□ There are 3 types of pain stimuli mechanical (pressure), thermal and chemical. The chemical stimuli consists of_______________? -
... [Show More] ANSWER--Bradykinin
-Serotonin
-Histamine
□ How does the brain suppress pain conduction? - ANSWER-By using endogenous compounds such as enkephalins and endorphins
□ What are the two types of pain? - ANSWER-Nociceptive and neuropathic
□ Nociceptive pain is somatic and visceral. Somatic pain results from injury to tissue (bones, joints, and muscles) and the pain is generally described as___________________? - ANSWER-Localized and sharp
□ Visceral pain results from injury to organs and is described as______________? - ANSWER-Vague, diffuse and aching
□ Pain that is described as burning, shooting, jabbing, or numbness is called_____________? - ANSWER-Neuropathic pain
□ Are opioids helpful for neuropathic pain? - ANSWER-Not really
□ What general groups of drugs are used for cancer pain? - ANSWER-- NSAIDs
- acetaminophen
- opioids
- TCAs
- AEDs
□ Give examples of neuropathic pain. - ANSWER-- Post herpetic neuralgia (PHN)
- diabetic neuropathy
- cancer pain
□ What types of agents are helpful for neuropathic pain? - ANSWER-- SNRIs
- TCAs
- AEDs
- anesthetics such as lidocaine
□ Why are antidepressants helpful for chronic pain? - ANSWER-Modulation of serotonin and NE decrease pain
□ Are SSRIs helpful for pain management? - ANSWER-Not really
□ Why are AEDs helpful for chronic neuropathic pain? - ANSWER-They reduce synaptic transmission and potentiate GABA
□ Why are elderly patients at increased risk of side effect and AE with analgesics? - ANSWER-Decline in hepatic metabolism and renal excretion
DRUGS FOR HEADACHE
□ What type of headache is characterized by a neurovascular disorder that involves vasodilation and inflammation of the intracranial blood vessels? - ANSWER-Migraine headache
DRUGS FOR HEADACHE
□ Define allodynia. - ANSWER-Painful responses to normally innocuous (unoffensive) stimuli.
think: "aloe hurts so cold"
DRUGS FOR HEADACHE
□ Define aura. - ANSWER-The migraine headache is preceded by neurologic symptoms such as flashes of light, a blank area in the field of vision, or a zig-zag pattern. Only 30% of "migraineurs" have auras.
DRUGS FOR HEADACHE
□ Increased plasma levels of CGRP (promote or decrease) migraine? - ANSWER-(Calcitonin Gene-related Peptide) CGRP promotes migraines
DRUGS FOR HEADACHE
□ Medication overuse headache (MOH) or rebound headache is the result of over use of medication for headaches.
Patients using abortive therapy more than 2-3 times a month should be considered for ___________ treatment? - ANSWER-Prophylactic treatment with possibly a beta adrenergic antagonist.
DRUGS FOR HEADACHE
□ Which agents used to treat migraine headaches release inflammatory neuropeptides that diminish perivascular inflammation and cause vasoconstriction by binding to 5-HT 1B/1D receptors? - ANSWER-Serotonin 1B1D- receptor agonists known as "triptans"
DRUGS FOR HEADACHE
□ True or False? Triptans cause vasoconstriction and a decrease in perivascular inflammation. - ANSWER-True
DRUGS FOR HEADACHE
□ Why is it important to take triptans at the first onset of the migraine? - ANSWER-These drugs are more effective when used in the early stage of a migraine.
DRUGS FOR HEADACHE
□ An overwhelming feeling of "chest tightness" and a heavy sensation in the chest is a common side effect of which agents that are used to treat migraine headaches? - ANSWER-Triptans. The chest tightness is not related to ischemia and is transient.
DRUGS FOR HEADACHE
□ Can patients with heart disease or cardiovascular risk factors take triptans? - ANSWER-No.
The most severe AE of triptans is vasospasm. This is different from the transient chest tightness. Use triptans in individuals that are free of ASCVD and or have not risk factors.
DRUGS FOR HEADACHE
□ What is the problem with the combination of SSRIs or NSRIS and triptans? - ANSWER-Serotonin syndrome can result due to excessive serotonergic activity.
DRUGS FOR HEADACHE
□ Can triptans be used in pregnancy? - ANSWER-No.
Triptans should be avoided during pregnancy.
DRUGS FOR HEADACHE
□ There are about 7 triptans on the market and some individuals have a better response to one over another. In addition, the half-life varies among these agents. If a patient has migraines that last for a long duration, they would benefit from_________ because it has a very long half-life. - ANSWER-Frovatriptan (Frova)
think: "Frov-ever"
DRUGS FOR HEADACHE
□ What is the syndrome of toxicity of ergot alkaloids characterized by constriction of peripheral arteries and arterioles in which extremities become cold, pale, and numb muscle pain develops and gangrene may result. - ANSWER-- Ergotism
- There is a "Black Box Warning for risk of peripheral ischemia. Ergot alkaloids are "second line" drugs for abortive therapy of migraines.
DRUGS FOR HEADACHE
□ Is it advisable to use a triptan with an ergot alkaloid or MAOI? - ANSWER-No. MAOIs can suppress degradation of sumatriptan, increasing plasma levels.
DRUGS FOR HEADACHE
□ Can the use of ergotamine cause physical dependence? - ANSWER-Yes
DRUGS FOR HEADACHE
□ Is it advisable for pregnant women to take ergotamine? - ANSWER-No. Ergotamine is Pregnancy Risk Category X (this classification is no longer used). It can cause uterine contractions.
DRUGS FOR HEADACHE
□ Which drugs are used for preventive therapy of migraines when patients have 3 or more migraines a month? - ANSWER-Beta blockers such as:
- propranolol (non cardio-selective)
- AEDs (topiramate), (Decakote ED)
- TCAs (amitriptyline)
- Botox injections
- ACEIs
- ARBs
DRUGS FOR HEADACHE
□ Which dietary supplements are recommended for migraine prophylaxis? - ANSWER-- Riboflavin 400 mg daily
- magnesium 400 mg/day
- Coenzyme Q-10 ---"Cog_nzyme"
- butterbur --> mmm butter on the brain
- feverfew ---> think: Fever causes HA
Beware that dietary supplements are poorly regulated in the U.S.
DRUGS FOR HEADACHE
□ The following: stress, fatigue, anxiety, alcohol, and tyramine rich foods are considered to be common migraine____________________? - ANSWER-- Triggers
- Migraineurs benefit from regular sleep habits, stress reduction, exercise, and healthy regular meals otherwise called "self-care."
ANTIPSYCHOTIC AGENTS AND THEIR USE IN SCHIZOPHRENIA
□ When do symptoms of schizophrenia typically present? - ANSWER-During adolescence and early adulthood
ANTIPSYCHOTIC AGENTS AND THEIR USE IN SCHIZOPHRENIA
□ What are some of the characteristics of schizophrenia? - ANSWER-Delusions, hallucinations, and disordered thinking
ANTIPSYCHOTIC AGENTS AND THEIR USE IN SCHIZOPHRENIA
□ What are the possible causes of schizophrenia? - ANSWER-Excessive activation for dopamine and insufficient activation of glutamate is postulated
ANTIPSYCHOTIC AGENTS AND THEIR USE IN SCHIZOPHRENIA
□ What are the two major groups of drugs used to treat psychosis? - ANSWER-Conventional (first generation) and atypical (second generation) antipsychotics.
ANTIPSYCHOTIC AGENTS AND THEIR USE IN SCHIZOPHRENIA
□ Of the conventional and atypical antipsychotics, which one has more extrapyramidal symptoms (EPS)? - ANSWER-Conventional or first generation antipsychotics such as haloperidol (Haldol) have more EPS symptoms
ANTIPSYCHOTIC AGENTS AND THEIR USE IN SCHIZOPHRENIA
□ What are the "positive" symptoms of schizophrenia? - ANSWER-- hallucinations
- delusion
- agitation
- tension
- paranoia.
ANTIPSYCHOTIC AGENTS AND THEIR USE IN SCHIZOPHRENIA
□ Describe the "negative" symptoms of schizophrenia. - ANSWER-- Low motivation
- lack of speech
- blunted affect
- social withdrawal
ANTIPSYCHOTIC AGENTS AND THEIR USE IN SCHIZOPHRENIA
□ What are the cognitive symptoms of schizophrenia? - ANSWER-Disordered thinking, reduced ability to focus attention, and prominent learning and memory difficulties.
ANTIPSYCHOTIC AGENTS AND THEIR USE IN SCHIZOPHRENIA
□ What is the MOA of antipsychotic drugs? - ANSWER-They block receptors for dopamine
ANTIPSYCHOTIC AGENTS AND THEIR USE IN SCHIZOPHRENIA
□ Neuroleptic agents are used for schizophrenia and_________? - ANSWER-- Bipolar disorder
- depression
- emesis
- dementia
- Tourette's syndrome
ANTIPSYCHOTIC AGENTS AND THEIR USE IN SCHIZOPHRENIA
□ How do neuroleptics suppress emesis? - ANSWER-By blocking dopamine receptors in the chemoreceptor trigger zone of the medulla
ANTIPSYCHOTIC AGENTS AND THEIR USE IN SCHIZOPHRENIA
□ What other receptors are blocked by first generation antipsychotics that contribute to side effect? - ANSWER-- ACh
- histamine
- alpha_1
- NE
ANTIPSYCHOTIC AGENTS AND THEIR USE IN SCHIZOPHRENIA
□ How long does it take to reach a therapeutic response when using antipsychotic drugs? - ANSWER-- initial 1-2 days,
- substantial improvement 2-4 weeks
- full effect a few months
ANTIPSYCHOTIC AGENTS AND THEIR USE IN SCHIZOPHRENIA [Show Less]