyclo-oxygenases to form prostaglandinsProstaglandins bind to prostanoid receptors on the surface of neurones leading to sensitization of the nerve cell

Which of the following statements is correct?As C fibres are unmyelinated their conduction of pain is fast Aδfibres are responsible for the “ouch” type painC fibres are responsible for the “ouch” type painAδfibres are unmyelinated and their conduction of pain is slowC fibres transmit a signal at 0.5-2m/s

What is phantom limb pain? [1]

Pain felt in a limb that is no longer present is thought to be a result of activation of fibres that remain within the limb stump. As these are still mapped to the same regions in consciousness their activation will give rise to the sensation of pain where there is no limb

What class does Ibuprofen belong to? [1]

Propionic Acid

Which COX enzyme is involved in

inflammation?a. COX 1b. COX2c. COX3d. Both a and be. None of the above

Give THREE clinical uses of NSAIDs? [3]

Anti-inflammation

Anti-pyretic

Analgesic

Anti-coagulant

Give an example of a COX2 inhibitor? [1]

CelecoxibEtoricoxibParecoxib

Apart from GI upset give FOUR side-effects

of NSAIDs [4] CV incidents:

thrombosis Headache Dizziness Insomnia Nervousness Depression Vertigo

Tinnitus Photosensitivity Renal Impairment Hypertension Hypersensitivity: skin

rashes and eruptions, angioedema, bronchospasm

Mrs K has been taking high doses of NSAIDs for three months. She has

presented with tinnitus and apnoea.i. What do you think is wrong with Mrs K?

[1]ii. Give TWO other symptoms she could

also have? [2] i. Salicylismii.

Auditory (ototoxicity, deafness)Pulmonary (aspiration pneumonitis, pulmonary oedema, alkylosis, respiratory arrest)Cardiovascular (tachycardia,hypotension, asystole, dysrhythmias)CNS (depression, seizure, encephalopathy, delirium, hallucinations)GI (pancreatitis, hepatitis (rare in acute cases))Renal FailureComa

Which of the following is not an opioid

receptor?a. ORL1b. μc. δd. κe. γ

What are the three grades of opioid

activity? [3] Give an example of each? [3]Pure agonists, full agonist activity,

may have strong (e.g. morphine, diamorphine, tramadol) or weak activity (e.g. codeine, dihydrocodeine)

Partial agonists/mixed agonist-antagonist (e.g. nalorphine, pentazocine, buprenorphine)

Antagonists (e.g.naloxone, naltrexone)

Give FOUR clinical uses of opioids? [4]

AnalgesiaAnaesthesiaAntitussiveAntidiarrhealCoronary CareCancer Care

How do opioids work? [3]

Opioids decrease neuronal transmission by:

Decreasing opening of VDCC

Decreasing CA2+ release from intracellular stores

Increasing K+ outflow via KATP and KIR channels

Decreasing exocytosis

Give FOUR side-effects of opioids? [4]

Respiratory depression

Conscious depression/mood alterations

Miosis

Reduced gastric motility

Nausea and vomiting

Smooth muscle spasm

Anaphylaxis

Psychiatric changes (e.g. Pentazocine, Tramadol)

Tolerance and dependancy – addiction/withdrawal

Mr D is a 23 year old presenting to A&E. It is thought he has taken an

opioid overdose. List the treatment that you would

administer. [4]NaloxoneO2GlucoseThiamine “Coma Cocktail”

Define tolerance and dependency? [2]

Tolerance: decreasing effect of drug following repeated admin: require increasing dose to obtain effectDependency: psychological and physiological components, through reinforcement of positive effects (euphoria, sedation)

Give FOUR symptoms of withdrawal from

opioids? [4]DysphoriaNausea and vomitingMuscle crampsLacrimationRhinorrhea

Pupillary dilationPiloerectionSweatingDiarrhoeaFeverYawning

InsomniaAnxietyTachycardiaTremor

Miss L is a 28 year old with a history of drug abuse. She tells you that she really wants to quit and has been looking into organisations that might be able to help

her. What are the stages of the transtheoretical model of change and which stage is Miss L in? [3]

Pre-contemplationContemplationPreparationActionMaintenanceTerminationPatient is in Preparation as she is actively looking into treatment but has not yet stopped.