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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
Q

PTSD

A

Anxiety while re-experiencing, increased arousal and startle responses, nightmares, sleep difficulties

26
Q

Acute Pain

A

pain that resolves after a short duration and that is usually directly related to tissue damage

27
Q

Allodynia

A

is a painful response to a stimulus that does not normally provoke pain, such as pain in response to light touch.

28
Q

Hyperalgesia

A

an exaggerated pain response to something that is normally painful (i.e. extreme pain in response to a pin prick)

29
Q

Neuropathic pain

A

pain that arises from damage to or dysfunction of any part of the peripheral or central nervous system

30
Q

Nociceptive pain

A

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
Q

A-delta fibers

A

acute/initial pain, sharp - transmit acute pain sensation from thermal, mechanical and chemical stimuli.
**Think hammer**

32
Q

A-beta fibers

A

are similar to A-delta fibers but transmit mechanical sensation (i.e. touch and vibration) - not pain
**think feathers*

33
Q

C-Fibers

A

bare nerve endings that only respond to noxious mechanical, heat and chemical stimuli
think heat & hot chili peppers

34
Q

TCA given for fibromyalgia

A

2nd line tx: amitriptyline
**if tried other meds in past and running out of options try this

35
Q

What drug is good for chronic neuropathic pain

A

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
Q

Meperidine (Demerol) (Opioid)

A

Do not take with an MAOL bc MAOI can cause increase in system and cause bad s/e

37
Q

Melatonin

A

Substance in the body made from the pineal gland.
-Circadian pacemaker
-Act on M1 receptors / M2 receptors

38
Q

Sleep wake switch

A

-think histamine and GABA (both are regulated in the hypothalamus.

39
Q

Caffeine

A

Works because it is an antagonist of adenosine.
Keeps people awake

40
Q

Trazodone

A
41
Q

Modafinil (Provigil)

A

It enhances chronic dopamine firing
wake promoting drug

42
Q

Rozerem

A
  • 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
Q

GABA

A

GABA calms

44
Q

Eszopiclone (Lunesta)

A

targets GABA-a1 isoform receptor
s/e - metallic taste in mouth

45
Q

Ambien CR

A

-sleep drug
-Good drug of choice for elderly people w/ no medical problems that don’t cause insomnia

46
Q

Benzos

A

-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
Q

GABA -A and GABA-B

A

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
Q

Naltrexone (Vivitrol)

A

antidote to opioid overdose

49
Q

Effexor

A

SNRI - know for serotonin withdrawal

50
Q

Lyrica

A

-off label tx for anxiety/worrying and social anxiety
-FDA approved for pain

51
Q

Temazepam

A

Benzo used for sleep

52
Q

Doxepin

A

-used for sleep

53
Q

SSRIs

A

Treat anxiety because they work on the CST loop/amygdala
–Fear - SERT/NE
–Worry - SERT/NE/DA

54
Q

Benzodiazepines
Alprazolam (Xanax)
Diazepam (Valium)
Lorazepam (Ativan)
Temazepam (Restoril)

A

**Sedating
**highly addictive
**hypotension, dizziness, fatigue
**weakness, confusion, depression
**withdrawal seizures possible
**short 1/2 life
Antidote - Flumazenil

55
Q

Pain Medications

A

Amitriptyline -
Duloxetine
Milnacipran
Pregabalin
Cyclobenzaprine

56
Q

Human Subjective experience of pain

A

When information from the discriminatory (thalamocortical) and emotional motivational (limbic) pathways combine

Nurs 660 (3 decks)

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