Sedation, Epilepsy, Memory (oh my) Flashcards
(226 cards)
1
Q
In classical conditioning, what is a conditioned stimulus?
A
a stimulus that used to be neutral that now provokes a conditioned response after being linked to an unconditioned stimulus
ex. a whistle that is consistently blown while giving a dog food will eventually make the dog drool on its own even without food present
2
Q
What drug binds at omega receptors on GABA?
A
benzodiazepines (between gamma and alpha subunits)
3
Q
What benzodiazepine is used for refractory status epilepticus?
A
midazolam (IV infusion)
4
Q
What are some connections to the limbic system?
A
limbic lobe, olfactory system, amygdaloid connections
5
Q
What is eszopiclone used for?
A
sleep maintenance insomnia
6
Q
What seizure disorder can phenobarbital be used for?
A
refractory status epilepticus (IV infusion)
7
Q
What is the pathway of the paralimbic cortex?
A
cingulate gyrus –> paraolfactory gyrus –> orbitofrontal cortex –> insula –> uncus –> parahippocampal gyrus –> cingulate gyrus
8
Q
What is a “hypnotic” agent?
A
an agent that causes drowsiness and sleep
9
Q
What is the main difference between mild and major neurocognitive disorder?
A
modest impairment (not significant)
does not interfere with daily life
10
Q
What are the downsides of phenytoin?
A
non-linear pharmacokinetics with high protein binding (hard to predict doses)
side effects: sedation, imbalance, diplopia, dizziness, gum hyperplasia, hirsuitism
more serious effects: hepatotoxicity, bone marrow suppression, rash
11
Q
Which anti-convulsants can also be used for neuropathic pain?
A
gabapentin, carbamazepine, pregabalin
12
Q
What is the concept of “extinction” in memory?
A
loss of responses to stimuli over time (ex. loss of stimuli conditioning)
failure of extinction may cause PTSD
13
Q
What is dementia?
A
a generic term for a progressive decline of mental status to the point of interference with daily activities
14
Q
What are the clinical features of mesial temporal lobe epilepsy?
A
seizures begin in childhood/adolescence
often a predisposing “hit” in the medical history (ex. trauma, infection)
often starts with generalized tonic-clonic seizures followed by typical focal seizures
associated with characteristic auras
usually requires surgery
15
Q
What is a myoclonus?
A
brief, lightening-like single jerk of a muscle or muscle group
16
Q
What is the difference between childhood absence epilepsy and juvenile absence epilepsy?
A
juvenile has a later onset (around puberty) and does not always go away (unlike the childhood form)
17
Q
What is the definition of epilepsy?
A
A set of disease states characterized by a predisposition to unprevoked seizures
18
Q
What is the metabolism of suvorexant?
A
CYP3A4 followed by glucuronidation
19
Q
What is the mechanism of valproate?
A
acts on T-type Ca2+ channels and may also act on Na+ channels and increase GABA levels
20
Q
Which anti-convulsants can also be used for migraines?
A
valproate, topiramate, zonisamide
21
Q
What is positive reinforcement?
A
providing a reward to increase behavior
ex. pushing a lever to get a treat
22
Q
In classical conditioning, what is a conditioned response?
A
a response to a conditioned stimulus
ex. salivation by a dog in response to a whistle that has been linked to presentation of food
23
Q
When is epilepsy onset most common?
A
in childhood or in old age (bimodal peaks)
24
Q
What are the appropriate pharmacological treatments for alcohol withdrawal?
A
benzodiazepines (diazepam, lorazepam,and oxazepam)
25
What is zonisamide?
a drug that acts on Na+ channels, Ca2+ channels, and carbonic anhydrase inhibition
used for all seizure types
26
What symptoms are associated with Wernicke-Korsakoff syndrome?
Wernicke symptoms: ataxia, eye movement abnormalities, confusional states
Korsakoff symptoms: longer term; anterograde *and* retrograde amnesia; poor judgment, initiative, impulse control, and sequencing tasks
*can cause "spurious answers" to questions*
27
What is C?
orbital frontal gyri + insula (not visible)
28
What are the side effects of topiramate?
kidney stones (most common)
paresthesias, sedation, cognitive impairment
29
What is the metabolism of the long acting \_\_\_azepams?
phase 1 metabolism by CYP2C19 and CYP3A4 to active intermediates that are hydroxylated (LOTs) and then glucuronidated
30
What are the side effects of valproate?
GI upset, sedation, cognitive impairment
hepatic failure, thrombocytopenia, and pancreatitis
highly teratogenic
31
What is a "sedative"?
a drug that reduces the excitatory responsiveness to external stimuli and produces a calming effect
32
What is a forgetting curve?
A curve that represents the fact that information loss is time dependent
## Footnote
*loss decreased by sleep and reviewing*
33
Which type of dementia is associated with inability to look down voluntarily?
progressive supranuclear palsy
34
What is the difference in dose of drug vs. biological effect for benzodiazepines compared to barbituates or propofol?
benzodiazepines general saturate at low anaesthetic levels (they function by increasing opening rate of chloride channels, which is self-limiting)
barbituates and propofol continue sedating to the point of coma or death at high doses (they function by increasing the opening duration of chloride channels, which is not self-limiting)
35
Which benzodiazepines are used for sedation and anaesthesia during medical procedures?
midazolam, diazepam
36
Which type of epilepsy is associated with generalized tonic-clonic seizures that only occur at night and resolve after puberty?
benign rolandic epilepsy
37
What is tigabine? What is it used for?
selective GABA reuptake inhibitor
used for partial seizures (but not often)
38
What are the main functions of the limbic system? What structures are associated with each function?
HOME
**H**omeostatic functions (including autonomic and neuroendocrine control) - hypothalamus
**O**lfaction - olfactory cortex
**M**emory - hippocampal formation
**E**motions and drives - amygdala
39
What is the clinical presentation of frontal lobe epilepsy?
seizures most often at night
usually not associated with arua or post-ictal confusion
involves bizarre and complex automatisms
40
What are the steps of the papez circuit?
parahippocampal gyrus (entorhinal cortex) --\> hippocampus (subiculum) --\> fornix mamillary bodies --\> anterior thalamic nuclei --\> cingulate gyrus --\> back to the parahippocampal gyrus
## Footnote
*info from the cortex enters this circuit through the perforate pathway and parahippocampal gyrus*
41
What is the cause of absence seizures?
abnormal cortico-thalamic interactions with the reticular nucleus of the thalamus acting as the pacemaker for cortical neurons and thalamic relay neurons
42
What are the spatial patterns of memory consolidation?
starts in the hippocampus, spreads out and gets incorporated into the cortex
43
When is a seizure automatically a medical emergency?
when it lasts a long time and becomes status epilepticus
44
What is levetiracetam?
unknown mechanism anti-convulsant
minimalside effect profile, minimal drug interactions
45
What is the clinical presentation and gross pathology of progressive non-fluent aphasia?
clinical presentation: deficits in expressive language, agrammatisms, apraxia of speech
gross pathology: atrophy of interior frontal and insular cortex, associated with both FTD-tau and FTD-TDP
46
What is A?
cingulate gyrus
47
What is working memory?
memory that involves retention of information for brief periods of time that is limited in time and capacity
48
What condition is associated with temporal lobe epilepsy?
mesial temporal sclerosis
49
What non-benzodiazepine and non-ZAZOLES agents are used to treat insomnia?
barbituates, scopolamine (antimuscarinics), diphenhydramine (antihistamines), ethanol
50
What is the function of the dentate gyrus?
thin cortex that acts as the input station for hippocampal information (from the cortex)
## Footnote
*cortex --\> entorhinal cortex --\> dentate gyrus (via perforant pathways) --\> hippocampus*
51
What are the two general pathways from the cortex to the hippocampus?
alvear pathway (via alveus) and perforant pathway (via dentate)
52
What are the treatments for frontotemporal lobar degeneration?
SSRIs, non-pharmacological interventions (reward based therapy, speech therapy, PT)
53
What is E?
parahippocampal gyrus
54
What is the treatment for mesial temporal lobe epilepsy?
usually requires surgery (anteromesial temporal lobectomy)
55
What is the utility of topiramate?
all seizure types (except absence seizures)
migraines, pain, and essential tremor
56
What benzodiazepines are used to treat muscle spasms?
diazepam and clonazepam
57
What is the clinical presentation and gross pathology of semantic dementia?
clinical presentation: lack of understanding or knowledge of words, objects, faces, and other items; can also have verbal deficits or trouble recognizing faces and behavioral changes
gross pathology: bilateral, frequently asymmetric atrophy of the temporal neocortex, associated with FTD-TDP
58
What sleep pattern changes are associated with insomnia?
longer latency period before sleep, multiple awakenings throughout the night, decreased total sleep tie, reduced slow wave sleep
59
What are the main side effects of vigabatrin?
visual field loss (but maybe not as bad as reported)
headaches, dizziness, depression, etc.
can also cause psychosis or other psychiatric disorders
60
What benzodiazepines are used for acute seizures?
lorazepam, diazepam
61
What is the clinical presentation of corticobasal syndrome?
clinical presentation: asymmetric motor signs and cortical signs
## Footnote
*usually associated with FTD-Tau and with FTD-TDP*
62
What are the components of the hippocampal formation?
dentate gyrus, hippocampus, subiculum
63
What is the effect of MT2 agonists?
used to treat non-24 hour sleep-wake disorder in patients that are blind
## Footnote
*ex. tasimelteon*
64
What is F?
fornix
65
Which anti-convulsants can also be used for bipolar disorder?
lamotrogine, valproate
66
What is the structure of the hippocampus?
A structure along the floor of the inferior horn of the lateral ventricle - becomes continuous with the fornix below the splenium of the corpus callosum
67
What are the side effects of lamotrigine?
headache, insomnia, and rash (stevens-johnson syndrome)
68
What is the effect of GABA antagonists? What are examples of competitive, non-competitive, and uncompetitive inhibitors of GABA-A?
they are convulsants
competitive: bicuculline (binds at GABA site)
non-competitive: picrotoxin (binds at the channel region of all subunits)
uncompetitive: penicillin (blocks open channel)
69
How are ZAZOLES metabolized?
With CYP3A4
70
What are the core features of lewy body disease?
1) fluctuations in attention and alertness
2) motor changes of Parkinsonism
3) recurrent visual hallucinations
* must have at least 2/3*
71
What types of seizures is carbamazepine used for?
partial and generalized tonic-clonic seizures
## Footnote
***can make absence, atonic, and myoclonic seizures worse***
72
What is the effect of HSV1 on the limbic cortex?
HSV1 has a tropism for the limbic cortex and can cause encephalitis of the limbic areas
leads to profound anterograde amnesia
73
What is the main indication for clobazam?
to treat drop attacks in children
74
Which type of dementia is associated with asymmetric vision, balance, speech, and swallowing problems?
corticobasal degeneration
75
What are the side effects of barbituates?
sedation, respiratory depression, cognitive impairment, hepatotoxicity, allergic rashes
76
What is the mechanism of eslicarbazepine?
potent inhibition of sodium channel activity
77
What is zaleplon used for?
good for sleep onset insomnia
78
What anti-convulsants are selective CYP3A inducers?
felbamate, topiramate, oxcarbazepine
79
What is the metabolism of \_\_\_azolam drugs?
metabolized by CYP3A4 before glucuronidation
80
What are the clinical features of lennox-gastaut syndrome?
mental retardation (usually severe)
multiple seizure types (GTC, myoclonic, atypical absence, atonic, focal)
seizures are not controllable
81
What is the effect of MT1 agonists?
reduce sleep latency (but do not alter the number of times waking up) in patients with insomnia
## Footnote
*ex. ramelteon*
82
What is positive punishment?
utilizing an aversive stimulus to decrease behavior
ex. shock delivered every time lever is pressed
83
What types of auras are associated with mesial temporal lobe epilepsy?
aura caused by limbic system malfunction
rising epigastric sensation (insular cortex)
deja vu (temporal neocortex)
olfactory hallucination (uncus)
sudden emotion (amygdala)
perceptual distortions (temporo-parieto-occipital association areas)
autonomic symptoms (insular cortex)
84
Where is the insula/insular cortex?
underneath the frontal lobe laterally
85
Where do benzodiazepines bind on the GABA-A receptor?
at the junction of the alpha and gamma subunits
86
What is the general mechanism of benzodiazepines?
allosteric modulation of the GABA-A receptor, which leads to increased fequency of Cl- channel opening and membrane hyperpolarization
87
What is zolpidem used for?
normalizes sleep without producing drowsiness
used for sleep onset insomnia and in patients who awaken frequently during the night
88
What structures are linked to explicit/episodic memories?
hippocampus and limbic system
89
What are the clinical features of neocortical epilepsy?
seizures that have a focal onset anywhere in the cortex (except mesial temporal lobe)
can have auras or can spread quickly and become generalized tonic-clonic seizures
90
What conditions can make benzodiazepines dangerous?
if patients have obstructive sleep apnea or COPD
when used in combination with opioids or ethanol
91
What are the criteria of major neurocognitive disorder?
1) evidence of significant cognitive decline
2) cognitive deficits interfere with daily activities
3) cognitive deficits do not occur specifically within the context of delirium
4) cognitive deficits are not better explained by another mental disorder
92
Which seizure syndrome is associated with mental retardation and uncontrollable seizures?
lennox-gastaut syndrome
93
What are the downsides of gabapentin?
only mildly effective for partial seizures
limited absorption (GI)
mild sedation, weight gain side effects
renal-only elimination
94
What is the difference between the neocortex, mesocortex, and archicortex?
archicortex = oldest cortex; 3 layers; hippocampus and dentate gyrus
mesocortex = 3-5 layers; parahippocampal gyrus, cingulate gyrus, subcallosal gyrus
neocortex = newest cortex; 5+ layers; primary motor cortex, primary sensory cortex, association cortex
95
What is the cause of juvenile myoclinc epilepsy and childhood absence epilepsy?
genetic - mutations found in GABA receptor, chloride channel, and calcium channel
96
What is 1?
uncus
97
What networks are responsible for encoding memories?
frontal networks
98
What is C?
mammillary body
99
What are the clinical uses of benzodiazepines?
to treat anxiety and insomnia, to produce sedation and amnesia for medical procedures, as anticonvulsants, and to treat muscle spasms and ethanol withdrawal
100
What are the clinical features of juvenile myoclonic epilepsy?
onset age 12-18
always occur upon awakening in AM
myoclonic seizures can culminate in a generalized tonic-clonic seizure
probably lifelong, but responds well to appropriate meds
101
What is A?
anterior thalamic nucleus
102
Which benzodiazepines are best to use in elderly patients and why?
lorazepam, oxazepam, temazepam
all three are intermediate-acting benzodiazepines that do not require CYPs for inactivation and do not have active intermediates
*older patients have reduced CYP function with age*
103
What are the consequences of chronic epilepsy?
self-injury
memory impairment
more seizures
psychiatric conditions
psychosocial maladjustment
discrimination
(rarely) sudden death
104
What side effects are associated with tigabine?
sedation, cognitive impairment, depression
105
Where is the entorhinal cortex?
anterior portion of parahippocampal cortex
106
In classical conditioning, what is an unconditioned response?
a reflexive response to an unconditioned stimulus
## Footnote
*ex. when a dog drools after being presented with food*
107
What are the components of neurofibrillary tangles?
hyperphosphorylated form of the tau protein
108
Where specifically do mesial temporal lobe epilepsy seizures originate?
hippocampus and/or amygdala
109
What is the general anatomical cause of dementia?
progressive disruption or damage to various brain circuits
110
What is the difference between seizures and epilepsy?
seizures are a symptom (can be caused by epilepsy or another trigger)
epilepsy is a disorder that involves seizures
111
What is the post-ictal period?
a period of confusion or lethargy that can follow seizures
112
What gross pathology and brain scan changes are associated with behavioral variant frontotemporal dementia?
relatively symmetric bilateral atrophy of the frontal and temporal lobes
113
What are the side effects of ZAZOLES?
sleep-related eating, driving, and amnesia
114
Which anti-convulsant is associated with Steven-Johnson Syndrome?
lamotrigine
115
What is the most common target for depressant drugs?
GABA-A receptor
116
What is a generalized tonic-clonic seizure?
also called a grand mal seizure
characterized by initial stiffening followed by back-and-forth shaking
*can also be just tonic (stiffening) or just clonic (shaking)*
117
What was learned from the case of H.M.?
formation of new memories involves structures in the mesial temporal lobes
118
What are some structural and metabolic causes of epilepsy?
hippocampal sclerosis
neoplasms
vascular malformations
cortical malformations
traumatic brain injury
ischemic stroke/hemorrhage
anoxic injury
tuberous sclerosis
cysticercosis
119
What is status epilepticus?
a state of continual seizure activity
120
What is the function of the papez circuit?
ties the cerebral cortex to the hypothalamus, provides an anatomic substrate for the convergence of cognitive activities, emotional experiences, expressions
121
What is the mechanism of carbamazepine and oxcarbazepine?
it blocks voltage-sensitive Na+ channels (like phenytoin)
122
What aspects of insomnia are remedied by benzodiazepines?
shorter latency, increased overall sleep duration (via increased duration of stage 1 and 2 sleep)
does NOT improve deep sleep (slow wave and REM) - makes it worse
123
What are three important examples of drugs that may exacerbate epileptic seizures?
tramadol, venflaxine (antidepression), and bupropion
124
What is the main pathway of the arousal circuitry?
light --\> retina --\> suprachiasmatic nucleus --\> subparaventricular zone --\> dorsomedial hypothalamic nucleus --\> inhibition of the VLPO (sleep switch) and stimulation of orexin neurons (leads to release of arousal amines)
125
What is an example of a benzodiazepine antagonist?
flumazenil
126
What benzodiazepines are used to treat anxiety or aggression?
diazepam (and most of the \_\_\_azepams)
## Footnote
*targets the limbic system*
127
What networks are responsible for retention of memories?
limbic memory networks
128
What are the treatments for Alzheimer's disease?
cholinesterase inhibitors (increases cerebral acetylcholine levels) and memantine (blocks overexcited NMDA glutamate receptors)
129
What is the function of the "ZAZOLES" drugs? Where do they bind?
a group of drugs that produce hypnosis (and normalize sleep architecture) but not anxiolytic effects or muscle relaxation
they bind at the junction of alpha1 and gamma subunits on the GABA-A receptor
130
What is the clinical presentation of behavioral variant frontotemporal dementia?
presents with significant changes in personality and behavior including deficits in attention, loss of personal and social awareness, disinhibition, hyperorality, stereotyped/compulsive behaviors, apathy, and abulia
131
What are the steps of the perforant pathway?
information goes from the cortex to the dentate --\> mossy fibers goto the CA3 area of the hippocampus --\> fibers bend above the thalamus and project to the fornix --\> axons of the fornix terminate in the mammillary body of the hypothalamus or the septal area and and anterior thalamus
132
What structures are linked to working memory?
front-parietal cortices
133
What are the benefits and downsides of variable schedule reinforcement?
more reliable response rates and resistant to extinction
slower time to conditioning
134
A 32-year-old female is diagnosed with panic disorder and agoraphobia. A drug is prescribed that acts as an agonist at both omega1 and omega2 benzodiazepine binding sites on GABA-A receptors possessing both alpha1 and alpha2 subunits. Which one of the following agents was prescribed?
a) flumazenil
b) alprazolam
c) zolpidem
d) zaleplon
e) ramelteon
b) alprazolam
135
What networks are responsible for retrieval of memories?
frontal networks
136
What is D?
uncus
137
What imaging findings are associated with Wernicke-Korsakoff syndrome?
markedly increased signal intensity in the periaqueductal gray matter, mammillary bodies, and dorsomedial thalami
138
Which type of dementia is associated with muscle weakness, shrinkage, and jerking?
FTD-MND
139
How are all benzodiazepines inactivated?
glucuronidation
140
What is negative punishment?
removal of a positive stimulus to decrease a behavior
## Footnote
*ex. pushing a lever means food is not dispensed*
141
What is Todd's paresis/paralysis?
a focal weakness in part of the body after a seizure
142
What are the three categories of focal seizures?
- focal seizure without impairment of consciousness/awareness
- focal seizure with impairment of consciousness/awareness
- focal seizure evolving into a bilateral, convulsive seizure
143
What are the unwanted pharmacological effects of benzodiazepines?
anterograde amnesia, breakthrough panic attacks, tolerance (after months), withdrawal symptoms
144
What is the effect of penicillin on GABA?
at high doses (or in people with reduced renal function), it acts as an uncompetive inhibitor of the GABA-A receptor (only works when it is opened by GABA)
145
What is the clinical presentation of childhood absence epilepsy?
onset between ages 4-8
may be provoked by hyperventilation and occur dozens of times per day
normal intellectual function
responds easily to medicines
resolves by puberty
*can rarely also have some generalized tonic-clonic seizures*
146
What is 2?
amygdala
147
Where does GABA bind on the GABA-A receptor?
binds at the junction of the alpha and beta subunits
148
What is G?
cingulate gyrus
149
Which type of GABA receptor targeting sedative require GABA to be present at all doses?
benzodiazepines
150
What are the routine tests for determining diagnosis and treatability of dementia?
history and physical exam (with mental status exam)
brain imaging
laborator tests (including TSH, vitamin B12, electrolytes, and CBC)
neuropsychological testing
151
What is the proposed mechanism of gabapentin?
increases GABA concentration at the synapse, possibly byreversing the direction of the GABA pump on neurons
152
What sectors of the hippocampal formation are most susceptible to ischemia?
Sommer sector (CA1 and 2)
153
What is variable interval reinforcement?
unpredictable reinforcement schedule based on an average time-period
154
What two diseases are associated with damage to the papez circuit generally?
Alzheimer's disease
transient global amnesia
155
What are the five major neurocognitive networks?
spatial attention (right)
face and object recognition (bilateral)
working memory/executive/comportment (bilateral)
memory/emotion (bilateral)
language (left)
156
Which benzodiazepines are used as anticonvulsants?
diazepam, lorazepam, or clonazepam
157
What is the mechanism of topiramate?
1) phenytoin-like effects on Na+ channels
2) inhibitionof voltage-sensitive Ca2+ channels
3) benzodiazepine-like effects on GABA-induced Cl- currents
4) inhibition of AMPA/kainate type glutamate receptors
5) inhibition of carbonic anhydrase
158
What is autoimmune limbic encephalitis?
inflammatory process that is localized to structures of the limbic system
produces cognitive impairment along with disordered perception, mood changes, and sleep disturbances (HOME-related symptoms)
seizures
may be paraneoplastic
159
What benzodiazepines are used for treating ethanol withdrawal?
lorazepam and oxazepam - will not accumulate in patients with liver dizease or the elderly
160
What is B?
paraolfactory gyrus (paraterminal gyrus on top of subcallosal gyrus)
161
What are the benefits and downsides of fixed schedule reinforcement?
faster response rate/conditioning
variable response rates (may decrease immediately after getting reinforcement)
162
What are the side effects of benzodiazepines?
sedation and respiratory depression (especially if combined with other sedatives/depressants)
163
What is D?
entorhinal cortex
164
What are automatisms? What type of epilepsy are they most associated with?
repetitive quasi-purposeful movements (ex. lip-smacking, swallowing, fumbling, etc)
associated with mesial temporal lobe epilepsy
165
What are risk factors for vascular dementia?
age
also: hypertension, cigarette smoking, MI, AFib, diabetes mellitus, hypercholesterolemia, hyperhomocysteinemia
166
What are the adverse effects of ramelteon?
metabolized by CYP1A2 (can have adverse effects if people have altered CYP1A2 function)
dizziness, fatigue, endocrine disorders
167
A 28-year-old actor was found unconscious in his hotel room from a multiple drug overdose. The drugs included alprazolam, diazepam, and temazepam, two opioids, and a sedative antihistamine. With respect to the benzodiazepines, which one of the following is a long-acting active metabolite that is the most likely to have contributed to prolonged respiratory depression seen with this multiple drug overdose?
a) the glucuronide derivative of temazepam
b) the hydroxylated derivative of alprazolam
c) the product of oxidative dealkylation of diazepam (nordazepam)
d) the glucuronide derivative of oxazepam
c) the product of oxidative dealkylation of diazepam (nordazepam)
168
What is the difference between unimodal and multimodal association areas?
unimodal = processing of one type of information
multimodal = integration of multiple types of information
169
In classical conditioning, what is a neutral stimulus?
a stimulus that does not evoke any response
## Footnote
*ex. blowing a whistle at a dog (no food present)*
170
What is seizure semiology?
signs and symptoms of epileptic seizrues
171
What are the indications for gabapentin?
partial seizures (mildly effective)
neuropathic pain (more common use)
172
What anti-convulsants are hepatic enzyme inhibitors?
valproate (UDP glucuronosyltransferase, CYP2C19)
topiramate and oxcarbazepine (CYP2C19)
felbamate (CYP2C19)
173
What is the difference between MT1 and MT2 receptors?
MT1 receptors - mediate sleepiness
MT2 receptors - alter phase shift of the circadian rhythm
174
What is E?
subiculum
175
What limbic system changes are associated with Alzheimer's disease?
degeneration of parts of the papez circuit
176
What is the mechanism of ethosuximide? What is it used for?
blocks T-type Ca2+ channels in a voltage-dependent manner
used to treat absence seizures
177
What structures are linked to implicit/priming/procedural memory?
basal ganglia and cerebellum
178
Which epilepsy syndromes are associated with generalized 3Hz spike and wave patterns on EEG?
absence epilepsy (childhood or juvenile)
179
What are the four categories of seizure semiology?
subjective sensory or autonomic symptoms (aura)
objective motor symptoms
autonomic effects
cognitive effects
180
What is the difference betweencarbamazepine and oxcarbazepine?
oxcarbazepine is better tolerated, does not induce hepatic enzymes as much, and does not cause hepatic toxicity
181
How is vascular dementia diagnosed?
must have the clinical presence of dementia and a temporal relationship between the occurence of stroke and dementia
182
What is fixed interval reinforcement?
reinforcement delivered after a set time-period
## Footnote
*ex. a paycheck delivered every 2 weeks*
183
What is B?
mammillothalamic tract
184
What is the definition of an epileptic seizure?
clinical manifestation of epilepsy that is presumed to result from abnormal or excessive discharge of a set of neurons in the brain
it is characterized by a sudden, rhythmic change in cortical electrical activity and is accompanied by a change in behavior (either outwardly or subjectively)
185
What is negative reinforcement?
remove an averse stimulus to increase a behavior
ex. pushing a lever makes the shock generator stop shocking you
186
What are the intermediate acting benzodiazepines?
LOT
**L**orazepam
**O**xazepam
**T**emazepam
187
What is the clinical presentation of progressive supranuclear palsy?
starts with falls, changes in executive functions and subtle changes in personality
also can be associated with progressive oculomotr dysfunction
associated with FTD-Tau
188
What types of memory are limbic-dependent vs. limbic-independent?
limbic-dependent: explicit memory (episodic or semantic)
limbic-independent: previously consolidated explicit memories, implicit memory (priming, skills/habits, conditioning)
189
What is the clinical presentation and gross pathology associated with logopenic progressive aphasia?
clinical presentation: slow speech, anomia, impaired repetition
gross pathology: atrophy of the left posterior temporal cortex and inferior parietal lobule, associated with FTD-TDP and AD
190
What aspects of insomnia are remedied by ZAZOLES?
they restore normal sleep patterns (decreased latency and awakenings, increased duration, and improved deep sleep)
191
What is the function of the GABA-A receptor?
it is a chloride ion channel that, when activated, causes membrane hyperpolarization and impairs membrane excitation
192
What is the characteristic EEG pattern associated with childhood absence epilepsy?
generalized (all leads) 3Hz spike and wave pattern
193
Where are the most likely locations of neocortical epilepsy?
temporal neocortex and frontal lobe
## Footnote
*parietal and occipital lobe less common*
194
What is the mechanism of lamotrigine?
a Na+ channel blocker that enhances the slow inactivated state of the channel
also inhibits glutamate release and acts on calcium channels
195
What would be a likely effect of mesial temporal lobe damage?
anterograde amnesia (bilateral hippocampal damage)
196
Which anti-convulsant is associated with kidney stones?
zonisamide
197
What benzodiazpines can be used to treat insomnia?
flurazepam, temazepam,clonazepam
## Footnote
*they are targeted to the "sleep switch" in the hypothalamus*
198
What is fixed ratio reinforcement?
reinforcement that occurs after a set number of correct responses
## Footnote
*ex. getting $1 for every $10 in sales*
199
What are these? What disease are they associated with?
amyloid plaques (left) and Tau protein tangles (right)
cause of Alzheimer's disease
200
What is continuous reinforcement?
reinforcement that is provided with every correct action
201
What is the most common neurodegenerative cause of dementia?
Alzheimer's disease
202
What is the cause of Wernicke-Korsakoff syndrome?
thiamine/B1 deficiency, most common in alcoholics or with bilateral necrosis of mammillary bodies (or of medial diencephalic or other periventricular nuclei)
203
What are the components of the limbic lobe?
parahippocampal gyrus, cingulate gyrus, subcallosal gyri
204
What is variable ratio reinforcement?
unpredictable reinforcement schedule based on an average ratio of correct responses
## Footnote
*ex. slot machines*
205
What is the effect of bilateral damage to the hippocampus?
loss of ability to establish new memories (anterograde amnesia) and loss of spatial memory
206
What is the function of orexin receptors? Orexin antagonists?
receptors: mediate wakefulness
antagonists: inactivates wakefulness to treat insomnia
207
A well-established sleep center at a major research university just received funding from the NIH to perform a comprehensive re-evaluation of the effects of selected pharmacological agents on the stages of sleep in patients with insomnia. Which one of the following results is the most likely to emerge from these studies?
a) ramelteon decreases sleep latency and decreases number of awakenings
b) scopolamine does not alter sleep latency but decreases the number of awakenings
c) diphenhydramine decreases sleep latency but does not change the number of awakenings
d) flurazepam decreases sleep latency, decreases the number of awakenings and increases both slow wave and REM sleep
e) eszopiclone decreases sleep latency, decreases the number of awakenings and can normalize REM and slow wave sleep architecture
e) eszopiclone decreases sleep latency, decreases the number of awakenings and can normalize REM and slow wave sleep architecture
208
What is an absence seizure?
"petit mal" seizure
characterized by an abrupt loss of awareness that lasts only seconds, sometimes associated with eye fluttering or automatisms
209
Which anti-convulsants are broad spectrum hepatic inducers?
carbamazepine, phenytoin, phenobarbital/primidone
## Footnote
*inducers = increase clearance and decrease steady-state concentrations of other drugs*
210
What is 3?
hippocampus
211
What is the spinal fluid protein profile associated with Alzheimer's disease?
low amyloid, high P-Tau
212
What is atonia?
a "drop attack" characterized by brief loss of muscle tone (can have devastating consequences)
213
In classical conditioning, what is an unconditioned stimulus?
a stimulus that produces a reflexive response
## Footnote
*ex. food produces a reflexive drooling response in dogs*
214
The emergency room attending physician wishes to reverse the respiratory depressant effects of the multiple benzodiazepines and their active metabolites in the overdose described in question 2. Which one of the followingagents should be employed?
a) suvorexant
b) flumazenil
c) flunitrazepam
d) esopliclone
b) flumazenil
215
What gene is associated with increased risk for alzheimer's disease?
E4 allele of apolipoprotein E
216
What is the mechanism of vigabatrin?
inhibits the catabolism of GABA by irreversibly inhibiting GABA transaminase
217
What is the most disruptive side effect of levetiracetam?
irritability and psychological effects
218
What are the two pathological hallmarks of Alzheimer's disease?
beta-amyloid plaques (between neurons) and neurofibrillary tangles (within neurons)
219
What is lacosamide? What are the side effects?
sodium channel-active agent that extends the slow-depolarization phase of sodium channel closure
side effects: significant ataxia
220
What are the side effects of carbamazepine?
hepatotoxicity, bone marrow suppression, and rash
hyponatremia
decreases in WBC count
major hepatic inducer
221
What are the long acting benzodiazepines?
diazepam, flurazepam
222
What benzodiazepines are useful for panic attacks?
alprazolam or clonazepam - provides immediate relief
## Footnote
*acts on limbic system*
223
What are the clinical features of benign rolandic epilepsy?
onset age 5-9
generalized tonic-clonic seizures occuring only at night
normal cognitive function, normal MRI
seizures always resolve by puberty and do not require treatment
224
Which form of epilepsy is associated with seizures upon waking up in the morning?
juvenile myoclonic epilepsy
225
What is the mechanism of phenytoin?
it produces voltage- and frequency-dependent block of Na+ channels, which prevents high-frequency firing of action potentials (associated with seizures)
226
What is the duration of each of the ZAZOLES?
ZAleplon - ultrashort
ZOLpidem - short/intermediate half life
ESzopiclone - intermediate duration
