Exam 3 THIS ONE

Question 1

What is initial insomnia?

Answer 1

difficulty falling asleep

Question 2

What is the treatment for initial insomnia

Answer 2

Short acting benzodiazepines

Sometimes trazodone and doxepin are used off label for their sedating effects

Question 3

What is middle insomnia?

Answer 3

Difficulty staying asleep

Question 4

What is treatment for middle insomnia?

Answer 4

Longer acting benzos

DORAs

Question 5

What is terminal insomnia?

Answer 5

Early morning waking.

Question 6

What is the treatment for terminal insomnia?

Answer 6

If r/t depression - SSRI or SNRI

DORAs

Question 7

What are beta fiber neurons?

Answer 7

Sensory nerve fibers responsible for transmitting signals related to touch and pressure sensation (mechanoreception) to the CNS -

non=noxious/feather

Relatively large and myelinated which allows for a faster transmission of signals.

Question 8

How fast are beta fiber neurons?

Answer 8

Due to myelination - moderate speed

Question 9

What are delta fiber neurons?

Answer 9

Transmit pain and temperature sensations (nociception and thermoreception) from the periphery to the CNS.

noxious mechanical and subnoxious thermal stimuli

Question 10

How faster are delta fiber neurons?

Answer 10

Slower than beta fibers.

They are myelinated but are thinner and smaller than beta fibers.

Question 11

What are C fiber neurons

Answer 11

unmyelinated

chemical and noxious heat

SLOW CHRONIC PAIN SIGNALS

NO MYELINATION - chronic pain

Question 12

How fast are C fiber neurons

Answer 12

unmyelinated - SLOW

Question 13

What is peripheral neuropathy

Answer 13

Dmg to peripheral nerves –> abnormal sensory signals sent to CNS

Central sensitization

Question 14

Difference between neuropathic pain and nociceptive pain.

Answer 14

Nociceptive pain is caused by tissue injury or inflammation.

Neuro pain is caused by dmg to the nerves.

Question 15

Neurotransmitters and receptors in peripheral neuropathy

Answer 15

glutamate and substance P

Question 16

Non pharm approaches to peripheral neuropathy

Answer 16

TENS units, CBT, physical therapy

Question 17

Pathophysiology of chronic pain

Answer 17

Peripheral sensitization - occurs in the peripheral nervous system, where nociceptors (pain receptors) become sensitized and more responsive to painful stimuli. Is often associated with inflammation or nerve dmg and leads to increased pain sensitivity in the affected area.

Central Sensitization: changes in the CNS. CNS becomes hypersensitive - amplifying pain signals and reducing pain threshold. As a result non-painful stimuli can be perceived as painful. The can remain after inflammation or initial injury has healed.

Question 18

allyodynia

Answer 18

pain due to stimulus that does not normally provoke pain

Question 19

What causes narcolepsy

Answer 19

not enough orexin

Question 20

Medication for narcolepsy

Answer 20

Modafinil

Question 21

What is the pathophysiology of anxiety?

Answer 21

Amygdala - Fear/Panic/Phobia

CSTC - Worry/Anxious/Obsession

Hippocampus - Memory/Internal fearmonger - re-experiencing

Question 22

What is the antidote to benzo overdose?

Answer 22

Flumazil

Question 23

What is the antidote to opiates?

Answer 23

Naloxone

Question 24

How does caffeine promote wakefulness?

Answer 24

Caffeine is an antagonist at adenosine receptors

Question 25

What is peripheral neuropathy

Answer 25

Peripheral tissue injury with central distribution

Question 26

Tx for peripheral neuropathy

Answer 26

Cymbalta Elavil Gabapentin - always use when trying to take off alcohol lyrica

Question 27

Allodynia

Answer 27

Pain due to something that shouldn’t cause pain

Question 28

Patho of chronic pain

Answer 28

Moves from peripheral process to Central sensitization

Question 29

Anxiety pathophysiology

Answer 29

SEE A BEAR → amygdala is stimulated → sympathetic nervous system stimulated → hypothalamus stimulated → stimulates anterior pituitary gland → cortisol is released → catacholimines are released (epinephrine) → energy/rediness to run for your life

Question 30

Benzo overdose antidote

Answer 30

Flumazenil

Question 31

Benzos can treat insomnia in ...

Answer 31

PTSD

Question 32

Alprazolam info

Answer 32

high potency due to high allosteric modulation short half life, low volume distribution

Question 33

Amitriptyline SE

Answer 33

anticholinergic SE H1, M1, Alpha1 voltage-gated sodium channel blockade - cardio toxicity

Question 34

Amitriptyline treats what

Answer 34

2nd line for fibromyalgia and neuropathy low dose - insomnia

Question 35

Buspirone MOA, How to use

Answer 35

5HT1A partial agonist -- Binds to pre - helps with depression -- Binds to post - it inhibits serotonin - helps with anxiety -- Adjunct for anxiety with SNRI or SSRI -- 3-4 weeks before you can feel it -- Not a PRN, 3-4 x/day

Question 36

Buspirone helps what SE of SNRI/SSRI

Answer 36

decreases sexual SE

Question 37

Cyclobenzaprine MOA, indications

Answer 37

5HT2A antagonist Used for: Skeletal pain, muscle spasms

Question 38

Cyclobenzaprine ADR

Answer 38

glaucoma and heart attack

Question 39

Diazepam half life etc and used for

Answer 39

High half life, high volume distribution → NOT VERY DEPENDANT Used for: ETOH detox

Question 40

Duloxetine SE and when not to use

Answer 40

SE: BP Hard on liver

Question 41

Lorazepam key points

Answer 41

gentle on the liver moderate benzo

Question 42

Melatonin - when is it used and where is it released from

Answer 42

initial insomnia Pineal gland when it's dark

Question 43

Milnacipran - drug class and what does it treat

Answer 43

SNRI 1st line treatment for fibromyalgia

Question 44

Modafinil- drug class and what does it treat

Answer 44

TCA narcolepsy

Question 45

Modafinil MOA

Answer 45

increases histamine to increase wakefullness inhibits dopamine reuptake

Question 46

Naloxone - what labs

Answer 46

check LFT first

Question 47

Paroxetine treats what and how

Answer 47

joint pain/arthritis suppresses T cells M1 receptors - sleep

Question 48

Pregabalin and gabapentin MOA

Answer 48

binds to OPEN voltage-sensitive calcium channels -- preventing the release of glutamate

Question 49

pregabalin and gabapentin used for

Answer 49

neuropathy and fibromyalgia

Question 50

SS of benzo OD

Answer 50

lethargy, ataxia, confusion, coma, respiratory depression

Question 51

Benzos ok in liver failure and ETOH withdrawal

Answer 51

Out The Liver Oxazepam Temazepam Lorazepam

Question 52

Alprazolam

Answer 52

short half life

Question 53

Belsomra MOA

Answer 53

Antagonism of orexin receptors (Orex 1 and 2)

Question 54

Benzos for ETOH detox

Answer 54

- Diazepam, lorazepam Benzos work BECAUSE they both work on GABA

Question 55

Z drugs and food

Answer 55

Take 3 hrs away from food

Question 56

Amygdala

Answer 56

fear

Question 57

Hippocampus

Answer 57

Memory/flashback -- PTSD worry -- anxious misery

Question 58

Parabrachial nucleus

Answer 58

Breathing symptoms with panic attack

Question 59

Periaqueductal gray

Answer 59

fight/flight

Question 60

Pineal gland

Answer 60

Secretes melatonin in response to darkness

Question 61

Prefrontal cortex

Answer 61

Anxiety Pain

Question 62

Thalamus

Answer 62

Temperature control Lymbic system Pain

Question 63

Hypothalamus

Answer 63

Regulates sleep cycle it's on when histamine is going

Question 64

Neurotransmitters responsible for sleep

Answer 64

GABA, histamine

Question 65

What areas of the brain are involved with PTSD

Answer 65

Amygdala, hippocampus, and PFC

Question 66

Short-acting benzos

Answer 66

LOT Lorazepam, oxazepam, temazepam

Question 67

Treatment for PTSD

Answer 67

Paroxetine and Sertraline

Question 68

DORAs MOA

Answer 68

Dual Orexin Receptor Antagonist -- Block orexin signals in the brain -- Need 8 hrs for sleep after -- Good options for middle and terminal