NURS 660 PAINFUL EXAM 3 REVIEW - MARYVILLE UNIVERSITY

NURS 660 PAINFUL EXAM 3 REVIEW - MARYVILLE UNIVERSITY.1. What is the medication that is the antidote for alprazolam? (If someone ODs). a. In overdosed-administer Flumazenil (benzo antagonist)-Stahl-can reverse od or induce sz or withdrawal in pts dependent on benzos 2. What is the MOA of pregabalin that makes it alleviate pain for people with fibromyalgia or chronic fatigue? a. Gabapentin and Lyrica are analgesic adjuncts that bind to open conformation of VS calcium channels (prevent release of NTs including glutamate) in CNS tissue and stabilize neuronal membranes, thus interfering with the transmission of pain impulses rather than binding to opioid receptors b. “Fibro-Fog” – Dorsolateral pre frontal cortex and anterior thalamus. 3. Caffeine – what is an antagonist of caffeine? So caffeine promotes being awake and alert, and opposes the homeostatic drive. It’s an antagonist of what? a. Caffeine and theophylline can block adenosine effects-Caffeine antagonist is adenosine b. withhold caffeine for 5 half-lives prior to adenosine; avoid dietary caffeine for at least 12 hrs prior to pharm stress test c. The body will build up levels of adenosine due to caffeine using receptor sites. 4. What is this diagnosis: the patient comes in with a CC of anxiety. She has been excessively worrying, increased arousal, increased tiredness and irritability. What is the least likely diagnosis? a. 5. Somebody w/ anxiety worries about having a panic attack, in addition has mood changes to avoid things in order to not have a panic attack. “It’s a little more specific than just anxiety”. (Probably panic disorder per Psychiatric Interviewing). a. 6. Which two areas of the brain are involved in a reciprocal relationship that we fear, anxiety & “fight or flight”. An example “ A woman was raped, and continues to have fear of opposite sex on her way to parking garage…so which two areas of the brain are involved?”. a. Amygdala & Hippocampus (She gave answer) 7. Know the MOA of modafinil (Provigil)- how does it promote normal wakefulness? a. Wake promoting b. Enhances tonic dopamine firing. 8. You have a sleep medication called Eszopiclone. What receptors does this target? How does it work? a. GABA α1-produces sedation and linked to daytime sedation, anticonvulsant actions, and possibly amnesia. Adaptations of this receptor w/ chronic hypnotic tx is thought to lead to tolerance and withdrawal α2&α3 -linked to anxiolytic, muscle relaxant, and alcohol-potentiating actions α5 -mostly in hippocampus may be linked to cognition and other functions b. Melatonin receptor agonist w/ high affinity for M1/M2 receptors c. Targets the GABA A alpha 1 isoform receptor. d. Boosts chloride conductance through GABA regulated channels, inhibitory actions in sleep centers that produces hypnotic effects. 9. Chronic PTSD. “He’s got arousal, anxiety, the amygdala and the hippocampus is associated w/ experience in Iraq”. Which would be the first line appropriate pharmacological agent for PTSD? It’s one that most people don’t use anymore, but it’s an example of this drug class “Even if you don’t agree with the medication, if you go with the drug class you will be safe” a. “Treat the best that you can” b. Therapy, EMDR, Exposure Therapy, CBT c. Reduce symptoms by increasing GLUTAMATE neurotransmission during periods of fear. d. First Line: target hyperarousal coming from the PTSD = PAXIL (PAROXETINE) SSRI 10. Active fibromyalgia, besides painful physical symptoms, patient may experience memory and difficulty concentrating. What mediation is used to alleviate to help cognitive pain and physical symptoms?