Exam 3 Flashcards
what is pain?
an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage
what is nociception?
the neural process of encoding noxious stimuli
Name and describe the neural steps in processing of pain signals
transduction: noxious stimuli are converted to electrical signals in sensory nerve endings
transmission: neural events which relay the information from the periphery to the cortex
modulation: the nervous system can selectively inhibit the transmission of pain signals
perception: subjective interpretation by the cortex of the noxious stimulus (sensory and affective component)
the therapeutic goal of pain treatment is to
eliminate abnormal pain without interfering with normal protective pain
activation of nociceptors sends signals to many parts of the brain including:
anterior cingulate cortex, basal ganglia, hypothalamus, parabranchial nucleus of dorsolateral pons, posterior cingulate cortex, posterior parietal complex, supplementary motor area
the ascending pain system…
transmits information from nerve endings to the brain
the descending pain system….
allows the brain to modulate incoming information by sending projections down to the spinal cord
afferent fibers synapse in the —- and project —- separate pathways to the —-. One pathway is for —— —— aspects of pain and the other is for the —– aspects of pain
dorsal horn, up, brain, sensory discriminative, emotional
Name and describe the three categories of primary afferent fibers
Alpha beta fibers: myelinated non-nociceptive, very fast conduction, convey light touch/vibration, may become nociceptive after nerve injury
Alpha delta fibers: myelinated nociceptors, fast conduction, convey fast pricking pain, cold, thermal
Nociceptive C fibers: unmyelinated nociceptors, slow conduction, convey slow burning and aching pain, polymodal (high threshold mechanical, thermal, cold)
first pain is characterized by —- fibers while second pain is characterized by — fibers
A delta, C fibers
Fibers are typically referred to by the stimuli they respond to an example would be CPM, CM, CH which stand for ——
Polymodal, mechano, heat
TRP channels are —– in nociceptors and other sensory neurons
thermosensors
what is allodynia?
perception of pain from a normally non-painful stimulus
what is hyperalgesia?
exaggerated perception of pain from a normally painful stimulus
today —- and other —– are commonly used for —— pain while —- and —- are gold standard for moderate to severe pain
aspirin, NSAIDS, inflammation-induced, morphine, opioid
what are opioids?
peptides that bind to the same postsynaptic receptors as bioactive opium extracts
name the 3 groups of endogenous opioid receptor ligands
endorphins (endogenous morphine), enkephalins, dynorphins
name and describe the 3 major GPCRs that bind opioid peptides
mu opioid receptors: major analgesic target, also responsible for addictive effects, bind endorphins
delta opioid receptors: minor analgesic target, bind enkephalins
kappa opioid receptors: possible pro-nociceptive effect, cause dysphoria, bind dynorphin
Describe how opioids are highly effective analgesics presynaptically and postsynaptically
presynaptic: block calcium influx, open potassium channels (potassium efflux), decreases excitatory neurotransmitter release
postsynaptic: open potassium channels, hyper polarize 2 order neuron, inhibit action potential generation
describe analgesics for acute pain
local anesthetics, blockage of voltage gated sodium channels, drugs end with Caine, side effects include respiratory depression, cardiovascular problems, seizures
acetaminophen: cox inhibition but different than NSAIDs, side effects kidney and liver failure
NSAIDs: inhibits COX1 & COX2, ends with in/en/ac/ib, side effects include ulcers, kidney failures, prolonged bleeding, reye syndrome
describe analgesics for acute-chronic pain
opioids: reduce activity of pain fibers and increase central modulation of pain, end with Eine/yl/one, side effect include vomiting, constipation, confusion, respiratory depression, abuse
Name and describe centrally acting analgesics
opioids, cannabinoids (sim to opioids in analgesic profile)
alpha 2 adrenergic agonists: used as opioid holiday during chronic opioid therapy
NE reuptake inhibitors: increase NE and activate alpha 2
selective ion channel blockers: Calcium and sodium ion channels modulate neuronal excitation and antagonists specific for channels subtypes may have few side effects
anxiolytic drugs can also treat —– and in high doses can cause —- and ——- from —— and ——-
insomnia, unconsciousness, death, respiratory , cardiavascular depression
acute anxiety can be treated by
benzodiazepines
panic disorder can be treated by
SSRI/SNRI and behavioral therapy
OCD can be treated by
long term antidepressants along with behavioral therapy
PTSD can be treated by
behavioral therapy, ketamine, prazosin, propranolol
Name and describe the classification of anxiolytic and hypnotic drugs
benzos: most important class used for treating anxiety and insomnia
5HT1A receptor agonists: showing anxiolytic activity with little sedation
barbiturates: now obsolete but still occasionally prescribed
Beta adrenoreceptor antagonists: mainly to reduce physical symptoms of anxiety such as tremors and palpitations
—— was the 1st benzodiazepine and some benzodiazepines like —– show anticonvulsant activity with less marked sedative effects
chlordiazepoxide, clonazepam
describe the mechanism of action for benzodiazepines
they act selectively on GABA A receptors
enhance the response to GABA by facilitating the opening of GABA-activated Cl- ion channels
do not affect receptors for other amino acids such as glycine or glutamate
name the main effects of benzodiazepines
-reduction of anxiety and aggression
-sedation and induction of sleep
-reduction of muscle tone and coordination
-anticonvulsant activity
-anterograde amnesia
with the exception of —— benzodiazepines do not have antidepressant effects
alprazolam
Benzodiazepines in acute overdose are —— dangerous than other anxiolytic drugs
less
in overdose, benzodiazepines cause
prolonged sleep without serious depression of respiration or cardiovascular function
what are the main side effects of benzodiazepines?
drowsiness, confusion, amnesia, impaired coordination
tolerance of benzodiazepines appears to represent a change at the —– level
receptor
stopping benzodiazepine treatment after weeks or months causes —–, —–, and —–
increase in symptoms of anxiety, tremor, dizziness
withdrawal of benzodiazepines after chronic administration causes physical symptoms similar to those that follow —- withdrawal, namely —–, —-, —–, and sometimes ——
opioid, nervousness, tremor, loss of appetite, convulsions
benzodiazepine clinical uses include
treatment of anxiety, status epilepticus, muscle spasm alcohol withdrawal, preoperative sedation, light anesthesia, anterograde amnesia
describe the pharmacokinetics of benzodiazepines
given orally, intravenously, intramuscularly
metabolized in liver and excreted in urine
benzodiazepines can have interactions with
alcohol and other CNS depressants by having an additive effect
SSRIs and SNRIs often have —— efficacy and —- incidence of side effects compared to —- and —–
greater, lower, benzos, barbituates
SSRIs and SNRIs can —– anxiety before anxiolytic effects can begin
worsen
side effects of SSRIs and SNRIs include
agitation, nausea, diarrhea, decreased sex drive, anorgasmia, weight gain, hypertension, tachycardia
they can also produce SSRI discontinuation syndrome
describe the pharmacology of Buspirone
-its a 5-HT1a receptor agonist
-it relieves anxiety without sedation
-takes a week to become effective, used for chronic anxiety
-low potential for addiction
-no muscle relaxation or anticonvulsant activity
-not as effective as benzos or SSRIs
Vilazodone is a ——/——- agonist for depression
SSRI/5HT1a
describe the pharmacology for Flumazenil
-completely blocks benzodiazepine binding sites
-counteracts adverse effects of benzodiazepine such as respiratory depression from intravenous administration or overdose
-intravenous use only, action lasts only 1-2 hours, repeated doses may be necessary for heavily sedated patient to remain alert
-use cautiously in persons with history of seizures or head injury
-no significant interactions with other drugs
drug dependence describes the human condition in which
drug taking becomes compulsive and takes precedence over other needs, often with serious consequences
drug abuse is a more —- term meaning….
general, recurrent use of substances that are illegal or that cause harm to the individual
drug addiction can be described as
a chronic condition centering around an intense desire to obtain increasing amount of a particular substance to the exclusion of all other activities
it involves the progression of acute drug use to the development of drug seeking behavior, the vulnerability to relapse, and the decreased slowed ability to respond to naturally rewarding stimuli
drug dependence refers to the body’s…
physical need for a specific agent, it represents a stable change in brain function
if someone becomes drug dependent they will develop —– or —– withdrawal symptoms after use of the substance is stopped
physiological, psychological
dependence is characterized by ——. this occurs when the body becomes —— ——- to a specific amount of a substance thereby causing the person to —– the amount of drug intake to achieve the previous effect
tolerance, less responsive, increase
several psychotropic drugs including —- and —– produce withdrawal symptoms but are not —- so it is important to distinguish between —- and —–
antidepressants, antipsychotics, addictive, dependence, addiction
—– dependence is not a major factor in sustaining long term drug dependence as —– ——– is more important
physical, psychological reinforcement
positive reinforcement is the —– felt from the ——– being ——-
pleasure, reward pathway, stimulated
negative reinforcement is the —— to drug cessation (—— ——) that subjects attempt to —– by ——- the drug
aversion, withdrawal symptoms, escape, self administering
—— also plays a role is sustaining drug dependence. Antecedents associated with drug taking themselves evoke a ——-. Or reversely those associated with drug cessation become ——
conditioning, pleasurable response, aversive
virtually all dependence-producing drugs activate the —— —- pathway, even though their primary sites of activation are generally elsewhere
mesolimbic dopamine
the reward pathways begins in the —— —– —- of the —– and connects to the —– —- via the ——– ——, the —–, and the —– as well as to the —— ——-
ventral tegmental area, midbrain, limbic system, nucleus accumbens, amygdala, hippocampus, prefrontal cortex
name the warning signs of drug abuse
-secrecy or withdrawal
-depressed or maybe even suicidal
-loss of focus on customary activities
-change in spending habits
-trouble with the law
-cycles of increased energy, restlessness, and inability to sleep
-abnormally slow movements, speech or reaction time
-confusion or disorientation
-sudden weight loss or gain
-cycles of excessive sleep
the controlled substances act created —- schedules which regulates the manufacture, importation, possession, and distribution of certain drugs and two federal departments —– and ——- determine which drugs are added or removed from the various scheduled. ——, —–, —–, and —– are explicitly exempt from the controlled substances act
5, department of justice, department of health and human services, tobacco, beer, wine, and caffeine
Schedule 1 drugs are those where….
- the drug or other substance has a high potential for abuse
-the drug or other substance has no currently accepted medical use in treatment
-there is a lack of accepted safety for use of the drug or other substance under medical supervision
-no prescriptions may be written for schedule 1 substances
schedules 2-4 all include drugs with —— —. Five is the least restrictive such as ——- while two is the most restrictive such as —–, —-, —–
medical uses, cough medicines with codeine, morphine, cocaine, methadone
examples of schedule 1 drugs include
cannabis, heroin, MDMA, LSD
pharmacological approaches to treating drug dependence include which 3 strategies?
substitution to alleviate withdrawal symptoms, long term substitution, blocking therapies
substitution to alleviate withdrawal symptoms include
-methadone used short term to blunt opiate withdrawal
-benzodiazepines to blunt alcohol withdrawal
-alpha 2 adrenoreceptor agonists (clonidine) to diminish withdrawal
long term substitution includes
-methadone substitution for opioid addiction
-nicotine patches or chewing gum
blocking therapies include
-nalterxone to block opioid effects
-mecamylamine to block nicotine effects
-immunisation against cocaine and nicotine to produce circulating antibody
CNS stimulants include which 3 drugs
amphetamines/methamphetamines, cocaine, nicotine
amphetamine and methamphetamine produce feelings of —- and —– ——
alertness, increased energy
name the different ways meth users ingest meth and the effects it brings
-smoking or injecting which gives an immediate rush that lasts for only a few minutes but is extremely pleasurable
-snorting which after 3-5 minutes produces euphoria high but no intense rush
-swallowing which after 15-20 minutes produces euphoria high but no intense rush
as with similar stimulants, meth users often go through a binge abuse cycle which consists of…..
rush, high, binge, tweaking, crash, normal and withdrawal
describe the rush that comes with meth use
-last 5-30 minutes
-the addicts heartbeat races
-metabolism blood pressure and pulse soar
-feelings of pleasure
describe the high that comes with meth use
-lasts 4-16 hours
-the addict often feels aggressively smarter and becomes argumentative
describe the binge that comes with meth use
-lasts 3-15 days
-the addict maintains the high for as long as possible and becomes hyperactive, both mentally and physically
describe the tweaking that comes with meth use
-most dangerous stage of the cycle
-tweaker has probably not slept in 3-15 days and is irritable and paranoid
-often behave or react violently and if they are using alcohol or another cans depressant, their negative feelings and associated dangers intensify
-craves more meth but no dosage will help recreate the euphoric high which causes frustration and leads to unpredictability and potential for violence
-eyes are moving 10 times faster than normal, voice has a slight quiver, and movements are quick and jerky
high intensity abusers of meth experience…
extreme weight loss, very pale facial skin, sweating, body odor, discolored teeth, scars or open sores on their bodies
scars are the results of abusers hallucination of bugs on their skin and attempts to scratch the bugs off
describe the withdrawal that comes with meth use
-no immediate symptoms are evident but the user will first become depressed and then lethargic
-the craving for meth hits and they may become suicidal
-fatigue, excessive sleeping, agitation, psychosis
describe the treatment for meth addiction
-must want to give up amphetamine/methamphetamine
-need to avoid all stimulants including caffeine and tobacco
-self help groups or treatment program
-prescribed medication including antidepressants for depression and craving, sedatives for anxiety and trouble sleeping, and antipsychotics for paranoia and cravings
describe the ways cocaine users ingest cocaine
-injecting where after 15-30 seconds an intense rush is produced
-snorting where it is absorbed via nasal membranes then into the brain within 3-5 minutes with peak effects a few minutes after that. self limiting ad the more cocaine that is absorbed the slower the absorption
-smoking where after 5-8 seconds an intense rush is produced
name and describe the different forms of cocaine
-cocaine hydrochloride (water soluble, suitable for drinking, snorting, or injecting)
-freebase cocaine (water insoluble, suitable for smoking)
-crack cocaine a freebase form made using sodium bicarbonate (water insoluble, suitable for smoking)
cocaine side effects include
anhedonia, loss of motivation, nightmares, hunger, emotional depression, insomnia
describe cocaine overdose
-most often not fatal but does feel like it
-overly sweaty, cold and clammy sensation, feeling of impending death
describe deaths from cocaine use
result from cardiac arrest, seizure, respiratory failure, extra high body temperature (severe hyperthermia)
describe treatment of cocaine addiction
no medications available, treatment programs, behavior modification
CNS depressants include which 3 drugs?
benzodiazepines, barbiturates, methaqualone
benzodiazepine withdrawal symptoms can be similar to….
alcohol withdrawal
benzodiazepine addiction treatment includes
transferring the physically dependent patient to an equivalent dose of diazepam then gradually weaning the patient off
barbiturates produce similar intoxication to ——. recreational user report that a barbiturate high gives them feelings of —— —– and ——. the main risk of barbiturate abuse is ——- ——–
ethanol, relaxed contentment, euphoria, respiratory depression
withdrawal symptoms from barbiturates include
anxiety, elevated cardio and respiratory rates, nausea, hallucinations, seizures, irritability, muscle pain, tremors, confusion
barbiturates decrease —- —– so withdrawal often results in disruptions such as ——, —–, or ——-
REM sleep, nightmares, insomnia, vivid dreaming
treatment for barbiturates addiction includes
transferring the physically dependent patient to an equivalent dose of diazepam then gradually weaning the patient off
generally describe methaqualone
sedative drug that is similar in effect to barbiturates
describe the recreational and overdose effects of methaqualone
-relaxation, euphoria, drowsiness, reduced heart and respiratory rate, increased sexual arousal, numbness of fingers and toes
-larger doses use depression muscular miscoordination, slurred speech, headache, photophobia
-overdose can cause delirium, convulsions, hypertonia, hyperreflexia, vomiting, renal insufficiency, coma and death through cardiac or respiratory arrest
describe treatment of methaqualone addiction
transferring the physically dependent patient to an equivalent dose of diazepam then gradually weaning
CB1 receptors are the…… in the human brain
most abundant GPCRs
CB2 receptors are largely found in —– —- and other —— —–
immune cells, peripheral tissues
CB1 receptors are highly expressed in the ——–, ——-. ——– ——, ——-, and —–. This distribution account for the effects of cannabis on ——, ——, and ——-
hippocampus, cortex, basal ganglia, cerebellum, and spinal cord, memory, cognition, and movement
describe the cellular mechanism of action of cannabinoid receptors
-directly inhibit N and P/Q type Ca++ channels
-indirectly inhibit A type Ca++ channels via adenylyl cyclase
-activate inwardly rectifying K+ channels
-directly inhibit Na+ channels
-activate the mitogen activated protein (MAP) kinase signaling pathway
describe the overall mechanisms of action of cannabinoids
THC acts as an agonist at CB1 and CB2 receptors
describe the effects of cannabinoids
euphoria, drowsiness, relaxation, impairs short term memory and mental activity, decreases muscle strength, impairs high skilled motor activity, catalepsy, analgesia, antiemetic action, increased appetite, xerostomia, hallucinations, delusions, enhancement of sensory activity
describe the clinical use of cannabinoids
-dronabinol is an appetite stimulant
-rimonabant which is a CB1 antagonist is an antiemetic, obesity treatment
-nabilone is a synthetic cannabinoid, used as an antiemetic, an analgesic for neuropathic pain, appetite stimulant
-sativex to alleviate neuropathic pain and spasticity
describe the pharmacokinetics of cannabinoids
-lipid soluble
-effects appear immediately but take about 20 minutes to reach maximum
-effects gone after 3 hours
-read more on the slide idk im in a rush
describe there adverse effects from cannabinoids
-increased heart rate, decreased blood pressure, reddening of the conjunctiva and sclera, reduced intraocular pressure, bronchodilation
-high doses cause toxic psychosis develops, tolerance and mild physical dependence
describe the tolerance of cannabinoids
tolerance develops rapidly
describe withdrawal of cannabinoids
-lack of immediate withdrawal symptoms has led people to incorrectly conclude withdrawal does not occur
-symptoms include anger irritability aggression, depression, slight tremors, decreased appetite, craving, aches pains chills, inability to concentrate, sleep disturbance, sweating
