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Brain and Behavior Part 2 > Week 2/3 Lectures > Flashcards

Week 2/3 Lectures Flashcards

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1
Q

Nitrous Oxide has rapid/slow onset and offset.

A

rapid

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2
Q

T/F NO is not a potent complete anesthetic alone.

A

T

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3
Q

T/F Halogenated volatile agents can provide a complete general anesthesia at high doses.

A

T

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4
Q

Anesthetic potency

A

how much you need for desired effect

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5
Q

Anesthetic pungency

A

degree of noxious character

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6
Q

Characteristics of general anesthesia

A

hypnosis, amnesia, analgesia, immobility/akinesia, areflexia blunting of autonomic reflexes

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7
Q

Anesthetics increase/decrease metabolism and increase/decrease synchrony of brain activity

A

decrease metabolism and increase synchrony

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8
Q

VRG

A

vessel rich group (brain, liver, kidney) receive anesthetic before muscle and then fat b/c of cardiac flow

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9
Q

Inhaled anesthetic gas is eliminated by _______

A

pulmonary ventilation

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10
Q

T/F there is almost no metabolic breakdown of inhaled agents.

A

T

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11
Q

General inhaled anesthetic is most soluble in _____, somewhat soluble in____ and least soluble in ______, therefore low/high soluble drugs are ideal.

A

fat > muscle >VRG –> low solubility can be cleared fastest

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12
Q

low solubility inhaled anesthesia is less/more potent, faster/slower onset.

A

less potent, faster onset/offset

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13
Q

desfluorane is more/less soluble than isofluorane.

A

less

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14
Q

inhaled agents increase/decrease cerebral blood flow

A

increase

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15
Q

T/F inhaled agents have dose-dependent changes on EEG.

A

T

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16
Q

inhaled agents are bronchodilators/constrictors

A

dilators

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17
Q

inhaled agents increase/decrease respiratory rate and increase/decrease tidal volume.

A

increase rate and decrease volume

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18
Q

inhaled agents increase/decrease ventilatory response to low blood O2 and high blood CO2

A

decrease

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19
Q

Inhaled agents are vasodilators/constrictors

A

dilators

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20
Q

Inhaled agents increase/decrease blood pressure

A

decrease

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21
Q

T/F Inhaled agents do not affect contractile strength of heart muscle.

A

F –> impaired contractile strength

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22
Q

the _____ is the dose at which 50% of patients will not move in response to surgical incision.

A

MAC –> minimal alveolar concentration

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23
Q

T/F MAC is a physical property of the anesthetic agent.

A

F

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24
Q

MAC fraction

A

the % of anesthetic gas of total gas exchanged in lungs is measured continuously

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25
Q

MAC increases/decreases with age.

A

decreases

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26
Q

Current theory of MOA of inhaled anesthetics

A

allosteric binding to specific binding sites in cell membrane

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27
Q

Key transmitter receptor in anesthetic effect

A

GABAa

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28
Q

_____ are used for induction and maintenance of general anesthesia

A

sedatives and hypnotics

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29
Q

how drugs get to effect site

A

pharmacokinetics –> route, metabolism, elimination, distribution

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30
Q

drug effect as a result of receptor binding

A

pharmacodynamics –>agonists/antagonists/partials, genetic variability in receptors, dose response, efficacy, potency, toxicity

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31
Q

the time it takes half of administered drug to eliminate from body

A

elimination half life

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32
Q

the time it takes half of administered drug to eliminate central compartment into other compartments

A

distribution halflife

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33
Q

most well perfused compartment

A

central compartment (vs. rapidly equilibrating muscle and slowly facilitating fat)

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34
Q

effect of a drug will be terminated by ______

A

redistribution from the central compartment to rest of compartments

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35
Q

context sensitive half time

A

the longer you infuse a drug, the longer it will take to eliminate

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36
Q

drugs that are most/least fat soluble have the highest context sensitive half time

A

most

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37
Q

T/F we essentially never get to steady state with fat soluble drugs

A

T

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38
Q

Which drug? milky white alkylphenol

A

propofol –> milk of amnesia

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39
Q

contraindication for propofol

A

egg allergy

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40
Q

induction agent of choice

A

propofol

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41
Q

Redistribution half time of propafol

A

2-8 minutes –> redistribution terminates effect after single dose

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42
Q

Most propofol is _____ or ____ prior to excretion

A

glucoronidated or sulfated

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43
Q

If central compartment increases in size, propofol concentration will increase/decrease so must increase/decrease dose.

A

decrease concentration, increase dose

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44
Q

Children need higher/lower doses of propofol.

A

higher –> larger central compartments

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45
Q

Propofol MOA

A

potentiates GABA effect by binding to B subunit // also affects alpha 2 adrenoreceptors, NMDA glutamate, and glycine receptors

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46
Q

T/F Propofal reduces pain

A

F

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47
Q

Propofol is a vasodilator/constrictor

A

vasodilator –> reduced BP, decreased sympathetic tone, variable HR

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48
Q

Propofol is a bronchodilator/constrictor and causes apnea and hypopnea.

A

bronchodilator

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49
Q

Propofol increases/decreases cerebral blood flow.

A

decreases

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50
Q

T/F Propofol suppresses bursts in the brain.

A

T

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51
Q

Adverse effects of propofol

A

pain on injection, PRIS, hypertriglyceridemia and pancreatitis, decreased PMN chemotaxis

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52
Q

Propofol is indicated/contraindicated in people with hemodynamic instability

A

contraindicated

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53
Q

T/F Propofol increases dopamine concentration in nucleus accumbens.

A

T

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54
Q

Major clinical use of etomidate.

A

induction of GA –> usually in people with hemodynamic instability (critically ill, cardiac anesthesia)

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55
Q

Redistribution half life of etomidate

A

2-8 minutes

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56
Q

Etomidate is excreted in _____

A

bile and urine

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57
Q

Etomidate is metabolized by _____

A

ester hydrolysis

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58
Q

MOA of Etomidate

A

potentiates effects of GABA

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59
Q

T/F Etomidate causes adrenocortical suppression.

A

T

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60
Q

Cardiovascular effects of Etomidate

A

mild

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61
Q

Neurologic effects of Etomidate

A

burst suppression and decreased cerebral blood flow, increased seizures

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62
Q

Etomidate increases/decreases post-op nausea/vomiting

A

increases

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63
Q

Contraindication to etomidate

A

allergy + (adrenal insufficiency, septic shock, post-op nausea/vomiting history)

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64
Q

Primary clinical use of thiopental

A

induction of general anesthesia (and methohexital in electroconvulsive therapy)

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65
Q

Redistribution half life of thiopental

A

5-10 minutes

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66
Q

T/F thiopental induces the enzymes that biotransform it in the liver

A

T

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67
Q

_____ is an exception to the rule of hepatic metabolism in thiopentals

A

phenobarbital –> mostly excreted unchanged

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68
Q

Contraindication to thiopental

A

acute intermittent porphyria

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69
Q

Thiopental MOA

A

potentiates GABA by binding to barbituate site on post-synaptic receptor –> increases duration of Cl channel opening w/wo GABA

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70
Q

Physiologic effects of thiopental

A

similar to propofol except not much bronchodilation and methohexital decreases seizure threshold

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71
Q

Adverse effects of thiopental

A

garlic taste, tissue irritation/necrosis, anti-analgesic

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72
Q

Which drug? causes dissociative hypnosis

A

Ketamine (phenylcyclidine derivative)

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73
Q

T/F Ketamine can be delivered non-IV

A

T

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74
Q

Redistribution half life of ketamine

A

11-16 minutes

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75
Q

T/F ketamine has a metabolite with clinical activity

A

T –> norketamine –> analgesia maintenance

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76
Q

Ketamine MOA

A

NMDA receptor antagonist but also affects many other receptors

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77
Q

T/F Ketamine does not affect sympathetic tone.

A

T –> no change in cardiac condition

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78
Q

T/F ketamine is a potent bronchodilator

A

T // preserves respiration

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79
Q

Adverse effects of ketamine

A

salivation, lacrimation, sympathetic stimulation, increased intracranial pressure, dysphoria

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80
Q

________ reverses benzodiazepines

A

flumazenil

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81
Q

Opioids are reversed by _______ and _____

A

naloxone and naltrexone // opioids are anesthetic adjuncts that reduce how much anesthetic is needed

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82
Q

Dexmedetomidine and clonidine are _____ antagonists

A

alpha 2 adrenoreceptor antagonists –> sleepiness

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83
Q

_____ and _____ are dopamine antagonists

A

deroperidol and haloperidol –> psychosis sedation/catatonia

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84
Q

____ and _____ are antihistamines

A

diphenhydramine and chlorpheniramine

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85
Q

_____ and ____ are Z drugs

A

zaleplon and zolpidem

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86
Q

_____ and ____ are melatonin agonists

A

melatonin and ramelteon

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87
Q

Which drug? partially metabolized in extrahepatic tissue?

A

propofol

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88
Q

Which drug? contraindication of porphyria

A

thiopental

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89
Q

Which drug? adrenocortical suppression

A

etomidate

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90
Q

Which drug? no requirement of IV access

A

ketamine

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91
Q

Which drug? potent analgesic

A

ketamine

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92
Q

Which drug? sympathetic stimulation

A

ketamine

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93
Q

Which drug? used in hemodynamically unstable patients

A

etomidate

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94
Q

Which drug? contraindicated in egg allergy

A

propofol

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95
Q

Local anesthetics are weak acids/bases.

A

weakly basic –> lipophilic aromatic ring + intermediate group + hydrophilic carbon chain with amino group

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96
Q

Two classes of local anesthetics differ in their ____

A

intermediate groups: esters vs. amides

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97
Q

Local anesthetics with two i’s are amide/ester class

A

amide

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98
Q

Local anesthetics with one i are amide/ester class

A

ester

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99
Q

Racemic mixtures of local anesthetics affect _____ but do not affect ____

A

affect toxicity but do not affect ability to induce neural blockade

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100
Q

s isomer is more/less cardiotoxic than r form.

A

less

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101
Q

MOA of local anesthetics

A

cross neural membrane –> gain positive charge –>bind to internal membrane of Na channel –> block membrane permeability to Na in open and inactive states (but not closed)

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102
Q

Nerves that fire more/less frequently are more likely to be blocked by local anesthetics.

A

more frequently

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103
Q

Why does local anesthetic not work in abscesses?

A

local anesthetic binds to H+ in acidic environment, gains positive charge, and cannot cross cell membrane

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104
Q

T/F local anesthesia affects resting membrane potential

A

F –> only increases firing threshold but does not affect resting membrane potential or threshold potential

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105
Q

Local anesthetics have high/low first pass uptake in the lung

A

high

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106
Q

Local anesthetics bind to ____ in blood

A

alpha 1 glycoprotein and albumin –> less toxicity

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107
Q

Why is epinephrine delivered next to local anesthetic?

A

vasoconstrictor prolongs neural blockade by reduced absorption

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108
Q

____ phase involves redistribution to well perfused tissue

A

alpha

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109
Q

____ phase involves redistributino to less perfused tissue

A

beta

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110
Q

____ phase involves clearance representing metabolism and excretion

A

gamma

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111
Q

Metabolism of local anesthetic

A

esters hydrolyzed in plasma by pseudocholinesterase and amides in ER of hepatocytes

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112
Q

risk of toxicity is lower/higher with esters vs amides

A

lower –> hydrolyzed in plasma

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113
Q

Potency and duration are directly correlated to ______

A

lipid solubility

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114
Q

Rapidity of onset is correlated with ____

A

pKa

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115
Q

Drugs with pKa closer to body’s pH will have more in unionized/ionized form.

A

unionized –> more uptake/faster onset

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116
Q

Allergy in local anesthetics is more common with ester/amide

A

ester –> PABA

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117
Q

CNS toxicity in local anesthetic occurs before/after cardiac toxicity

A

before except bupivacaine (same time)

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118
Q

Tx of cardiac toxicity

A

lipid emulsion with intralipid

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119
Q

T/F all local anesthetics are vasodilators

A

F –> all except cocaine

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120
Q

Levobupivacaine is produced as the ___ isomer

A

s –> less cardiotoxic

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121
Q

Which local anesthetic can cause methemoglobinemia?

A

prilocaine

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122
Q

Which anesthetic is typically applied as a cream an hour before procedure?

A

EMLA

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123
Q

T/F Social attachment bonds develop from the activation of a biologically based motivational system.

A

T

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124
Q

Attachment behaviors associated with:clinging, suckingling, cooing, separation response

A

infant-parent

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125
Q

Attachment behaviors associated with: nursing, retreival, nest building, grooming, defense

A

mother-infant

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126
Q

Attachment behaviors associated with: retrieval, nest building, grooming, defense

A

father-infant

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127
Q

Attachment behaviors associated with: shared territory, cohabitation, partner preference, mate guarding, separation response

A

pair bonding

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128
Q

T/F Imprinting happens immediately after birth.

A

F before and immediately after bith

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129
Q

Olfactory system for attachment is mediated by _____, enhanced by _____, and inhibited by ______.

A

norepinephrine, isoproterenol and propanolol

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130
Q

Which NTs are associated with odor preference?

A

dopamine and oxytocin

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131
Q

Maternal behavior is mediated via ____ and ____.

A

oxytocin and estrogen

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132
Q

Blockade of oxytocin enhances/eliminates maternal behavior

A

eliminates

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133
Q

Effect of estrogen on oxytocin

A

regulates # of CNS oxytocin receptors

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134
Q

In socially attaching animals like prairie voles, , oxytocin receptors are found in_____

A

reward centers: nucleus accumbens and prelimbic cortex

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135
Q

4 necessary conditions for development of attachment

A

sufficient interaction, discriminative abilities of infant, mirror neurons, object permanence

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136
Q

Phase of indiscriminate sociability

A

first two months –> anyone is good

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137
Q

Phase II of attachment formation

A

2-7 months attachment in the making

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138
Q

Phase III of attachment formation

A

7-24 months clear cut attachments

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139
Q

Phase IV of attachment formation

A

> 24 months goal coordinated partnerships

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140
Q

At what phase of attachment do infants begin to differentiate between caregivers?

A

II

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141
Q

at what age does stranger anxiety manifest?

A

6-8 months

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142
Q

at what age does separation anxiety manifest?

A

10-18 months

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143
Q

Clinical syndrome manifest by difficulty forming long-lasting intimate relationships and characteristic absence of ability to be affectionate

A

reactive attachment disorder

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144
Q

Inhibited RAD

A

child appears fearful and restricted

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145
Q

Disinhibited RAD

A

indiscriminate in his interest in caregivers/displays shallow relationships

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146
Q

Constitutionally based individual differences in reactivity and self-regulation as observed within the domains of emotionality, motor activity, and attention.

A

Temperament

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147
Q

Temperament refers to inborn/learned characteristics.

A

inborn

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148
Q

Reciprocal interaction/circularity

A

parents and children interact with each other reciprocally

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149
Q

T/F Goodness of fit is crucial.

A

T –> consonance between parent’s expectations/demand and child temperament

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150
Q

HPA Axis

A

stress signals from hypothalamus –> pituitary and then to adrenal –> cortisol release —> detected by hippocampus –> binds GR receptor –> signal to shut down stress circuit

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151
Q

Vasopressin is expressed in a specific subset of neurons within the hypothalamic ____ nucleus

A

paraventricular

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152
Q

Stress signals increase synthesis and release of of pituitary ____ and ____

A

CRH and AVP

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153
Q

Methylation turns on/turns off GR gene and increases/decreases GR receptor which makes for more relaxation/agitation.

A

turns off GR, reduces GR protein, increases agitation. - -> poor nurturing

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154
Q

T/F history of child maltreatment is associated with shorter telomeres

A

T

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155
Q

The symptoms of neglect are profound in boys/girls whereas the symptoms of sexual abuse are more profound in girls/boys

A

neglect = boys, sexual abuse = girls

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156
Q

rt. temporal gyrus is vulnerable to

A

emotional abuse btwn ages 7-9

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157
Q

corpus callosum is vulnerable to

A

neglect in infancy, sexual abuse in elementary school years

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158
Q

Three adolescent growth routes

A

continuous, surgent, tumultuous

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159
Q

4 basic theories of personality

A

psychoanalytic, humanistic, social cognitive, trait

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160
Q

psychoanalytic theory

A

importance of unconscious processes and early childhood development

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161
Q

humanistic theory

A

+ psychology emphasizing self + fulfillment of potential

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162
Q

social cognitive theory

A

learning and conscious cognitive processes including beliefs about self, goal setting, and self regulation

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163
Q

trait theory

A

emphasizes description and measurement of personality differences among individuals

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164
Q

Freud’s dynamic theory of personality

A

three conflicting psychological forces at three dimensions of conciousness –> ego defense mechanisms work to protect us from conflicts, unacceptable impulses

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165
Q

Repression

A

unconscious forgetting –> fundamental ego defense

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166
Q

Displacement

A

impulses are redirected to a substitute object or person

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167
Q

Three domains of positive psychology

A

pleasant life (of enjoyment), good life (of engagement), meaningful life (of affliation)

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168
Q

Five factor model “Big Five”

A

extraversion, neuroticism, conscientiousness, agreeableness, openness

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169
Q

paranoid personality disorder

A

pervasive and unwarranted belief that others intend to harm

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170
Q

schizoid personality disorder

A

detached loners –> limited social skills and no sense of humor –> “aspergers”

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171
Q

schizotypal personality disorder

A

look odd/act strange, uncomfortable with others, talk to selves, use words differently, vague in speech

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172
Q

antisocial personality disorder

A

no regard for others’ rights, shirking responsibilities, irresponsible, lying, stealing –> lack of empathy

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173
Q

borderline personality disorder

A

instability –> intense fear of being abandoned; often child abuse, lack of respect in history

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174
Q

histrionic personality disorder

A

high drama, need approval, constantly seeking attention

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175
Q

narcissistic personality disorder

A

grandiosity about self –> see self as unique, feel entitled to admiration, recognition, and special privileges

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176
Q

dependent personality disorder

A

widespread and longstanding dependency on and submissiveness to others; complete passivity, sensitivity to disapproval

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177
Q

avoidant personality disorder

A

avoid social situations, no close friends, anxious about looking anxious

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178
Q

obsessive-compulsive personality disorder

A

perfectionistic and inflexible, focus on detail, order, structure, performance never good enough

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179
Q

Which dopamine receptor is associated with ADHD?

A

DRD4.7

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180
Q

dual system of attention

A

posterior (orients to and engages novel stimuli –> NE, superior colliculus, pulvinar) and anterior (PFC and anterior singulate that subserves executive system–>dopa)

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181
Q

Which part of the brain and which transporter is involved in the onset of paying attention?

A

posterior parietal cortex, NE1 alpha 2a

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182
Q

Which part of the brain is involved in planning a response to attention and what molecules/transporters are involved?

A

prefrontal, D1, D4, D5, and NET alpha 2a

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183
Q

Which part of the brain is involved in carrying out tasks and what transporters are implicated?

A

striatum and dat, d2

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184
Q

methylphenidate MOA

A

reversibly and partially blocks reuptake of norepinephrine or dopamine –> boosts signal

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185
Q

amphetamine MOA

A

diffuses into vesicles and increases dopamine release, inhibits reuptake of dopamine, and blocks vesicular uptake of dopamine –> speeds up the whole cycle

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186
Q

Which drug? chain substituted amphetamine derivative with a chemical structure similar to cocaine; binds to dopamine transporter and inhibits dopamine reuptake presynaptically

A

methylphenidate

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187
Q

Methylphenidate has a slow/fast uptake and clearance.

A

slow

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188
Q

Which class of compounds does methylphenidate belong to?

A

piperidine

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189
Q

Which drug? influences serotonin and norepinephrine

A

amphetamine

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190
Q

Parasympathetic nervous system is mediated by cholinergic/adrenergic receptors

A

cholinergic

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191
Q

the Sympathetic nervous system is mediated by cholinergic/adrenergic receptors

A

adrenergic alpha and beta

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192
Q

the ____ has a craniosacral outflow

A

PNS

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193
Q

the ____ has a thoracolumbar outflow

A

SNS

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194
Q

the ____ ganglia are located near the spinal cord with short preganglionic axons and long postganglionic axons

A

SNS

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195
Q

PNS ganglia have long/short preganglionic and long/short postganglionic axons

A

long pre and short post

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196
Q

T/F the preganglionic nt in SNS and PNS is ACh

A

T

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197
Q

Postganglionic sympathetic nt to renal vascular smooth muscle is ____

A

dopamine

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198
Q

Postganglionic sympathetic nt to cardiac and smooth muscle is _____

A

NE

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199
Q

Postganglionic sympathetic nt to sweat glands is _____

A

ACh M

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200
Q

Primary nt for SNS are ____

A

N/Epi, Dopamine, Serotonin

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201
Q

Contransmitters in the SNS are _____

A

ATP, galanin, neuropeptide Y

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202
Q

The rate limiting step in the production of catecholamines is _____

A

conversion of tyrosine to dopa via tyrosine hydroxylase

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203
Q

The precursor aa for catecholamines is ____

A

tyrosine

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204
Q

Dopa is converted to dopamine via the action of _____

A

LAD: l-aromatic aa decarboxylase

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205
Q

Dopamine hydroxylase converts dopamine to ______

A

norepinephrine

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206
Q

PNMT-Penylethanolamine N-methyltransferase converts _____ to _____

A

norepinephrine to epinephrine

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207
Q

What is the acute mechanism for increasing synthesis of catecholamines?

A

regulation of tyrosine hydroxylase by phosphorylation (PKA and PKC)

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208
Q

There is an immediate/delayed increase in tyrosine hydroxylase gene expression after nerve stimulation

A

delayed

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209
Q

T/F Autistic symptoms can change with age.

A

T –> optimal outcome

210
Q

Autism triad of deficits

A

early impairment in language and communication, impairments in social and emotional reciprocity, restricted interests and repetitive and stereotyped behaviors

211
Q

anxiety, ADHD, seizures, sleep disorders, and ID are common co-morbidities of ____

A

autisms

212
Q

Autism vs. Asperger’s

A

asperger’s has no communication disability

213
Q

Pervasive Disability Disorder NOS vs. Autism

A

signs and symptoms but not enough criteria to be autism

214
Q

T/F autism subgroups are stable over time.

A

F

215
Q

T/F autism runs in families

A

T

216
Q

Which genetic disorder is primarily linked with autism?

A

Fragile X

217
Q

The _____ pathway is implicated in autism, resulting in too little protein expression in tuberous sclerosis and too much in fragile x.

A

mGluR

218
Q

T/F autisms are related to megalo and macrocephaly

A

T

219
Q

Fusiform gyrus is responsible for _____ and is hyper/hypoactive in autisms

A

person perception hypo

220
Q

Superior temporal sulcus is responsible for _____ and is hyper/hypoactive in autisms

A

facial expression perception hypo

221
Q

Amygdala is responsible for _____ and is hyper/hypoactive in autisms

A

social arousal, attention/salience hypo

222
Q

Superior frontal gyrus is responsible for _____ and is hyper/hypoactive in autisms

A

theory of mind hypo

223
Q

Ventral striatum is responsible for _____ and is hyper/hypoactive in autisms

A

reward/motivation hypo

224
Q

T/F Autisms tend to associate with cortical asynchrony

A

T

225
Q

Mood/affect is the most observable descriptor of emotional state.

A

Affect

226
Q

sadness/depression should be readily understandable in context and should be relived by activities that help engage in desired activities and distract from negative thoughts.

A

sadness

227
Q

What kind of MDD? severe recrurrent depression in mid to late life

A

endogenous/melancholia

228
Q

What kind of MDD? milder depression with reverse vegetative features; often chronic, strongly female dominant, s/w more common in bipolar

A

atypical

229
Q

What kind of MDD? characteristic fall/winter onset, responsive to white light therapy, linked to bipolar

A

seasonal

230
Q

What kind of MDD? associated with life events, anxiety, trauma

A

neurotic

231
Q

What kind of MDD? most severe form with delusions and hallucinations

A

psychotic

232
Q

What kind of MDD? duration of symptoms for at least two years or superimposition of a MDE on an antecedent dysthymia

A

chronic

233
Q

What kind of MDD? onset after childbirth

A

postpartum

234
Q

T/F Marriage is a protective factor for depression

A

T but for men only

235
Q

T/F Life stress is more important in initial depressive events vs. later events.

A

T

236
Q

Which brain area? executive functions, working memory, decisions

A

prefrontal cortex

237
Q

Which brain area? rational cognitivie functiosn like reward, anticipation, empathy

A

anterior cingulate cortex

238
Q

Which brain area? primary role in processing emotional reactions

A

amygdala

239
Q

Which brain area? storage of associative and episodic memories

A

hippocampus

240
Q

Which brain area? convergent information processing to develop emotionally relevant context for sensory experience

A

insular cortex

241
Q

bipolar type ____ is associated with at least 1 manic episode

A

type 1

242
Q

bipolar type ___ is associated with hypomania and depression without manic episodes

A

type 2

243
Q

____ is used to describe a person who seems to have bipolar disorder but who never recovers back to a consistent baseline

A

schizoaffective disorder

244
Q

A distinct period of abnormally elated or irritable mood is called ____

A

mania

245
Q

T/F in mania, delusions are more common than hallucinations

A

T

246
Q

Episodes that require hospitalization are manic/hypomanic

A

manic

247
Q

Episodes that are associated with marked vocational or social impairment are manic/hypomanic

A

manic

248
Q

Episodes that are associated with delusions or hallucinations are manic/hypomanic

A

manic

249
Q

T/F hypomanic episodes can be short-lived

A

T

250
Q

What kind of bipolar? 4+ episodes/year

A

rapid cycling

251
Q

What kind of bipolar? concurrently meets criteria for mania/hypomania and depression

A

mixed features

252
Q

What kind of bipolar? depression in fall/winter and mania in spring/summer

A

seasonal

253
Q

T/F bipolar ii diagnosis is heavily dependent on the threshold for hypomania

A

t

254
Q

Which presents earlier in life? bipolar vs. depressive

A

bipolar–> >25% of depressions prior to age 20 convert to bipolar

255
Q

Which is more heritable? bipolar or depression

A

bipolar

256
Q

Which has a greater impact across the board? bipolar or unipolar

A

bipolar

257
Q

T/F suicide typically occurs during a depressive episode

A

T

258
Q

T/F risk of completed suicide is greater in bipolar than in MDD

A

T

259
Q

Major goal in bipolar

A

mood stabilization

260
Q

T/F mood stabilizers prevent against future relapse of bipolar

A

T

261
Q

What kind of drug? lithium, carbamazapine, divalproex, ect

A

mood stabilizers –> reduce mania and depression and do not cause mania or depression

262
Q

T/F the effect of bipolar treatment can be evaluated within a few weeks.

A

F –> need several weeks

263
Q

T/F monotherapy is standard for BPD

A

F –> bipolar requires combination therapy

264
Q

T/F antidepressants are helpful in treating BPD

A

t –> but may worsen disease course

265
Q

Where is serotonin found

A

10% platelets, 80% GI tract, 20% CNS

266
Q

_____ cells in the GI tract produce serotonin

A

enterochromaffin cells

267
Q

role of serotonin in platelets

A

causes aggregation/clotting

268
Q

T/F serotonin is both a vasodilator and a vasoconstrictor

A

T –> dilator in healthy vessels, constrictor in damaged vessels

269
Q

serotonin role in GI system

A

secretory and peristaltic reflexes

270
Q

EC cells in gut release serotonin into _____

A

lamnia propria

271
Q

In the CNS serotonin is released by ____

A

raphe nuclei –> rostral (B5-9) and caudal (b1-4)

272
Q

Function of serotonin released by caudal raphe nuclei

A

spinal cord sensory, motor, and autonomic

273
Q

Function of serotonin released by rostral raphe nuclei

A

cortex, basal ganglia, thalamus, hypothalamus –> limbic

274
Q

serotonin is produced from what essential AA

A

tryptophan

275
Q

rate limiting step in production of serotonin

A

tryptophan hydroxylase

276
Q

serotonin is a precursor of what hormone

A

melatonin in pineal

277
Q

Which enzyme degrades serotonin?

A

MAO

278
Q

How many genes regulate serotonin synthesis?

A

2 –> Tph1 = periphery and Tph2 = CNS

279
Q

short term regulators of tryptophan hydroxylase

A

pka, ca/camk2, pkc –> phosphorylation leads to increased enzymatic activity

280
Q

long term regulators of tryptophan hydroxylase

A

exogenous signals like cAMP can up/down regulate total amount of protein via gene regulation –> neuronal activity, stress, drugs

281
Q

Tryptophan depletion is achieved by ingestion of a drink of ___ AA

A

neutral –> reduced plasma tryptophan and subsequent reduced synthesis

282
Q

Which protein is responsible for removal of serotonin from synaptic cleft

A

SERT

283
Q

Which protein is responsible for vesicular concentration of catecholamines and serotonin

A

vesicular monamine transporters 1 and 2

284
Q

SERT is inhibited by ____ and ____

A

SSRIs and fenfluramine

285
Q

Vesicular monamine transporters are inhibited by _____ and _____

A

reserpine and fenfluramine

286
Q

Which VMAT is responsible for vesicular uptake?

A

VMAT2

287
Q

Fenfluramine MOA

A

stimulates release of 5HT by blocking VMAT and disrupting proton gradient in vesicles –> increase in intracellular 5HT –> reverse action of SERT | also inhibits inward function of SERT

288
Q

T/F amphetamine will cause active release of serotonin

A

T

289
Q

T/F polymorphism in 5HT transporter is associated with susceptibility to MDD and anxiety

A

T –> 44bp insertion (L) or deletion (S)

290
Q

p-chloroamphetamine is a releaser/inhibitor of neurons

A

releases and depletes neurons

291
Q

MDMA moa

A

reverses direction of SERT and blocks reuptake

292
Q

T/F active releasing agent stimulates 10x more 5ht release than a reuptake inhibitor

A

T

293
Q

Which genes encode MAO

A

MAO A (serotonergic neurons) and MAO B

294
Q

____ regulates free intraneural concentration of NE or 5HT

A

MAO

295
Q

Where is MOA produced?

A

mitochondria

296
Q

Which serotonin receptor subtype? mostly CNS, some blood vessels, Gi coupled (cAMP)

A

5HT1R

297
Q

Which serotonin receptor subtype? mainly CNS, some blood vessels, Gq (IP3/DAG)

A

5HT2R

298
Q

Which serotonin receptor subtype? mainly peripheral, ion channel

A

5HT3R

299
Q

Which serotonin receptor subtype? mainly enteric, some in CNS, Gs (cAMP)

A

5HT4R

300
Q

5HT 1 receptor family have what in common?

A

inhibition of adenylyl cyclase as a signaling mechanism

301
Q

5HT2 receptor family have what in common?

A

inhibition of IP3 as a signaling mechanism

302
Q

Which serotonin receptors gate calcium?

A

5HT3

303
Q

T/F serotonin receptors also also autoreactive

A

T –> 5HT 1A and 1B are presynaptic and gate the release of serotonin

304
Q

Name a few medicinal uses for serotonin drugs

A

depression, anxiety, migraine, obesity

305
Q

4 classes of antidepressants

A

TCA, SSRI, NRI, MAOI

306
Q

Why are SSRIs better than TCAs?

A

no affinity for histamine, muscarinic, and adrenergic receptors –> fewer side effects

307
Q

serotonin behavioral syndrome

A

when switching among ssri’s or to other drug classes –> overactivation of central serotonin receptors –> abdominal pain, diarrhea, sweating, fever, tachycardia, increased blood pressure, AMS

308
Q

SSRI antidepressant effect

A
  1. increased 5HT levels from long-term reuptake inhibtion, 2. increased transcription of CREB, 3. increased production of neurotrophins like BDNF, 4. increased hippocampal neurogenesis
309
Q

SSRI anxiolytic effect

A
  1. downregulation of 5HT2c receptors, 2. increased GABA release in forebrain regions, 3. increased production of neurosteroids like allopregnanolone
310
Q

Mechanism of serotonin migraine

A

vasoconstriction, reduce neuroinflammation, inhibit CGRP release

311
Q

Where in the neuron do the final steps of epinephrine/norepinephrine synthesis take place?

A

in the vesicles

312
Q

2 adrenal medulla cell types

A

those with NE only (no PNMT) and those with E (contain PNMT)

313
Q

NE diffuses from ____, is methylated by ____ to epinephrine in the _____ which then reenters the _____

A

granules, PNMT, cytoplasm, granules

314
Q

Synthesis of PNMT is regulated by _____ secreted in the ______

A

glucocorticoids in the adrenal cortex

315
Q

Stress increases the release of _____ from adrenal cortex and ___ from adrenal medulla

A

cortisol and E

316
Q

T/F diffusion of NT across vesicular membrane impacts neurotransmission

A

F

317
Q

T/F neuroamines have a long halflife

A

F –> short

318
Q

In nerve endings, catecholamines are stored in ___ which function to ____

A

vesicles, protection from degradation (granules in adrenal medulla)

319
Q

Vesicle membranes contain an uptake pump called ____

A

VMAT

320
Q

Vesicles contain what supporting molecules?

A

dopamine beta hydroxylase, PNMT, cotransmitters ATP and NPY

321
Q

T/F Vesicle mediated activities like NT synthesis are ATP-dependent

A

T

322
Q

Exocytic release of vesicle contents is ___ dependent

A

Calcium

323
Q

calcium interacts with ____ proteins that trigger fusion of the vesicular membrane with the terminal membrane

A

vesicle associated membrane (VAMP)

324
Q

_____ sit on the presynaptic nerve terminal and can bring about varied responses to NT release

A

autoreceptors

325
Q

Alpha-1 receptor is Gq/Gi/Gs and binds _____ NT resulting in ____

A

Gq, epi/norepinephrine –> increased free Ca2+

326
Q

Alpha-2 receptor is Gq/Gi/Gs and binds _____ NT resulting in ____

A

Gi, epi/norepinephrine –> decreased cyclic AMP

327
Q

Beta-1 receptor is Gq/Gi/Gs and binds _____ NT resulting in ____

A

Gs, epi/norepinephrine –> increased cyclic AMP

328
Q

Beta-1 receptor is Gq/Gi/Gs and binds _____ NT resulting in ____

A

Gs, epinephrine –> increased cyclic AMP

329
Q

beta 1 and 2 receptors do what to cyclic AMP levels?

A

increase

330
Q

Beta 1 and 2 receptors are Gq/gi/gs

A

Gs

331
Q

______ of serine residues on Gprotein receptors allows binding of _____ which reduces ligand binding

A

phosphorylation and beta arrestin

332
Q

T/F when ligand is no longer bound to receptor, affinity for beta arrestin drops.

A

T

333
Q

T/F tyrosine’s entry to the cytoplasm of the neuron is energy dependent

A

T

334
Q

Where in the cell is tyrosine hydroxylase located?

A

cytoplasm

335
Q

_____ refers to the reuptake of NE into nerve endings (high affinity, low capacity)

A

uptake 1 (NET)

336
Q

_____ refers to mechanisms of extra-neuronal uptake (low affinity, high capacity)

A

uptake 2

337
Q

which uptake system is important for removing circulating amines

A

uptake 2

338
Q

5HT, NE, and tryptamine are substrates for which MAO

A

MAO A

339
Q

Dopamine and tryptamine are substrates for which MAO

A

MAO B

340
Q

___ functions as a safety valve to inactivate excess NT in the synaptic cleft or leaking NT

A

MAO

341
Q

T/F MAO can degrade NT in extraneuronal sites

A

T –> all over body

342
Q

T/F inhibiting tyrosine hydroxylase is not beneficial

A

T –> not selective

343
Q

Which drug? inhibits L-aromatic AA decarboxylase

A

alpha methyldopa

344
Q

Which drug? inhibits LAAD in the periphery

A

carbidopa

345
Q

Which drug? inhibits dopamine beta hydroxylase

A

disulfiram/tetraethylthiuram

346
Q

Reserpine MOA

A

blocks VMAT uptake of dopamine into vesicle –> tx of HTN and snakebite

347
Q

Bretylium MOA

A

causes release of NE and thereafter blocks fusion of vesicles by preventing AP from reaching terminals –> tx of vfib

348
Q

Guanethidine MOA

A

NE release inhibitor –> Tx HTN –> degradation of nerve endings

349
Q

Dopamine MOA

A

sympathomimetic agonsit –> inotropic agent –> Tx shock (alpha and b1 adrenoceptor)

350
Q

Dobutamine MOA

A

sympathomimetic agonist -> inotropic –> CHF –> b1

351
Q

Ldopa MOA

A

precursor of dopamine administered with carbidopa (LAAD inhibitor)

352
Q

Bromocriptine MOA

A

selective D2 agonist

353
Q

Amphetamine MOA

A

promote NT release (lipid soluble and can penetrate brain), resistant to MAO b/c of alpha methyl group

354
Q

Cocaine MOA

A

reuptake inhibitor of NE

355
Q

Imipramine MOA

A

uptake inhibitor of NE and serotonin –> antideprx

356
Q

Which uptake mechanism is blocked by cocaine and TCA?

A

uptake 1

357
Q

Selegiline MOA

A

inhibits MAO B at low doses –> delayed breakdown of dopamine –> NT accumulation –> tx of antideprx

358
Q

monoamine theory of depression

A

depression is a result of depletion of monoamines like 5HT, NE, and Da

359
Q

Which neurotransmitter is associated with: obsessions, compulsions

A

serotonin

360
Q

Which neurotransmitter is associated with: alertness

A

NE

361
Q

Which neurotransmitter is associated with: attention, pleasure reward, motivation

A

dopamine

362
Q

Which neurotransmitter is associated with: anxiety

A

serotonin, NE

363
Q

Which neurotransmitter is associated with: mood

A

serotonin, NE, dopamine

364
Q

NE neurons originate in ____ and innervate the brain except for _____

A

locus ceruleus, except nucleus accumbens

365
Q

Dopamine originates in _______.

A

ventral tegmental area and substantia nigra

366
Q

Phencyclidine and ketamine block ______ resulting in effects thought to mimic schizophrenia.

A

NMDA receptors

367
Q

____ exerts inhibitory effect by increasing CL flow to hyperpolarize neurons

A

GABA

368
Q

____ exerts inhibitory effect via allosteric modulation of NMDA receptor

A

glycine

369
Q

sedative hypnotics (benzos) and some anticonvulsants (barbituates) act via unique binding sites on _____

A

GABA regulated Cl channels

370
Q

Which NT is implicated in AD?

A

Ach

371
Q

What class of drugs? shared pharmacological property of D2 receptor antagonism

A

antipsychotics –> opposite of agents like cocaine and amphetamines that increase synaptic dopamine –> reduce psychosis

372
Q

overabundance of dopamine in the _____ pathway results in negative symptoms of schizophrenia like social isolation and poor hygiene.

A

mesocortical

373
Q

overabundance of dopamine in the _____ pathway results in positive symptoms of schizophrenia like delusions and perceptual disturbances

A

mesolimbic

374
Q

blocking dopamine in the _____ area results in side effects like dystonia, akathisia, TD, NMS

A

nigrostriatal

375
Q

blocking dopamine in the ____ area results in prolactin side effects like galactorrhea and gynecomastia

A

tuberoinfundibular

376
Q

T/F antipsychotics lower the seizure threshold

A

T

377
Q

T/F antipscyhotics can prolong QT

A

true

378
Q

T/F antipsychotics are major tranquilizers

A

T

379
Q

2 types of first generation antipsychotics

A

high potency –> haloperidol vs low potency (more antihistamine, antiadrenergic, anticholinergic) –> chlopromazine

380
Q

____ antipsychotics block D2 as well as 5HT receptors.

A

atypical/2nd generation –> not more effective but better tolerated

381
Q

Which generation of antipsychotics is better tolerated?

A

atypicals/2nd generation

382
Q

What major risk do atypical antipsychotics pose?

A

agranulocytosis

383
Q

diabetes, dyslipidemia, weight gain are associated with _____ syndrome which is a side effect of ______ antipsychotics

A

metabolic syndrome –> 2nd generation/atypicals

384
Q

____ is a partial DA agonist

A

abliify –> risk of worsening psychosis

385
Q

torsade de pointe

A

TCA fatal overdose

386
Q

which antidepressant class is best tolerated?

A

ssri

387
Q

which antidepressant class is used for a comorbid pain syndrome

A

snri

388
Q

which antidepressant requires food restrictions?

A

MAOI

389
Q

T/F antidepressants increase suicidality

A

F –> may unmask suicidal thoughts

390
Q

_____ is thought to enhance monaminergic function by inhibiting the recylcing of neuronal membrane phosphoinositides involved in generation of IP3 and DAG

A

lithium

391
Q

_____ are associated with side effects like weight gain and neural tube defects and often require therapeutic blood monitoring and have numerous drug interactions

A

mood stabilizers

392
Q

______ result in inhibitory neurotransmission by increasing the frequency of GABA Cl channel ion opening and causing neuronal hyperpolarization –> promote sleep onset and duration –> REM

A

Benzos –>treat symptoms via GABA A

393
Q

which receptor is modulated by benzodiazepines?

A

GABA A

394
Q

what are the most common sedatives used

A

benzodiazepines

395
Q

T/F some benzodiazepines get processed by liver once and others twice

A

T –> some get glucoronidated AND oxidized

396
Q

which benzodiazepines only undergo glucoronidation in the liver?

A

loraze, oxaze, temazepam –> use them for alcohol withdrawal or in people with bad livers

397
Q

T/F risk of abuse in benzodiazepines has to do with onset and duration of action

A

T

398
Q

the only medications useful in treating dementia are ____

A

AChEI and NMDA receptor antagonist (namenda)

399
Q

T/F dementias can only be treated for symptoms and to slow progression

A

T

400
Q

the standard size of an alcoholic drink is

A

12 g ethanol

401
Q

BAL

A

blood alcohol content by percentage

402
Q

legal limit for bal is what in us

A

80-100 mg/dL = 0.08%

403
Q

one drink will yield BAL of

A

30 mg/dL = 0.03%

404
Q

alcohol has a high/low diffusion coefficent

A

high –> can be measured in expired air

405
Q

T/F Alcohol is both lipid and water soluble

A

T –> hydrophilic = large volume of distribution

406
Q

Alcohol has a large/small volume of distribution

A

large

407
Q

T/F Absorption is accelerated by CO2

A

T

408
Q

Alcohol is absorbed passively/actively

A

passively

409
Q

T/F Rate of absorption partially predicts BAL

A

T

410
Q

Rate of absorption of alcohol depends on what 3 factors

A

concentration (shot > wine > beer), food in stomach (fat>cho>protein), habitual vs occasional drinking pattern

411
Q

Why do women achieve a higher BAL for a given dose than men?

A

greater body fat content, lower total body water content –> higher Vd

412
Q

T/F volume of distribution partially predicts BAL

A

T

413
Q

Maximum BAL depends on what 3 factors

A

Vd, absorption rate, rate of metabolism

414
Q

___% of alcohol is metabolized

A

90

415
Q

Primary alcohol metabolic pathway

A

oxidative pathway in the liver –> 2E1 cytochrome p450 –> MEOS (microsomal ethanol oxidizing system)

416
Q

Which enzyme? converts ethanol to acetaldehyde

A

Alcohol dehydrogenase –> mainly in liver (also in GI endothelial cells and brain)

417
Q

which gender has higher ADH activity in GI tract?

A

men

418
Q

T/F ADH is saturable

A

T –> can be exhausted

419
Q

Which enzyme? converts ethanol to acetaldehyde when ADH is saturated

A

MEOS/CYP2E1 –> byproducts = h2o2, toxins, free radicals

420
Q

T/F Cyps are induced in response to increased exposure

A

T

421
Q

Which enzyme? converts acetaldehyde to acetate and then to CO2 and H2O

A

ALDH

422
Q

Which group of people have lower GI ADH activity?

A

women and asians

423
Q

Which enzyme do people of asian decent have a deficiency in (alcohol metabolism)

A

ALDH

424
Q

which drug causes flushing upon drinking alcohol?

A

disulfuram –> inhibits breakdown of acetaldehyde

425
Q

What order kinetics does alcohol follow

A

first order up to BAL 100 mg/dL (saturation of ADH) –> zero order kinetics at 8 grams/hour

426
Q

In habitual drinkers _____ enzyme is upregulated –> can result in what interaction?

A

CYP 2E1 –> tolerance –> upregulation of metabolism of drugs (e.g. OCP)

427
Q

In occasional drinkers, competitive inhibition may result in reduced metabolism of ____

A

warfarin

428
Q

Chronic alcoholism effects

A

frontal lobe white/gray loss, reduced brain metabolism, wernicke/korsakoff amnestic syndrom, neuropathy (saturday night palsy)

429
Q

Acute cardiovascular effects of alcohol

A

vasodilation, reduced myocardial contractility, atrial and ventricular arrhythmias

430
Q

Chronic cardiovascular effects of alcohol

A

hypertension, dilated cardiomyopathy, atherosclerosis, increased TAG

431
Q

French paradox

A

30g/d of alcohol is cardioprotective –> increases HDL cholesterol, antioxidant content of alcohol beverages, increases in tissue plasminogen activator

432
Q

Increasing BAL increases/decreases ADH secretion

A

decreases –> diuresis and kaluriesis

433
Q

Alcohol increases/decreases uric acid excretion

A

decreases –>gout

434
Q

Alcohol increases/decreases incidence of PUD

A

increases –> stimulates secretion of gastrin, pepsin, histamine, gastric acide –> PUD, pancreatitis, cancer (from acetaldehyde)

435
Q

T/F alcohol is directly hepatotoxic

A

T

436
Q

T/F alcohol suppresses immunity

A

T –> reduced platelets from marrow suppression, reduced folate metabolism (macrocytosis), reduced neutrophil/t cell function

437
Q

Increased BAL increases/decresease the ventilatory response to increased CO2 acutely.

A

decreases

438
Q

Alcohol increases/decreases sleep latency

A

decreases

439
Q

Alcohol’s empty calories

A

alcohol suppresses gluconeogenesis which leads to hypoglycemia concomittant with hypokalemia

440
Q

T/F Alcohol freely crosses placenta and enters breast milk

A

T

440
Q

T/F metabolic pathway for alcohol is not developed in fetus and neonate

A

T –> fetal alcohol syndrome

441
Q

Alcohol dependence with physiological dependence

A

alcohol dependence accompanied by tolerance and/or withdrawal

441
Q

alcohol treatment stages

A
  1. id, 2. detox/withdrawal, 3. rehab, 4. aftercare
442
Q

Which drug? In alcohol withdrawal treatment, decreases severity, stabilizes vitals, prevents seizures and delirium tremens, addictive.

A

benzodiazepines

443
Q

Which drug? In alcohol withdrawal treatment improves vital signs, reduce cravings

A

beta blocker

444
Q

Which drug? In alcohol withdrawal treatment decrease withdrawal symptoms only

A

alpha agonists

445
Q

Which drug? In alcohol withdrawal treatment decrease severity and may prevent seizures

A

anticonvulsants

446
Q

Naltrexone’s effect on alcohol consumption

A

opiate blocker reduces risk of heavy drinking

447
Q

contraindications for naltrexone

A

current use of opioids, pregancy/breastfeeding

448
Q

Any chemical compound with pharmacologic actions similar to those of morphine (narcotic analgesic)

A

opiate

449
Q

Opioids are pupillary constrictors/dilators

A

constrictors

450
Q

T/F Opiods are ineffective analgesics

A

F –> very effective

451
Q

morphine is an agonist of the ____ receptor causing ____

A

mu, analgesia, euphoria

452
Q

ketocylcazocine is an agonist of the ____ receptor causing ____

A

kappa, dysphoria, analgesia

453
Q

Opioid dependence treatment

A
  1. detox- agonist taper, 2. substitution-methadone, buprenorphine, 3. antagonist- naltrexone, 4. relapse prevention-naltrexone
454
Q

Which drug? Opiod orally active antagonist

A

naltrexone

455
Q

Which drug? parenterally active antagonist of opioids, orally inactive

A

naloxone

456
Q

_____ functions by inhibition of local axonal conduction

A

local anesthesia (e.g. cocaine)

457
Q

_____ inhibits pain perception in cortical and subcortical brain

A

opioid analgesic

458
Q

____ receptors mediate both spinal (DRG) and supra spinal analgesia in periaqueductal gray matter, thalamus, sensory cortex.

A

Mu

459
Q

___ receptors mediate spinal analgesia for pain C fibers in spinothalamic tract.

A

delta

460
Q

Which opioid receptors are in the DRG/dorsolateral funiculus

A

delta

461
Q

Euphoria is produced by actions on the ____ dopaminergic neurons which project to the n. accumbens and medial prefrontal cortex.

A

VTA

462
Q

nausea is produced at the ____

A

area postrema

463
Q

respiratory depression is produced at the ____ decreasing neuronal sensitivity pco2

A

brainstem

464
Q

anti-tussive action is produced in the ____

A

brainstem

465
Q

opioid mediated decreased propulsion in Gi tract/constipation is produced by actions at the ____

A

local gut ganglia

466
Q

opioid constriction of the pupil is produced by actions at the ____

A

3rd motor nucleus

467
Q

opioid peripheral vaso-dilation is produced by action at the ____

A

vagal nucleus

468
Q

3 main endogenous opioid receptor ligands in CNS

A

endorphin, enkephalin, dynorphin

469
Q

___ and ____ receptors bind enkephalins and endorphins preferentially

A

mu and delta

470
Q

____ receptors bind dynorphin

A

kappa

471
Q

acute cellular response to morphine

A

morphine/b endorphin binds to mu receptor –> gi activation —> inhibition of cAMP –> decreased activation of PKA –> hyperpolarization of cell via receptor linked K+ channels, reduced CREB phosphorylation

472
Q

____ is administered IV with very rapid onset, lasting several hours- -> opioid antagonist

A

naloxone

473
Q

2 mechanisms of opioid tolerance

A

mu receptor phosphorylation by 1. src kinase –> increase in cAMP levels –> signal reversal (binding to Gs vs Gi), 2. gprotein kinase –> mu receptor internalization (reduced receptors on surface)

474
Q

Chronic response to morphine

A

uncoupling of gi by phosphorylation –> increase in cAMP levels + binding of beta arrestin –> endocytosis of receptors

475
Q

Desensitization of mu opioid receptors

A

beta arrestin mediated MOR internalization –> will need to increase morphine levels over time for pain management

476
Q

Fate of internalized MOR

A

degradation in lysosomes or resensitizaiton and reinsertion via release of beta arrestin

477
Q

____ linkes MOR c terminus to actin to mediate internalization

A

FILA

478
Q

____ inhibits g protein activation by MOR

A

PPL

479
Q

T/F opioid tolerance has a ceiling

A

T –> 200mg heroine/day

480
Q

T/F opioid withdrawal can begin 12 hours after last dose of morphine

A

T

481
Q

T/F physical symptoms of opioid withdrawal are mild

A

T –> anxiety, agitation, diarrhea, pupillary dilation, craving (cued)

482
Q

T/F 50% of risk for opioid addiction is inherited

A

T

483
Q

T/F 85% of drug-free rehab for opioid relapse in 1 year

A

T

484
Q

Gordian knot of opioid addiction

A

relapse initiated by craving –> must control craving

485
Q

3 advantages of methadone opioid addiction tx vs. drug-free rehab

A
  1. lower rate of HIV and hepatitis, 2. lower rate of re-arrest, 3. increased employment
486
Q

_____ is an orally active partial mu agonist which dissociates very slowly from the mu opioid receptor causing less sever withdrawal symptoms

A

buprenorphine

487
Q

T/F buprenorphine/naloxine is a promising new treatment for opioid addiction treatment

A

T –>Naloxone is not absorbed into the bloodstream to any significant degree when Suboxone is taken correctly by allowing it to dissolve under the tongue. However, if a Suboxone tablet is crushed and then snorted or injected the naloxone component will travel rapidly to the brain and knock opioids already sitting there out of their receptors. This can trigger a rapid and quite severe withdrawal syndrome. Naloxone has been added to Suboxone for only one purpose – to discourage people from trying to snort or inject Suboxone.

488
Q

N118 A-G polymorphism in MOR effect

A

AA > translation of MOR than AG or GG –> more euphoria with GG

489
Q

____ is able to block effect of alcohol euphoria among people with G allele in MOR

A

naltrexone

490
Q

Naltrexone effect on alcohol addiction

A

blunts euphoria by blocking opioid receptor –> reduces relapse for heavy drinking but does not influence probability of abstinence outcome

491
Q

Does A118G genotype affect treatment response to naltrexone among alcohol addicted patients?

A

relapse is blunted among alcohol addicted people with G allele on naltrexone –> genotype specificity

492
Q

____ is produced in ventral tegmental area whereas ____ is thalamic/cortical/spinal

A

euphoria vs. analgesia

493
Q

T/F Addiction is a chronic disease that is responsive to treatment

A

T

494
Q

T/F Addiction has a predictable morbidity and mortality and can be fatal

A

T

495
Q

T/F The chronic medical consequences of addiction are late developments of the disease

A

T

496
Q 
The following are signs of withdrawal from what drug? 
Tachycardia
Increased BP
Increased temperature
Anxiety
Headache
Tremor
Diaphoresis
Nausea/vomiting/loose stool
Photophobia/phonophobia
Hallucinations
Seizures
Delirium
A

Alcohol if with delirium tremens, sedatives

497
Q 
The following are signs of intoxication by what drug?
Slurred speech
Ataxia
Nystagmus
Respiratory depression – can be fatal
A

Barbituates

498
Q

The following are signs of intoxication by what drug?
Slurred speech
Sedation
Respiratory depression not usually fatal unless mixed with alcohol

A

benzodiazepines

499
Q 
The following are signs of withdrawal from what drugs? 
Tachycardia
Pupil dilation
Runny nose
Diaphoresis
Yawning
Muscle/joint aches
Goose pimples/piloerection
Restlessness
Anxiety
Tremors
Abdominal cramps/diarrhea
A

opiates

500
Q

The following are complications of what drugs?
Vasospasm, increased BP/HR, increased O2 needs
MI, stroke, dissecting aneurysm, spontaneous abortion, renal failure, bowel ischemia

Electrophysiological disturbance
Seizures, arrhythmias
Hyperthermia
Hyperactivity
Rhabdomyolysis, trauma
Aggression, paranoia, grandiosity
Trauma and other risky behaviors (STDs…)
A

stimulants

501
Q 
The following are signs of intoxication with what drug?
Dry mouth, red eyes, relaxed muscles
Cognitive disturbances
Trauma
Tachycardia and arrhythmia
A

marijuana

502
Q 
The following are sequelae of using what drug?
Pulmonary disease
Decreased libido & sperm count
Immunosuppression
Anhedonia
A

marijuana

503
Q

T/F depression is associated with an increase in death rate at any age, independent of suicide, smoking, or other risk factors

A

T

504
Q

Depression leads to increased/decreased neurogenesis, increased/decreased HR variability, increased/decreased platelet activatoin, increased/decreased sympathetic tone

A

decreased, decreased, increased, increased

505
Q

Depression leads to an increased/decreased CRF, increased/decreased HPA activity, increased/decreased insulin resistance, increased/decreased cell mediated immunity, increased/decreased cytokines, increased/decreased bone formation/density, increased/decreased bone resorption

A

increased, increased, increased, decreased, increased, decreased, increased

506
Q

T/F women are more resistant to minor depression than men and don’t tend to die as much.

A

T

507
Q

Depression and cardiovascular disease have a bi/unidirectional relationship

A

bidrectional –> depression is a significant independent risk factor for CAD; MI increases depression

508
Q

hypercoagulability and depression

A

evidence that increased density in platelet serotonin receptors might increase coagulation in depression

509
Q

increased cortisol and depression

A

depression increases cortisol which increases HPA axis –> promotes atherosclerosis, hypertension, injury to vascular endothelia, loss of suppression of inflammatory cytokines from insufficent glucocorticoid signaling which disrupts negative feedback

510
Q

Which cytokines are elevated in depression?

A

IL1, 6, TNF alpha

511
Q

Which cytokines are associated with insulin resistance, diabetes, and obesity?

A

IL6 and TNF alpha

512
Q

___ is an index of inflammation in the body

A

c reactive protein

513
Q

T/F men and women are affected by cancer equally

A

T

514
Q

Can depression be prevented?

A

Yes –> prophylactic ssri can prevent interferon therapy caused depression | also after stroke

515
Q 
a
perceived difficulty
or dissatisfaction with sleep and typically
entai
ls a constellation of several
daytime
symptoms (exhaustion, poor concentration, irritability and, or reduced interest in
activities)
A

insomnia

516
Q

_____ is c
haracterized by social isolation and extreme individualism without
craving human contact

A

schizoid

517
Q

__________ is characterized by magical thinking, odd beliefs (numerology,
psychic hotline)

A

schizotypal

518
Q

________ is characterized by extreme suspicion and distrust of others

A

paranoia

Brain and Behavior Part 2 (6 decks)

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