1. Peer Support MCQs and SAQs Pain and Pain Pharmacology

2. 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

3. What is hyperalgesia? [1] Exaggerated pain response to a noxious stimuli

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

5. 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

6. 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

7. Explain why syringomyelia can lead to loss of pain sensation? [2] Expansion of the spinal canal Compression of the 2 nd order neurones of the pain pathway as they decussate in front of the spinal canal Leads to bilateral loss of sensation

8. Pain from the face is detected by which nerve? a. Trigeminal b. Facial c. Glossopharyngeal d. Accessory e. Hypoglossal

9. 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

10. 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

11. Which of the following statements is correct? As C fibres are unmyelinated their conduction of pain is fast A δ fibres are responsible for the “ouch” type pain C fibres are responsible for the “ouch” type pain A δ fibres are unmyelinated and their conduction of pain is slow C fibres transmit a signal at 0.5-2m/s

12. 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

13. What class does Ibuprofen belong to? [1] Propionic Acid

14. Which COX enzyme is involved in inflammation? a. COX 1 b. COX2 c. COX3 d. Both a and b e. None of the above

15. Give THREE clinical uses of NSAIDs? [3] Anti-inflammation Anti-pyretic Analgesic Anti-coagulant

16. Give an example of a COX2 inhibitor? [1] Celecoxib Etoricoxib Parecoxib

17. 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

18. 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

19. Which of the following is not an opioid receptor? a. ORL1 b. μ c. δ d. κ e. γ

20. 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)

21. Give FOUR clinical uses of opioids? [4] Analgesia Anaesthesia Antitussive Antidiarrheal Coronary Care Cancer Care

22. How do opioids work? [3] Opioids decrease neuronal transmission by: Decreasing opening of VDCC Decreasing CA 2+ release from intracellular stores Increasing K + outflow via K ATP and K IR channels Decreasing exocytosis

23. 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

24. 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”

25. 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)

26. 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

27. 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.