719 final Flashcards
Diabetic peripheral neuropathy is caused by
inflammation or damage in the periphery combined with central disturbance in pain processing.
Meperidine
a potent serotonin reuptake inhibitor and should not be given with MAOIs
Mechanism & cause for “wide spread pain”:
“Suprasegmental” central sensitization is hypothesized to be linked to plastic changes that occur in brain sites within the nociceptive pathway, especially the thalamus and cortex, in the presence of known peripheral causes or even in the absence of identifiable triggering events (ex. wide spread pain). In the case of peripherally activated suprasegmental central sensitization, it it as though the brain “learns” from its experience of pain, and decides not only to keep the process going, but also to enhance it and make it permanent. In the case of pain that originates centrally without peripheral input, it is as though the brain has figured out how to spontaneously activate its pain pathways. Conditions hypothesized to be caused by suprasegmental central sensitization syndromes of pain originating tin the brain without peripheral pain input include fibromyalgia, the syndrome of chronic widespread pain, and painful physical Sx of depression and anxiety Dos, especially PTSD.
Mechanism & cause for diabetic peripheral neuropathy:
Neuropathic pain arises from damage to, or dysfunction of, any part of the peripheral or central nervous system, whereas “normal” pain is caused by activation of nociceptive nerve fibers. Peripheral mechanisms in neuropathic pain Normal transduction and conduction in peripheral afferent neurons can be hijacked in certain neuropathic pain states to maintain nociceptive signaling in the absence of a relevant noxious stimulus. Neuronal damage by disease or trauma can alter electrical activity of neurons, allow cross-talk btw neurons, and initiate inflammatory processes to cause peripheral sensitization.
SSRIs may have
inconsistent effects on pain because serotonin can both inhibit and facilitate ascending nociceptive signals.
Milnacipran
can alleviate physical pain (fibromyalgia) and has potential effect on cognitive functioning.
Duloxetine
can treat both chronic pain and depression without significant side effects.
Zolpidem
Ambien. Non-benzo hypnotic.
Short-term Tx of insomnia (controlled-release indication is not restricted to short-term)
As needed for the Tx of insomnia when a middle-of-the-night awakening is followed by difficulty returning to sleep and there are at least 4 hours of bedtime remaining before the planned time of wakening (Intermezzo)
Zolpidem dose
10 mg/day at bedtime for 7–10 days (immediate), 12.5 mg/day (controlled)
Zaleplon
Sonata. Non-benzo hypnotic.
Short-term Tx of insomnia
Zaleplon dose
10 mg/day at bedtime for 7–10 days
Flurazepam
Dalmane. Benzo (hypnotic).
Insomnia characterized by difficulty in falling asleep, frequent nocturnal awakenings, and/or early morning awakening
Recurring insomnia or poor sleeping habits /Acute or chronic medical situations requiring restful sleep
Temazepam
Restoril. Benzo (hypnotic).
Short-term treatment of insomnia
All of these medications are schedule
IV
Sertraline and zolpidem
Sertraline increases plasma levels of zolpidem
A 72-year-old woman has difficulty falling asleep and frequent nighttime awakenings. The best medicine for her is
zolpidem
Eszopiclone
Lunesta.
approved for insomnia without S/E of tolerance/dependence.
the mechanism to treat insomnia with the least amount of psychomotor impairment.
Melatonin receptor stimulation
DSM-5 Dx for ADHD
(Sx in two or more settings)
· Inattention: 6 Sx have persisted for at least 6 months (5 Sx for over age 17)
· 1. Often fails to give close attention to details or makes careless mistakes 2. Often has difficulty sustaining attention in tasks or play activities 3. Often does not seem to listen when spoken to directly 4. Often has difficulty organizing tasks and activities 6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort 7. Often loses things necessary for tasks or activities 8. Is often distracted by extraneous stimuli 9. Is often forgetful in daily activities
Hyperactivity and impulsivity Dx
6 Sx for at least 6 months (5 Sx for over age 17)
· 1. Often fidgets with or taps hands or feet or squirms in seat 2. Often leaves seat in situations when remaining seated is expected 3. Often runs about or climbs in situations where it is inappropriate 4. Often unable to play or engage in leisure activities quietly 5. Is often “on the go,” acting as if “driven by a motor” 6. Often talks excessively 7. Often blurts out an answer before a question has been completed 8. Often has difficulty waiting his or her turn 9. Often interrupts or intrudes on others
· The age threshold for diagnosing ADHD changed from 7 to 12 years old.
Sustained attention is hypothetically modulated by the
cortico-striatal-thalamic-cortical loop involving the dorsolateral prefrontal cortex (DLPFC)
Amphetamine (Dexedrine)
stimulant (Schedule II)
ADHD (6 or 3 depending on formula), Narcolepsy (12 or 6)
Amphetamine (Adderall)
stimulant (Schedule II)
ADHD ages 3–12 (Adderall, Evekeo),
ADHD ages 6–17 (Adderall XR, Evekeo, Dyanavel XR, Adzenys XR-ODT)
and in adults (Adderall XR, Evekeo, Adzenys XR-ODT), Narcolepsy (Adderall, Evekeo),
Exogenous obesity (Evekeo)
Lisdexamfetamine
Vyvanse stimulant (Schedule II)
ADHD age 6, Binge eating disorder
