Term
Anxiety NT?
inhib or stim? |
|
Definition
|
|
Term
| Benzodiazepines _____________ GABA |
|
Definition
|
|
Term
| What are the NT decreased in depression? |
|
Definition
|
|
Term
| What is SSRI and what are the examples(4)? |
|
Definition
Selective Serotonin Reuptake Inhibitors:
fluoxetine (Prozac)
paroxetine (Paxil)
sertraline (Zoloft)
citalopram (Celexa) |
|
|
Term
| What is SNRI and what are some examples(2)? |
|
Definition
Serotonin/NE Reuptake Inhibitor:
venlafaxine (Effexor)
duloxetine (Cymbalta) |
|
|
Term
| What are TCAs and what is an example? |
|
Definition
Tricyclic Antidepressants
amitryptilline (Elavil) |
|
|
Term
| St John's Wort is used for...? |
|
Definition
|
|
Term
| St John's Wort works by increasing which NTs? |
|
Definition
|
|
Term
| What may be the vitamin deficiencies that may causes depression? |
|
Definition
folic acid
vit b12
vit b6
omega-3 fa's |
|
|
Term
| What are the natural products used for depression? |
|
Definition
St Johns Wort
SAMe
5-HTP
L-Trp |
|
|
Term
| What are the natural products used for anxiety? |
|
Definition
St Johns Wort
SAMe
5-HTP
L-Trp
Kava
Valerian |
|
|
Term
| St Johns Wort inhibits which NTs? |
|
Definition
|
|
Term
| What are the active ingredients of St Johns Wort? |
|
Definition
| xanthones, hypericins, hyperforin |
|
|
Term
| Why might St Johns Wort cause drug interactions? |
|
Definition
*Induces CYP 450 3A4 and P-glycoprotein
*Lesser extent CYP1A2 and CYP2C9
*Due to hyperforin! |
|
|
Term
| St Johns Wort should only be used in _________ depression |
|
Definition
|
|
Term
| SAMe works like _________ |
|
Definition
|
|
Term
| SAMe (do/do not) have many adverse effects. |
|
Definition
|
|
Term
| SAMe could convert bipolar patients to ________. |
|
Definition
|
|
Term
| SAMe has (high/poor) quality. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| SAMe should be recommended in what form |
|
Definition
| butanedisulfonate salt form |
|
|
Term
| St Johns wort should not be used with ____ |
|
Definition
|
|
Term
|
Definition
|
|
Term
| L-Trp is associated with EMS, which is? |
|
Definition
| EMS = Eosinophilia-myalgia syndrome |
|
|
Term
TRUE/FALSE.
L-Trp may have contaminant problems or not. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Valerian affects which NT receptor? |
|
Definition
|
|
Term
| Valerian is associated with what kind of toxicity? |
|
Definition
| hepatotoxicity; damage to liver |
|
|
Term
| Valerian can increase effects of __________________ |
|
Definition
ohter CNS depressants
alcohol, benzodiazepines, barbiturates, etc. |
|
|
Term
|
Definition
| 150-300 mg root extract daily |
|
|
Term
|
Definition
increase GABA binding sites
no effect on benzodiazepien receptors |
|
|
Term
| Kava kava adverse effects include: |
|
Definition
hepatotoxicity
dizziness and drowsiness |
|
|
Term
| Kava kava drug interaction problems |
|
Definition
not with other CNS depressants
not with anticoagulants and cyps |
|
|
Term
|
Definition
|
|
Term
| ____% of adults are current smokers |
|
Definition
|
|
Term
| Who smokes more? Males or females? |
|
Definition
| Males 23.9% vs Females 18% |
|
|
Term
| What race/ethnicity smokes the most? |
|
Definition
|
|
Term
| Which education level smokes most? |
|
Definition
|
|
Term
| What is the difference between regular cigarettes and light cigarettes?? |
|
Definition
| extra ventilation holes (usually covered by fingers....) |
|
|
Term
| What are the gas compounds (5)in smoke? |
|
Definition
carbon monoxide
hydrogen cyanide
ammonia
benzene
formaldehyde |
|
|
Term
| What are the non-gas particles in smoke? |
|
Definition
nicotine
nitrosamines
lead
cadmium
polonium |
|
|
Term
| For ever $1 spent by the states, the tobacco industry spends ______ to market its products. |
|
Definition
|
|
Term
| ___% of smokers want to quit. |
|
Definition
|
|
Term
| How many deaths are annually attributable to smoking?? |
|
Definition
|
|
Term
| Smoking costs SOCIETY _______ per pack |
|
Definition
|
|
Term
| Sm)oking reproductive effects?? |
|
Definition
reduced fertility in women
poor pregnancy outcomes (low birth weight, preterm delivery
infant mortality |
|
|
Term
Second hand smoke causes premature death and disease in nonsmokers.
Children risks:
SIDS, acute resp infection, ear problems, severe asthma, slowed lung growth
Adult risks:
CV risk, CHD, and lung cancer |
|
Definition
CV = cardiovascular
CHD = coronary heart disease |
|
|
Term
AFTER STOPPING:
*circulation and lung fxn improves in ___ weeks
*lung cilia to normal, ability to clear lungs, coughing, fatigue, short breath decrease within _______ months
*risk of CHD decreases in _____ year
*stroke reduced in _______ years
*lung cancer death decrease, mouth, throat, etc cancers decrease in ______ years
*risk of CHD similar to those who have never smoked after ______ years |
|
Definition
2-3 weeks
1-9 months
1 year
5 years
10 years
15 years |
|
|
Term
| At ____ age, there are benefits of quitting. |
|
Definition
|
|
Term
| On average, cigarette smokers die approximately ____ years younger than do nonsmokers. |
|
Definition
|
|
Term
| Describe absorption of nicotine. |
|
Definition
pH dependent
in acidic, ionized, poorly absorbed
in basic, nonionized, well-absorbed
**at physiologic pH, nicotine is readily absorbed. |
|
|
Term
| pharmacokinetics vs pharmacodynamics |
|
Definition
pharmacokinetics - effects of the body on the drug
pharmacodynamics - effects of the drug on the body |
|
|
Term
cigarettes have limited absorption
all other forms have significant absorption
what is pH of mouth |
|
Definition
|
|
Term
| Nicotine is (well/poorly)-absorbed in the small intestine but has low bioavailability (20-45%) due to first pass hepatic metabolism |
|
Definition
|
|
Term
TRUE/FALSE:
Nicotine is rapidly absorbed across the respiratory epithelium. |
|
Definition
|
|
Term
| What is nicotine distribution in the blood? How fast does nicotine take to reach the brain?? |
|
Definition
Arterial blood carries most nicotine.
11 seconds! |
|
|
Term
| Nicotine is broken down to what? |
|
Definition
| cotinine(70-80%) and other metabolites(10%) and 10% excreted in urine |
|
|
Term
what is nicotine t1/2
what is cotinine t1/2 |
|
Definition
nicotine t1/2 = 2 hr
cotinine t1/2 = 16 hr |
|
|
Term
| Excretion of nicotine in which ways.... |
|
Definition
|
|
Term
| Nicotine has predominantly (stimulatory/inhibitory) effects. |
|
Definition
|
|
Term
| What are the NT related to Nicotine? |
|
Definition
Dopamine-pleasure; appetite suppression
NE-arousal,appetite suppression
ACh-arousal,cognitive enhancement
Glutamate-learning,memory enhancement
Serotonin-mood modulation, appetite suppression
B-endorphin-reduction of anxiety,tension
GABA-reduction of anxiety,tension |
|
|
Term
| Describe the dopamine reward pathway. |
|
Definition
1. nicotine stimulates dopamine release
2. pleasurable feelings
3. repeat admin
4. tolerance develops
**discontinutation leads to withdrawal symptoms |
|
|
Term
| Nicotine Withdrawal symptoms: |
|
Definition
irritability
anxiety
difficulty concentrating
restlessness
depression
insomnia
increased weight |
|
|
Term
| When do nicotine withdrawals start and stop? |
|
Definition
Peak within the first week.
Stop within 2-4 weeks |
|
|
Term
| What is the test for nicotine dependence? |
|
Definition
| Fagerstrom Test for Nicotine Dependence (FTND) |
|
|
Term
| What are the factors contributing to tobacco use? |
|
Definition
Environmental
Physiology
Pharmacology |
|
|
Term
| Treatment should address which parts of the problem? |
|
Definition
| physiological and behavioral |
|
|
Term
| What happens to caffeine when smoking? |
|
Definition
| Caffeine amount DOUBLES via induction of CYP1A2 |
|
|
Term
| Smoking cessation reverses the effects of many drugs and especially ____________. |
|
Definition
|
|
Term
| What are the 2 risks that cause someone to be of greater risk of stroke, myocardial infarction, and thromboembolism. |
|
Definition
1. Women 35+ years old
2. Women smoking 15+ cigarettes per day |
|
|
Term
| What are the National Cancer Institute's 5 A's for quitting smoking. |
|
Definition
Ask-about tobacco use
Advise-tobacco users to quit
Assess-readiness to quit
Asist-with the quit attempt
Arrange-follow-up |
|
|
Term
| With help from a clinician, the odds of quitting approximately ___________. |
|
Definition
|
|
Term
| What are the 4 stages of readiness to quit smoking? |
|
Definition
Stage 1-not ready in the next month
Stage 2-ready in the next month
Stage 3-recent quitter, within 6 mos
Stage 4-former user, over 6 mos |
|
|
Term
| What are th DON'Ts of counseling ppl who are NOT ready to quit. |
|
Definition
DON'T persuade
DON'T cheerlead
DON'T tell them how bad tobacco is bc this is judgemental
DON'T provide a treatment plan bc they are not ready!! |
|
|
Term
| What are the 5 Rs for enhancing motivation for smokers in Stage 1? |
|
Definition
Relevance
Risks
Rewards
Roadblocks
Repetition |
|
|
Term
| In Stage 2, how is counseling approached? |
|
Definition
1. Assess tobacco use history(praise readiness,type,amount,duration,previous quit attempts)
2. Discuss key issues (reasons to quit,confidence,triggers, routines)
*stress
*weight gain (bupropion)
*withdrawal (2-4 wks)
3. Facilitate quitting process(methods, quit date, tobacco use log,coping)
*cognitive coping
*behavioral coping |
|
|
Term
| What is the smoking cessation hotline?? |
|
Definition
|
|
Term
| What are 3 nonpharmacologic aids for cessation of smoking? |
|
Definition
1. Cold turkey
2. unassisted tapering (fading)
3. assisted tapering (quitkeys)
4. cessation programs
4. acupuncture
5. hypnotherapy
6. massage therapy |
|
|
Term
|
Definition
Computer-developed taper based on patient's smoking level.
Includes telephone counseling support. |
|
|
Term
| What are the 3 general classes of FDA-approved drugs for smoking cessation? |
|
Definition
1. nicotine replacement (NRT)
2. psychotropics (bupropion)
3. partial nicotinic receptor agonist(varenicline) |
|
|
Term
| Pharmacotherapy for smoking cessation is NOT recommended for: |
|
Definition
1. smokeless tobacco users
2. smokers of <10 per day
3. adolescents |
|
|
Term
| What are the different NRT products? |
|
Definition
Polacrilex gum (Nicorette)
Nasal Spray (Nicotrol)
Lozenge(Commit)
Inhaler(Nicotrol)
Transdermal Patch(NicoDermCQ) |
|
|
Term
| Patients (should/should not) discontinue their use of tobacco products when using NRT. |
|
Definition
|
|
Term
|
Definition
Patients with underlying CV disease
*myocardial infarcation with past 2 wks
*serious arrhythmias
*serious angina(chest pain) |
|
|
Term
| Nicotine Gum ingredients/dosing? |
|
Definition
resin complex(nicotine/polacrilin)
2mg,4mg |
|
|
Term
| Nicotine Gum ingredients/dosing? |
|
Definition
resin complex(nicotine/polacrilin)
2mg (<25 cigs/day)
4mg (>25 cigs/day)
First 6 wks: 1 piece q 1-2hrs
7-9 wks: 1 piece a 2-4hrs
10-12 wks: 1 piece q 4-8hrs
**NOT exceed 24 pieces per day!
**BUT at least 9 per day!! |
|
|
Term
| Do not eat or drink ____ minutes before or while using nicotine gum. |
|
Definition
|
|
Term
| Counseling for Nicotine gum? |
|
Definition
*chew slowly
*at first sign of peppery/tingling stop chewing gum and "park" it between cheek and gum
*resume chewing when tingle fades
*REPEAT |
|
|
Term
| What are the side effects of nicotine gum? |
|
Definition
mouth soreness
hiccups
dyspepsia
jaw muscle ache |
|
|
Term
| Advantages and Disadvantages of nicotine gum. |
|
Definition
Advantages:
satisfy oral cravings
delay weight gain (4mg)
titrate therapy
flavors
Disadvantages
Frequent dosing
dental work
proper technique
not acceptable to chew gum |
|
|
Term
| Nicotine lozenges dosing is based on ___________________ as an indicator of nicotine addiction |
|
Definition
time to first cigarette (TTFC)
>30 min of waking = 2mg
<30 min of waking = 4mg |
|
|
Term
|
Definition
Weeks 1-6: 1 lozenge every 1-2 hours
Weeks 7-9: 1 lozenge every 2-4 hours
Weeks 10-12: 1 lozenge every 4-8 hours
*use at least 9 lozenges for the first 6 weeks |
|
|
Term
| Advantages and disadvantages of nicotine lozenges. |
|
Definition
Advantages:
Oral cravings
Delay weight gain
Easy to use and conceal
Titrate therapy
Flavors
Disadvantages:
Frequent dosing
GI side effects |
|
|
Term
| What are the different strengths of nicotine patches. |
|
Definition
|
|
Term
| What is the dosing for nicotine patch? |
|
Definition
Light Smoker <10 cigs/day
6 weeks - 14mg
2 weeks - 7mg
Heavy smoker >10 cigs/day
6 weeks - 21mg
2 weeks - 14mg
2 weeks - 7mg |
|
|
Term
| What area of skin is the nicotine patch used? |
|
Definition
| Upper body or upper outer part of the arm |
|
|
Term
| Do not leave patch on skin for more than ____ hours |
|
Definition
|
|
Term
| What are the side effects of the nicotine patch? |
|
Definition
| itching, burning, tingling, sleep disturbances, and headache |
|
|
Term
| Advantages and disadvantages of nicotine patches |
|
Definition
Advantages
consistent nicotine
easy to use and conceal
once daily dosing
Disadvantages
cannot titrate
allergic reactions
dermatologic problems |
|
|
Term
| How much nicotine is sprayed per dose of nasal spray? |
|
Definition
| 50mcL spray contains 0.5mg nicotine |
|
|
Term
| one dose of nasal spray is how many sprays?? |
|
Definition
|
|
Term
|
Definition
1-2 doses per hour
maximum dosage of 5 doses per hour (40mg) daily
use at least 8 doses daily for the first 6-8 weeks |
|
|
Term
| Counseling points for nasal spray? |
|
Definition
breathe through mouth when administering
wait 2-3 minutes before blowing nose
wait 5 minutes before driving |
|
|
Term
| Advantages and disadvantages of nasal spray |
|
Definition
Advantages
titrate therapy
Disadvantages
frequent dosing
nasal/throat irritation
higher dependence |
|
|
Term
| How much nicotine does one inhaler contain? |
|
Definition
|
|
Term
|
Definition
start with at least 6 cartridges/day for the first 3-6 weeks
maximum of 16 cartridges/day
about 1 cartridge every 1-2 hours
*3 months duration |
|
|
Term
| Inhaler nicotine is absorbed across __________________ mucosa |
|
Definition
|
|
Term
| ____ minutes of puffing on nicotine inhaler depletes it |
|
Definition
|
|
Term
| OPen inhaler cartridges are only potent for ____ hours |
|
Definition
|
|
Term
| Nicotine inhaler is not as effective in (hot/cold). |
|
Definition
|
|
Term
| Advantages or disadvantages of nicotine inhaler |
|
Definition
Advantages
titrate therapy
hand-to-mouth
Disadvantages
frequent dosing
throat/mouth irritation
not stored in warm
bronchospastic disease must use caution |
|
|
Term
| What are the non-nicotine aids for smoking cessation? |
|
Definition
|
|
Term
| What is bupropion's (Zyban)MOA? |
|
Definition
antidepressant affecting levels of dopamine, ne
*decreases craving for cigarettes
*decreases symptoms of nicotine withdrawal |
|
|
Term
| Explain pharmacokinetics of bupropion. |
|
Definition
Absorption: bioavailability 5-20%
Metabolism: hepatic metab CYP2B6
Elimination: urine(87%) and feces(10%)
Half-Life: 21 hours(metabolites:20-37 hours) |
|
|
Term
|
Definition
| An acquired and persistent loss of intellectual functions due to a brain disorder |
|
|
Term
|
Definition
| acquired, persistent, slowly progredient disorder leading to loss of various organ functions over time |
|
|
Term
| What is in the brain of an Alzheimer's patient that isnt in a normal brain? |
|
Definition
neurofibrillary tangles
amyloid plaques |
|
|
Term
| What are the current treatment strategies for Alzheimer's disease? |
|
Definition
enhancement of cholinergic function in order to improve cognition
*inhibition of AChE
*muscarinic agonists |
|
|
Term
| What are near future treatment strategies for AD? |
|
Definition
reduction of amyloid and NFT formation
*antioxidative strategies |
|
|
Term
| What are far future treatment strategies for AD? |
|
Definition
| stem cell and gene therapies |
|
|
Term
|
Definition
brain-permeable muscarinic agonist of botanical origin
betel nut, betel palm |
|
|
Term
| What is Physostigma venenosum (calabar bean)? |
|
Definition
First anticholinesterase known
West African climbing herb |
|
|
Term
| What are more recent AChE inhibitors from plants? |
|
Definition
Galanthamine (from botanicals: snowdrop,spiderlilly,daffodil)
Huperzine A (chinese club moss) |
|
|
Term
| How does Huperzine A work? What is it a treatment for? How is it dosed? |
|
Definition
inhibits AChE reversibly
AD
50-200 micrograms orally 2-4x per day |
|
|
Term
| What are the constituents(ingredients) of Extract Ginkgo biloba #761(EGb-761)? |
|
Definition
*flavone glycosides eg rutin (25-30%)
*terpenoids: ginkgolides, bilobalide(3%)
*organic acids eg chlorogenic acid, ascorbic acid |
|
|
Term
| Extraction procedures for EGb eliminates what?? |
|
Definition
ginkgolic acids
proanthycyanidines(tannins)
steroids(sitos,terin)
proteins(lectins)
minerals(heavy metals) |
|
|
Term
| What are the CV effects of EGb761? |
|
Definition
antioxidant(flavonoids)
rheologic effects(reduces blood visc)
PAF-antag
inhibits platelet aggregation
*also useful for arterial occlusive disease and tinnitus and possibly for cerebrovascular insufficiency |
|
|
Term
| What are the neuroprotective effects of EGb |
|
Definition
increase tolerance to hypoxia
inhibition of edema formation
inhibition of memb breakdown during ischemia
interactions with various NTs and recs
active in stroke, brain,trauma, dementia |
|
|
Term
| Anti-dementia drugs are used to..... |
|
Definition
| prevent further neuronal degeneration |
|
|
Term
| EGb could also be used for...? (but not clinically proven effective) |
|
Definition
hypercholesterolemia/HTN
ashtma/bronchitis
angina pectoris
regulation of gastric acidity
improvement of liver fxn
premenstrual syndrom
improvement of sexual performance
eye problems
dysentery/filariasis |
|
|
Term
| Describe toxicity of EGb761. |
|
Definition
lethal dose about 2g
no organ damage during chronic use
no carcinogenicity
no teratogenicity
low clinical toxicity
rare allergenicity, GI probs, bleeding
DO NOT use in patients with coagulopathies |
|
|
Term
| Describe Curcumin and what is it used for? |
|
Definition
reduce amyloid formation, but NO clinical data available
uses for dementia/AD |
|
|
Term
| How is ursolic acid used and what for? |
|
Definition
antioxidative properties and may reduce amyloid plaque formation
dementia/AD |
|
|
Term
|
Definition
Indian Ginseng
commonly used in ayurvedic medicine |
|
|
Term
| Bupleurum aka ________________-- |
|
Definition
|
|
Term
| Salvia and Melissa aka _______________ |
|
Definition
|
|
Term
| Beneficial effects for aging or dementai have NOT been shown for what herbs? |
|
Definition
Curcuma
ORiganum marjorana
Withania
Bupleurum
Melissa and Salvia |
|
|
Term
| Hawthorn is a ________ stimulant. |
|
Definition
|
|
Term
| Rosemary stimulates __________, improves ____________, and relieves _____________. |
|
Definition
circulation
digestion
depression |
|
|
Term
| Siberian ginseng increases ___________ and improves _________________. What is a caution with this one? |
|
Definition
endurance
cerebral circulation
**use with caution if you have high bp |
|
|
Term
| Lemon balm (Melissa) reduces ____________ and __________. |
|
Definition
|
|
Term
| Ginger helps with general _____________ |
|
Definition
|
|
Term
| St Johns Wort helps relieve ___________ and ____________ |
|
Definition
|
|
Term
Which of the following plant constituents are inhibitors of acetylcholinesterase ?
Arecoline
Physostigmine
Tubocurarine
Scopolamine
Huperzine A |
|
Definition
Arecoline
Physostigmine
Huperzine A |
|
|
Term
EGb contain
bilobalide
hypericine
ginkgolide b
nicotine
yangonine |
|
Definition
| bilobalide and ginkgolide b |
|
|
Term
Adverse effects of Ginkgo biloba extracts include:
Possible allergic reactions
Kidney failure
Increase of bleeding time
Teratogenic effects
Gastrointestinal disturbances |
|
Definition
allergic reaction
increase bleeding time
GI disturbances |
|
|
Term
| Somatic pain is within what parts of the body? |
|
Definition
| skin, bone, joint, muscle, connective tissue |
|
|
Term
| Visceral pain is within which parts of body? |
|
Definition
| internal organs: pancreas, large intestine |
|
|
Term
| Nociceptive pain is (acute/chronic) |
|
Definition
|
|
Term
| Neuropathic pain is (acute/chronic) |
|
Definition
|
|
Term
| Nociceptive pain is transmitted by which kind of nerve fibers |
|
Definition
|
|
Term
| What are the differences between A and C nociceptive pain nerve fibers? |
|
Definition
A: large diameter, myelinated, sharp pain
C: small diameter,unmyelinated, dull, aching pain |
|
|
Term
| What NT do nociceptive pain fibers release? |
|
Definition
glutamate
substance P
calcitonin gene-related peptide |
|
|
Term
| ______________ works as relay for transmission of pain. |
|
Definition
|
|
Term
| Conscious experiences takes place in higher ________ region in the brain |
|
Definition
|
|
Term
| Nociceptive pain is an _________ __________ system |
|
Definition
|
|
Term
| What are the NTs for modulation of nociceptive pain |
|
Definition
endorphins
dynorphins
enkephalins |
|
|
Term
| What are the receptors for nociceptive pain? |
|
Definition
|
|
Term
| Describe NMDA activation of nociceptive pain. |
|
Definition
| decrease binding of opiates to receptors |
|
|
Term
| Neuropathic pain is known as _________ pain which is disengaged from noxious stimuli |
|
Definition
|
|
Term
| Neuropathic pain is because of.....? |
|
Definition
nerve stimulation, autonomic neuronal pain stimulation
burning, tingling, shooting pain |
|
|
Term
Describe tension headache.
Location?
Nature?
Onset?
Duration? |
|
Definition
Location: bilateral, over top of head and on to base of skull
Nature: diffuse ache to tight, pressing, constricting pain
Onset:gradual
Duration: minutes to days |
|
|
Term
Describe migraine headache.
Location?
Nature?
Onset?
Duration? |
|
Definition
Location: unilateral
Nature:throbbing
Onset:sudden
Duration:hours to days |
|
|
Term
Describe sinus headache.
Location?
Nature?
Onset?
Duration? |
|
Definition
Location:face, forehead, periorbital area
Nature:pressure behind eyes or face; dull, bilateral pain; worse in the morning
Onset:simultaneous with sinus problems, including prurulent nasal discharge
Duration:days |
|
|
Term
| What is the specific NT for migraines? |
|
Definition
|
|
Term
| Migraines are from perivascular axons release what?? |
|
Definition
calcitonin gene-related peptide(CGRP)
neurokinin A
substance P |
|
|
Term
| What are the therapies for migraines? |
|
Definition
|
|
Term
| What for and How is Ergotamine used? |
|
Definition
moderate to severe migraine
5-HT1 rec agonist used to constrict intracranial BVs, inhibit neurogenic inflammation
Side effects: nausea/vomiting |
|
|
Term
| What is MOA of Triptans and what is it used for? |
|
Definition
serotonin rec agonists effective against migraines
Sumatriptan(1st gen.)
Almotriptan(2nd gen.)
used to normalize dilated intracranial arteries
side effects: fatigue, dizziness, flushing |
|
|
Term
| What is active ingredient for Devil's Claw? |
|
Definition
| harpagoside-iridoid glycoside |
|
|
Term
| How does Devil's Claw work? |
|
Definition
inhibits lipoxygenase and COX2
helps production of TNF-alpha(anti-inflammatory)
**lower back pain
may cause hypoglycemic effects |
|
|
Term
|
Definition
prevention of migraines
less nausea/vomiting
inhibits PG synthesis
increased photosensitivity |
|
|
Term
| What are the constituents in Feverfew? |
|
Definition
parthenolide
michefuscalide
chrysanthenyl acetate |
|
|
Term
| What are constituents of Comfrey? |
|
Definition
toxic alkaloids (pyrrolizidine)
symlandine
symphytine
echimidine |
|
|
Term
|
Definition
suppress degranulation of azurophil granules and superoxide generation in leukocytes
alter PG production and thus reducing inflammation |
|
|
Term
| What is ingredient of Bromelain? |
|
Definition
| sulfur containing proteolytic digestive enzyme from the stem and fruits of the pineapple |
|
|
Term
| What is MOA of Bromelain? |
|
Definition
not clear...
may inhibit synthesis of PGs by lowering kininogen and bradykinin in serum and tissues
activate plasmin production from plasminogen
reduce pain and inflammation after tooth extraction
may increase absorption of antibiotics
inhibit platelet aggregation and thus there is risk of bleeding |
|
|
Term
| What are the 4 stages of sleep? |
|
Definition
1. more wake than sleep
2. 50%; light sleep
3/4. deep/delta; low freq
REM=high freq; eyes move, bp, hr, temp, respiration, metab all increase |
|
|
Term
Short term insomnia lasts how long?
How long does chronic insomnia last? |
|
Definition
|
|
Term
| NREM sleep controlled by forebrain primarily by what NT |
|
Definition
|
|
Term
| Decrease serotonin causes (increase/decrease) sleep |
|
Definition
|
|
Term
| Increase dopamine (increase/decrease) sleepiness |
|
Definition
|
|
Term
| Which NT cause wakefulness? |
|
Definition
| Dopamine, NE, ACh, Histamine, and substance P |
|
|
Term
|
Definition
| hydrophilic imidazole ring and amino group and 2 methylene groups From histidine Metab by MAO 4 diff types of histamine |
|
|
Term
|
Definition
| Throughout CNS and dense in hypothalamus Increases wakefulness Inhibits appetite Bronchoconstriction and contraction of gut NO release Role in contraction of various smooth muscles |
|
|
Term
|
Definition
| mainly in CNS, ganglia, hippocampus, and cortex |
|
|
Term
|
Definition
| present on immune cells such as eosinophils and neutrophils |
|
|
Term
| Activation of H3 and H4 receptors decrease cellular __________. |
|
Definition
|
|
Term
| List some H1 antagonists. Describe general features. |
|
Definition
Diphenhydramine
Tripelennamine
*cross BBB
inhibit response to ACh
prevents motion sickness
used for acute allergies
well-absorbed in GIT and peaks in plasma about 2h with t1/2=4-8hrs
Eliminated more rapidly by children |
|
|
Term
| What is important about H1 antagonist toxicity? |
|
Definition
induces hepatic CYP(reduced clearance)
sedation as side effect
loss of appetite, nausea, vomiting, constipation, diarrhea
dry mouth, resp passage, urinary retention
**additive if taken with CNS depressants
excreted in breast milk |
|
|
Term
| What are some side effects for diphenhydramine? |
|
Definition
liver disease
inhibits CYP2D6(reduce clearance of metaprolol, codeine, propanolol, venlafaxine)
Enhances effects of BPH
increase dementia risk
CV disease-angina
**abuse with antipsychotic meds |
|
|
Term
| Benzodiazepines are used for what and how? |
|
Definition
relieve insomnia(GABA agonist)
increase stage 2 and decrease REM, stage 3/4
**NOT used with CNS depressants
t1/2 prolonged in elderly patients-psychomotor impairment
MOA: bind/enhance GABA effect-promoting sleep
Side effects: headache, blurry vision, vertigo, nausea, vomiting |
|
|
Term
Brain acts as a gate to ------- the flow of nerve impulse from CNS
Increase
Decrease
Both |
|
Definition
|
|
Term
1.Feverfew A.contain pyrrolizidine
2.Devil'sClaw B.photosensitivity
3.Comfrey C.Dcrs bradykinin/kininogen
4.Bromelain D.hypoglycemic effects |
|
Definition
|
|
Term
| What is the difference between primary and secondary headaches? |
|
Definition
Primary - no underlying disease
Secondary - symptom of other disease |
|
|
Term
|
Definition
|
|
Term
| Allergic rhinitis (increases/decreases) with increase age. |
|
Definition
Decreases
*as you age, your immune system is weaker |
|
|
Term
|
Definition
| seasonal allergic rhinitis |
|
|
Term
| Perrenial/persistent allergic rhinitis |
|
Definition
| symptoms persist throughout the year |
|
|
Term
| Immune mediators are from..... |
|
Definition
| mast cells and granulocytes |
|
|
Term
| Histamine, Kinins, PGs, adn leukotrienes are what?? |
|
Definition
| immune mediators that cause allergic reaction |
|
|
Term
| Histamine causes which symptoms of allergic rhinitis? |
|
Definition
itching
pain
vasodilation
sneezing |
|
|
Term
| What are the phases of allergic rhinitis? |
|
Definition
Sensitization
Early
cellular Recruitment - cells set up shop and pump out mucus
Late |
|
|
Term
| Diagnosis for allergy via ______ |
|
Definition
|
|
Term
| Complications/comorbidities of allergic |
|
Definition
Sinusitis
Conjunctivitis
Otitis media
Sleep apnea
Asthma exacerbations
Anosmia (loss of smell)
Loss of taste or taste
Nasal polyps
Taste perversion |
|
|
Term
| Exclusions for self care for allergic rhinitis?? |
|
Definition
Children < 12 years*
Pregnant or lactating women*
Symptoms of nonallergic rhinitis
Symptoms of otitis media (OM), sinusitis, bronchitis, or other infection
Symptoms of undiagnosed or uncontrolled asthma, COPD, or other lower respiratory disorder
Moderate-to-severe PAR or symptoms unresponsive to treatment
Severe or unacceptable ADEs to treatment |
|
|
Term
|
Definition
air quality index
**usually worse inside your house than outside |
|
|
Term
|
Definition
|
|
Term
| What is the ABCDE process for pain? |
|
Definition
Ask and Assess
Believe patient and family
Choose appropriate therapy
Deliver interventions
Empower and Enable the patient to control pain |
|
|
Term
| What is the PQRST assessment for pain? |
|
Definition
Provocative factors (causes it)
Palliative factors (relieves it)
Quality of Pain
Region or Radiation
Severity (pain rating scales)
Temporal course or Treatment tried |
|
|
Term
|
Definition
Symptoms
Characteristics
History
Onset
Location
Aggravating Factors
Remitting Factors |
|
|
Term
| What are the different pain scales? |
|
Definition
Numerical Rating Scales(NRS)
Visual Analog Scale (VAS)
Wong-Baker Faces Scale |
|
|
Term
| What kind of headache is on the lateral side of your head? |
|
Definition
|
|
Term
| What kind of headache is dull aching on the back of your head? |
|
Definition
|
|
Term
| Whatt are the exclusions for self treatment of headaches? |
|
Definition
*severe head pain
*over 10 days w/ or w/o treatment
*last trimester
*under 8yo
*high fever/sign of infection
*liver disease or >3alcohols/day
*underlying pathology(secondary)
*migraine symptoms w/o diagnosis of migraines |
|
|
Term
| What is MOA for Acetaminophen(APAP)? What is it used for? |
|
Definition
central inhibition of PG synthesis
analgesic(pain) and antipyretic(fever)
NOT anti-inflammatory |
|
|
Term
| What are the drug interactions with Acetaminophen(APAP)? |
|
Definition
Chronic alcohol use
Liver disease
Hepatotoxic meds
Pts with G6PDH deficiency
Warfarin(blood thinner) |
|
|
Term
|
Definition
Rapidly absorbed
Onset:30 minutes
Duration:4 hrs |
|
|
Term
|
Definition
Acute overdose = 10g/day or 15g/2days or 4g/day chronically
*hepatic necrosis and renal tubular necrosis
early symptoms: nausea, vomiting, drowsiness, confusion, and ab pain
late symptoms(2-4days later):jaundice, bruising, bleeding
**FATAL |
|
|
Term
| What are examples of NSAIDs? |
|
Definition
Ibuprofen
Naproxen
Aspirin
Non-acetylated Salicylates |
|
|
Term
| What is Ibuprofen/Naproxen (not salicylates) MOA and uses? |
|
Definition
Peripheral inhibition of COX and thereby PG synthesis(reversible)
Used as analgesic(pain) and antipyretic(fever) and anti-inflammatory(Rx ONLY)! |
|
|
Term
| Ibuprofen/Naproxen adverse events. |
|
Definition
dyspepsia
nauseau
heartburn
anorexia
epigastric pain
antiplatelet
hypoglycemia |
|
|
Term
| Ibuprofen/Naproxen Toxicity. |
|
Definition
minimal
may include N/V, ab pain, lethargy, dizziness,etc. |
|
|
Term
| Ibuprofen/Naproxen PK/PD. |
|
Definition
rapidly absorbed
renal elmination
Onset:30 minutes
Duration(Ib):6-8 hrs
Nap:12 hours
Administer WITH FOOD |
|
|
Term
| Salicylates (ASA) MOA and uses? |
|
Definition
peripheral inhibition of COX and PG synthesis (IRREV)
analgesic, antipyretic, anti-inflammatory(RxONLY) |
|
|
Term
| Salicylates adverse events. |
|
Definition
GI upset
ulceration
antiplatelet
hypoglycemia |
|
|
Term
|
Definition
salicylism
reye's syndrome
hypersensitivity |
|
|
Term
| NSAID drug or disease interactions. |
|
Definition
Alcohol
anticoag
liver disease
corticosteroids
PUD
*possible increased risk of GI bleeding |
|
|
Term
| Ibuprofen drug or disease interactions. |
|
Definition
ASA use for CV disease
*decreased antiplatelet effect of ASA |
|
|
Term
| ASA + other salicylates drug or disease interactions. |
|
Definition
acute viral illness in children 15yrs and younger
Reye's syndrome(vomiting,lethargy,diarrhea,tachypnea,weakness,seizures) |
|
|
Term
| NSAIDs including salicylates drug or disease interactions. |
|
Definition
antihypertensive(bc effect is inhibited)
heart failure
fluid retention |
|
|
Term
| Salicylates are contraindicated with. |
|
Definition
|
|
Term
| Acetaminophen in what formulations? |
|
Definition
|
|
Term
| Ibuprof in what formulations? |
|
Definition
|
|
Term
| Naproxen in what formulations? |
|
Definition
|
|
Term
| Aspirin in what formulations? |
|
Definition
Bayer
St. Joseph
Alka-Seltzer |
|
|
Term
| Mg Salicylate in what formulations? |
|
Definition
|
|
Term
|
Definition
Adults:325-1000mg Q 4-6hrs(4000/day)
Children:10-15mg/kg Q 4-6hrs(>2yo)(5doses) |
|
|
Term
|
Definition
Adult:200-400mg Q4-6hrs (1200mg)
Children:7.5mg/kg Q6-8hrs(4 doses) |
|
|
Term
|
Definition
Adult:220mg Q8-12hrs (660mg)
Children:same as adult(>12yo ONLY) |
|
|
Term
|
Definition
Adult:650-1000mg Q4-6hrs(4000mg)
Children:10-15mg/kg Q4-6hrs(>15yo)(5 doses) |
|
|
Term
|
Definition
Adults:650mg Q4hrs or 1000mg Q6hrs(4000mg)
Children:NOT approved |
|
|
Term
| Self care for pain depends on what?? |
|
Definition
age - YES self care
length of pain - NO
nature/origin of pain - YES
prior attempts to control pain - NO
inflamm component - YES
side effect profile - NO
pregnancy/breast-feeding - YES
concomitant disease states - NO
concomitant drug therapy - YES
patient preference - NO
cost - YES |
|
|
Term
| Musculoskeletal pain caused by....? |
|
Definition
injury or inflammation
myofascial(muscular) pain
osteoarthritis |
|
|
Term
| What are the kinds of musculoskeletal pain that is self-treatable? |
|
Definition
overexertion, muscle, or joint injury
myalgia,tendonitis,bursitis,sprains,strains
osteoarthritis(w/ formal diagnosis) |
|
|
Term
| what are complementary options for musculoskeletal pain self-care? |
|
Definition
glucosamine
chondroitin
MSM
SAMe
acupuncture
massage
chiropractic care |
|
|
Term
|
Definition
500mg 3-4xdaily
caution:shellfish allergy, bleeding disorders, diabetes,renal impairment
COntraindication:active bleeding, peri-surgical(avoid for 14 days before surgery/dental work)
may work w/ chondroitin |
|
|
Term
|
Definition
part of connective tissue; absorbs H2O
200-400mg 2-3xdaily (1200mg)
Caution: bleeding disorders, perisurgical |
|
|
Term
|
Definition
Methyl sulfonyl methane; DMSO
Anti-inflammatory by limiting release of inflammatory mediators
Sulfur smell possible
Cautions: none reported |
|
|
Term
|
Definition
S-adenosyl-methionine
Literature for use in many conditions, including OA
Cautions: MAOIs, SSRIs, TCAs, oral hypoglycemics |
|
|
Term
| Devil's Claw for musculoskeletal pain has what cautions? |
|
Definition
Cautions
bleeding disorders, peri-surgical
Pregnancy (uterine contractions)
Cardiovascular arrhythmias
GI disorders
Diabetes
Gallstones |
|
|
Term
| Comfrey for musculoskeletal pain should only be used ___________. |
|
Definition
|
|
Term
| What are the exclusions to self treatment for musculoskeletal pain? |
|
Definition
Moderate to severe pain (pain score > 6)
Pain that lasts more than 2 weeks
Pain that persists (no change) or worsens after 7 days of treatment
Increased intensity or change in the character of pain
Pelvic or abdominal pain (other than dysmenorrhea)
Accompanying N/V, fever, or other signs of systemic infection or disorder
Visually deformed joint, abnormal movement, weakness in any limb, or suspected fracture
Age under 2 years (see individual product literature)
Third trimester of pregnancy
Trauma requiring medical attention
Pain distribution along a nerve rather than a particular muscle mass or joint
Rheumatoid arthritis |
|
|
Term
| What is the follow up care for overexertion, muscle or joint pain; and for osteoarthritis? |
|
Definition
Overexertion, muscle, or joint pain
7 days
If improved, continue therapy to < 2 weeks
If not improved, proceed with medical referral
Osteoarthritis
1 month
If improved, continue therapy
If unsatisfied with pain relief, adjust and re-evaluate in 1 month, then to medical referral |
|
|
Term
| What are Analgesic-Anesthetic-Antipruritics used for? |
|
Definition
Inhibit cutaneous sensory receptors
Used for local cuts, burns, abrasions, etc.
Will be covered to some degree in sunburn lecture |
|
|
Term
| What are the counterirritants? |
|
Definition
Paradoxical effect (generally)
Common ingredients:
Methyl salicylate – consider topical absorption
MOA – unknown
Camphor – dose-related response
Low concentrations: depression of cutaneous receptor response
Higher concentrations: stimulation of cutaneous receptors
Menthol – dose-related response
See Camphor notes above
Capsaicin
MOA – depletion of Substance P |
|
|
Term
|
Definition
Counterirritant:
MOA – depletion of Substance P
*local irritation without rubefaction
0.025-.25% 3-4xdaily |
|
|
Term
|
Definition
Counterirritants:
dose-related response
Low concentrations: depression of cutaneous receptor response
Higher concentrations: stimulation of cutaneous receptors
*cooling sensations
1.24-16% NMT 3-4xdaily |
|
|
Term
| What is methyl salicylate? |
|
Definition
Counterirritant:
consider topical absorption
MOA – unknown
Rubefaciant(cutaneous dilation)
10-60% NMT 3-4xdaily |
|
|
Term
| What are the differences in formulations of salicylates? |
|
Definition
Liquid:Choline salicylate is more water soluble than ASA; therefore available in solution
Enteric Coated: absorbed only from small intestine
Buffered: absorbed more rapidly; but clinical benefit is not significantly better
Effervescent: rapidly absorbed, but clinical benefit not proven (sodium content)
Sustained release: slower onset; possibly beneficial for overnight relief
Unaltered/uncoated drug: great for quick relief and for early treatment of acute myocardial infarction (AMI) – ASA only |
|
|
Term
| What is the difference between acetylated vs nonacetylated salicylates? |
|
Definition
Acetylated: Irreversible inhibition of platelet aggregation
Non-acetylated: No appreciable effect on platelets |
|
|
Term
| What defines hyperpyrexia? |
|
Definition
| Hyperpyrexia – body temperature exceeding 106°F (41.1°C) |
|
|
Term
| What defines hyperthermia? |
|
Definition
| Hyperthermia – malfunctioning of the normal thermoregulatory process |
|
|
Term
|
Definition
| Pyrogen – substance that induces fever |
|
|
Term
| What is meant by core temperature? |
|
Definition
| Core temperature – temperature of blood surrounding the hypothalamus |
|
|
Term
| Children have (more/less) variation when it comes to fever? |
|
Definition
|
|
Term
| Higher temperatures that would not be considered fever are caused by what?? |
|
Definition
Elderly
Immunocompromised patients
Infants under 3 months of age
Daily Fluctuation
Circadian rhythm 3AM-5AM(lower) vs. 5PM-7PM(higher)
Activity or exercise
Menstrual cycle |
|
|
Term
| What are the complications of fever? |
|
Definition
Dehydration
Delirium/altered sensorium
Coma
Neurological damage
Muscle damage
Seizures – 2-4% of all children from 6 months to 5 years of age |
|
|
Term
| What are febrile seizures? |
|
Definition
Seizures due to fever.
1-2% of children who experience a febrile seizure have status epilepticus (low rate overall)
Typically seen before age 3
No predictable temperature
Increased risk if prior febrile seizure
No prophylaxis necessary for simple febrile seizures |
|
|
Term
| What are the characteristics of simple febrile seizures? |
|
Definition
15 min or less
non-recurring during fever
generalized, short postictal state
no significant neurological sequence |
|
|
Term
| What are the characteristics of complex febrile seizures? |
|
Definition
greater than 15 min
repetitive(more than once in 24 hrs)
focal origin signs
latent epilesy |
|
|
Term
| Pyrexia causes alter thermoregulation by....? |
|
Definition
Inhibit heat dissipation via decreased sweating
Inhibit heat dissipation via vasoconstriction
Heat generation via increased metabolic rate
Altered behavioral response: obtundation |
|
|
Term
| Pyrexia causes pharmacologic action by....? |
|
Definition
Endotoxin release from bacteria following antibiotic use
Endotoxin release from cellular injury following chemotherapy use
Endogenous pyrogens from damaged erythrocytes following use of oxidizing drugs in G6PD deficiency |
|
|
Term
| What other smaller categories does pyrexia cause? |
|
Definition
Drug administration
Toxic vehicles
Venous irritation
Hypersensitivity
Antigen-antibody complexes
Idiosyncrasy
Malignant hyperthermia
Neuroleptic malignant syndrome (NMS) |
|
|
Term
| Fever can be induced in which 3 ways? |
|
Definition
microbes
pathologically
drugs |
|
|
Term
| Describe glass thermometers and their disadvantages. |
|
Definition
oral or rectal
diff to find
break easily
damaged by excessive heat
hard to read
long wait for accurate reading |
|
|
Term
| Describe digital thermometers. |
|
Definition
oral, rectal, temporal, tympanic, axillary
easy and relatively quick to read |
|
|
Term
| Describe thermometer use when using orally. |
|
Definition
20-30 min after eating, drinking, smoking
probe under tongue
avoid mouth breathers
avoid when recent oral surgery
avoid when not alert
avoid for <3yo
FEVER at >37.5degC(99.5degF) |
|
|
Term
| Describe use for rectal thermometers. |
|
Definition
lubricate tip
child face down or in fetal position
insert NO more than 1 inch(children) and 2 inches(adults)
Cautions for use:
netropenic patients
recent rectal surgery/injury
never leave patient unattended
preferred over axillary in children 1-3 mo
FEVER at >38degC(100.4degF) |
|
|
Term
| Describe use of axillary thermometers. |
|
Definition
probe must touch skin not clothing
put arm down after probe in place
Considerations:
for patients who cannot have temp taken oral or rectally
good for children 3mos -5yo
FEVER at 37degC(98.6degF) |
|
|
Term
| Describe use of tympanic thermometers. |
|
Definition
in ear
<1yo pull ear backward
>1yo pull ear backward and UP
probe points towards eye while in ear
Considerations:
expensive but quick
accuracy dependent on technique, cerumen impaction,inflammation, and age/size of patient
NOT for infants <3-6mos
FEVER at >37.8degC(100degF) |
|
|
Term
| Describe use of temporal thermometers. |
|
Definition
place probe on center of forehead
while pressing the button, slide it across to hairline and then release button
Considerations:
expensive but quick
must adjust to room temp at least 30 min
do not use over scars, open wounds
faster response to temp change
more accurate than tympanic
FEVER at:
>37.8degC(100degF)for 4yo+
>37.9degC(100.3degF)for 2-47mos
>38.1degC(100.7degF)for 0-2mos |
|
|
Term
| Describe use of skin thermometers. |
|
Definition
FeverScan has poor correlation with core body temp
ThermoFocus is expensive and must allow thermometer to adjust to room temp for 30min; less accurate than tympanic |
|
|
Term
| What is the goal of treatment in fever patients? |
|
Definition
| alleviate discomfort by reducing core temperature to normal range....NOT to reduce temperature to normal range!! |
|
|
Term
| What are the exclusions for self-treatment of FEVER??? |
|
Definition
Anyone 6mos+ with temperatures of 104°F+
Infants <6mos w/ a rectal temperature of 101°F+
Severe symptoms of infection that are not self-limiting or recent infection
Fever that persists > 3 days with or without treatment
Fever accompanied by a stiff neck
Child who develops spots or rash
Child who refuses to drink any fluids or is vomiting and cannot keep fluids down
Child who is lethargic
Concomitant diseases* and conditions
Risk for hyperthermia
Impaired oxygen utilization (i.e. severe COPD, respiratory distress, heart failure)
Impaired immune function (i.e. HIV, cancer, immunosuppressant medications) |
|
|
Term
| What are some non-drug approaches to reducing fever? |
|
Definition
dress patient lightly
give patient cool, clear liquids
limit play or activities
cool environment
sponge w/ moderately cool water |
|
|
Term
| Pharmacologic approach to fever is limited to ____ hours from ONSET of fever, not from start of treatment. |
|
Definition
|
|
Term
| What are the different types of sleep, and what distinguishes them? |
|
Definition
Difficulty falling asleep:Sleep onset
Difficulty maintaining sleep:Sleep maintenance
Early morning awakening:Sleep offset
Unrefreshing sleep:Non-restorative sleep |
|
|
Term
| What are the differences between transient, short-term, and chronic insomnia? |
|
Definition
Transient
Self-limiting
< 1 week
Travel, hospitalization, or upcoming stress
Short-term
1 – 3 weeks
More serious stressor (death, unemployment, divorce)
Chronic
Almost every night for > 3 weeks
Result of an underlying cause |
|
|
Term
| What are the possible causes of situational insomnia? |
|
Definition
Daytime napping
Activity before sleep
Eating
Exercise
Jet lag
Shift work
Stress
Poor sleep hygiene |
|
|
Term
| What are some possible underlying disease states that could cause secondary insomnia? |
|
Definition
Angina
Anxiety
Asthma/COPD
Depression
Diabetes
Gastrointestinal reflex
Heart failure
Hyperthyroidism
Internet addiction
Mania or hypomania
Menopausal symptoms
Overactive bladder
Pain
Periodic limb movement
Pregnancy
Restless leg syndrome
Sleep apnea |
|
|
Term
| List the medications used for insomnia. |
|
Definition
Albuterol
Alcohol
Antipsychotics
Beta blockers
Bupropion
Caffeine
Clonidine
Corticosteroids
Stimulants
Levadopa
Methyldopa
Nicotine
Decongestants
SSRI antidepressants
Theophylline
Tricyclic antidepressants |
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Term
| What are some of the complications involved with insomnia? |
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Definition
Worsening health
Depression
Headaches
Heart disease
Substance abuse
Daytime drowsiness
Decreased productivity
Car accidents
100,000 car accidents attributed to drowsiness
1,500 deaths annually |
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Term
| What are the signs/symptoms of insomnia? |
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Definition
Signs/Symptoms
Complaint of difficulty falling or staying asleep
Daytime fatigue
Poor concentration
Impaired memory
Irritability |
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Term
| What are the exclusion to self-treatment of insomnia? |
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Definition
Frequent nocturnal awakenings or early morning awakening
Chronic insomnia (> 3 weeks)
Sleep disturbances occurring nightly for several days
Sleep disturbances secondary to psychiatric or general medical disorders |
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Term
| How can we have good sleep hygeine? |
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Definition
Stick to a schedule
Even on weekends
Exercise regularly
But not too close to bedtime
Turn off worries
Make bedroom quiet and comfortable
Don’t eat large meal before bed
Don’t read or watch TV in bed
Sleep and sexual activity only
If you can’t sleep, get up!
15-20 minutes
Remove the clock from sight
Avoid or limit daytime naps
Limit to 30 minutes in the early afternoon
Reduce alcohol, nicotine, and caffeine use
Avoid using sedatives frequently |
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Term
| What AH are recommended for short-term or transient insomnia? |
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Definition
diphenhydramine-Benadryl
doxylamine-Unisom and Nyquil |
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Term
| What is the MOA of AH for insomnia? |
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Definition
ethanolamine AH
blocks H1 and muscarinic receptors |
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Term
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Definition
25-50mg by mouth 30-60min before bedtime
*use for 3 nights, then take a night off
*Do NOT use for more than 14 nights in a row |
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Term
| What are the adverse affects of AH for insomnia? |
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Definition
Sedation
Morning hangover effect
Dry mouth
Constipation
Blurred vision
Urinary retention |
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Term
| What drugs interact with AHs? |
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Definition
anticholinergic meds
CYP2D6 |
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Term
| What are the contraindications/precautions for AHs for insomnia? |
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Definition
Males of advanced age
Especially with prostatic hyperplasia
Angle closure glaucoma
Dementia
Cardiovascular disease
Angina or arrhythmias
May have prolonged half-life in patients with cirrhosis |
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Term
| What are some counseling points w/ regards to AHs for insomnia? |
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Definition
Patient counseling
May develop tolerance with repeated use
Use caution when performing tasks that require alertness/coordination
Driving, cooking, operating equipment
Do not drink alcohol while taking antihistamines
Paradoxical effect |
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Term
| How can alcohol be used for insomnia? |
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Definition
Initially improves sleep in nonalcoholics
Tolerance develops quickly
Leads to higher doses
Chronic drinkers have disturbed sleep cycle
Typically experience
More restless sleep
Wake up after 2-4 hours
Reduced total sleep time |
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Term
| What is the MOA of Valerian as use for insomnia? |
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Definition
Benzodiazepine-like effects
Increase GABA activity in CNS by inhibiting an enzyme that metabolizes GABA |
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Term
| What are some counseling points on Valerian as use for insomnia? |
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Definition
Counseling
Dose: 400-900 mg/day 30 minutes to 2 hours before bed(0.4%-0.6% of valerenic acid)
Slowly discontinue after long term use |
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Term
| What are the precautions of Valerian as used for insomnia? |
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Definition
Precautions
Few cases of hepatotoxicity (consider monitoring LFTs for long term use)
Drug interactions possible with CYP450 3A4 |
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Term
| What are the adverse effects of Valerian when used for insomnia? |
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Definition
Adverse effects
Less hangover effect
Headache |
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Term
| Valerian may be used with which other OTCs to help with insomnia? |
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Definition
Hops
Lavender
Lemon balm
Skullcap |
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Term
| What is the MOA for melatonin when used for insomnia? |
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Definition
Increases endogenous production by pineal gland
May allow for rapid adjustment of circadian rhythm after changing time zones |
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Term
| What are the clinical effects of melatonin when used for insomnia? |
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Definition
Evidence for jet lag (> 5 time zones east) > insomnia
Increase REM, latency, duration
Not effective for shift work |
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Term
| Describe counseling for melatonin when used for insomnia? |
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Definition
Counseling
Dose: 0.3-5 mg 30 minutes before bed
2-5 mg between 1700 and 2200 the day of arrival at destination and at bedtime for 2-5 days |
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Term
| Describe the adverse effects for melatonin when used for insomnia? |
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Definition
Adverse effects- rare
N/V, headache, tachycardia, irritability, “hangover” |
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Term
| What are the precautions for using melatonin for insomnia? |
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Definition
Precautions
Several drug interactions known
Warfarin, immunosuppressants, calcium channel blockers |
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Term
| Describe German Chamomile and its use for insomnia. |
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Definition
“Bedtime tea”
Calm & relaxation may not translate into efficacy for insomnia!
No reliable evidence it’s effective for insomnia
May interact with CYP450 3A4
Avoid in patients with ragweed or similar allergies |
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Term
| Describe Passionflower and how it relates to insomnia. |
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Definition
Once was an OTC sleep aid
Actually removed from the market in 1978!
Safety: Possibly safe
Efficacy: Insufficient evidence
Now marketed as a dietary supplement
Commonly used as a tea
May cause sedation by affecting benzodiazepine receptors
No evidence it helps insomnia! |
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Term
| Describe KavaKava related to insomnia. |
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Definition
Efficacy: Insufficient evidence
Safety: Possibly unsafe
Bottom line:
Do NOT use for treatment of insomnia! |
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Term
| Describe St. John's Wort in relation to insomnia. |
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Definition
Efficacy: Likely effective for those who suffer from depression
Wake up during the night
Safety: Likely safe
Bottom line:
Lots of drug interactions!
Common side effect is insomnia
Not effective for non-depressed patients |
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Term
| Describe 5HT in relation to insomnia. |
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Definition
Efficacy: Insufficient evidence
Safety: Possibly unsafe
Bottom line:
Do NOT use for treatment of insomnia! |
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Term
| Describe L-Trp in relation to insomnia. |
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Definition
Efficacy: Insufficient evidence
Safety: Possibly unsafe
Recalled by FDA in 1990
Bottom line:
Do NOT use for treatment of insomnia! |
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Term
| Describe CoenzymeQ10 in relation to insomnia. |
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Definition
Efficacy: Possibly effective
Safety: Likely safe
Bottom line:
Helps patients with insomnia due to heart failure
May be worth a try
Discuss with physician first |
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Term
| Describe elderly patients regarding insomnia. |
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Definition
Elderly
Duration of sleep is shorter
# of nocturnal awakenings increases
Less time in stage 4 and REM sleep
Normal sleep latency
Diphenhydramine can cause increased cognitive impairment and falls |
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Term
| Describe children and insomnia. |
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Definition
Children
Teens should be asked about caffeine and alcohol intake
Nonpharmacologic therapy first line
Antihistamines not indicated to treat insomnia in children < 12 y/0
Not recommended to induce sleep in infants
Use of melatonin is controversial |
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Term
| Describe insomnia in relation to pregnancy and lactation. |
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Definition
Pregnancy
Diphenhyradmine: Category B
Should be referred for evaluation
Herbals not recommended
Lactation
May limit lactation
Increase infant drowsiness |
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Term
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Definition
Benzodiazepines
Restoril ® (temazepam)
Non-benzodiazepines
Ambien®, Ambien CR® (zolpidem)
Lunesta® (eszcopiclone)
Sonata® (zaleplon)
Antidepressants
Desyrel® (Trazodone)
Remeron® (Mirtazepine)
Melatonin agonist
Rozerem® (Ramelteon) |
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Term
| What is the overall take home message with insomnia? |
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Definition
Practice good sleep hygiene
Chronic use can build reliance
Sedatives may cause impairment
Don’t combine multiple sedatives
Excessive sedation |
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Term
| Decreased Serotonin(5-HT) causes what kinds of feelings? |
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Definition
anxiety
irritability
impulsivity
appetite
aggression |
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Term
| Decreased NE causes what kinds of feelings? |
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Definition
Regulates vigilance
motivation
energy
anxiety
irritability |
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Term
| Decreased dopamine causes changes in what feelings? |
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Definition
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Term
| What is the biogenic amine hypothesis? |
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Definition
| Depression caused by decreased brain levels of neurotransmitters |
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Term
| What is the noradrenergic model of anxiety? |
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Definition
| Autonomic nervous system is hypersensitive and overreacts to stimuli |
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Term
| What is the GABA model of anxiety? |
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Definition
Major inhibitory neurotransmitter of CNS
Regulatory effect on 5-HT, NE, DA |
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Term
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Definition
| Complementary and Alternative Medicine |
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Term
| What is another name for St John's Wort? |
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Definition
Hypericum perforatum
*sun for the soul |
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Term
| St Johns Wort's main adverse effect is _________________ and __________ syndrome. |
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Definition
photosensitivity
serotonin |
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Term
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Definition
Influences neuronal membrane fluidity
Increases 5-HT turnover and NE & DA levels |
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Term
| SAMe is (expensive/inexpensive)? |
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Definition
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Term
| What are the constituents of Valerian that cause inhibition of GABA? |
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Definition
| Valepotriates and sesquiterpene consituents of the volatile oils and other unidentified active components |
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Term
| Perivascular axons associated with migraines release what?? |
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Definition
calcitonin gene-related peptide (CGRP)
neurokinin A
substance P |
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Term
| Released peptides interact with ______ blood vessels to promote vasodilation and neurogenic inflammation |
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Definition
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Term
| How does ergotamine work for migraines? |
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Definition
| 5-HT1 receptor agonists, constrict intracranial blood vessels, inhibit neurogenic inflammation |
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Term
| How do Triptans work for migraines? |
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Definition
Triptans: Serotonin receptor agonists effective against migraines
Sumatriptan (1st generation): 71% patients (oral, 1h vs subcutaneous, 10 min)
Almotriptan, rizatriptan etc. (2nd generation):oral, nasal, SC injection
Normalize dilated intracranial arteries |
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Term
| What is active ingredient of Devils claw and how does it work? |
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Definition
harpagoside-iridoid glycoside
Inhibits lipoxygenase and COX-2
Helps in the production of TNF-α (antiinflammatory effects)
Clinical Trials: lower back pain |
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Term
| How is devils claw dosed? |
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Definition
50-100mg harpagoside daily reduce low back pain (compare 12.5mg rofecoxib)
2-9g of crude extract
Tablets 600-2400mg (50-100mg harpagoside)
Cause hypoglycemic effects |
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Term
| How is feverfew used for migraines and what are the constituents? |
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Definition
Inhibits prostaglandin synthesis
Constituents: parthenolide, michefuscalide, chrysanthenyl acetate
**increased photosensitivity |
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Term
| HOw is comfrey used adn what are the active ingredients? |
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Definition
Comfrey roots contain toxic alkaloids (pyrrolizidine-hepatotoxic, lethal at high dose)
Active ingredients: symlandine, symphytine & echimidine
Suppress degranulation of azurophil granules and superoxide generation in leucocytes |
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Term
| What is dosing for comfrey for inflammation? |
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Definition
| 2-3g topical, 3-4 times/day for 2 weeks |
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Term
| What is Bromelain and what is it used for? |
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Definition
Sulfur containing proteolytic digestive enzyme from the stem and fruits of the plant-pineapple
MOA not clear-may inhibit the synthesis of prostaglandins by lowering kininogen and bradykinin in serum and tissues
Activate plasmin production from plasminogen
Reduce pain and inflammation after tooth extraction
May reduce pain while walking after episiotomy |
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Term
| What is dosing for Bromelain and what are some risks associated?! |
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Definition
240mg bromelain (Ananase) daily for 5 days
May increase the absorption of antibiotics
Inhibit platelet aggregation-risk of bleeding |
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Term
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Definition
| noradrenergic aka NE or E |
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Term
| What substances cause wakefulness? |
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Definition
NE and ACh in cortex
Histamine & substance P in hypothalamus
Dopamine |
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Term
| Histamine is a ___________ molecule consisting of an ___________ ring and an _______ group connected by two _____________ groups. |
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Definition
hydrophilic
imidazole
amino
methylene |
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Term
| H1-receptor stimulation increases _______ leading to feedback inhibition of histamine release from mast cells and basophils. |
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Definition
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Term
| Where are most H3 receptors located? |
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Definition
| H3 receptors are expressed mainly in the CNS, in the ganglia, hippocampus and cortex. |
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Term
| What are the main 4 actions of H1 receptors? |
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Definition
*increases wakefulness
*inhibits appetite
*bronchoconstriction & contraction of the gut
*facilitates NO release and plays role in the contraction of various smooth muscles |
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Term
| What does EGb consist of? |
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Definition
Flavone glycosides, e.g. rutin (25-30%)
Terpenoids: ginkgolides, bilobalide (3% each)
Organic acids (e.g. chlorogenic acid), ascorbic acid |
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