NURS 660 Exam 3 Flashcards
Buspirone (Buspar)
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
Anxiety
Classified into 2 parts:
1. Fear
2. Worry
The amygdala is responsible for
Fear
Where symptoms of anxiety/panic attacks originate
Parabrachial nucleus
S/S of Anxiety/Panic Attacks
trouble breathing, racing heart, Body goes into fight or flight mode.
2 brain regions most associated with anxiety
amygdala and hippocampus
OCD
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.
GAD Treatment
Benzos
Benzos target the GABA neurotransmission via the PAM–the GABA calm through the positive allosteric modulation
PTSD - Treatment
SSRI
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
FEAR Circuit
5HT, GABA, glutamate, CFR/HPA, NE, voltage-gated ion channels
Reticularis pontis caudalis
associated with increased startle response in the central fear response system
Benzos should not be used with
alcohol, opioids, and sedating antihistamines.
Treatment for Benzo overdose
Flumazenil - Antidote (GABA receptor antagonist)
Alcohol Detox
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.
Worry Circuit “worry loop”
5HT, GABA, DA, NE, glutamate, Voltage-gated ion channels.
Worry comes from what circuit?
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.
Neuropathy (Symptoms of)
Caused by inflammation or damage in periphery combined by central disturbance and pain processing
Chronic wide spread pain
MOA central sensitization of the thalamus and cortex
Fibro-fog
parts of the brain that produce this is the DLPFC (dorsolateral prefrontal cortex) and anterior thalamus
Lyrica
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.
Milnacipran(Savella)
SNRI
Used to treat (fibromyalgia) - fibro-fog (cognitive) and pain (physical)
Heavier on NET
GAD ( General Anxiety Disorder)
worry, anxiety, arousal, fatigue, sleeplessness, muscle tension, irritability, difficulty concentrating
Panic Disorder
anticipatory anxiety (worry about panic), unexpected panic attacks (spontaneous panic attacks) trying to avoid future attacks
Social Anxiety Disorder
Anxiety/fear over social performance, tied to embarrassment
PTSD
Anxiety while re-experiencing, increased arousal and startle responses, nightmares, sleep difficulties
Acute Pain
pain that resolves after a short duration and that is usually directly related to tissue damage
Allodynia
is a painful response to a stimulus that does not normally provoke pain, such as pain in response to light touch.
Hyperalgesia
an exaggerated pain response to something that is normally painful (i.e. extreme pain in response to a pin prick)
Neuropathic pain
pain that arises from damage to or dysfunction of any part of the peripheral or central nervous system
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.
A-delta fibers
acute/initial pain, sharp - transmit acute pain sensation from thermal, mechanical and chemical stimuli.
**Think hammer**
A-beta fibers
are similar to A-delta fibers but transmit mechanical sensation (i.e. touch and vibration) - not pain
**think feathers*
C-Fibers
bare nerve endings that only respond to noxious mechanical, heat and chemical stimuli
think heat & hot chili peppers
TCA given for fibromyalgia
2nd line tx: amitriptyline
**if tried other meds in past and running out of options try this
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”
Meperidine (Demerol) (Opioid)
Do not take with an MAOL bc MAOI can cause increase in system and cause bad s/e
Melatonin
Substance in the body made from the pineal gland.
-Circadian pacemaker
-Act on M1 receptors / M2 receptors
Sleep wake switch
-think histamine and GABA (both are regulated in the hypothalamus.
Caffeine
Works because it is an antagonist of adenosine.
Keeps people awake
Trazodone
Modafinil (Provigil)
It enhances chronic dopamine firing
wake promoting drug
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
GABA
GABA calms
Eszopiclone (Lunesta)
targets GABA-a1 isoform receptor
s/e - metallic taste in mouth
Ambien CR
-sleep drug
-Good drug of choice for elderly people w/ no medical problems that don’t cause insomnia
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
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
Naltrexone (Vivitrol)
antidote to opioid overdose
Effexor
SNRI - know for serotonin withdrawal
Lyrica
-off label tx for anxiety/worrying and social anxiety
-FDA approved for pain
Temazepam
Benzo used for sleep
Doxepin
-used for sleep
SSRIs
Treat anxiety because they work on the CST loop/amygdala
–Fear - SERT/NE
–Worry - SERT/NE/DA
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
Pain Medications
Amitriptyline -
Duloxetine
Milnacipran
Pregabalin
Cyclobenzaprine
Human Subjective experience of pain
When information from the discriminatory (thalamocortical) and emotional motivational (limbic) pathways combine
