Nervous System and Pain Perception
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Questions and Answers

What enzyme is responsible for the breakdown of phospholipids in cell membranes, leading to the formation of arachidonic acid?

  • Phospholipase A (correct)
  • Cyclooxygenase (COX)
  • Bradykinin
  • Histamine

    • Which type of nerve fibers are responsible for carrying thermal and chemical pain impulses?

  • Myelinated fibers
  • A-delta fibers
  • C-fibers (correct)
  • Bradykinin fibers

    • What is the role of prostaglandins in the sensation of pain?

  • They inhibit the activity of nociceptors
  • They sensitize nociceptors and lower the pain threshold (correct)
  • They have no effect on nociceptors
  • They increase the pain threshold

    • Which of the following is NOT a chemical mediator that can alter the membranes of pain receptors and affect the transmission of pain impulses?

    <p>Endorphins</p> Signup and view all the answers

    What are the characteristics of A-delta fibers in the afferent pathway?

    <p>They are myelinated and have a fast conduction velocity with small reception fields</p> Signup and view all the answers

    Where does the afferent pathway terminate in the central nervous system?

    <p>The dorsal horn of the spinal cord</p> Signup and view all the answers

    What is the goal of treatment for cancer pain?

    <p>Keep the pain at a tolerable level for the patient</p> Signup and view all the answers

    When does chronic pain transition from acute pain according to some experts?

    <p>After 12 months since onset</p> Signup and view all the answers

    What is a key principle of patient education in pain management?

    <p>Having the patient monitor pain levels</p> Signup and view all the answers

    Which type of setting may require transitioning from intravenous to oral pain medications before discharge?

    <p>Emergency setting</p> Signup and view all the answers

    What should be evaluated when selecting an opioid and dose for a patient's pain?

    <p>Benefits versus risks</p> Signup and view all the answers

    What defines chronic pain?

    <p>$Pain that extends beyond the expected period of healing$</p> Signup and view all the answers

    What are some impacts of pain that can occur according to the text?

    <p>$Cognitive disorders$, anxiety, stress, depression</p> Signup and view all the answers

    What is the purpose of consistently using a common pain scale initially and at each visit?

    <p>To establish a baseline for measuring progress</p> Signup and view all the answers

    Why is it important to obtain a history about self-treatment and past treatment successes and failures?

    <p>To understand the patient's response to various treatments</p> Signup and view all the answers

    What information does the State Board of Pharmacy Prescription Drug Monitoring Program (PDMP) report provide?

    <p>List of filled controlled substance prescriptions</p> Signup and view all the answers

    Which factor is essential when assessing the past medical history of a patient for opioid use?

    <p>History of pain-related illnesses relevant to opioids</p> Signup and view all the answers

    Why is a social history important in assessing patients for pain management?

    <p>To identify behavioral issues that may affect compliance or misuse</p> Signup and view all the answers

    Which statement is true regarding validated screening tools used in pain assessment?

    <p>They help assess quality of life and functional ability</p> Signup and view all the answers

    What is the primary purpose of using screening tools for opioid misuse risk assessment and depression screening?

    <p>To identify risk factors before prescribing opioids</p> Signup and view all the answers

    Why is it important to use one of the specified tools when considering initial therapy with an opioid?

    <p>To evaluate the patient's risk factors for opioid misuse</p> Signup and view all the answers

    What action should providers take when evaluating patients who have been previously treated by another provider?

    <p>Use appropriate tools based on the patient's current situation</p> Signup and view all the answers

    What component of a patient's history is crucial in identifying potential issues with compliance or misuse?

    <p>Education and employment history</p> Signup and view all the answers

    What type of pain is typically described as feeling tingling, prickling, burning, or shock-like?

    <p>Neuropathic pain</p> Signup and view all the answers

    Which type of fibers are poorly localized and have slower impulses compared to A-delta fibers?

    <p>C-fibers</p> Signup and view all the answers

    Which neurotransmitters play a role in modulating sensitivity to pain in efferent pathways?

    <p>Norepinephrine and serotonin</p> Signup and view all the answers

    Which type of pain is often perceived at a site distant from the actual source?

    <p>Referred pain</p> Signup and view all the answers

    What produces complaints of sharp, stabbing, or throbbing pain similar to somatic pain arising from tissue damage to hollow organs?

    <p>Visceral pain</p> Signup and view all the answers

    What is the primary difference between A-delta and C-fibers in terms of response to stimuli?

    <p>Localized vs. poorly localized</p> Signup and view all the answers

    'Gastric motility and blood flow to the viscera decrease' is a physiological response associated with which type of pain?

    <p>Acute pain</p> Signup and view all the answers

    'Examples are burns, arthritis, or metastatic bone pain' describes which type of pain?

    <p>Somatic pain</p> Signup and view all the answers

    'Behavioral signs can range from stoicism and stillness to demonstrative expressions such as grimacing' is associated with the expression of which type of sensation?

    <p>Painful sensations</p> Signup and view all the answers

    What type of tissues does somatic pain primarily involve?

    <p>Skin, joints, muscle</p> Signup and view all the answers

    What is the main reason for performing a urine drug test (UDT) when considering the treatment of a pain patient with an opioid?

    <p>To confirm if the patient has taken any drugs recently</p> Signup and view all the answers

    Which tool consists of three questions, each scored 0 to 10, and is used when a full depression screening cannot be completed?

    <p>Pain intensity, Enjoyment of life, and General activity (PEG)</p> Signup and view all the answers

    Which type of urine drug test is used to identify drugs not included in immunoassay tests?

    <p>Gas chromatography mass spectrometry (GC/MS)</p> Signup and view all the answers

    What is the pH range for a urine specimen used in a urine drug test?

    <p>4.5 to 8.0</p> Signup and view all the answers

    Which factor can impact the results of a urine drug test?

    <p>Urine volume</p> Signup and view all the answers

    What does a fully negative urine drug test for a patient reported to be taking a pain medication indicate?

    <p>Misuse or overuse of medication may be happening</p> Signup and view all the answers

    Which tool is primarily completed by the clinician as part of opioid assessment?

    <p>DIRE</p> Signup and view all the answers

    What is the main purpose of using immunoassay (IA) drug panels in urine drug testing?

    <p>To detect substances present or absent based on a cutoff level</p> Signup and view all the answers

    What should be done if a UDT result shows drugs not expected based on the patient's history?

    <p>Repeat the UDT to confirm the unexpected findings.</p> Signup and view all the answers

    What is one of the key considerations before committing to long-term treatment of a chronic pain patient?

    <p>Whether the provider has the necessary time, skills, and education to effectively guide the patient.</p> Signup and view all the answers

    Which of the following is NOT mentioned as a necessary resource for a provider's practice to manage a chronic pain patient?

    <p>A support group for patients to share their experiences with chronic pain.</p> Signup and view all the answers

    Which of the following scenarios would suggest that a patient has achieved satisfactory pain relief using a regular opioid dose?

    <p>The patient reports that they can manage daily activities without significant pain interference.</p> Signup and view all the answers

    Based on the information provided, when should a provider consider offering naloxone to a patient?

    <p>When the patient is using high dose opioids (greater than 50 MME/day) or benzodiazepines.</p> Signup and view all the answers

    Which of the following statements accurately describes a scenario where a provider should consider continuing long-term opioid treatment for a chronic pain patient?

    <p>The patient reports that they can manage daily activities without significant pain interference, and there are no identified misuse issues or failure to comply with the PPA.</p> Signup and view all the answers

    Which of the following statements is TRUE regarding the pharmacological response to the same drug in different patients?

    <p>Genetic research shows that the same drug can produce a subtly different pharmacological response based on distinct activation profiles of $\mu$ receptor subtypes.</p> Signup and view all the answers

    Which type of receptor is primarily responsible for the analgesic (pain-relieving) effects of opioids?

    <p>Mu () receptors</p> Signup and view all the answers

    What is the primary function of the kappa () opioid receptors?

    <p>Sedative effects</p> Signup and view all the answers

    What is the role of the periaqueductal gray (PAG) area in the midbrain in pain modulation?

    <p>All of the above</p> Signup and view all the answers

    What is the function of the raphe magnus in the brainstem regarding pain modulation?

    <p>Both a and b</p> Signup and view all the answers

    What is the purpose of the dermatomal map in the context of pain localization?

    <p>It helps identify sources of neurological pain.</p> Signup and view all the answers

    What is the role of the substantia gelatinosa in the spinal cord regarding pain transmission?

    <p>It is a key anatomical region with multiple synapses, where pain impulses can be intensified or blocked.</p> Signup and view all the answers

    What is the role of glutamate and its binding to NMDA receptors in the context of pain perception?

    <p>Glutamate binding to NMDA receptors is thought to produce a pain memory, leading to chronic pain syndromes.</p> Signup and view all the answers

    What is the role of the efferent pathways in the modulation of pain sensation?

    <p>They connect the reticular formation, midbrain, and substantia gelatinosa in the dorsal horn of the spinal cord to inhibit the transmission of pain signals.</p> Signup and view all the answers

    What is the role of the medulla and hypothalamus in the context of pain perception and response?

    <p>They activate coping responses, such as the release of catecholamines and corticosteroids, and physical responses, such as increased heart rate and blood pressure.</p> Signup and view all the answers

    What is the recommended temperature range for a urine specimen within 4 minutes of voiding?

    <p>90F to 100F</p> Signup and view all the answers

    According to the passage, what is the recommended pH range for a urine specimen?

    <p>4.5 to 8.0</p> Signup and view all the answers

    What is the significance of a creatinine level less than 2 mg/dL in a urine specimen?

    <p>It is not consistent with human urine</p> Signup and view all the answers

    What is the recommended approach when initiating an opioid medication?

    <p>Use immediate-release dosing</p> Signup and view all the answers

    According to the passage, what is the recommended maximum opioid dosage?

    <p>No more than 90 morphine milligram equivalents (MME) per day</p> Signup and view all the answers

    What is the purpose of the physical exam described in the passage?

    <p>All of the above</p> Signup and view all the answers

    What is the significance of a positive urine drug test (UDT) result?

    <p>It demonstrates recent drug use</p> Signup and view all the answers

    What is the recommended approach when increasing opioid dosage?

    <p>Increase the dose gradually</p> Signup and view all the answers

    What is the recommended approach if the opioid medication is not beneficial or greater risk develops?

    <p>Optimize other therapies and lower or stop opioid therapy</p> Signup and view all the answers

    What is the significance of individual variability in response to analgesics?

    <p>It is due to genetic differences</p> Signup and view all the answers

    What is the potential impact of combining opioid and benzodiazepine therapies?

    <p>It increases the risk of misuse, abuse, and addiction</p> Signup and view all the answers

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