NURS549 MIDTERM EXAM QUESTIONS WITH VERIFIED ANSWERS

NURS549 MIDTERM EXAM QUESTIONS WITH VERIFIED ANSWERS Basic functions of Norepi, Dopamine, Serotonin,Acethylcholine and GABA in the CNS - Answer-1. Excitatory in the CNS Arousal, reward system, wakefulness, learning, mood, MEMORY, focus, attention 2. Excitatory in the CNS Reward behavior, motor control 3. Excitatory in the CNS, Associated with Mood and is the target for antidepressants 4.Excitatory in the CNS Arousal, reward, memory, sustains attention. 5.Inhibitory Neurotransmitter in the CNS ( mediates Chloride influx into the cell, making it hyperpolarized and LESS excitable.GABA regulates CNS excitability, regulates the N/V center in the CNS, and has muscle relaxation properties Parkinson's disease - Answer-There is a loss of 80+% of dopaminergic fibers & dopamine levels in the CNS ( Basal Ganglia).Abnormal movements due to upset of the BALANCE of dopamine and ACH (not enough dopamine and APPARENT over action of ACH) No cure only symptom relief Carbidopa - Answer-It is a dopa-decarboxylase inhibitor, given with L-dopa, that diminishes the metabolism of L-DOPA in the GI tract and peripheral tissues increasing the availability of L-DOPA to the CNS. L- DOPA will cross the BBB Sinemet - Answer-carbidopa/levodopa Bromocriptine (Parlodel) - Answer-A straight Dopamine Receptor Agonist ( sounds good-but not) Severe side effects OF N/V, Hallucinations, & confusion limit use. Alzheimer's disease - Answer-reduced synthesis of the neurotransmitter acetylcholine ( ACH ) . Central Acethylcholinesterase inhibitors - Answer-Donepezil ( Aricept) Rivastigmine ( Exelon) Benztropine (Cogentin) - Answer-Blockage of cholinergic transmission produces effects similar to augmentation of dopaminergic transmission ( because of imbalance) Namenda (memantine) - Answer-a NMDA (N-methyl-D-aspartate) glutamate receptor antagonist protects brain cells against excess glutamate, a chemical neurotransmitter released in large amounts by cells damaged by Alzheimer's disease and other neurological disorders Attachment of glutamate to cell surface NMDA receptors permits calcium ( with sodium and potassium) to flow freely into the cell. Over time, this leads to chronic overexposure to calcium, which can speed up cell damage Benzodiazepines - Answer-Lorazepam(Ativan) Alprazolam (xanax) Diazepam(Valium) Temazepam(Restoril) enhance the effect of the central INHIBITORY neurotransmitter gamma-aminobutyric acid (GABA), enhancing chloride entry into cell, creating in an Inhibitory Post-Synaptic Potential ( IPSP) , and is used for: sedative, hypnotic (sleep-inducing) properties anxiolytic (anti-anxiety) properties Anticonvulsant properties muscle relaxant properties In high doses of many shorter-acting forms, amnesic-dissociative properties are seen. Z drugs - Answer-Zolpidem ( Ambien) Not a Benzodiazepine in structure , BUT acts on a specific subset of the benzodiazepine receptor family..... the BZ1 receptor. ( not a sloppy benzo receptor agonist) • In contrast to the benzodiazepines, which non-selectively bind to and activate all BZ receptor subtypes on the GABA receptor, zolpidem has a higher affinity for the BZ1 receptor subtype on the Benzodiazepine / GABA receptor ( the hypnotic inducing site..!!!!!) This selective binding of zolpidem on the BZ1 receptor also explains the relative absence of muscle relaxant activity, anticonvulsant effects, and minimal tolerance with prolonged use. 2. Zaleplon ( Sonata) - same mechanism 3. Eszopiclone ( Lunesta) - same mechanism SSRI MOA and advantages - Answer-SELCTIVELY BLOCK THE REUPTAKE OF SEROTONIN BACK INTO THE NERVE ENDING, ELEVATING NEUROTRANSMITTER LEVELS. ADVANTAGES of SSRI's: No effect on Dopamine reuptake- no accumulation of Dopamine -low addiction potential ( not addictive ) Little blocking activity at Muscarinic receptor- no anti-muscarinic effects observed- blurred vision, dry mouth, urinary retention, constipation..etc are observed Little blocking activity at alpha-adrenergic receptors- no hypotension observed Little blocking activity at Histamine H1 receptors - no side effect of sedation BOTTOM LINE WITH SIDE EFFECTS •They have far fewer side effects as compared to the original anti-depressants of other categories of anti-depressants. ( Tri-Cyclic Antidepressants) •They are safe drugs , even in over dosage. SSRI DRUGS - Answer-1.Fluoxetine-(Prozac) 2. Paroxetine-(Paxil) 3. Sertraline-(Zoloft) 4. Escitalopram-(Lexapro) SNRIs and MOA - Answer-inhibits reuptake of NE and serotonin 1. Venlafaxine ( Effexor) 30:1 Ind:--depression, anxiety, pain, bipolar disorder, hot flashes 2. Duloxetine ( Cymbalta)10:1 - affects serotonin to a lesser extent compared to Effexor. Ind: - depression, anxiety, pain, nerve pain, fibromyalgia 3. Desvenlafaxine ( Pristiq) 10:1 ( 2007 ) Ind: - depression, anxiety, pain, nerve pain, fibromyalgia 4. Levomilnacipran ( Fetzima) 1:2 Ind: - depression, major depression Atypical Antidepressants - Answer-1. Buproprion- ( Wellbutrin ) -antidepressant and smoking cessation aid MOA = dopamine, norepinephrine and serotonin reuptake inhibitor Not much or little effect on serotonin reuptake, and a 2 to 1 effect of norepinephrine reuptake to dopamine reuptake. Very little effect on Serotonin reuptake....!!!!!!! The Antidepressant effect associated with NE reuptake inhibition Does not cause weight gain or sexual dysfunction as seen with SSRI's 2. Mirtazapine ( Remeron) ( NaSSA) • a Noradrenergic and Specific Serotonergic Antidepressant (NaSSA) • Act by antagonizing Central α2-adrenergic receptor and certain serotonin receptors • By blocking α2-adrenergic auto-receptors , NaSSA's enhances adrenergic and serotonergic neurotransmission in the brain involved in mood regulation 3.Vortioxetine- ( Brintellix ) - The exact mechanism of vortioxetine is not fully understood; however, it is thought that this agent enhances the serotonergic activity in the central nervous system (CNS) by: Tricylic Antidepressants (TCAs) - Answer-Block NE and Serotonin reuptake back into pre-synaptic neuron, much like the SNRI drugs. ( but not in the class of SNRI's) If discovered today, they may have been categorized as SNRI's Also an alternative- to patients not responding to SSRI's and SNRI's BUT --Side Effects: UNLIKE SSRI & SNRI, are not selective, and they DO BLOCK alpha adrenergic, muscarinic, and histamine H1 receptors causing a wide variety of side effects. Dry mouth - ( muscarinic blockade) Blurred vision ( muscarinic blockade) Decreased GI motility and secretion ( muscarinic blockade) Urinary retention ( muscarinic blockade) Sedation ( H1 receptor blockade) Hypotension ( Alpha adrenergic blockade) TCA drugs - Answer-Amitriptyline (Elavil) Imipramine (Tofranil) MAOIs (monoamine oxidase inhibitors) MOA - Answer-Inhibits the inactivation of the monoamine neurotransmitters by monoamine oxidases within the pre-synaptic neuron and this ultimately PUSHES them in the direction of the SYNAPTIC CLEFT. Excess neurotransmitters will diffuse into the synaptic space