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Nurs 660 > NURS 660 Exam 3 > Flashcards

NURS 660 Exam 3 Flashcards

1
Q

Buspirone (Buspar)

A

Tx: GAD
*5HT1A partial agonist @ pre and postsynoptic receptors
*Does not affect GABA receptors
*Augmenting w/antidepressants results in enhanced serotonergic activity in amygdala, PFC, striatum, and thalamus
*DOES NOT SEDATE

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2
Q

Anxiety

A

Classified into 2 parts:
1. Fear
2. Worry

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3
Q

The amygdala is responsible for

A

Fear

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4
Q

Where symptoms of anxiety/panic attacks originate

A

Parabrachial nucleus

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5
Q

S/S of Anxiety/Panic Attacks

A

trouble breathing, racing heart, Body goes into fight or flight mode.

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6
Q

2 brain regions most associated with anxiety

A

amygdala and hippocampus

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7
Q

OCD

A

not classified as an anxiety disorder
It comes from the COMT met genotype and people with this genotype are more susceptible to worry and anxiety disorders.

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8
Q

GAD Treatment

A

Benzos
Benzos target the GABA neurotransmission via the PAM–the GABA calm through the positive allosteric modulation

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9
Q

PTSD - Treatment
SSRI

A

No med for PTSD specifically. Treat the symptoms, if going to use meds, want to reduce symptoms by increasing glutamate neurotransmission during periods of fear.
1st line of med -targeting arousal- from PTSD is PAXIL. (for hyperarousal)
Works on the H2 receptors-sedating
Known for serotonin withdrawal

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10
Q

FEAR Circuit

A

5HT, GABA, glutamate, CFR/HPA, NE, voltage-gated ion channels

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11
Q

Reticularis pontis caudalis

A

associated with increased startle response in the central fear response system

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12
Q

Benzos should not be used with

A

alcohol, opioids, and sedating antihistamines.

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13
Q

Treatment for Benzo overdose

A

Flumazenil - Antidote (GABA receptor antagonist)

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14
Q

Alcohol Detox

A

1st acute episode of alcohol detox (24-48 hours), higher risk of seizure. **exception to the benzo w/alcohol rule **
(Ativan(Lorazepam) recommended to prevent seizure) Then given Librium to taper off of alcohol withdrawal.

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15
Q

Worry Circuit “worry loop”

A

5HT, GABA, DA, NE, glutamate, Voltage-gated ion channels.

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16
Q

Worry comes from what circuit?

A

comes from the CSTC loop
“Cortico-striatal-thalamic-cortical circuit”
CSTC loop originates and ends in the DLPFC (dorsolateral prefrontal cortex). Overactivation leads to worry.

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17
Q

Neuropathy (Symptoms of)

A

Caused by inflammation or damage in periphery combined by central disturbance and pain processing

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18
Q

Chronic wide spread pain

A

MOA central sensitization of the thalamus and cortex

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19
Q

Fibro-fog

A

parts of the brain that produce this is the DLPFC (dorsolateral prefrontal cortex) and anterior thalamus

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20
Q

Lyrica

A

Used a lot in treatment of fibromyalgia - how it stops the pain (it binds to open VSCC and opens CC so it can bind to the neurotransmitters and stop the pain receptors.

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21
Q

Milnacipran(Savella)
SNRI

A

Used to treat (fibromyalgia) - fibro-fog (cognitive) and pain (physical)
Heavier on NET

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22
Q

GAD ( General Anxiety Disorder)

A

worry, anxiety, arousal, fatigue, sleeplessness, muscle tension, irritability, difficulty concentrating

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23
Q

Panic Disorder

A

anticipatory anxiety (worry about panic), unexpected panic attacks (spontaneous panic attacks) trying to avoid future attacks

24
Q

Social Anxiety Disorder

A

Anxiety/fear over social performance, tied to embarrassment

25
PTSD
Anxiety while re-experiencing, increased arousal and startle responses, nightmares, sleep difficulties
26
Acute Pain
pain that resolves after a short duration and that is usually directly related to tissue damage
27
Allodynia
is a painful response to a stimulus that does not normally provoke pain, such as pain in response to light touch.
28
Hyperalgesia
an exaggerated pain response to something that is normally painful (i.e. extreme pain in response to a pin prick)
29
Neuropathic pain
pain that arises from damage to or dysfunction of any part of the peripheral or central nervous system
30
Nociceptive pain
results from direct activation of pain nerve fibers, either due to chemical, inflammatory or mechanical mediators, and is usually die to tissue irritation, impending injury, or actual injury.
31
A-delta fibers
acute/initial pain, sharp - transmit acute pain sensation from thermal, mechanical and chemical stimuli. ******Think hammer******
32
A-beta fibers
are similar to A-delta fibers but transmit mechanical sensation (i.e. touch and vibration) - not pain ******think feathers*****
33
C-Fibers
bare nerve endings that only respond to noxious mechanical, heat and chemical stimuli ****think heat & hot chili peppers****
34
TCA given for fibromyalgia
2nd line tx: amitriptyline **if tried other meds in past and running out of options try this
35
What drug is good for chronic neuropathic pain
Cymbalta --be careful b/c it runs through the liver and can increase liver enzymes. **Don't give to pt with liver problems - could put them into liver failure Give liver patients - "Pristiq"
36
Meperidine (Demerol) (Opioid)
Do not take with an MAOL bc MAOI can cause increase in system and cause bad s/e
37
Melatonin
Substance in the body made from the pineal gland. -Circadian pacemaker -Act on M1 receptors / M2 receptors
38
Sleep wake switch
-think histamine and GABA (both are regulated in the hypothalamus.
39
Caffeine
Works because it is an antagonist of adenosine. Keeps people awake
40
Trazodone
antidepressant/works for sleep - it targets 5HT2C and H1 antagonism ---
41
Modafinil (Provigil)
It enhances chronic dopamine firing wake promoting drug
42
Rozerem
- melatonin based and it targets the MT1 and MT2 receptors - sleep drug ***great for people who have a hx of addiction b/c its not controlled and its not addictive
43
GABA
GABA calms
44
Eszopiclone (Lunesta)
targets GABA-a1 isoform receptor s/e - metallic taste in mouth
45
Ambien CR
-sleep drug -Good drug of choice for elderly people w/ no medical problems that don't cause insomnia
46
Benzos
-treat anxiety/insomnia -work on GABA-A receptors -when combined with CNS depressants can cause respiratory depression -not recommended for pregnant/breastfeeding women -metabolized in the liver - 1/2 lives
47
GABA -A and GABA-B
Receptors in the brain ----Benzos work on GABA-A ----Non-Benzos work on alpha-1 subunit of GABA-sedation (Ambien/Lunesta) are examples of non-benzos
48
Naltrexone (Vivitrol)
antidote to opioid overdose
49
Effexor
SNRI - know for serotonin withdrawal
50
Lyrica
-off label tx for anxiety/worrying and social anxiety -FDA approved for pain
51
Temazepam
Benzo used for sleep
52
Doxepin
-used for sleep
53
SSRIs
Treat anxiety because they work on the CST loop/amygdala --Fear - SERT/NE --Worry - SERT/NE/DA
54
Benzodiazepines Alprazolam (Xanax) Diazepam (Valium) Lorazepam (Ativan) Temazepam (Restoril)
**Sedating **highly addictive **hypotension, dizziness, fatigue **weakness, confusion, depression **withdrawal seizures possible **short 1/2 life Antidote - Flumazenil
55
Pain Medications
Amitriptyline - Duloxetine Milnacipran Pregabalin Cyclobenzaprine
56
Human Subjective experience of pain
When information from the discriminatory (thalamocortical) and emotional motivational (limbic) pathways combine

Nurs 660 (3 decks)

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