Neuropathic Pain Quiz 2 Flashcards
Consider acetylcholine’s role as a neurotransmitter.
A) Acetylcholine is generally an inhibitory neurotransmitter
B) Excitatory transmitted acting on the NMDA receptor
C) Is an excitatory neurotransmitter effecting memory and cognition in the cerebral cortex and opposing dopamine in the basal ganglia
D) Serves an excitatory role by inhibiting GABA receptors
C – Ach is excitatory not inhibitory (so A is wrong), glutamate binds NMDA receptors (so B is wrong), Ach does not act on GABA receptors (so D is wrong)
T or F: Dopamine, epinephrine and norepinephrine are catecholamines.
True
Serotonin inhibits the GABA receptor. T or F?
F
Dopamine is a neurotransmitter for pathways that influence motor control, mood and emotion, and also nausea and vomiting. T or F?
T
5-hydroxytryptamine is a neurotransmitter for pathways that influence pain, mood and behavior, depression and anxiety, and nausea and vomiting. T or F?
T
Which statement best describes the properties of centrally acting medications?
A) Can be taken orally, poorly soluble in water, complex metabolism and low extraction, large distribution volumes and lengthy half lives. Narrow therapeutic index
B) Must be injected, eliminated by the kidney, short half lives, high therapeutic index.
C) Can be taken orally, poorly soluble in water, high hepatic extraction, large distribution volumes and lengthy half lives. Narrow therapeutic index
D) Can be taken orally, highly soluble in water, complex metabolism and low extraction, large distribution volumes and lengthy half lives. Wide therapeutic index
A
What is the risk of taking warfarin and duloxetine concurrently?
Considered a major interaction because it significantly increases bleeding risk, as duloxetine depletes platelet serotonin. This sometimes elevates PT and PTT. Patient should be advised of these risks.
When do you predict to see the peak effect of adding duloxetine to warfarin?
Both have longer half lives, so the expected peak effect is around one to two weeks after starting the medication, but the intensity can still continue to increase over time
Would you continue warfarin for a pt with a thrombolic disorder that needs to start duloxetine for NPP? Warfarin has controlled her disorder well for the last 5 years.
Since the pt is doing well on warfarin and is struggling with NPP, I would keep the pt on both medications. Educate the pt on the importance of being consistent with follow up appointments and on any red flag sx of bleeding that would warrant an ER visit. Start off on a short term sequence of duloxetine to see how she responds before committing to a long term regimen.
