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. Amytriptyline

c. Gabapentin

d. Both a and c

e. Both b and c

First order neurones in the pain pathway can travel

between spinal segments in which tracts?

a. Rubrospinal

b. Lissaurs

c. Thalamic

d. Vestibulospinal

e. 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 canal

Leads to bilateral loss of sensation

Pain from the face is detected by which

nerve?a. Trigeminal

b. Facial

c. Glossopharyngeal

d. Accessory

e. Hypoglossal

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

are they not found? a. Respiratory system

b. Gastrointestinal System

c. Musculoskeletal System

d. Central Nervous System

e. Cardiovascular system

Explain how prostaglandin release

causes pain? [3]Arachidonic acid released due to injury

Converted by cyclo-oxygenases to form prostaglandins

Prostaglandins 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 pain

C fibres are responsible for the “ouch” type pain

Aδfibres are unmyelinated and their conduction of pain is slow

C 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 1

b. COX2

c. COX3

d. Both a and b

e. 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]

Celecoxib

Etoricoxib

Parecoxib

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. Salicylism

ii. 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 Failure

Coma

Which of the following is not an opioid

receptor?a. ORL1

b. μ

c. δ

d. κ

e. 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]

Analgesia

Anaesthesia

Antitussive

Antidiarrheal

Coronary Care

Cancer 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]Naloxone

O2

Glucose

Thiamine

“Coma Cocktail”

Define tolerance and dependency? [2]

Tolerance: decreasing effect of drug following repeated admin: require increasing dose to obtain effect

Dependency: psychological and physiological components, through reinforcement of positive effects (euphoria, sedation)

Give FOUR symptoms of withdrawal from

opioids? [4]Dysphoria

Nausea and vomiting

Muscle cramps

Lacrimation

Rhinorrhea

Pupillary dilation

Piloerection

Sweating

Diarrhoea

Fever

Yawning

Insomnia

Anxiety

Tachycardia

Tremor

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-contemplation

Contemplation

Preparation

Action

Maintenance

Termination

Patient is in Preparation as she is actively looking into treatment but has not yet stopped.