660 exam 3 Flashcards
Which neurotransmitters is the sleep wake cycle regulated by?
DASH - N
Dopamine
Acetylcholine
Serotonin
Histamine
Norepinephrine
What regulates wakefullness
Orexin
keeps you awake
Loss of orexin regulation can cause what?
narcolepsy
Where is the sleep switch of the brain?
Ventrolateral preoptic nucleus
Active while sleeping –secretes GABA
What is the control center for the sleep/wake cycle?
The hypothalamus
– it houses the TMN (tuberomamillary nucleus) and the VLPO (ventrolateral preoptic nucleus
What is the “On” switch of the brain?
Activation of the TMN
- causes release of histamine, norepinephrine, and orexin
What is the body’s internal clock and what is it activated by?
Suprachiasmatic Nucleus (SCN)
Melatonin - darkness
Light - sunlight/daytime
How does cortical arousal work?
Like a knob on the radio vs a switch
Can have hypo or hyper arousal
A1, H1, and M1
Insomnia neurotransmitters
Overactivity of:
- Histamine
- ACH
- Norepinephrine
Types of insomnia
Initial: hard to fall asleep
Middle Insomnia: Sleep is choppy
Terminal: wakes too early
What kind of neurotransmitter medication do you use for insomnia
H1 antagonist
M1 antagonist
A1 antagonist
How does histamine promote wakefullness?
activates G protein
Which medications for Sleepiness during the day
Stimulants, Caffeine, Modafinil
Which two brain regions are associated with anxiety?
Amygdala and Hippocampus
Main job of the amygdala
emotional regulator of the fear response
Main job of the hippocampus
storing memory & re-experiencing
Two parts of anxiety
Fear: amygdala
– physical/physiological symptoms
Worry: CSTC loop
– psychological symptoms
Amygdala physical symptoms of anxiety
irritability, restlessness, muscle tension, insomnia
Neurotransmitters involved with anxiety in the amygdala
Serotonin, GABA, Voltage gated ion channels
Norepinephrine - anxiety/panic symptoms
increases glutamate transmission
A1 and B1 release - autonomic activity
What is the worry loop of anxiety? And what s/s
CSTC circuit
- Anxious misery
- Apprehension
- Obsession
What medications for worry caused by overactivation of the CSTC loop
GABA agents (benzos)
— enhances GABA in PFC
Alpha2 ligand binding agent
— Blocks excessive release of glutamate
Serotonin agents
— increase serotonin in CSTC loop
Hippocampus r/t fear
internal fear monger
remembers something – triggers fear when it’s encountered again
Traumatic memories stored – activate the amygdala - re-experience
—Hallmark feature of PTSD
Anterior Pituitary r/t anxiety
feelings of anxiety and depression
- increase cortisol lvls
- increase risk for cardiometabolic disease
Parabrachial nucleus (PBN) r/t anxiety
Regulates heart rate and breathing
Activation of PBN causes a person to have difficulty breathing and increased HR
- sense of being smothered
Periaqueductal gray (PAG) r/t anxiety
regulates: HR, bld pressure, autonomic process
produces fearful & defensive reactions
- flight/fight
- freezing
- defense/avoidance
Prefrontal Cortex r/t worry
Thinking, decision making
Associated with worry –> CSTC worry loop
Excessive dopamine leads to increased worry
Generalized anxiety disorder is …
generalized fear and worry
Panic disorder is …
anxiety + worry about panic attack
OCD is …
Excessive obsessions and compulsions to thoughts or behaviors
Individual is personally bothered by their behavior
PTSD is …
Traumatic event - re-experiencing memories
Treat PTSD
Paroxetine - first line
caution with benzos
Ascending pain pathway
periphery to dorsal horn to brain
Descending pain pathway
regulates ascending pain information
– dampens pain signals coming from the periphery
– decreased output from descending pain pathways can increase pain response
Pain r/t PFC
contributes to cognitive dysfunction
Most common pain receptor
Mu
+ Naloxone
blocks the inflammatory response of pain
Blocks TLR4 receptors - may help reverse chronic pain
TCA and SNRI for chronic pain
enhances descending pain pathways
increases dampening of pain signals from the periphery
What causes peripheral neuropathy
Inflammation or dmg to an injured nerve
– can be central or peripheral
What are the causes of neuropathic pain
trauma - phantom limb
DM
Autoimmune
Neuropathic pain - pathways
Involves ascending/afferent pathway
Hyperalgesia is what
increased sensitivity to painful stimulus
– touch/pressure
– pinprick
– heat/cold
Allodynia is what
Pain caused by nonpainful stimuli
– light touch
What is suprasegmental central sensitization
enhances the process and keeps it going
makes it permanent
Ex: Fibromyalgia
