68 Questions
What enzyme is responsible for the breakdown of phospholipids in cell membranes, leading to the formation of arachidonic acid?
Phospholipase A
Which type of nerve fibers are responsible for carrying thermal and chemical pain impulses?
C-fibers
What is the role of prostaglandins in the sensation of pain?
They sensitize nociceptors and lower 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?
Endorphins
What are the characteristics of A-delta fibers in the afferent pathway?
They are myelinated and have a fast conduction velocity with small reception fields
Where does the afferent pathway terminate in the central nervous system?
The dorsal horn of the spinal cord
What is the goal of treatment for cancer pain?
Keep the pain at a tolerable level for the patient
When does chronic pain transition from acute pain according to some experts?
After 12 months since onset
What is a key principle of patient education in pain management?
Having the patient monitor pain levels
Which type of setting may require transitioning from intravenous to oral pain medications before discharge?
Emergency setting
What should be evaluated when selecting an opioid and dose for a patient's pain?
Benefits versus risks
What defines chronic pain?
$Pain that extends beyond the expected period of healing$
What are some impacts of pain that can occur according to the text?
$Cognitive disorders$, anxiety, stress, depression
What is the purpose of consistently using a common pain scale initially and at each visit?
To establish a baseline for measuring progress
Why is it important to obtain a history about self-treatment and past treatment successes and failures?
To understand the patient's response to various treatments
What information does the State Board of Pharmacy Prescription Drug Monitoring Program (PDMP) report provide?
List of filled controlled substance prescriptions
Which factor is essential when assessing the past medical history of a patient for opioid use?
History of pain-related illnesses relevant to opioids
Why is a social history important in assessing patients for pain management?
To identify behavioral issues that may affect compliance or misuse
Which statement is true regarding validated screening tools used in pain assessment?
They help assess quality of life and functional ability
What is the primary purpose of using screening tools for opioid misuse risk assessment and depression screening?
To identify risk factors before prescribing opioids
Why is it important to use one of the specified tools when considering initial therapy with an opioid?
To evaluate the patient's risk factors for opioid misuse
What action should providers take when evaluating patients who have been previously treated by another provider?
Use appropriate tools based on the patient's current situation
What component of a patient's history is crucial in identifying potential issues with compliance or misuse?
Education and employment history
What type of pain is typically described as feeling tingling, prickling, burning, or shock-like?
Neuropathic pain
Which type of fibers are poorly localized and have slower impulses compared to A-delta fibers?
C-fibers
Which neurotransmitters play a role in modulating sensitivity to pain in efferent pathways?
Norepinephrine and serotonin
Which type of pain is often perceived at a site distant from the actual source?
Referred pain
What produces complaints of sharp, stabbing, or throbbing pain similar to somatic pain arising from tissue damage to hollow organs?
Visceral pain
What is the primary difference between A-delta and C-fibers in terms of response to stimuli?
Localized vs. poorly localized
'Gastric motility and blood flow to the viscera decrease' is a physiological response associated with which type of pain?
Acute pain
'Examples are burns, arthritis, or metastatic bone pain' describes which type of pain?
Somatic pain
'Behavioral signs can range from stoicism and stillness to demonstrative expressions such as grimacing' is associated with the expression of which type of sensation?
Painful sensations
What type of tissues does somatic pain primarily involve?
Skin, joints, muscle
What is the main reason for performing a urine drug test (UDT) when considering the treatment of a pain patient with an opioid?
To confirm if the patient has taken any drugs recently
Which tool consists of three questions, each scored 0 to 10, and is used when a full depression screening cannot be completed?
Pain intensity, Enjoyment of life, and General activity (PEG)
Which type of urine drug test is used to identify drugs not included in immunoassay tests?
Gas chromatography mass spectrometry (GC/MS)
What is the pH range for a urine specimen used in a urine drug test?
4.5 to 8.0
Which factor can impact the results of a urine drug test?
Urine volume
What does a fully negative urine drug test for a patient reported to be taking a pain medication indicate?
Misuse or overuse of medication may be happening
Which tool is primarily completed by the clinician as part of opioid assessment?
DIRE
What is the main purpose of using immunoassay (IA) drug panels in urine drug testing?
To detect substances present or absent based on a cutoff level
What should be done if a UDT result shows drugs not expected based on the patient's history?
Repeat the UDT to confirm the unexpected findings.
What is one of the key considerations before committing to long-term treatment of a chronic pain patient?
Whether the provider has the necessary time, skills, and education to effectively guide the patient.
Which of the following is NOT mentioned as a necessary resource for a provider's practice to manage a chronic pain patient?
A support group for patients to share their experiences with chronic pain.
Which of the following scenarios would suggest that a patient has achieved satisfactory pain relief using a regular opioid dose?
The patient reports that they can manage daily activities without significant pain interference.
Based on the information provided, when should a provider consider offering naloxone to a patient?
When the patient is using high dose opioids (greater than 50 MME/day) or benzodiazepines.
Which of the following statements accurately describes a scenario where a provider should consider continuing long-term opioid treatment for a chronic pain patient?
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.
Which of the following statements is TRUE regarding the pharmacological response to the same drug in different patients?
Genetic research shows that the same drug can produce a subtly different pharmacological response based on distinct activation profiles of $\mu$ receptor subtypes.
Which type of receptor is primarily responsible for the analgesic (pain-relieving) effects of opioids?
Mu () receptors
What is the primary function of the kappa () opioid receptors?
Sedative effects
What is the role of the periaqueductal gray (PAG) area in the midbrain in pain modulation?
All of the above
What is the function of the raphe magnus in the brainstem regarding pain modulation?
Both a and b
What is the purpose of the dermatomal map in the context of pain localization?
It helps identify sources of neurological pain.
What is the role of the substantia gelatinosa in the spinal cord regarding pain transmission?
It is a key anatomical region with multiple synapses, where pain impulses can be intensified or blocked.
What is the role of glutamate and its binding to NMDA receptors in the context of pain perception?
Glutamate binding to NMDA receptors is thought to produce a pain memory, leading to chronic pain syndromes.
What is the role of the efferent pathways in the modulation of pain sensation?
They connect the reticular formation, midbrain, and substantia gelatinosa in the dorsal horn of the spinal cord to inhibit the transmission of pain signals.
What is the role of the medulla and hypothalamus in the context of pain perception and response?
They activate coping responses, such as the release of catecholamines and corticosteroids, and physical responses, such as increased heart rate and blood pressure.
What is the recommended temperature range for a urine specimen within 4 minutes of voiding?
90F to 100F
According to the passage, what is the recommended pH range for a urine specimen?
4.5 to 8.0
What is the significance of a creatinine level less than 2 mg/dL in a urine specimen?
It is not consistent with human urine
What is the recommended approach when initiating an opioid medication?
Use immediate-release dosing
According to the passage, what is the recommended maximum opioid dosage?
No more than 90 morphine milligram equivalents (MME) per day
What is the purpose of the physical exam described in the passage?
All of the above
What is the significance of a positive urine drug test (UDT) result?
It demonstrates recent drug use
What is the recommended approach when increasing opioid dosage?
Increase the dose gradually
What is the recommended approach if the opioid medication is not beneficial or greater risk develops?
Optimize other therapies and lower or stop opioid therapy
What is the significance of individual variability in response to analgesics?
It is due to genetic differences
What is the potential impact of combining opioid and benzodiazepine therapies?
It increases the risk of misuse, abuse, and addiction
Learn about the three areas of the nervous system involved in sensation and perception of pain, including afferent pathways, central nervous system (CNS), and efferent pathways. Explore how nociceptive pain receptors in peripheral tissues respond to injury or inflammation.
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