Therapeutic drugs Exam 2

All of the following about Pregabalin (Lyrica) apply EXCEPT: -It is a controlled substance -Has the benefit of taking only 1 week for benefits to be seen -Can be used as a "prn" (as needed) medication -Can be a second-line alternative or add-on therapy in treatment of generalized anxiety disorder

-Can be used as a "prn" (as needed) medication

Buspar (buspirone) must be used: -Consistently like an antidepressant to work -On a "prn" (as needed) basis -Consistently or as a prn drug, depending on the severity of the case -None of the above apply since more research needs to be done

-Consistently like an antidepressant to work

Lithium toxicity can become serious and life threatening. Which of the following is NOT a sign of lithium toxicity? -Constipation -Ataxia -Nausea and vomiting -Coma and seizure

-Constipation

Some people feel emotionally detached or experience a reduction of positive and negative emotions while taking SSRI's. This is called: -Emotional blunting -Punding =Serotonin syndrome -Shadow depression

-Emotional blunting

SSRI's can cause Serotonin discontinuation syndrome if they are stopped abruptly. However, there is one exception to this rule when it comes to one particular SSRI, which is: -Paroxetine (Paxil) -Sertraline (Zoloft) -Fluoxetine (Prozac) -Citalopram (Celexa)

-Fluoxetine (Prozac)

SSRI's work by: -Blocking the enzyme COMT which boosts serotonin levels -Block serotonin autoreceptors -Inhibit the reuptake of serotonin back into the axon terminal -Displaces serotonin from its presynaptic vesicles

-Inhibit the reuptake of serotonin back into the axon terminal

Bupropion (Wellbutrin) has no risk of sexual side effects because: -It stimulates production of sex hormones -It enhances hypothalamus activity -It lacks pharmacological effects on serotonin -It blocks dopamine receptors

-It lacks pharmacological effects on serotonin

Which of these medications can cause a potentially life-threatening skin reaction? -Lithium -Fluoxetine (Prozac) -Lamotrigine (Lamictal) -Divalproex (Depakote)

-Lamotrigine (Lamictal)

Which of the following is true? -Long acting benzodiazepines are harder to taper off of compared to shorter acting ones -There is no difference among the benzodiazepines with respect to tapering difficulties -Long acting benzodiazepines are easier to taper off of compared to shorter acting ones -None of the above

-Long acting benzodiazepines are easier to taper off of compared to shorter acting ones

Which of these medications would be classified as a Tetracyclic Antidepressant? -Amitriptyline (Elavil) -Mirtazipine (Remeron) -Venlafaxine (Effexor) -Fluvoxamine (Luvox)

-Mirtazipine (Remeron)

_________ has guided the development of antidepressant drugs for more that 50 years -Monoamine Hypothesis of Depression -Hypothalamic Disregulation Hypthothesis -Low Serotonin Transmission Hypothesis -The Jedi Scrolls

-Monoamine Hypothesis of Depression

Buspar (buspirone) works as a: -Alpha 2 agonist -Partial agonist on 5-HT-1a receptor -Postsynaptic dopamine receptor antagonist -Norepinephrine reuptake inhibitor

-Partial agonist on 5-HT-1a receptor

When anticonvulsants are used to treat bipolar disorder, their primary mechanism of action is: -Direct agonist on GABA receptors -Dopamine antagonist -Negative modulator for norepinephrine -Positive modulator for GABA

-Positive modulator for GABA

Individual trauma-focused psychotherapy can provide greater and more sustained benefit than pharmacotherapy (reduces symptoms in 70% of patients!) in: -Obsessive Compulsive Disorder -Post Traumatic Stress Disorder -Social Anxiety Disorder -Generalized Anxiety Disorder

-Post Traumatic Stress Disorder

All of the following about Pristiq and Effexor are correct EXCEPT: -Effexor is metabolized and converted into Pristiq in the body -Effexor is better absorbed than Pristiq as Pristiq is too hydrophilic -Pristiq is in no way related to Effexor, it is a completely different drug that works by a different mechanism of action -Pristiq coincidentally came to the market after Effexor's patent expired

-Pristiq is in no way related to Effexor, it is a completely different drug that works by a different mechanism of action

Several drawbacks of SNRI therapy include all of the following EXCEPT: -Agitation -Insomnia -Hypertension -Purple hairy tongue

-Purple hairy tongue

Benzodiazepine I sites are to ________ as benzodiazepine II sites are to __________. -Reduced seizures/increased hypnotic effects; reduced anxiety and stress -Reduced seizures/decreased hypnotic effects; reduced anxiety and stress -Reduced anxiety and stress; increased hypnotic effects -Reduced anxiety and stress; decreased hypnotic effects

-Reduced seizures/increased hypnotic effects; reduced anxiety and stress

Lithium -Has a wide therapeutic window -Shows effective reductions in depressive symptoms of bipolar -Requires regular blood monitoring to help carefully adjust doses for efficacy and to avoid toxicity -Is not considered an effective mood stabilizer

-Requires regular blood monitoring to help carefully adjust doses for efficacy and to avoid toxicity

Barbiturates, the first anxiolytics, had a narrow therapeutic window that led to a potentially lethal case of : -Kidney failure -Heart arrhythmia -Respiratory depression -Acute swelling of the brain

-Respiratory depression

The drawbacks that come from Tramadol (Ultram), such as serotonin syndrome and seizure risk, are mainly due to Tramadol's: -activity at the mu receptor -high plasma protein binding -extreme lack of hydrophilic properties -SNRI activity

-SNRI activity

A type of depression that occurs in winter months for some people is referred to as: -Winter blues -Hypomania -Seasonal Affective Disorder -Partial Depressive Disorder

-Seasonal Affective Disorder

A friend of yours is taking Prozac (fluoxetine) for depression and wants to take Robitussin DM (which contains dextromethorphan) over the counter for his cough. What is the best statement about this situation? -The two medications can be mixed together with no problem -The Robitussin DM might make the Prozac weaker and your friend's depression could hit him hard -The two medications could possibly cause an interaction called serotonin syndrome due to the dextromethorphan interacting with the Prozac, which could be dangerous -The Prozac will prevent the Robitussin DM from working and his cough won't get better

-The two medications could possibly cause an interaction called serotonin syndrome due to the dextromethorphan interacting with the Prozac, which could be dangerous

Pain can impact a person's life in many ways, including: -Lost productivity at work -Missed social or family events -The possible development of depression or the symptoms of depression -All of the above

All of the above

Which of the following is NOT an example of nociceptive pain? A)Pain after a dental surgery B)Swollen, inflamed hands from rheumatoid arthritis C)Back pain as a result of twisting the wrong way while lifting a heavy object D)Pain from a cut on the arm from gashing against a splintered fence

B)Swollen, inflamed hands from rheumatoid arthritis

All of the following were potential hazards with barbiturates EXCEPT: A)Narrowing of the therapeutic index B)Severe effects upon abrupt discontinuation C)Possible QT prolongation D)Risk of severe respiratory depression E)Potential for addiction

C)Possible QT prolongation

What makes stage 1 of Tylenol poisoning so dangerous? A)There is no stage 1, the patient progresses to fulminant hepatic (liver) failure immediately and dies within 24 hours of overdose B)Stage 1 consists of extreme rises in blood pressure and body temperature, putting the patient at risk for hypertensive crisis or convulsions C)There are usually none to some non-specific symptoms that the patient may feel while the Tylenol is attacking the liver during this time period D)Stage 1 is always associated with severe vomiting, diarrhea, and extreme fluid loss

C)There are usually none to some non-specific symptoms that the patient may feel while the Tylenol is attacking the liver during this time period

TCA's are known for their anticholinergic side effects, which of the following would NOT be expected to occur from this? -Urinary retention -Diarrhea -Dry mouth -Impaired cognitive functioning

Diarrhea

Depression symptoms can include all of the following EXCEPT: -Loss of interest or pleasure in activities one used to enjoy -Change in weight -Difficulty sleeping or oversleeping -Feeling of increased energy

Feeling of increased energy

SNRI's: -Enhance synthesis of serotonin and norepinephrine -Prevent serotonin and norepinephrine reuptake -Block metabolism of dopamine -Block serotonin, norepinephrine, and dopamine receptors

Prevent serotonin and norepinephrine reuptake

A pain without obvious origin is known as: -Nociceptive Pain -Inflammatory Pain -Neuropathic Pain -Idiopathic Pain

Idiopathic Pain

Mixing an SSRI like fluoxetine (Prozac) with St. Johns Wort (herbal remedy for depression) can cause: -No problem at all because St. Johns Wort is an herbal remedy and natural products are usually very safe -A problem since they will cancel each other out, leaving the patient feeling very depressed -A possible drug interaction called Serotonin syndrome which can be dangerous -An interaction where the patient will feel extreme happiness followed by rebound depression

-A possible drug interaction called Serotonin syndrome which can be dangerous

Mirtazapine (Remeron) exerts its mechanism of action by: -Acting as an autoreceptor antagonist on adrenergic and serotonergic neurons -Blocking dopamine, serotonin, and norepinephrine reuptake -Causing upregulation of post synaptic serotonin and norepinephrine receptors -Acting as an agonist on dopamine and norepinephrine receptors

-Acting as an autoreceptor antagonist on adrenergic and serotonergic neurons

What statement best reflects how long antidepressants take to work? -These drugs work quickly and full effects can be seen in 5 to 7 days -These drugs can work within 1 to 2 days and can be used on an "as needed" basis because of their quick action -Antidepressants work through a reregulation process that takes an extended period of time to work, where improvements can start to be seen in 2 to 3 weeks of starting therapy with full effect taking 6 to 8 weeks -Antidepressants are known for taking a long time to work and full evaluation of therapy may not be assessed until the patient has been taking the medication for at least 6 months

-Antidepressants work through a reregulation process that takes an extended period of time to work, where improvements can start to be seen in 2 to 3 weeks of starting therapy with full effect taking 6 to 8 weeks

SNRI's, although they are antidepressants, have the additional benefit of effectively treating: -Delusions and hallucinations -Anxiety and certain types of pain -Constipation and irritable bowel syndrome -Diabetes (Type 2 only)

-Anxiety and certain types of pain

If a drug or class of medication is known as being a danger to the elderly population and is considered a poor choice for this patient population, it is placed on the: -Red Label List -Black Box Warning List -BEERS List -Geriatric Restriction List

-BEERS List

In panic disorder where the patient is in a severe state, -Benzodiazepines are a good option for acute control while an antidepressant is started for maintenance treatment -Only antidepressants should be used -Antidepressants are used briefly while benzodiazepines are started for long-term treatment -Cognitive behavioral therapy is used until symptoms are controlled, then medicine is started

-Benzodiazepines are a good option for acute control while an antidepressant is started for maintenance treatment

Tricyclic Antidepressants: -Block reuptake of serotonin and norepinephrine -Stimulate dopamine and norepinephrine receptors -Inhibit the catabolism of serotonin and norepinephrine -Act as antagonists on autoreceptors on the presynaptic membrane

-Block reuptake of serotonin and norepinephrine

SNRI's work by: -Blocking reuptake of serotonin and norepinephrine -Blocking autoreceptors on axon terminals of serotonergic and noradrenergic neurons -Antagonizing serotonin and norepinephrine post synaptic receptors -Blocking synthesis of monoamine neurotransmitters

-Blocking reuptake of serotonin and norepinephrine

Using stimulants in the elderly depressed patients: -Is not a good idea due to the risk of seizures in this population -Can be helpful if combined with a SSRI for short time, leading to a faster improvement in depression symptoms -Can be helpful, but the stimulant must be used for at least 6 months with an SSRI to see any remission of depression -Can be used safely, no precautions need to be regarded

-Can be helpful if combined with a SSRI for short time, leading to a faster improvement in depression symptoms

Tricyclic Antidepressants are highly bound to plasma proteins which means: -These drugs do not undergo any type of metabolism -Their pharmacodynamic action is altered -They have a lot of possible drug interactions with other medications that compete for these same binding sites -The binding of Tricyclics to plasma proteins makes them have a much better tolerated side effect profile and most patients experience no side effects from these medications at all

-They have a lot of possible drug interactions with other medications that compete for these same binding sites

Which of the following advantages do SSRI's have over TCA's? -They don't cause withdrawal -They start to work quickly, usually within 3 days or less -They lack anticholinergic and alpha-1 blocking side effects -They can produce complete, long-term remission of depression

-They lack anticholinergic and alpha-1 blocking side effects

The advantage of benzodiazepines had over barbiturates is: -They have no risk of physical dependence -They reduce anxiety without causing sedation -They produced less sedation than barbiturates -They do not cause any type of withdrawal syndrome

-They produced less sedation than barbiturates

When SSRI's hit the market in the 1980's, they were viewed as safe until observations were made that led to a black box warning being added in 2006 because of: -Serotonin syndrome being possible when mixed with other drugs -They interacted with tyramine containing foods to cause hypertensive crisis -Their abrupt discontinuation from therapy was found to lead to withdrawal effects -They were found to have an increased risk for suicide in children and teens taking these medications

-They were found to have an increased risk for suicide in children and teens taking these medications

Monoamine Oxidase Inhibitors can cause a possible hypertensive crisis when mixed with: -High protein foods -Dairy products -Tyramine containing foods -Foods high in gluten and fiber

-Tyramine containing foods

One of your older relatives hears that you took an amazing pharmacology course this past semester at UC Merced and asks you if you knew of any medications that could treat his depression, neuropathy, and fibromyalgia all at once. You tell him: -No, you need a magic pill and they don't make that yet -Yes, you need to take a TCA like amitriptyline -Yes, you could try taking an anticonvulsant like gabapentin (Neurontin) -Yes, you should take an SNRI like Duloxetine (Cymbalta)

-Yes, you should take an SNRI like Duloxetine (Cymbalta)

A friend of yours is taking antidepressants and tells you that they are thinking of quitting the medication abruptly after taking it for 2 years. What would you say to them? -That sounds like a good plan, you will feel so much better after the medication stopped -Don't do that, antidepressants are narcotic medications and you are probably addicted and will suffer withdrawal symptoms -You should be okay to do that since you have only been on the medication for 2 years -You should talk to your doctor about that since you will probably have to taper off the medication since they cause withdrawal like effects even though they aren't habit forming

-You should talk to your doctor about that since you will probably have to taper off the medication since they cause withdrawal like effects even though they aren't habit forming

Most opioid drugs exert their action by binding to and stimulating the: -mu receptors -alpha autoreceptors -dopamine receptors -beta receptors

-mu receptors

Which of the following cases could possibly be treated with opioids? (Raise your hand for each one that you feel qualifies) A)Pain from dental surgery B)Pain from a broken finger C)A patient with acute case of diarrhea D)Diabetic neuropathy E)A smoker in the hospital with a cough resulting from chronic bronchitis F)A person suffering from rheumatoid arthritis in the hands and elbows G)A person who has post-shingles neuralgia

A)Pain from dental surgery B)Pain from a broken finger C)A patient with acute case of diarrhea E)A smoker in the hospital with a cough resulting from chronic bronchitis

Raise your hand for EACH of the following statements that is INCORRECT regarding the use of Narcan: A)The person must be at least somewhat conscious before Narcan can be administered B)The nasal spray must be inhaled for it to be effective C)The patient may experience sweating, goose bumps, and severe GI cramping when they come to D)After administration of Narcan, the patient should be placed on their back so that they can breathe easily as they regain consciousness E)Some indications of the need for Narcan include slow, shallow breaths or no breaths, a death rattle, pinpoint pupils, unconsciousness F)It will reverse the respiratory depression but still allow the opioid to induce analgesia G)Once the patient regains consciousness, they are out of danger and no further treatment is needed

A)The person must be at least somewhat conscious before Narcan can be administered B)The nasal spray must be inhaled for it to be effective D)After administration of Narcan, the patient should be placed on their back so that they can breathe easily as they regain consciousness F)It will reverse the respiratory depression but still allow the opioid to induce analgesia G)Once the patient regains consciousness, they are out of danger and no further treatment is needed

The __________ is the brain structure most associated with fear and anxiety -Occipital lobe -Nucleus accumbens -Amygdala -Medulla oblingata

Amygdala

Your uncle tells you that his doctor put him on an antidepressant and he was told not to eat certain cheeses, pickled foods, and drink any wine while he is taking the medication. Which medications is he probably taking? -An SSRI -A TCA -An MAOI -An atypical antidepressant

An MAOI

If a person discontinues the use of their antidepressant (fluoxetine not withstanding) abruptly after taking it for a year, all of the following reactions might occur EXCEPT: -Flu like symptoms -Anxiety and insomnia -An unexplained "rebound happiness" which persists for 5 to 7 days -Electric shock feelings in their nerves

An unexplained "rebound happiness" which persists for 5 to 7 days

Which drug class would be a poor choice to use ALONE in treating bipolar disorder for fear of inducing mania? -Lithium -Anticonvulsants -Antipsychotics -Antidepressants

Antidepressants

A person that is having seizures as a result of excessive tramadol intake can best be treated with: A)An opioid B)An antiseizure medication C)Narcan D)Tricyclic

B)An antiseizure medication

A person who experiences unusual mood changes where they cycle from being very happy and active (a state of mania) to hopeless and down and then back to feeling up, etc. would be potentially diagnosed as having: -Depression -Hypomania -Bipolar Disorder -Intermittent depression

Bipolar Disorder

Flumazenil is an antidote for benzodiazepine overdose, it's mechanism of action is: A)A GABA receptor agonist B)A positive modulator at the GABA receptor C)Antagonism of the benzodiazepine receptor D)GABA reuptake inhibitor

C)Antagonism of the benzodiazepine receptor

If Gabapentin blocks calcium channels as one of the theories states, what would the effect be on the neurotransmitters for that particular neuron? A)Enhanced release of the neurotransmitters by more vesicles binding to the cell wall B)Enhanced storage of neurotransmitters in the vesicles C)Decreased neurotransmitter release due to disruption of vesicles binding to the cell wall D)Inhibited metabolism of the neurotransmitters both in the synapse and inside the presynaptic cell

C)Decreased neurotransmitter release due to disruption of vesicles binding to the cell wall

Which of the following is a fully synthetic opioid? A)Morphine B)Codeine C)Fentanyl D)Hydrocodone

C)Fentanyl

___________ is a pain that usually last longer than 6 months and can continue after the injury has healed -Acute Pain -Chronic Pain -Hyponatremic Pain -Intermittent Pain

Chronic Pain

All of the following apply to Tylenol EXCEPT: A)It's mechanism of action lies outside of the synapse B)It can form a toxic metabolite when mixed with alcohol which can damage the liver C) It is found in numerous prescription and non-prescription medications which lends it to the possibility of be accidentally overdosed D) It can be potentially lethal in an overdose causing rapid kidney failure

D) It can be potentially lethal in an overdose causing rapid kidney failure

Barbiturates cause CNS depression by A)Blocking sodium channels B)Acting as a GABA agonist C)Acting as a GABA partial agonist D)Acting as a positive modulator on the GABA receptor E)Acting as an antagonist at dopamine, glutamate, and norepinephrine receptors

D)Acting as a positive modulator on the GABA receptor

Tramadol: A)Fails to bind to opioid receptors B)Prevents the reuptake of dopamine, serotonin, and norepinephrine C)Is not a controlled substance D)Can cause subjective effects similar to morphine at above therapeutic doses

D)Can cause subjective effects similar to morphine at above therapeutic doses

Which of the following sequences represents the order of opioid that would most likely lead to the need for the use of Narcan, starting with most probable working down to least probable? A)Codeine > morphine > oxycodone > fentanyl B)Oxycodone > morphine > fentanyl > hydrocodone C)Fentanyl > oxycodone > carfentanil > hydrocodone D)Carfentanil > fentanyl > oxycodone > codeine

D)Carfentanil > fentanyl > oxycodone > codeine

Valium (diazepam) is a benzodiazepine that has a long half-life because: A) It does not get metabolized, it is only excreted from the urine unchanged B) Is highly lipophilic and hides in the fat tissue, where it slowly gets secreted back into the blood over time C)It's chemical structure makes it hard to metabolize D)It produces active metabolites

D)It produces active metabolites

Most opioid drugs act on the: A)Delta receptor B)Kappa receptor C)GABA receptor D)Mu receptor

D)Mu receptor

In an overdose situation with tramadol, Narcan could: A)Make things worse by causing serotonin syndrome B)Enhance the metabolism of tramadol by increasing the number of enzymes in the liver that catabolize it C)Help reverse all of the toxicity associated with tramadol D)Only reverse the respiratory depressant effects that are occurring from the overdose

D)Only reverse the respiratory depressant effects that are occurring from the overdose

A person presents with diaphoresis (excessive sweating), unstable blood pressure, confusion, and moderate muscle incoordination. Which of the following combinations of medications did the patient probably mix? A)Tylenol (alone) with 2 other prescription medications that had large doses of Tylenol in each of them B)Tylenol and Gabapentin C)Tramadol, Tylenol and Gabapentin D)Tramadol, Prozac, and hydrocodone

D)Tramadol, Prozac, and hydrocodone

Which medication is considered the "drug of choice" for treating diabetic neuropathy? -Oxycodone (Oxycontin) -Tramadol (Ultram) -Any of the TCA's -Duloxetine (Cymbalta)

Duloxetine (Cymbalta)

A low-grade, daily depressed mood that persists for at least 2 years is called: -Major Depressive Disorder -Hypomania -Dysthymia -Cyclothymic Disorder

Dysthymia

Which mechanism of action best describes the analgesic effects of opioids? A)They enhance the effects of GABA by stimulating GABA receptors B)They block the reuptake of serotonin and norepinephrine C)They decrease the effects of glutamate and substance P at the spinothalamic level D)They stimulate mu receptors in the medulla to weaken pain signals before they reach the thalamus E)C and D are correct

E)C and D are correct

Which of the following would not be an expected side effect of opioids? A)Constipation B)Drowsiness C)Coughing D)Itching E)Decreased immune system

E)Decreased immune system

All of the following statements best describe Gabapentin (Neurontin) EXCEPT: -It is generally well tolerated with very minimal drug interactions -Among the anticonvulsants, Gabapentin is considered the better option because the others generally have more serious toxicities and more dangerous drug interactions -Gabapentin is not considered a good option for neuropathy because it is not effective in this type of pain management -It may work by blocking the excitatory effects of glutamate by antagonism of NMDA receptors

Gabapentin is not considered a good option for neuropathy because it is not effective in this type of pain management

Tramadol: -Is more likely to cause respiratory depression compared to morphine -Considered a step up in intensity in the treatment of pain relative to opioids -Has no abuse potential -Has the potential to cause serotonin syndrome when mixed with certain medications

Has the potential to cause serotonin syndrome when mixed with certain medications

Regarding the previous question, what could happen to your uncle if he disregarded the doctor's warning and mixed tyramine containing foods with his prescribed medication? -He could develop a head to toe rash and his hair will fall out -He might develop severe, acute gastric symptoms which could be relieved by Pepto Bismol -He could develop delusions telling everyone his name is Jon Snow and repetitively muttering "Winter is Coming" -He could develop a dangerous, possibly life-threatening spike in his blood pressure which may need medical intervention

He could develop a dangerous, possibly life-threatening spike in his blood pressure which may need medical intervention

Heroin causes a much greater rush than morphine does. This can be attributed to the fact that: -Heroin is more potent at the receptor than morphine -More morphine gets stuck in the bloodstream due to protein binding -Heroin is more hydrophilic than morphine and can pass through the blood-brain barrier easier -Heroin is more lipophilic than morphine and can pass through the blood-brain barrier easier

Heroin is more lipophilic than morphine and can pass through the blood-brain barrier easier

The mechanism of action for MAOI's is best explained as: -Decreasing neurotransmitter synthesis leading to their increased amount in the synapse -Inhibiting catabolism of neurotransmitters, thus boosting their levels in the synapse -Promoting vesicular release of the neurotransmitters from out of the axon terminal and into the synapse -Promoting an increased rate of catabolism of neurotransmitter, thereby increasing their synaptic levels

Inhibiting catabolism of neurotransmitters, thus boosting their levels in the synapse

Why can a person abruptly stop Prozac (fluoxetine) and usually not expect to suffer any withdrawal effects? -Prozac has a different mechanism of action compared to all the other antidepressants -It has low binding to plasma proteins -It has a very long half-life and naturally tapers its way out of the body -Prozac causes irreversible blockade of serotonin reuptake transporters and it takes the brain a long time to cause upregulation of new transporter proteins on the axon terminals

It has a very long half-life and naturally tapers its way out of the body

Antidepressants generally don't work quickly, mainly because: -They take a long duration of time to pass the blood brain barrier -It is thought that "reregulation" occurs between the volume of receptors and neurotransmitters -They cause a deficiency in neurotransmitter synthesis which takes a long time for the brain to recover from -These medications have an extremely short half life and it takes weeks to months for the drugs to "build up" to therapeutic levels

It is thought that "reregulation" occurs between the volume of receptors and neurotransmitters

How does acetaminophen work? -It boosts dopamine levels in the nucleus accumbens, driving the reward and pleasure sensation in a person so that they don't focus on the pain they are feeling -It may reduce the production of prostaglandins in the CNS, thereby elevating the pain threshold -It stimulates opioid receptors in the spine to help scatter the pain signal as it travels up the spinothalamic tract -It enhances the release and synthesis of endogenous opioids

It may reduce the production of prostaglandins in the CNS, thereby elevating the pain threshold

Which of the following statements about serotonin syndrome is false? -It is more likely to occur if a person is taking multiple medications that boost serotonin levels -It can cause high fever, seizures, and unstable blood pressure -It occurs when a person takes numerous medications that, when mixed together, lead to excessive dopamine levels -The syndrome can sometimes be fatal

It occurs when a person takes numerous medications that, when mixed together, lead to excessive dopamine levels

The Monoamine Hypothesis states that: -Monoamine neurotransmitter deficiency causes a depressive mood -An excess of monoamine neurotransmitters causes a reverse effect on the brain where depression sets in -Monoamine neurotransmitters may lead to depression when the amount of dopamine surpasses that of norepinephrine and serotonin combined -Monoamines cause depression by overstimulating the medulla and thalamus

Monoamine neurotransmitter deficiency causes a depressive mood

A person who is suspected of possibly overdosing on an opioid and is unresponsive may be able to have their life saved by the use of: -Naltrexone -Fentanyl (Duragesic) -Naloxone (Narcan) -Tramadol (Ultram)

Naloxone (Narcan)

Diabetics sometimes get painful nerve sensations that occur on their skin, usually on the legs and feet. This is a common example of: -Nociceptive Pain -Neuropathic pain -Idiopathic pain -Inflammatory pain

Neuropathic pain

The effectiveness of successful remission in depressed patients after just the first antidepressant has been used can be summed up as: -Not very effective as less than 1/3 of patients achieve remission after the first antidepressant is tried -Extremely effective with most patients achieving full remission after the initial treatment is completed -No effect is seen at all with just the first treatment used, EVERYONE will need combination treatment -About half the people achieve remission with initial monotherapy

Not very effective as less than 1/3 of patients achieve remission after the first antidepressant is tried

Neuropathic Pain can be treated effectively by all of the following EXCEPT: -Opioids like hydrocodone -Tricyclic Antidepressants -SNRI's like Duloxetine (Cymbalta) -Anticonvulsants like Gabapentin

Opioids like hydrocodone

A patient who suffers from self-harm: -Usually just does this behavior one time and then stops -Almost always means to kill himself or herself at the initial onset of the disorder -Report hurting themselves as an attempt to stop feeling hurt, lonely, or hopeless, especially when the patient is a teenager -All of the above are correct

Report hurting themselves as an attempt to stop feeling hurt, lonely, or hopeless, especially when the patient is a teenager

One huge point of concern with bupropion (Wellbutrin) at excessively high doses is: -Hallucinations -Low blood pressure -Seizures -Stomach ulcers

Seizures

All of the following are possible antidepressant medical treatment options EXCEPT: -Monoamine oxidase inhibitors (MAOI's) -Sulfonylureas (specifically second generation) -Selective serotonin reuptake inhibitors (SSRI's) -Serotonin - Norepinephrine Reuptake Inhibitors (SNRI's)

Sulfonylureas (specifically second generation)

Tricyclic Antidepressants have the possibility of interacting with a lot of other medications, why is that? -The TCA's block the metabolism of many drugs in the liver, hampering their first pass effects -TCA's are highly bound to plasma proteins so they compete with other drugs for these binding sites -TCA's prevent certain medications from crossing into the blood brain barrier -TCA's induce the production of numerous liver enzymes, meaning certain drugs will be metabolized faster and thus be less effective

TCA's are highly bound to plasma proteins so they compete with other drugs for these binding sites

Which of the following statements best describes Tricyclic antidepressants (TCA's) with regards to treating neuropathic pain? -TCA's are a great choice for this type of pain management in the elderly -TCA's aren't very effective in any type of pain management because they only treat depression -TCA's effectively treat neuropathic pain, often at doses lower than those required to treat depression -The side effect profile for the TCA's is quite tolerable and makes it a valued option for all patients suffering from pain

TCA's effectively treat neuropathic pain, often at doses lower than those required to treat depression

Tricyclic antidepressants (TCA's) are on the BEERS list which means: -It would be best to take the medication with a beer -The TCA's are deadly if you mix them with certain types of beer -The TCA's are on a long list of drugs that are considered dangerous or harmful to the elderly -There is no such thing as a BEERS list with respect to medications

The TCA's are on a long list of drugs that are considered dangerous or harmful to the elderly

One of the dangers of mixing or taking too many pain medications is that many of them have acetaminophen in them. Which of the following statements about acetaminophen toxicity is true? -Acetaminophen is just Tylenol, it is a benign drug and overdose / toxicity is not a huge issue to be concerned with -Acetaminophen toxicity will cause immediate symptoms such as liver pain, fever, rash, and vomiting -The toxicity is mild at best and can be managed with hydration and taking ibuprofen (Motrin, Advil) to relieve any discomfort it causes -The toxicity is life threatening and can be deceiving since the person may not feel any symptoms for the first 24 hours after overdose

The toxicity is life threatening and can be deceiving since the person may not feel any symptoms for the first 24 hours after overdose

How does activating opioid receptors in the medulla reduce pain? -The medulla is the pain center of the brain. -There is an inhibition of pain signals passing through the medulla to elsewhere in the brain. -There is a reduction in sympathetic nervous system activity, which makes someone less reactive to pain -They produce rewarding effects which counteracts pain signals.

There is an inhibition of pain signals passing through the medulla to elsewhere in the brain.

A pure opioid receptor antagonist: -cannot counteract an agonist for opioid receptors. -binds to all opioid receptors but only fails to activate one type of opioid receptor. -binds to but does not activate opioid receptors. -is unable to cross the blood-brain barrier.

binds to but does not activate opioid receptors.

The activation of opioid receptors on a neuron: -inhibit neuronal activity. -increase neuronal activity. -stabilize a high rate of action potentials. -stop sodium-potassium pump activity.

inhibit neuronal activity.

Most of the pharmacological effects of opioids are produced by activating: -mu receptors. -delta and kappa receptors. -ORL-1 receptors. -kappa receptors.

mu Receptors.

The time an absorbed opioid drug takes to enter the brain is affected by: -the formulation of the drug used. -whether or not the drug is synthetic or semisynthetic. -the affinity of the drug for opioid receptors. -passage through the blood-brain barrier.

passage through the blood-brain barrier.

The symptoms of an overdose from an opioid receptor agonist may be reduced if the user is given a(n): -pure opioid receptor agonist. -pure opioid receptor antagonist. -partial opioid receptor agonist. -mixed opioid receptor agonist-antagonist.

pure opioid receptor antagonist.

Pain fibers release glutamate and ____________ at postsynaptic terminals on spinothalamic neurons. -substance P -GABA -dopamine -beta-endorphin

substance P