Quiz 2 Flashcards
What are the two minor affective disorders (which are mood disorders)?
- Depression-dysthymia (-Dysthymia is minor depression, DSM5 qualification requires: longer than two years, lowered mood/anhedonia, incidence is about 6% at any one time females are more likely) 2. Cyclothymia (-Cycles of dysthymia to minor state of mania-minor bipolar-longer than two years-no gender bias -No drugs for these usually, some of our most brilliant people like Einstein entered this manic part of cyclothymia and was productive
How does marijuana cause dopamine release?
It activates cannabinoid receptors
What are the three different types of pain that will factor in to which analgesic we choose?
- Musculoskeletal 2. Inflammatory 3. Visceral Pain
What is the pathway of pain transmission starting at the injury?
Starts at injury, the noxious stimuli activate the sensitive peripheral ending of the primary afferent nociceptor by the process of transduction. The message is then transmitted over the peripheral nerve to the spinal cord, projection neurons send axons across the midline, where it synapses with cells of origin of the major ascending pain pathway, the spinothalamic tract. The message is relayed in the thalamus to the somatosensory cortex 1 and 2.
What are the main three atypical anti-psychotic drugs?
- Clozapine (Can cause serious agranulocytosis, wiping out WBC’s) 2. Quetiapine 3. Olanzepine
If you are older than 85, what percent chance do you have of getting Parkinson’s?
50%
How does administration of local anesthetic change with Parkinson’s Disease patients?
For patients receiving levodopa and/or entacapone, limit administration to three cartridges of 2 percent lido with 1:100,000 epi per 30 minute period to avoid hypertension and tachycardia. For patients on selegiline, do not administer agents containing epinephrine because of result of severe hypertension.
How does caffeine cause dopamine release?
It activates adenosine receptors
What are the four basic physiologic processes in nociception? And where do they take place?
Transduction, transmission, modulation, and perception. Transduction happens in primary afferent nociceptor, then transmission happens when action potential passes through dorsal root ganglia to actual spinal cord, where modulation takes place, crosses the midline, and goes up spinothalamic tract to the thalamus, and then into the cortex where pain perception takes place.
What are the characteristics of Stage I of Parkinson’s Disease?
Mild/Early Disease - Only one side of the body is affected, so tremor in just one limb for example, and usually with minimal or no functional impairment
What is the definition of nociception?
The physiological process by which information on actual/potential tissue damage is conveyed to the CNS
What do most abused substances do to the brain?
They enhance dopamine activity in the nucleus accumbens (particularly reltaed to pleasure, motor, and cognitive function). Glutamate and GABA are other pathways also involved.
What is the “gate control” theory of pain? What fibers converge for this?
The gate control theory of pain asserts that non-painful input closes the “gates” to painful input, which prevents pain sensation from traveling to the central nervous system. Therefore, stimulation by non-noxious input is able to suppress pain. So an example is putting pressure on palate to attempt to inhibit nociception from the injection. Gate control is inhibition of pain by touch. There is a convergence of inputs from A-beta and A-delta fibers, competing for same train tracks.
What is a severe acute anxiety-panic attack?
It is a dramatic acute outburst, peak in 10 minutes-Self-limiting-Autonomic outburst-Sense of dread and impending doom, confusion-Sometimes associated with depression
What are the drugs that might help with autism psychotic, aggressive or repetitive behaviors, but don’t help with the progression of the disease?
Atypical antipsychotics or SSRI’s
How does secondary activation of nociceptor nerves work?
Chemical messengers released from activated nociceptor nerve endings act locally to release messengers that further activate the nociceptors. This is positive feedback. Action potentials propagate toward the cell body in the dorsal root ganglia and then enter the spinal cord.
What are the four “other” opioid narcotics?
- Meperidine (for moderate pain, demerol) 2. Pentazocine (It is unique because of its interaction with the kappa receptor, so makes it less likely that people will abuse this, it has a mixed agonist/antagonist effect) 3. Methadone (If an opioid addict is going to methadone clinics, then chart that and know that you don’t need to give them more pain coverage, also used to treat opioid addiction) 4. Buprenorphine (As they go to higher doses it turns into an antagonist, shuts everything off, and kicks them into withdrawals, so harder to get addicted to, similar to two above)
What are the two “other” schizophrenia types?
- Acute psychotic disorder (-Stress-related/maybe delusions, and maybe halucinations. There is a fast recovery, and once you can resolve the stress, the psychosis goes away) 2. Schizoaffective (-Poorly defined, You have severe depression and bouts of schizophrenia, Looks a lot like bipolar)
What is the definition of nociceptive pain?
Pain resulting from activation of nociceptors as a result of actual or potential tissue damage and processing by the CNS (Somatic/visceral/inflammatory)
What are the two main barbiturates for treating anxiety disorders?
- Pentobarbital (short-acting, helps with anesthesia induction) 2. Phenobarbital (longer-acting, for seizures)
What are some common environmental factors that might induce Parkinson’s Disease?
Mg and Hg, Pesticides (farmers are more likely), Trauma (quinones)
What does COX-1 normally help out with?
GI protection, platelet aggregation, renal activities.
What are the characteristics of Stage II of Parkinson’s Disease?
Both sides of the body are affected but posture and balance remain normal
What are seven tips for maintaining and improving dental health with PD?
- Use an electric toothbrush 2. Try one handed strategies 3. Apply stannous fluoride gel 4. Visit dentist in the morning 5. Take levodopa 60-90 minutes before visit 6. Try non-alcohol based mouthwash 7. Plan several shorter dentist visits
What are the names of the two Ibuprofen-like NSAIDS?
Ketoprofen and Naproxen. Ketoprofen is same properties, but more potent; 50 mg is recommended analgesic dose. Naproxen is longer-lasting and slower-acting (Aleve)
What kind of effects do drugs that enhance the action of NE and 5HT in the CNS have?
Antinociceptive effects. They don’t give you much of a sensation other than the pain goes away.
What is the definition of nociceptors?
Specialized ion channels on sensory nerve endings that respond to noxious stimuli. There are 4 or 5 different nociceptors that we will be talking about
What are the main genetic components of Alzheimer’s?
Certain apolipoprotein that has relevance, as well as abnormal APP (amyloid precursor protein) to beta amyloid
How is Multiple Sclerosis best diagnosed?
There are no definitive tests but MRI’s are used often to get a way to feel good about diagnosis. -MRI measures blood perfusion, and these white spots show that there is tissue damage, inflammation, cell death, and could indicate MS, you need 2 or more of these lesions to have a definitive diagnosis that it is multiple sclerosis -These white areas could also be a tumor, stroke scar, cancer -And you combine all this with increased symptoms
What is the background to, and the different types of Anxiety disorders?
It is a natural response but in excess. Involves adrenaline and the sympathetic nervous system 1. Chronic, mild anxiety - -Constant frequent times of irritation, you don’t have patience, you can’t focus -Linked to environment, there is a cause, you can say this happened and then I got anxiety. Usually don’t need drugs, just relax, take a trip 2. Chronic, moderately severe –Anxiety feelings persist for longer than 6 months, and while they may be coming and going, it is there, and it is genetic, and there is no obvious stressor. Anxiolytics, sedatives, psychotherapy, relaxation, exercise.
Why would combining an opioid agonist (something that mimics enkephalin) with a substance P antagonist?
You would get synergism and additivity, and it would enhance the drug, and you wouldn’t have to use as much opioid agonist so you could reduce the side effects caused by opioids.
How many hours of CE credit on drug abuse issues in Utah do you have to take a year if you want to maintain your license?
2 hours of CE credit
What is the definition of drug misuse?
Either not prescribed or clinically inappropriate
What is the DSM-5 criteria for schizophrenia?
-They need to persist for longer than 6 months -You have deteriorating functions, can’t take care of family or self -Active psychosis, not relating to reality -A differential diagnosis is that there are no drugs or trauma
What is the function of serotonin in the brain and what is its pathway?
Mood, memory processing, sleep cognition, and it starts in the dorsal raphe in the brainstem and gets dropped off in the nucleus accumbens, frontal cortex, hippocampus, and striatum, just like the dopamine pathway.
What happens when prostaglandin receptors are stimulated?
It results in activation of specific Na+ channels, making the nociceptive nerve ending more excitable, so it is increasing pain sensitization of nociceptors. If you block PG’s or don’t let them form, it doesn’t end up letting sodium come in, which doesn’t activate the TRPV1 nociceptor, and we don’t feel as much pain.
What are the four different subtypes of specific ion channels on free nerve endings that respond to actual or potential tissue damage?
- Mechanical 2. Chemical 3. Thermal 4. Polymodal
What are the five main clinical manifestations of Parkinson’s Disease?
- Tremor/rigidity/bradykinesia 2. Postural abnormalities (-Stooped, they shuffle feet) 3. Autonomic and neuroendocrine (-Increased salivation, can give an anticholinergic like Atropine to help -Speech is slurred as it progresses, they get frustrated -Dysphagia - they can’t swallow very well -They also get altered taste, and that can be an early indication that Parkinson’s is starting) 4. Late symptoms (-Depression, about 60-70% of patients get significant depression, new studies are showing that depression throughout life can make you 4X more likely to get Parkinson’s. ADHD is also linked and Ritalin) 5. Oral status (-They usually come in with a lot of root canals because it is hard for them to take care of their mouths-They salivate more but the saliva isn’t normal, it is very thick and ropy and doesn’t clean and they get cervical caries)
For initiation of treatment on PD patients, how long after PD meds should treatment start?
Should begin 90 minutes after PD meds, and appointments should be shorter than 45 minutes.
All drugs of addiction increase release of dopamine where in the brain?
The Nucleus Accumbens
What are the symptoms of schizophrenia?
-There are many types -There are remissions -They will do better than have a relapse, it is a cycle -They have withdrawn -Their thinking and speech is abnormal -Usually anhedonic, they don’t get pleasure out of life, not rewarding -Often thinking about and occasionally implement suicide -Personal appearance is abnormal -Tends to be worse in men -For men, late teen to 20’s, more aggressive and faster in mens -For women, late 20s to 30s -Their thinking has loose connections -They are dillusional (your sensory input is ok, but the way you interpret that input doesn’t relate to reality) -They have hallucinations (sensory input has been corrupted) -Emotions - flat affect -Difficulty in filtering sensory input, get distracted easy -Lack of pre-pulse inhibition (they get a heightened startle reflex and their brain cannot tone it down)
What are the characteristics of Stage V of Parkinson’s Disease?
Severe, fully developed disease is present; the person often is cachectic, restricted to bed or wheelchair unless aided
Which drug causes the highest activity of dopamine release in the nucleus accumbens?
Amphetamines, by far, so it causes the greatest amount of neurotixicity. 1000 for meth and 350 for cocaine.
How do opioid narcotics cause dopamine release?
They activate opioid receptors
What should you avoid if you have kidney disease?
COX-1 and COX-2 inhibitors
Benztropine
Used for Parkinson’s Disease. This is an anticholinergic medication that helps with tremors, and is effective because it counteracts the cholinergic sensitivity that arises in response to dopamine depletion. It helps dry sialorrhea from PD patients as well. It can give you confusion, blurred vision, urinary retention.
What is the definition of drug use?
Prescribed and clinically appropriate
What are the main two types of Bipolar?
- Cyclothymia (minor bipolar, not treated with meds) 2. Major Manic/Depressive (-When they are manic, they have episodes of grandiosity that might not be realistic -During manic episodes they can’t sleep, they are unrealistic, divorce is common-They get lost for days -They look schizophrenic)
What is the mechanism behind excitatory amino acids triggering CNS degenerative diseases?
-Glutamate….NMDA/non-NMDA receptors. These are Ionotropic receptors -Too much Ca2+ in cell messes up everything and can kill cells.
What are the main two types of sensory nerve fibers than transmit pain?
A delta and C fibers. They carry nociceptive transmission to the spinal cord.
How much does “pain” cost the US each year?
Around $635 billion
How do you treat a severe acute anxiety-panic attack?
Treat them with an SSRI, like Paxil or anti-depressants that have mixed effects, like Venlafaxin.
What is the primary function of NSAIDS?
They inhibit synthesis of prostaglandins that are involved in sensitizing the nociceptor nerve ending.
What percentage of smokers want and try to quit? What percentage of long-term smokers began before 18 years old?
75% and 92%
What is the six-step addiction cycle for prescription drugs?
- Relieve medical condition 2. Causes reinforcing effects (increased dopamine in brain) 3. Induces physical dependence 4. Often there is a tolerance and withdrawal issue 5. Patients often have substance abuse risk before treatment (mental risk/pre-existing problem) 6. Patient uses various strategies to maintain drug supply
What is the role of placebos and pain?
They may have an endogenous analgesia effect, most likely caused by release of endorphins, and there might be a connection with acupuncture.
In regards to the MSE, what is mood?
Types and extreme
What are the characteristics of Stage IV of Parkinson’s Disease?
Advanced Disease - Both sides of the body are affected, and there is disabling instability while standing or walking; the person in this stage requires substantial help and cannot live alone
What is the key locus in the endogenous pain suppressant neural system? And what are the primary opioid mediators of these pain modulation systems?
Periacqueductal gray, although there are multiple stations in which modulation of pain can occur. Enkephalins.
What are the two “sedative” benzodiazepine drugs used to treat anxiety disorder?
- Diazepam 2. Alprazolam -Sedative are longer-lasting (8-12 hours), while hypnotic are shorter lasting (2-4 hours).
How does amphetamines work in regards to dopamine release?
They release dopamine from vesicles and then they pump them in reverse out of the dopamine transporter so they can be in the synaptic cleft and activate dopamine receptors.
What is the nucleus accumbens?
It is a region in the basal forebrain rostral to the preoptic area of the hypothalamus. Each cerebral hemisphere has its own nucleus accumbens. The nucleus accumbens, being one part of the reward system, plays an important role in processing rewarding stimuli, reinforcing stimuli (e.g., food and water), and those which are both rewarding and reinforcing (addictive drugs, sex, and exercise). The nucleus accumbens is selectively activated during the perception of pleasant, emotionally arousing pictures and during mental imagery of pleasant, emotional scenes.
What is the name of the plexus of nerves in the pulp called? And what two groups of fibers does it consist of?
The Plexus of Raschkow, or Sub-Odontoblastic Plexus. It consists of sensory afferents of the trigeminal nerve and sympathetic branches from the superior cervical ganglion.
What is Celebrex?
It is a COX-2 inhibitor
What are the characteristics of dynorphins?
Act on Kappa receptors. 17 amino acids long. There are A and B Dynorphins, they are inhibitory, they tend to block a lot of the typical reward functions. The kappa receptors are antagonistic to mew and delta, but they still have analgesic properties.
What are the dose requirements and characteristics of Ibuprofen-type NSAIDs?
COX-1 and COX-2 inhibitor Analgesia is 400 mg Anti-inflammation is 800 mg Antipyretic is 400 mg Duration is 4 hours Often a little better pain relief than aspirin -Causes GI ulcers, anti-clotting (-Only indirectly affects platelets unlike salicylic acid, but indirectly through prostaglandins), cardiovascular effects.
What drug schedule are most opioid drugs?
Schedule II. Schedule I is strongest.
Who is autism most prevalent in?
White boys. 1 in 42 boys, and 1 in 189 girls.
If you are above 85, what is the percentage of you getting Alzheimer’s?
40-50% chance
What does amphetamines do th dendrites and synaptic connections?
They alter dendrites and increase synaptic connections and the influence of an axon is dependent on how many connections are made from one cell to another so Meth makes reward become a more potent driver with these increased synaptic connections.
What is the main Butyrophenone drug?
Haloperidol
What are the two “hypnotic” benzodiazepine drugs used to treat anxiety disorder?
- Lorazepam 2. Triazolam -Sedative are longer-lasting (8-12 hours), while hypnotic are shorter lasting (2-4 hours).
What is the name of the nucleus that inputs the information to the thalamus?
Trigeminal nucleus
What are the three main anti-epileptic drugs used for Bipolar Disorder?
- Valproic Acid 2. Carbamazepine 3. Lamotrigene
What are the main three therapeutic uses for opioid narcotics?
- Analgesia (somatic and visceral) 2. Antitussive 3. Antidiarrheal
L-dopa + Carbidopa
Used for Parkinson’s Disease. L-dopa gets across blood-brain barrier much better than dopamine, and Carbidopa blocks the metabolism of L-dopa and dopamine so it can last longer. Some drugs are used in combination with carbidopa-levodopa to either inhibit dopamine breakdown by the body or to improve the effectiveness of carbidopa-levodopa. Azilect inhibits dopamine breakdown while Entacapone improves the effect of Carbidopa-levodopa by inhibiting COMT, Catecholamine Methyl Transferase, which metabolizes neurotransmitters like MAO does.
Which part of the brain integrates CNS information to make complex decisions and select appropriate behaviors, GO-NO Go system?
-Prefrontal cortex,
What is the mechanism behind free radicals triggering CNS degenerative diseases?
-Free radicals are usually not good things and the body like to keep these things controlled. -They are reactive electrons that cause a cascade of protein damage and interfere with gene expression -The two places most likely to do this are the catecholamines, especially dopamine, and the other source of free radicals is glutamate, which generates nitric oxide -e.g., catecholamines [quinones] and glutamate [NO
What is the mechanism behind protein aggregation triggering CNS degenerative diseases?
-Proteins by nature are very sticky because of negative and positive charged sides. -They are also abnormally sticky because of a protein alteration because of genetics, trauma. -These can elicit an inflammatory response, which can then compromise function, and this is all associated with Beta-amyloid (which is known with Alzheimers)
Which part of the brain is involved with being the impulsivity center, rapidly selects behaviors based on dominance, rewards, and pereceived immediate emotional needs?
Amygdala/nucleus accumbens.
What is the definition of neuropathic pain?
Pain sensations that may be continuous or periodic, but occur without activation of nociceptors by actual or potential tissue damage. Hyperalgesia and allodynia are common and dramatic here. May result form abnormal activity in nociceptive fibers that have been damaged, but after injury has healed, or from abnormal activity in central pain pathways. There is no protective function and it does not terminate with healing. Triggers can initiate. Involves continuous deep burning, aching, or periodic shock, and is characterized by 1 or more peripheral nerves caused by damage to the nerve.
What is the most potent opioid narcotic and what is it’s equipotent IM dose?
Fentanyl at 0.1 mg
What are the characteristics of Monoamine Oxidase Inhibitors?
They block the metabolizing enzyme for monoamines (serotonin, dopamine, epinephrine, NE), so they increase these neurotransmitters. Side effects include altered autonomic system activity, orthostatic hypertension, weight gain, may interact with foods that have tyra mine, people have died from eating these foods and taking an MAOI inhibitor, remember these will enhance the nervous system, so when we provide local anesthetic with epinephrine, it could cause cardiovascular problems
Is the D1 or D2 receptor more involved with pleasure?
-D2 receptor is more involved with the pleasure than D1, and if you activate these too much, it could start to look like Schizophrenia (to treat Schizophrenia you use a D2 antagonist)
What is the group of people must susceptible to multiple sclerosis? More males or females?
Scandinavians have a high incidence, Japan has low. 2:1 ratio from male to female.
What is the mechanism behind immune responses triggering CNS degenerative diseases?
-Autoimmune disorders
What is the mechanism behind ion fluxes triggering CNS degenerative diseases?
-Ca2+/Mg2+ can kill neurons and result in degenerative disorders
How dooes nicotine cause dopamine release?
It activates nicotinic receptors
What are the three main classes of opioid receptors and what are the three endogenous opioid peptides that interact with them?
Mu, Delta, and Kappa. Enkephalin, Beta-Endorphin, and Dynorphin.
What are the characteristics of Anti-epileptic agents for treating Bipolar Disorder?
These have fewer side effects, better compliance, more expensive, usually for maintenance after lithium starts, GABA/Glutamate pathways might be responsible for some of the bipolar cycling, depression and manic staging, and that is why antiepileptic agents work.
What is central sensitization?
It is when dorsal horn projection neurons become sensitized and hyper-responsive to nociceptive input, which contributes to hyperalgesia, and to touch input, which contributes to allodynia. Prostaglandins released from neurons and/or glia in the dorsal horn in response to neural input and inflammatory mediators are probably involved in central sensitization as well. And NSAIDS can inhibit the synthesis of prostaglandins in the dorsal horn that participate in central sensitization, this is considered a second mechanism for the anti-nociceptive action of NSAIDS.
What are the characteristics of Stage III of Parkinson’s Disease?
Moderate Disease - Both sides of the body are affected, and there is mild imbalance when standing or walking; however, the person remains independent
What is acetaminophen’s mechanism?
It is a Non-NSAID, Non-COX 1 or 2 inhibitor—perhaps blocks a COX 3 and/or works on 5HT. It is non-anti-inflammatory, has good anti-pyretic and some good analgesia. So does not help with inflammation, but can help with pain caused by inflammation.
In regards to the MSE, what is cognitive function, and what are the means of assessing?
It is information processes, decision-making, planning and implementing. The assessment takes place with orientation (-Relate to environment, do you know who you are, question after concussion), concentration (-Can they focus -Can they stay on task), memory (-Short, intermediate, long-term memory? The first one to dissapear for Alzheimer’s is short), fund of knowledge (-Do you have a wealth of knowledge, well-informed, read the newspaper), abstraction (-Going obvious to subtle -Taking basic instruction, extrapolate to real-life case), judgment (-Appropriate reactions to situations like someone telling you your zipper is down), and insight (-Subtle-Intuitive-Schizophrenics are horrible at reading facial expressions)
In what two areas do opioid analgesics primarily act on?
The Periacqueductal Gray (PAG) and the Dorsal Horn.
How can you get analgesic effects in the dorsal horn of the spinal cord?
Any influence that reduces the release of glutamate and substance P from the primary afferent are analgesic.
What does Bupropion treat, and what are its characteristics?
It is used to treat anxiety disorders, and it is a non-sedating sedative, not a depressant, but still has anxiolytic activity. We use it for everyday stress and anxiety. Usually for short-term use. Not very addicting, can interact with MAO inhibitors or anti-seizure medicines.
What is the first-line drug treatment (3 of them, and they are all FDA approved) to manage neuropathic pain like Trigeminal neuralgia?
- Gabapentin (antiseizure 2. Duloxetine (antidepressant) 3. Nortriptyline (antidepressant)
What are the characteristics of Barbiturates?
They enhance GABA, has short-acting for anesthesia induction, and long-term for seizures. This one is a major depressor of respiration and tolerance (careful with the airway). Not frequently used, narrow margin of safety, major interactions with liver.
What happens to post-synaptic D2 receptors after long-time drug addictions?
The ability to experience rewards is damage, the receptors are not as receptive or plentiful because the body is trying to get rid of them because of the increased synapses that have been taking place bcause of the drug addiction. If their D2 receptors are not receptive, they are not getting the same high from something that we might be getting high from.
