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Pharm U5 Terms
Pharmacology: Unit 5 terms
| Question | Answer |
|---|---|
| Cerebral cortex | contains cell bodies of neurons (gray matter) that control voluntary activities of the body |
| Electroencephalogram (EEG) | recording of electrical activity of the cortex; useful in diagnosing various brain disorders |
| Cerebral medulla | composed of myelinated axons (white matter); includes basal ganglia (group of cell bodies (gray matter) sometimes called extrapyramidal system (EPS); regulates skeletal muscle tone and movement |
| Dopamine | functions as neurotransmitter in basal ganglia of brain; blocked by antipsychotic drugs |
| Brainstem | 10 of 12 cranial nerves originate from this part of the brain; includes thalamus, hypothalamus, pons, medulla oblongata |
| Thalamus | regulates sensory impulses traveling to cortex; evaluates sensory information, directs it to appropriate cortex centers |
| Hypothalamus | controls many body functions (temp, water balance, appetite, sleep, ANS, certain emotional/behavioral responses) |
| Pons | located below hypothalamus; regulates respiration, serves as relay station for nerve fibers traveling to other areas of the brain |
| Medulla oblongata | lies just above spinal cord; three vital centers – cardiac, vasomotor, respiratory; injury to this area frequently results in death |
| Cerebellum | lies behind brainstem and below cerebrum; coordinates body movements, posture, maintains body equilibrium |
| Reticular formation | diffuse network of nerve fibers that travel throughout brainstem and cerebrum; composed of excitatory and inhibitory fibers |
| Reticular activating system (RAS) | excitatory fibers responsible for consciousness, arousal, degree of alertness, a filter process that allows for concentration |
| Inhibitory fibers | decrease activity of RAS and, consequently, degree of arousal/alertness; decrease usually occurs in period of rest/sleep |
| Limbic system | collection of neurons that form a specific neural pathway; most structures of system located around hypothalamus, lower portions of cerebrum; involved w/ emotional & behavioral responses, learning & memory |
| Extrapyramidal system | somatic motor pathway located in CNS that affects skeletal muscles; associated w/ coordination of muscle group’s movement and posture |
| Inhibitory neurotransmitters | GABA (gamma-aminobutyric acid), dopamine |
| Excitatory neurotransmitters | glutamate (primary); also ACh, NE, Epi, serotonin |
| Sensation of pain | occurs with local irritation sensed by nociceptors, followed by recognition within the CNS |
| Nociceptors | located in skin, muscle, joints, bones, viscera; respond to tissue injury; quiet if no injury present |
| Pain management/selection of appropriate analgesic | dependent upon the type and duration of pain |
| Analgesics | relieve pain without affecting consciousness |
| Factors that lower pain threshold | anxiety, sleeplessness, tiredness, anger, fear, fright, depression, discomfort, pain, isolation |
| Factors that increase pain threshold | symptom relief, sleep, rest, diversion, empathy, specific medications (analgesics, antianxiety agents, antidepressants) |
| Pain classifications | acute/chronic; visceral/somatic; nociceptive/neuropathic; slow/fast |
| Acute pain | state in which individual experiences presence of severe discomfort or uncomfortable sensation; sudden onset that usually subsides with treatment; ex. myocardial infarction, appendicitis, kidney stones |
| Chronic pain | persistent or recurring pain that continues for more than six months; may be difficult to treat effectively; ex. cancer, rheumatoid arthritis |
| Visceral source of pain | origin in smooth musculature or sympathetically innervated organ systesm; often difficult to localize since it is dull and aching and may also be referred |
| Somatic source of pain | arises from activation of nociceptors in skeletal muscles, fascia, ligaments, vessels, or joints; usually localized, constant; may be described as aching/throbbing |
| Nociceptive pain | can only occur when all neural structures (nerve cell, nerve endings, spinal cord, brain) are functioning properly; can be acute or chronic |
| Neuropathic pain | pain resulting from abnormal signals or nerves damaged by entrapment, infection (i.e. HIV, amputation, diabetes); usually chronic, but may be intermittent |
| Fast pain | pain signal through A-delta fibers |
| Slow pain | pain signal through C-fibers |
| Referred pain | occurs when nerve fibers from visceral & somatic areas converge in same area in dorsal horn are processed in such a way that pain is perceived as originating in same area of somatic sensory A-delta fiber rather than visceral C-fiber |
| Opioid (agonist) analgesics | include opiates, narcotic analgesics that produce the same pharmacological effects as opium. |
| Opioid (agonist) analgesics | combine with mu, kappa, and delta opiate receptors within the CNS to produce analgesic effect by alter perception of pain; do not impair peripheral nerves |
| Opioid (agonist) analgesic side effects | sedation, euphoria, dysphoria, constipation, urinary retention, miosis, respiratory depression, hypotension, bradycardia, bronchoconstriction, emesis, anti-emetic; different receptors (mu, kappa, delta) produce different effects |
| Morphine | major analgesic drug contained in crude opium; prototype strong agonist; show high affinity for mu receptors, varying affinities for delta and kappa receptors |
| Agonist-antagonist agents | drugs that stimulate one receptor but block another; effects of these agents depends on previous exposure to opioids; in opioid dependence will induce withdrawal symptoms due to blocking effects |
| Mixed opioid agonist-antagonist agents | bind with kappa receptors and block or have minimal effects on mu receptors; have no antitussive effects and fewer GI effects than agonists do |
| Other analgesics | centrally acting bind to mu opioid receptors; weakly inhibits re-uptake of NE and serotonin; used to treat moderate to severe pain; can cause seizures in pt taking serotonin reuptake inhibitors/antidepressants |
| Opioid antagonists | compete with narcotics for receptor sites, thereby hindering narcotic effect; work only on opioid narcotic agonists; used for respiratory depression (drug-induced), opioid toxicity, opioid overdose, treatment of addiction; Narcan is the main agent |
| Naloxone (Narcan) | opioid antagonist given IV, IM, or SC; drug of choice b/c does not produce respiratory depression; if this agent doesn’t work, indicates that patient overdosed on a non-opioid substance |
| Nonsteriodal anti-inflammatory drugs (NSAIDS) | nonopioid analgesics; inhibit leukotriene and or prostaglandin pathways; can interact with cyclooxygenases (enzymes that produce prostaglandins) |
| Older NSAIDS | non-opioid analgesic considered nonselective—any COX will do; produce analgesia (COX1 & COX2) or decreased platelet aggregation that are beneficial; adversely alters stomach lining, though |
| Newer NSAIDS | non-opioid analgesics that relieve pain and inflammation but do not cause gastric problems by selectively inhibiting only COX2; analgesia equal to that of other NSAIDS |
| Non-steroidal anti-inflammatory drugs (NSAIDs) | relieve mild to moderate pain without altering consciousness or mental function; reduce inflammation, relieve fever, releave vascular headaches, inhibition of platelet aggregation, myocardial infarction |
| Antiarthritic (antirheumatic) agents | treats inflammation in patients not responding to other therapy; suppresses inflammation of synovial membrane in joints affected by arthritis during active stage disease; relieve pain, swelling, stiffness; can arrest progression of the disease |
| Uricosuric drugs (anti-gout) | control acute inflammation of gout attack; increase excretion of uric acid, decrease production of uric acid |
| Gout | inborn error of metabolism causing disorder in metabolism of uric acid; primarily affects males in middle age, and post-menopausal women; characterized by deposits of uric acid crystals in joints, especially big toe |
| Uricosuric drug contraindications/precautions | aspirin can interfere with uric acid excretion causing exacerbation of gout |
| Generalized anxiety disorder | characterized by at least six months of excessive anxiety and uncontrollable worry about everyday problems; primarily emotional experience giving individual sense of angst, unease, apphrehension; resulting distractibility and forgetfulness |
| Depression | manifested by emotions of sadness, anhedonia, negative ruminations, somatic preoccupations, psychomotor retardation. |
| Glutamate gamma-aminobutyric acid (GABA) | major inhibitory NT; plays critical role in anxiety, depression, sleep |
| Sleep disturbances | common disturbance in both clinical anxiety, depression |
| Sleep latency | time it takes to fall asleep |
| Goals of management of sleep disorders | reduce sleep latency, increase total time of sleep & sleep quality, enhance subjective sense of refreshment upon awakening in the morning |
| Benzodiazepines | antianxiety agent; decreases excitability & functional activity of specific brain/spinal cord areas by potentiating GABA effects (increase Cl channel openings); greater degree of hyperpolarization & neuronal depression, which reduces activity of CNS areas |
| Benzodiazepine uses | treatment of anxiety states, depression, preanesthesia, withdrawal syndromes, sustained seizures |
| Benzodiazepine antagonist—flumazenil (Romazicon) | benzodiazepine receptor antagonist; admi IV to reverse depressant effects but not respiratory depressant effects of benzos; used in management of overdose; if pt. benzo dependent, can produce withdrawal reaction (seizure) |
| Azapirones | nonbenzodiazopene; new class of antianxiety agent that also produces antidepressant effects; appear to act on serotonin receptors; main agent Is buspirone (BuSpar) |
| Piperazine derivatives | nonbenzodiazepine agent; depresses CNS; tranquilizing effect produced primarily by depression of hypothalamus, brain stem reticular formation rather than cortical areas |
| Sedative | an agent that produces state of calmness when given in divided doses; in high doses becomes hypnotic |
| Hypnotic | agent given at bedtime to induce sleep; usually larger dose than a sedative |
| Sedative and hypnotics | alleviate symptoms, but do not cure; dependence potential; induce rest by increasing amount of sleep, but do not necessarily produce restful REM sleep |
| Barbiturates | in low doses, increases actions of GABA, reduces neuronal excitability; in high doses, causes general depression of entire CNS similar to actions of general anesthetics; main site of action is reticular formation and cerebral cortex |
| Barbiturates | only used if nonbarbiturate doesn’t work; sedative (low dose) and hypnotic (high dose); operatively and as an anesthetic; anticonvulsant agent; causes excessive CNS depression, anxiety, hypersensitivity; very narrow therapeutic index, very addictive |
| Nonbarbituates | diverse group of drugs with differing chemical structures and pharmacologic characteristics; newer drugs do not disturb sleep cycle, low risk for tolerance, dependency, withdrawal reactions; includes sleep aids (Sonata, Ambien, Lunesta) |
| Benzodiazepines | depresses CNS by increasing GABA neuronal inhibition; used for insomnia, preoperative sedation, anxiety, sleep induction, hypnotic therapy, withdrawal syndromes; can cause CNS changes, hypotension, respiratory depression, CNS excitement |
| Alcohol | GABA receptor antagonist; CNS depressant; sedation (low dose) & hypnotic/unconsciousness (high dose); effects are euphoria, depressed inhibitions, increase in activity, decreased fine motor skills, libido; diuresis (blocks ADH), appetite stimulation |
| Fetal alcohol syndrome | set of congenital psychological, behavioral, cognitive, physical abnormalities appearing in infants whose mothers consumed alcoholic beverages during pregnancy |
| Disulfiran (Antabuse) | used as treatment for compliant patients who refrain from alcohol; can cause severe complications if taken within 30 minutes of alcohol intake; flushin, diaphoresis, hypoventilation, copious vomiting, confusion, chest pain, breathing difficulty |
| CNS stimulant | substance that quickens the activity of the CNS by increasing rate of neuronal discharge or blocking inhibitory NT |
| Therapeutic CNS stimulation | restoring mental alertness/consciousness, stimulating respiratory center or depression, treating hyperkinetic children by acting as a depressant in a child; agents include amphetamines, anorexiants, analeptics |
| Amphetamines and amphetamine-like drugs | stimulate release of NE, which causes increased alertness, less fatigue, elevated mood; used for treatment of narcolepsy, endogenous obesity, ADHD, mental depression, withdrawal symptoms |
| Narcolepsy | syndrome characterized by sudden sleep attacks; due to lack of orexin in brain |
| Endogenous obesity | obesity resulting from dysfunction of endocrine or metabolic systems |
| Attention deficit hyperactivity disorder (ADHD) | childhood condition involving inattention, impulsivity, hyperactivity |
| Tachyphylaxis | repeated administration of some drugs results in a marked decrease in effectiveness (tolerance) |
| Anorexiants (sympathomimetics) | suppress appetite by acting on hypothalamus; used for weight reduction when accompanied by medical complications; similar side effects to those of amphetamines; tolerance and abuse are possible |
| Analeptics and methylxanthines | stimulate CNS by acting on cerebral cortex and medulla; used to produce wakefulness and increase alertness, in OTC cold medicines and analgesics with caffeine; side effects include teratogensis, caffeinism, seizures, tolerance, abuse |
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michellerogers
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