NURS 549 Final Review QUESTIONS WITH
CORRECT ANSWERS
4 steps of pain pathway - CORRECT ANSWERS ✔✔transduction, transmission,
perception, modulation
Transduction - CORRECT ANSWERS ✔✔Stimulus converted to nerve impulse
Travels from most distal nerve ending toward CNS
Transmission - CORRECT ANSWERS ✔✔Impulse carried to brain/CNS
Through Neospinothalamic tract (fast) or Paleospinothalamic tract (slow)
Perception - CORRECT ANSWERS ✔✔message from periphery interpreted by brain
Alterations in neural circuitry in brain can cause change in pain perception
--> Mood, stress, rest
Modulation - CORRECT ANSWERS ✔✔Brain sends signals that cause pain signals
from periphery to be suppressed or amplified
Fast pain receptors - CORRECT ANSWERS ✔✔Type A-delta fibers
Felt <0.1 second of stimulus: sharp, acute
Mechanical, acute thermal pain
Not in deep tissues
,Slow pain receptors - CORRECT ANSWERS ✔✔Type C fibers
Felt 1+ second of stimulus: aching, throbbing, burning
Chemical pain
Neospinothalamic tract - CORRECT ANSWERS ✔✔Type A-delta fibers
Mechanical and thermal pain
Spine --> Thalamus fibers, pain localized precisely
Paleospinothalamic tract - CORRECT ANSWERS ✔✔Type C fibers
Chemical pain
Terminates in brain stem, only 10-25% terminate in thalamus, cannot localize pain
Endogenous pain modulation/suppression - CORRECT ANSWERS ✔✔Serotonergic
and enkephalin neurons BLOCK pain
Analgesia signals can block pain from peripheral neurons - from both Type A-delta
and C fibers
NSAIDS: COX inhibitors - CORRECT ANSWERS ✔✔Inhibit transduction of TYPE C
pain fibers
COX-1: constitutive (occurs all the time)
COX-2: induced by cytokines in presence of inflammation --> localized to pain
NSAIDS Side Effects - CORRECT ANSWERS ✔✔GI ulceration and bleeding d/t
decreased platelet aggregation
Decreased renal function, not good for CKD or ARF pts
, Acetaminophen - CORRECT ANSWERS ✔✔COX inhibitor (COX-3?), better for fever
than inflammation or pain
Opioids - CORRECT ANSWERS ✔✔Block transmission of pain, binds to Mu
receptors
S/S: suppresses respiratory center of brain stem, Chemoreceptor Trigger Zone (CTZ) -
N/V, constipation, urinary retention
Tramadol (Ultram) - CORRECT ANSWERS ✔✔Selective, weak mu-opioid receptor
agonist
Increases risk of SEIZURE
Antidepressants for pain - CORRECT ANSWERS ✔✔SNRIs (Duloxetine/Cymbalta)
or tricyclics
Good for chronic neuropathy or chronic musculoskeletal pain
Antiepileptics for pain - CORRECT ANSWERS ✔✔Pregablin/Lyrica, Gabapentin
Often need increased dose for pain management
Good for chronic neuropathy or chronic musculoskeletal pain
Goals of pulmonary meds - CORRECT ANSWERS ✔✔Reduce inflammation
Stimulate bronchodilation
Block bronchoconstriction
Control cough (may be more than one goal)
CORRECT ANSWERS
4 steps of pain pathway - CORRECT ANSWERS ✔✔transduction, transmission,
perception, modulation
Transduction - CORRECT ANSWERS ✔✔Stimulus converted to nerve impulse
Travels from most distal nerve ending toward CNS
Transmission - CORRECT ANSWERS ✔✔Impulse carried to brain/CNS
Through Neospinothalamic tract (fast) or Paleospinothalamic tract (slow)
Perception - CORRECT ANSWERS ✔✔message from periphery interpreted by brain
Alterations in neural circuitry in brain can cause change in pain perception
--> Mood, stress, rest
Modulation - CORRECT ANSWERS ✔✔Brain sends signals that cause pain signals
from periphery to be suppressed or amplified
Fast pain receptors - CORRECT ANSWERS ✔✔Type A-delta fibers
Felt <0.1 second of stimulus: sharp, acute
Mechanical, acute thermal pain
Not in deep tissues
,Slow pain receptors - CORRECT ANSWERS ✔✔Type C fibers
Felt 1+ second of stimulus: aching, throbbing, burning
Chemical pain
Neospinothalamic tract - CORRECT ANSWERS ✔✔Type A-delta fibers
Mechanical and thermal pain
Spine --> Thalamus fibers, pain localized precisely
Paleospinothalamic tract - CORRECT ANSWERS ✔✔Type C fibers
Chemical pain
Terminates in brain stem, only 10-25% terminate in thalamus, cannot localize pain
Endogenous pain modulation/suppression - CORRECT ANSWERS ✔✔Serotonergic
and enkephalin neurons BLOCK pain
Analgesia signals can block pain from peripheral neurons - from both Type A-delta
and C fibers
NSAIDS: COX inhibitors - CORRECT ANSWERS ✔✔Inhibit transduction of TYPE C
pain fibers
COX-1: constitutive (occurs all the time)
COX-2: induced by cytokines in presence of inflammation --> localized to pain
NSAIDS Side Effects - CORRECT ANSWERS ✔✔GI ulceration and bleeding d/t
decreased platelet aggregation
Decreased renal function, not good for CKD or ARF pts
, Acetaminophen - CORRECT ANSWERS ✔✔COX inhibitor (COX-3?), better for fever
than inflammation or pain
Opioids - CORRECT ANSWERS ✔✔Block transmission of pain, binds to Mu
receptors
S/S: suppresses respiratory center of brain stem, Chemoreceptor Trigger Zone (CTZ) -
N/V, constipation, urinary retention
Tramadol (Ultram) - CORRECT ANSWERS ✔✔Selective, weak mu-opioid receptor
agonist
Increases risk of SEIZURE
Antidepressants for pain - CORRECT ANSWERS ✔✔SNRIs (Duloxetine/Cymbalta)
or tricyclics
Good for chronic neuropathy or chronic musculoskeletal pain
Antiepileptics for pain - CORRECT ANSWERS ✔✔Pregablin/Lyrica, Gabapentin
Often need increased dose for pain management
Good for chronic neuropathy or chronic musculoskeletal pain
Goals of pulmonary meds - CORRECT ANSWERS ✔✔Reduce inflammation
Stimulate bronchodilation
Block bronchoconstriction
Control cough (may be more than one goal)
