Exam 1 (week 1) Flashcards
(511 cards)
1
Q
- 3 weeks of embryology - what happens in nervous system
A
- surface ectoderm turns into neural groove
2
Q
- cavity in neural tube becomes what
A
- ventricles in brain and cavity in spinal cord
3
Q
- what happens in 4 weeks of embryology
A
- anterior end of neural tube starts to get bulges (Forebrain, midbrain and hindbrain)
- flexures start happening
- midbrain/cephalic flexure ventrally-down
- cervical flexure at medulla/spinal cord ventrally/down
- flexures start happening
4
Q
- latin terms for parts of brain
A
- forebrain = prosencephalon, midbrain = mesencephalon, hindbrain = rhombencephalon
5
Q
- what happens in 5 weeks of embryology
A
- 5 brain vesicles - forebrain subdivides into cerebral hemispheres (Telencephalon) and diencephalon (major part is thalamus)
- hindbrain also subdivides into (cerebellum and pons - mesencephalon) and (medulla oblongata - myelencephalon)
- flexure:
- at level of pons - neural tube bends dorsally (pontine flexure)
6
Q
- what part of brain is retina derived from
A
- diencephalon
7
Q
- where are ventricles
A
- 2 in each cerebellum (lateral), 1 in diencephalon, 1 in cerebellum,pons and medulla
8
Q
- where is the central aqueduct
A
- in midbrain connecting 3rd ventricle and 4th ventricle
9
Q
- what happens at 3 months of developmentnt
A
- cerebral hemispheres grow in all directions, diencephalon is completely covered
10
Q
- what happens at 6 months of development
A
- midbrain gets covered by cerebral hemispheres - covered until the cerebellum
11
Q
- what happens at 9 months of development
A
- gyri, fissures and sulci are formed
12
Q
- when is maximum weight of brain achieved
A
- 8 years old
13
Q
- what is deeper, fissure or sulcus
A
- fissure
14
Q
- what are the lobes and poles in the brain
A
- frontal lobe and pole
- temporal lobe and pole
- occipital lobe and pole
- parietal lobe
- insular lobe (within lateral fissure)
- limbic lobe
15
Q
- division between frontal and parietal lobes
A
- central sulcus
16
Q
- division between temporal and parietal/frontal
A
- lateral sulcus
17
Q
- division between parietal/temporal and occipital
A
- laterally, arbitrary line between parietal occipital sulcus to pre occipital notch
- medially parietal occipital sulcus
18
Q
- division between limbic lobe and rest
A
- lyric lobe is made of 2 gyri, cingulate sulcus (separates cingulate gyrus and frontal/parietal) and collateral sulcus (separates parahippocampal gyrus and temporal lobe)
19
Q
- separation between cerebral hemispheres
A
- superior longitudinal fissure until corpus collosum
20
Q
- separation between occipital pole and cerebellum
A
- transverse cerebral fissure
21
Q
- how to identify central sulcus
A
- look for 3 parallel sulci - middle is central. central doesn’t reach all the way down to lateral fissure
22
Q
- what sulcus runs within parietal lobe on lateral surface
A
- intraparietal sulcus
23
Q
- what does intraparietal sulcus separate
A
- superior and inferior parietal
24
Q
- frontal lobe gyri (4)
A
- pre central gyrus (area 4, primary motor)
- superior frontal
- middle frontal
- inferior frontal
25
- parietal lobe gyri (4)
- post central gyrus (primary somatosensory, areas 3,1,2)
- superior parietal (paint temp touch)
- inferior parietal (language)
- precuneus (medially)
26
- temporal lobe gyri (3)
- superior temporal
- middle temporal
- inferior temporal
27
- parahipocampal gyrus ending
- uncus (close to temporal pole)
28
- occipital lobe gyri (2)
- on medial surface there’s calcarine sulcus - above is called cuneus
- below is called lingual
29
- anatomical parts of corpus coliseum
- rostrum (nose), genu (knee), body and selenium (tail)
30
- structures to identify on ventral surface of brain (6)
- olfactory bulb
- olfactory tract
- optic nerve
- optic chasm
- pituitary stalk
- mammary bodies
31
- what structures does internal capsule run through
- between thalamus and basal ganglia gray matter (caudate, putamen and globus pallidus)
32
- brainstem subdivisions from dorsal to ventral
- tectum (roof)
- tegmenjtum (floor)
- basilar region
33
- where is tectum
- only in midbrain, above cerebral acqdueduct
34
- what does tegmenjtum contain
- cranial nerve nuclei, reticular formation, and tracts to cerebrum
35
- what does basilar region contain
- descending motor tracks from cerebral cortex
36
- what does tectum contain
- superior colliculus (vision)
| - inferior colliculus (hearing)
37
- cranial nerve that exits dorsally
- trochlear (4)
38
- what nerves exit between midbrain and pons
- 3rd - oculomotor
| - 4th - trochlear
39
- what nerve exits from basilar region of pons
- 5th - trigeminal
40
- what nerves exit between pons and medulla
- 6th (abducens)
- 7th (Facial)
- 8th
41
- what nerves exit from medulla
- 9th - 12th
42
- what is the demarcation between brainstem and spinal cord
- pyramidal decussation
43
- describe primitive neuroepithelium
- pseudstratefied epithelium, with stem cells at the apical/luminal surface
44
- what do neuroepithelial stem cells differentiate into
- either neuroblasts or gliablasts
45
- what are the cells that line the central canal, what are they derived from
- ependymal cells (glial cells - also form the choroid plexus)
46
- what are microglial cells and what are they derived from
- phagocytes of CNS, monocyte derivative - mesodermally derived (Bone marrow)
47
- what is mantle zone- what kind of matter does it become
- down toward ventricle, contain lots of cell bodies that cell processes peripherally (GREY matter)
48
- what is marginal zone - what kind of matter does it become
- myelinated outer core - peripheral process from mantle zone (WHITE matter)
49
- what does mantle layer get divided into
- dorsal alar plates (eventually sensory horns)
| - ventral basal plates (eventually motor horns)
50
- division of grey and white in brain
- deep grey, intermediate white, superficial grey (migrates up from deep manta layer)
51
- how does grey matter neurons migrate in brain?
- via radial glial cells - serve as train tracks from deep to periphery (like elevator)
52
- genes important for nervous system stratification (motor, ibternueorns, sensory)
- BMP (dorsal gradient - induces sensory neurons)
- SHH (ventral gradient - induces motor neurons)
- interneurons are induced by overlap
53
- gene that regulates face development (and what over/under expression causes)
- cyclopia - under expression of SHH
| - facial duplication - over expression of SHH
54
- most common developmental defect of forebrain
- holoprosencephaly - single forebrain vesicle instead of two lateral. get mid facial defects - due to SHH defects
55
- where does spina bifida generally occur (along spina cord)
- lower lumbar/sacral (lower has better prognostic outcomes)
56
- what superficial presentations occur with spina bifida occulta
- hairy nevus overlaying area of spinal cord where this defect is occurring (lumbar)
57
- difference between meningocele and meningomyleocele
- meningocele is herniation of JUST cerebrospinal fluid, meningomyelocele also herniates spinal cord contents
58
rachiscesis
- when spina bifida open neural tube to the outside world - causes paralysis (and possible infection)
59
- what can you monitor in maternal serum to detect spina bifida in fetus
- increased levels of alpha-fetoprotein
60
- what can you provide women to reduce levels of spinal tube defects
- folic acid supplementation (40mcg/day). because deficiency leads to abnormal cell division - can reduce incidence of neural tube defects by 70-80%
61
- point where coronal and sagittal sutures meet
- bregma
62
- point where saggital suture meets occipital bone
- lambda
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- junction of temporal, sphenoid, parietal and frontal bone
- pterion (greater wing of the sphenoid)
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- junction of temporal, parietal and occipital bone
- asterion
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- extra bones at sutures
- wormion bones
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- fontanelles
- anterolateral where pterion forms
- posterolateral where astern forms
- anterior at bregma
- posterior at lambda
67
- first and last fontanelles to close
- first = posterior (1-2months after birth)
| - last = anterior (2 years after birth)
68
what percentage of americans have some mental health disorder
18%
69
what type of opioid has recently been responsible for the most deaths
fentanyl
70
what percentage of homeless individuals living in shelters have a serious mental illness
26%
71
what percentage of homeless individuals living in shelters have substance use disorders
35%
72
what range of percentages of adult inmates have mental illnesses
45-64% in federal, state and local jails
73
what percentage of youth in juvenile justice systems have mental health conditions
20%
74
premature mortality in serious mental illness (decreases lifespan by how many years)
15-20 years
75
what percentage of illnesses contributing to early mortality in mental illness
40% (health behaviors)
76
what are 60% of premature schizophrenia deaths caused by (3)
cardiovascular, pulmonary and ID
77
first psychiatric drug approved by FDA
thorazine, chloramphetachol
78
componentts of the mental status exam (7)
1. general appearance, behavior and attitude
2. consciousness and orientation
3. speech and language
4. mood and affect
5. thought content, form and perceptions
6. memory and cognition
7. judgement and insight
79
4 D's in psychopathology
1. danger
2. distress
3. dysfunction
4. deviance
all have problems - not ideal markers
80
sections of the DSM diagnosis
1. symptoms
2. duration/time course
3. ruling out medical conditions/substances
81
when does myelin form on axon
when axon gets a diameter more than 1 micrometer (micron)
82
what are nissl bodies
layers of rough ER and ribosomes in neuron cell bodies (NOT axons)
83
what direction and what protein does anterograde transport use
anterograde is from cell body down axon, uses kinesis
84
what direction and what protein does retrograde transport use
retrograde is back up to cell body from axon, uses dynein
85
what do synapses look like on EM
fuzzy catterpillars
86
what is euthymic mood
normal range of mood, absence of depressed or elevated mood
87
what is expansive mood
expression of feelings without restraint
88
what is anhedonia
loss of interest and withdrawal from regular and pleasurable activities
89
what is alexithymia
inability or difficulty in describing or being aware of one's emotions
90
what is diurnal variation in mood
mood is worst in the morning, immediately after awakening and improves as the day progresses
91
what is echopraxia
pathologial immitation of movements of one person by another
92
what is catalepsy
immobile position that is constantly maintained
93
what is catatonic excitement
agitated, purposeless motor activity
94
what is catatonic stupor
markedly slower motor activity - seeming unawareness of surroundings
95
what is catatonic rigidity
assumption of rigid posture,held against all efforts to being moved
96
what is catatonic posturing
assumption of an inappropriate or bizarre posture, maintained for long periods
97
what is cerea flexibilitas
waxy flexibility - person can be molded into a position that is then maintained
98
what is negativism
resistance to all attempts to be moved or to instructions
99
what is cataplexy
temporary loss of muscle tone and weakness due to an emotional state
100
what is stereotypy
repetitive fixed pattern of physical action or speech
101
what is mannerism
ingrained, habitual involuntary movement
102
what is akathisia
subjective feeling of muscular tension, causing restlessness, pacing, repeated sitting and standing
103
what is aggression
the motor counterpart of the affect of rage, anger or hostility
104
what is a formal thought disorder
disturbance in form of thought, not content of thought - characterized by loosened associations, neologisms, illogical constructs
105
what is magical thinking
form of illogical thought similar to preoperational phase in children in which thoughts, words or actions assume power (can cause or prevent events)
106
what is neologism
new word created by patient by combining syllables of other words
107
what is circumstantiality
indirect speech that is delayed in reaching the point but eventually gets to desired goal
108
what is tangentiality
inability to have goal-directed associations of thought - never gets to desired goal
109
what is perseveration
persisting response to a prior stimulus after a new stimulus has been presented
110
what is verbigeration
meaningless repetition of specific words or phrases
111
what is echolalia
repeating of words or phases of one person by another
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what is flight of ideas
rapid, continuous verbalizations or plays on words that produce constant shifting from one idea to another that tend to be connected
113
what is clang association
association of words with similar sounds not meanings
114
what is blocking
abrupt interruption in train of thought before its finished. after a while the person has no recall of the previous thought (AKA thought deprivation)
115
what is a systematized delusion
false beliefs united by a single event or theme (persecuted by the CIA)
116
what is a bizarre delusion
invaders from space planted electrodes in my brain - totally implausible
117
what is a mood-congruent delusion
delusion with content that has no association with mood, or is mood-neutral
118
what is a nihilistic delusion
false feeling that self, others or the world is nonexistent or ending
119
what is somatic delusion
false belief involving functioning of one's body (brain is melting)
120
what is a delusion of reference
false belief that the behavior of others refers to oneself (belief that persons on the television are talking to our about you)
121
what is thought withdrawal
delusion that one's thoughts are being removed from on'es mind
122
what is thought broadcasting
delusion that one's thoughts can be heard by others
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what is thought control
delusion that one's thoughts are being controlled by others
124
what is pseudologia phantastica
associated with munchausen's, a type of lying in which the person appears to believe in the reality of his/her fantasies and acts on them
125
what is non-spontaneous speech
no self-initiation of speech - only speaks when spoken to
126
what is poverty of speech vs poverty of content of speech
poverty of speech = restriction of amount of speech (monosyllabic responses)
poverty of content of speech = adequate amount of speech, but conveys too little information
127
what is dysprosody
loss or normal speech melody
128
what is dysarthria
difficulty in articulation (not word finding or grammar)
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what is motor aphasia
understanding remains intact, but ability to speak is impaired (Broca's, nonfluent, expressive)
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what is sensory aphasia
loss of ability to understand, but speech is fluid (Wernicke's, fluent, repetitive)
131
what is nominal aphasia
difficulty in finding correct name for an object
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what is syntactical aphasia
inability to arrange words in proper sequence
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what is jargon aphasia
words are totally neologistic, nonsense words repeated with various intonations and inflections
134
what is global aphasia
combination of nonfluent aphasia with fluent aphasia
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what is hypnagogic hallucination
false sensory perception while falling asleep (non-pathological)
136
what is hypnopompic hallucination
false perception occurring while awaking from sleep (non-pathological)
137
what is somatic hallucination
false sensation of things occuring in or to the body
138
what is illusion
misperception or misinterpretation of real external sensory stimuli
139
what is anosognosia
ignorance of illness
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what is somatopagnosia
ignorance of the body - inability to recognize a body part as one's own
141
what is prosopagnosia
inability to recognize faces
142
what is apraxia
inability to carry out specific tasks
143
what is visual agnosia
inability to recognize objects or persons
144
what is depersonalization
subjective sense of being unreal, strange or unfamiliar to oneself
145
what is derealization
sense that the environment is strange, unreal
146
what is anterograde amnesia
amnesia for events occuring AFTER a point in time
147
what is retrograde amnesia
amnesia for events occurring BEFORE a point in time
148
difference between immediate, recent, recent past, and remote memory
immediate = seconds to minutes
recent = past fes days
recent past = past few months
remote = distant past
149
IQ for mild mental retardation
50 or 55 - 70
150
IQ for moderate mental retardation
35 or 40 - 50 or 55
151
IQ for severe mental retardation
20 or 25 - 34 or 40
152
IQ for profound mental retardation
below 20 or 25
153
what is dyscalculia
inability to do calculations not caused by anxiety or impairment in concentration
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what is dysgraphia
loss of ability to write in cursive style, loss of word structure
155
what is alexia
loss of previously possessed reading facility
156
what is pseudodementia
clinical resemblance to dementia but caused by depression
157
what is concrete thinking
literal thinking - one-dimensional thought
158
what is abstract thinking
ability to appreciate nuances of meaning - multidimensional thinking
159
excitatory neurotransmitter in CNS
glutamate
160
inhibitory neurotransmitter in CNS
GABA (brain)
| glycine (spinal cord)
161
which astrocytes are in white matter
fibrous
162
which astrocytes are in grey matter
protoplasmic
163
which cell can myelinate more than one neuron
oligodendrocytes
164
difference between unmyelinated neurons in PNS vs CNS
PNS is still surrounded by cytoplasm of schwann cell
165
what does leptomeninges incldue
dura and arachnoid
166
what mater is most close tot he spinal cord
pia
167
what mater has innervation
dura only
168
what is falx cerebri and what innervates it
dura mater right down the hemispheres, in the anterior cranial fossa, is innervated by ophthalmic and maxiillary branches of trigeminal CN V
169
innervation of middle cranial fossa
ophthalmic and maxilary V1, V2 and some V3 mandibular
170
posterior cranial fossa innervation
vagus X
C1, C2 and C3 dorsal rami
(maybe glossopharyngeal)
171
what is subarachnoid space
between arachnoid and pia, contains CSF and vasculature
172
what is epidural space
between bone and dura, only a potential space in the skull
173
what is subdural
not naturally occuring space, between dura and arachnoid
174
where is superior saggital sinus
along middle of hemispheres - top of falx cerebri
175
where is transverse sinus, and where does it receive blood from
meets up with superior saggital sinus and straight sinus (which is inferior sagittal sinus and great cerebral vein combination) into confluence and then transverse
176
what does transverse sinus become
sigmoid, which then becomes internal jugular
177
what are arachnoid granulations and where are they
little mushrooms of arachnoid into superior sagittal sinus - how CSF gets recycled
178
what is in cavernous sinus and what's around it
around pituitary and sphenoid, contains CN 3, 4, V1 V2, 6 and internal carotid
179
if you have a supratentorial lesion/tumor, what could happen
temporal lobe can be pushed through tenrtorial notch and impinge on cn3
180
if you have a pituitary adenoma, where could it go and what could it do
it could push up through the diaphragma sellae and impact the optic chiasm, causing tunnel vision (bitermporal hemianopsia)
181
STUDY THE FORAMEN
separate piece of paper
182
lefort 1
transverse maxillary fracture -"floating palate"
183
lefort 2
pyramidal fracture- through orbital rim, "floating maxilla"
184
lefort 3 and 4
craniofacial disjunction - through orbital walls "floating face"
185
on what bone are the nuchal lines
occipital bone
186
a tumor that presses on jugular foramen would impact which nerve
glossopharyngeal
187
parts of sphenoid bone (4)
1. lesser wing (above superior orbital fissure)
2. greater wing (below superior orbital fissure, extends laterally to side of face)
3. sella turcica - depression above body where pituitary is
4. lateral and medial pterygold plates - muslce attachments
188
muscles associated with functino of eustacian tube (4)
1. levator veli palatini (elevates palate - innervated by vagus)
2. saslpingopharyngeus (closes eustacian tube)
3. tensor tympani (tenses tympanic membrane)
4. tensor veli palatini (flattens palate)
189
why do kids get ear infections
eustacian tube is more horizontal and it's shorter
190
what's the problem with emissary veins
can bring infection from scalp to brain through emissary veins
191
where do bringing veins go
cerebral veins to sinus
192
skull fracture at pterion would cause epidrual hematoma from which artery
middle meningial artery (MMA)
193
scalp acroynym
```
skin
connective tissue
aponeurosis (connects to muscles)
loose areolar tissue
periosteum (dura mater reflection)
```
194
dermatomes of C2 - ventral vs dorsal ramus
C2 dorsal ramus on back of scalp
| C2 ventral is neck and ear
195
what movements are along the vertical axis of eye
abduction and adduction
196
what movements are along the horizontal axis of eye
elevation and depression
197
what muscles do oculomotor nerve innervate in eye (extrinsic)
superior rectus
medial rectus
inferior rectus
inferior oblique
198
what muscle does trochelar lnerve innervate in eye
superior oblique
199
what muscle does abducens innervate in eye
lateral rectus
200
what movements are along the visual axis of eye
```
intorsion = eyeball rotates towards nose
extosion = eyeball rotates away from nose
```
201
what is convergence in terms of eyes
medial rectus (oculomotor CN3) work to make eyes crossyeed
202
how to test SR and IR eye muscles
put eye laterally then elevate or depress the eye
203
how to test superior oblique
bring eye medially and then down
204
how to test eye muscles generally
first line up line of pull with visual axis then
205
how to test inferior oblique
bring eye medially and then up
206
oculomtor nuclei tracks where do they go and come out
motor nucleus
edinger-westphal nucleus
through interpeduncular fossa through cavernous sinus
207
what does edinger-westphal contain
parasympathetic to ciliary ganglion
208
when someone has unilateral damage to CN3, what will the eye look like
1. drooping eyelid
2. eye is down and out "lateral strabismus"
3. mydriasis (dilated pupil)
209
ptosis due to sympathetic - what will pupil look like
smaller - myosis
210
ptosis due to CN3 damage - what will pupuil look like
dilated - mydriasis
211
slight ptosis caused by what muscle
superior tarsal
212
what are the intrisnci muscles of the eye that CN3 innervates (and what motion do they control)
1. sphincter pupillae (constricts pupil) - parasympthathetics
2. ciliary bodies (accommodation reflex)
213
where does dilator pupillae innervation coem from
from sympathetic trunk to superior cervical ganglion - leads to pupil dilation
214
what nuclei are involved in pupillary reflex - path from optic nerve to pupil contraction
optic nerve to pretectal nuclei, to EW nuclei, to oculomotor nerve, to ciliary ganglion to pupil contraction
215
what are the components of the accomodation reflex - what things need to change
1. convergence
2. pupil constriction
3. rounding of lens (via ciliary bodies)
216
what motions of eye does trochlear control
1. depression
2. intorsion
OF OPPOSITE EYE
due to innervation of superior oblique
217
what will the eye look like with trochlear damage
eye will be slightly up and medial
218
what kind of double vision will you have
vertical double vision
219
how do people with trochlear nerve
tilt away from affected eye (so that the affected eye can extort)
220
when abducens is damaged, what will the eye look like
affected eye will be medially rotated - medially strabismus
221
what is reticular formation, where is it housed
cells packed in meshwork of tracks.
housed in the tegmentum
222
what does ascending reticular system do and where does it go
projects to cortex - maintains brain at appropraite level of arousal -- reticular activating system
223
what does descending reticualr system do and where does it go
pass to spinal cord in reticulospinal tract
modulates spinal reflex activity
224
what structures are in tegmentum (4)
1. reticular formation
2. cranial nerve nuclei and tracts
3. ascending pathways from spinal cord
4. some descending pathways
225
what senses are carried in visceral sensory
taste
| visceral
226
what senses are carried in special sensory
vision
hearing
balance
227
where in brainstem are sensory nuclei grouped - dorsal, ventral, medial or lateral
lateral
228
where in brainstem are motor nuclei grouped - dorsal, ventral, medial or lateral
medial
229
what sensory info decussates in the internal arcuate fibers
touch, vibration, proprio
230
what replaces substantia gelatinosa in medulla cross section
spinal tract and nucleus of V (recieves SENSORY info from 5, 7, and 9 from the head/face)
231
what are the two most medial small structures at level in medulla, right dorsally to the decussation of the gracillis and cuneatus gracts
medial lemniscus
232
once you get above the nucleas cuneatus/gracilis, what are the CN nuclei from medial to lateral
1. hypoglossal (motor)
2. dorsal motor nucleus of 10 (motor)
3. solitary nucleus and tract (senosory)
4. vestibular nuclei (sensory)
233
where to hypoglossal axons exit
in pre olivary sulcus
234
where do dorsal motor nucleus of 10 axons exit
in post olivary sulcus
235
what info does dorsal motor nucleus contain/carry
preganglionic parasympathetics to thorax and abdominal viscera
236
what info does solitary nucleus contain
taste from 7, 9 and 10
237
what nucleus is ventral to the rest of the bunch of nuclei in the medulla at the level of the 4th ventricle
nucleus ambiguus
238
what does the nucleus ambiguus do
controls swallowingn and vocalization from 9 and 10
239
what is lateral to nucleus ambiguus
reticular formation that controls heart rate
240
what CNs does medial longitudinal fasciculus play a role in communicating between
3, 4, 6
241
what facial deficits would you see with medial medullary lesion
eye is down and out
| tongue deviates away from affected ey
242
3 structures in base of pons
1. pontine nuclei most medial and dorsal
2. pontocerebellar fibers, running lateral to medial ventral to the pontine nucleus
3. corticospinal tracts most ventral, which will become pyramids
243
what percentage of american suffer from an anxiet disorder
18%
244
what are the primary anxiety disorders (5)
1. generalized anxity disroder
2. panic disorder
3. agoraphobia
4. specific phobia
5. social phobia
245
what are four medical conditions that can cause anxiety
1. hyperthyroidism
2. COPD
3. congestive heart failure
4. arrhythmia
246
what are 2 substances that canc ause anxiety
1. caffeine
| 2. stimulants (amphetamines, cocaine)
247
what are the neurotransmitters involved in anxiety (3)
1. GABA
2. NE
3. serotonin
248
what are the 3 components or sides to anxiety (and the 3 A's)
1. cognitive (anticipation)
2. physiologic (arousal)
3. behavioral (avoidance)
249
hormone involved in anxiety
cortisol
250
why is axiety worse when you're lying down
carbon dioxide - your tidal volume decreases and your trigger mechanism in carotids goes off
251
what drug don't you give in anxiety
alprazolam (xanax) - tends to have more reinforcing or addictive effects
252
how to treat specific phobias therapeutically
systemic desensitization
253
what are the 3 parts to systemic desnsitization
1. stimulus hierarchy (start with thinking, then photo, then removed, then touching)
2. learn coping mechanisms
3. learn to connect stimulus to response and coping mechanisms
254
what percentage of population has social anxiety disorder
13%
255
what are the therapeutic treatments for social anxiety disorder (2)
1. social skills training/exposure (group therapy)
| 2. cognitive behavior therapy
256
what are the medications for social anxiety disorder (4)
1. SSRI
2. SSNI
3. MAOI
4. benzos
257
what are the medications for generalized anxiety disroder
1. SSRI/SNRI
2. benzos
might have to start with benzos to get the initial symptoms controlled, because ssris take some time. also ssri's can cause initial worsening of symptoms
258
steps in cognitive behavior therapy (3)
1. identify thought
2. identify that it is distorted (unlikely)
3. make thought more logical
259
how long do panic attacks have to persist to be classified as panic attacks
1 month or more
260
what percentage of population has panic disorder
2-5%
261
what two things are often comorbid with panic disorder
1. major depressive disorder
| 2. substance dependence
262
what percentage of individuals with panic disorder are treatment responsive
70%
263
how long out of the day does a person do their compulsions in ocd
more than an hour
264
etiologies of OCD (3)
1. genetics
2. infections
3. PANDAS - autoimmune
265
treatments for OCD (pharm and therapy) (5)
1. high dose SSRI/SNRI
2. exposure therapy (virtual reality)
3. systematic desensitization
4. deep brain stim
5. bilateral cingulotomy neurolosurgery
266
where is the abducens nucleus in the tegmentum of the pons
just ventral to the 4th ventricle
267
where is the facial motor nucleus to the abducens nucleus
just ventral and lateral to the abducens nucleus - the fibers from the facial motor nucleus wrap around the nucleus and form the facial colliculus (bump in 4th ventricle)
268
where do the abducens fibers exit
just over pyramids
269
where do facial motor nucleus fibers exit
lateral to the pyramids
270
where is the trigeminal nucleus in the pons
sensory is lateral, motor is medial
271
where do trigeminal nerve fibers exit
through transverse fibers, lateral to pyramids
272
what is basis of cereral peduncles also called
crus cerebri
273
what do you find in crus cerebri (3)
decsneding tracks of
1. corticospinal
2. corticobulbar
3. corticopontine
274
what cranial nerve nuclei will you find in midbrain
CN3 oculomotor and Edinger Westphal
CN4
275
where si the oculomotor nuclei in midbrain
just ventral to cerebral aqueduct
276
what nuclei (NON-CN nuclei) are also in midbrain
1. red nucleus
| 3. substantia nigra
277
superior colliculi controls relates to what sense
vision
278
inferior colliculi controls relates to what sense
auditory
279
symptoms of lateral medullary syndrome- what nuclei/tracks are disrupted (7)
1. vertigo (vestibular)
2. coordination issues (cerebellar peducnles)
3. dysphagia and dysarthria (n. ambiguus)
4. glossopharyngeal
5. vagal
6. spinothalamic track (pain and temp sensation)
7. descending sympathetic
280
how long do you have to have symptoms for depressioin
at least 2 weeks
281
what symptoms do you have to have for depression
5 of the following
1. depressed mood
2. loss of interest or pleasure
3. weight loss or weight gain
4. insomnia or hypersomnia
5. psychomotor agitation/retardation
6. loss of energy
7. decreased concentration
8. inappropriate guilt
9. thoughts of death or suicide
282
is anxiety episotic or chronic
chronic
283
is depression episodic or chronic
episodic
284
what do you see with depression with "mixed features" (2)
elevated mood
| inflated self esteem
285
what kind of sleep disturbances do you see with melancholic depression
early morning awakening
286
what are atypical features in depression (4)
mood reactivity
increased apetite (Carbs)
hypersomnia
rejection sensitivity
287
what cancer is specifically linked to depression
pancreatic
288
difference between persistent depressive disorder, depressive personality disorder, and major depressive disorder
timecourse and severity
MDD - 5 symptoms for 2 weeks, episodic
PDD - 3 symptoms for 2 years
DPD - constant
289
what is adjustive disorder iwth depressed mood vs MDD
in reaction to stressor - does not meet criteria for MDD
290
what is double depression
coexistance of MDD and PDD (persistent depressive disorder)
291
diathesis
genetic vulnerability
292
what nuclei produce seratonin
raphe nuclei
293
problems with neocortex will cause what symptom in depression
concentration
294
problems with striatum (reward center) will cause what symptom in depression
lack of interest
295
problems with amygdaloid body will cause what symptom in depression
anxiety
296
problems with the hypothalamus will cause what symptoms in depression
sleep and appetite
297
problems with the hippocampus will cause what symptom in depression
memory issues
298
what percent of depressed individuals will go into remission after initial treatment
30% (60% respond to a drug, but only 30% are made better just by that first treatment)
299
what percentage of people will go into remission after dedicated longer term treatment
70%
300
how may neurons in the brain, and how many synapses do eac make
100 billion neurons
| each make 1,000 synapses
301
how many glia per neuron
about 1:1, if not less - but it differes in different areas - more glia in cerebral cortex, fewer in cerebellar cortex
302
how many seconds after blood supply stops to the brain do we lose consciousness
10 seconds
303
how many minutes after blood supply stops to brain does irreparable brain damage occur
3-5min
304
what is the function of the spines on the dendrites (2)
1. termination sites of glutamatergic input (#s incrase for more synapse formation)
2. sites of memory storage
305
what is the function of the axon hillock (2)
1. screens out cellular organelles like Nissl bodies that shouldn't be in axon
2. summates synaptic potentials from dendrites and soma
306
what is the function of the initial segment of the axon (2)
1. highest density of voltage-gated Na+ channels
| 2. thus, is the site of AP generation and propagation along the axon
307
what does botulinum toxin do to neurons
cut the synaptic vesile release machinery (SNARE complex - all 3 components) which allows for vesicle docking and fusion
308
what does Tetanus toxin do to neurons
cut synaptobrevin part of SNARE complex to inhibit neurotransmitter vesicle docking and fusion
309
what is molecular mechanism of lambert-eaton
autoimmune destruction of Ca2+ channels (in response to antigen in small-cell lung carcinoma) - causes reduced Ca2+ entry in response to AP, decreased Ach release, muscle weakness
310
what is the most common cause of neurodegeneration, generally speaking
failures in axon maintenance
311
what are neurofilaments in axon responsible for
caliber of axon and thus AP conduction along axon
312
what are microtubules in axon responsible for
polarity, morphology (shape), transportation and scaffolding
313
what does fast anterograde transport use, and what does it transport (3)
```
uses kinesin
transports:
1. transmitter vesicles
2. neurotransmitters (NE, serotonin, dopamine)
3. mitochondria
```
314
what neurotransmitters are NOT transported via fast anterograde transport
glutamate, GABA and Ach (those are synthesized and recycled in axon terminals)
315
what does slow anterograde transport use, and what does it transport (3)
mechanisms not well known (involves microtubles and neurofilaments)
transports:
1. cytoskeletal/cytoplasmic proteins
2. organelles
3. neurotransmitter synthesizing enzymes (for GABA and Ach)
316
what does retrograde axonal transport use and what does it transport (3)
```
uses dynein
transports:
1. aging organelles and protein waste for destruction
2. nerve growth factors
3. viruses and toxins
```
317
what does Taxol (paclitaxel) do to axons
stabilizes the microtubule and blocks cell division, but also leads to axonal degeneration
318
Defects in what cause Charcot-Marie-Tooth diseases (not just one thing)
tubulins, dynein, kinesin or other microtubule-associated molecules
319
what protein is disrupted in Alzheimers
Tau - microtubule associated protein - normally stablizes microtubules and blocks cargo transport. when phosphorylated, cargo can pass. aggregates of tau in alzheimers causes tangles and disrupts the axons
320
where is tau usually at higher concentrations along axons
at distale end because they are needed for regulation at synaptic terminals for cargo loading and unloading
321
what protein is disrupted in Lewy Body dementia and parkinson's
alpha-synuclein - transports membrane vesicles to axon terminals for neurotransmitter vesicle formation. Aggregates disrupt mitochondria transport along the axon, causing axonal degeneration
322
examples of diseases caused by mutations in mitochondrial fusion genes (Mfn2 and OPA1) (2 known, 4 speculated)
1. axon degeneration in Charcot-Marie Tooth type 2A
2. AD optic nerve atrophy - retinal ganglion axon degeneration
3. speculated in Parkinson's alzheimers, huntington's and ALS
323
overexpression and accumulation of what proteins causes ALS
1. tau
| 2. neurofilaments
324
5-10% of ALS cases caused by what genetic mutation
missense mutation in superoxide dismutase (SOD) - antioxidant enzyme, making aggretation more likely and causing axonal aggregation
325
what marker do most astrocytes express in the hippocampus
GFAP (glial fibrillary acidic protein) only a few do in the thalamus
326
what protein is expressed in astrocytes in gray matter
gap junction protein connexin 30 to connect among astrocytes
327
how do astrocytes interact with glutamate (and what enzymes/transporters are used) (2)
they clear the synaptic cleft of glutamate, preventing epilepsy.
1. they uptake glutamate via glutamate transporters, convert glutamate to glutamine via GLUTAMINE SYNTHETASE, transfer glutamine out. glutamine then gets converted back to glutamate in presynaptic neuron terminal via GLUTAMINASE
2. They also release glutamate (gliotransmitter) into presynaptic terminal to modulate modulate synaptic transmission
328
how do astrocytes interact with GABA (and what enzymes/transporters are used)
GABA is taken up via GABA transporters, converted to Glu, then Gln, then Gln is transported out of astrocyte and into GABAergic terminal of neuron, where it is reconverted to GABA via GLUTAMIC ACID DECARBOXYLASE (GAD)
329
relationship between astrocytes and glycogen
they store glycogen and provide energy (via lactate) to neurons when blood glucose is limited
330
relationship between astrocytes and potassium (2)
1. removes excess potassium so that the brain doesn't get hyperexcited (epilepsy) or have excess glutamate (excitotoxicity)
2. this release of K+ into arteriolar smooth muscles leads to dilation and increased bloodflow which make active brain regions seen on functional MRI
331
how does brain get more glucose and oxygen (2)
1. increased neuronal activity causes increased CO2 which increases calcium in astrocytes, leading to COX1 generation and release of prostaglandin PGE2 to relax pericytes and dilate blood vessels - allowing more glucose and oxygen to be delivered to active brain regions
2. increased neuronal activity also causes nitric oxide release which increases arteriolar smooth muscles and pericyte relaxation
332
how are reactive astrocytes double edged swords (3 good, 2 bad)
Good:
1. fill in the space caused by injury
2. promote neuronal survival around injury site via antioxidant, growth factor and glutamate uptake
3. uses inflammation (IL-1, TNF alpha, prostaglandins) to activate microglia
BAD:
1. scar inhibits axonal regeneration
2. excessive microglia activation exacerbate brain tissue damage
333
what type of cancer results from proliferative capacity of astrocytes - and which subtype especially
astrocytoma
glioblastoma multiforme (GBM) in frontal or temporal lobe)
334
what causes neuronal damage and dementia in HIV patients
infected microglia which release a bunch of stuff like ROS that damage neurons and cytokines that activate astrocytes
335
role of microglia in development
50% of neurons have to undergo programmed cell death in early postnatal life and their corpses must be cleared
336
role of microglia in promoting neuronal cell survival
microglia secrete insulin-like growth factor (IGF-1) - neurons that express IGF receptors survive, those that don't undergo apopotosis
337
relationship between microglia and Alzheimers/Parkinson's
microglia come in contact with the tangles of tau, beta-amyloid or alfa-synuclein, get activated, release cytokines etc that cause neuronal cell death/damage, which then promotes more microglia activation (perpetual cycle)
338
microglia and OCD/autism
autism/schizophrenia: increased microglial density in prefrontal cortex
OCD: microglia-related cause of trichotillomania (hair pulling)
339
diseases that attack myelin producing cells (2)
MS= oligodentroglia
| Guillain Barre= Schwann cells
340
learning new skills does what to neurons in white matter
increases myelination
341
which neurotransmitters in brain are composed of biogenic amines (6)
1. serotonin
2. acetylcholine
3. norepineprhine
4. dopamine
5. histamine
6. epinephrine
342
what are the catecholamines (3)
1. epi
2. norepi
3. dopa
343
neurotransmitter small molecule (amino acids) (4)
GABA
glutamate
aspartate
glycine
344
large molecule (peptide) neurotransmitters (3)
opioids:
enkephalin
endorphin
dynorphin
345
excitatory amino acid
glutamate
346
inhibitory amino acid
GABA
347
which way do glutamate projections go
descending (from cortex down)
348
huntington's and amino acid in brain
you see neurotoxicity via a subtype of glutamate receptor
349
too little GABA activity causes what disease processes (3)
1. epilepsy
2. anxiety
3. huntingtons
350
what direction do dopa projections go (and from what nucleus)
ascending (from nucleus accumbens and ventral tegmental)
351
dopa cell body death seen in what disease process
Parkinsons
352
dopa cell body hyperactivity seen in what
schizophrenia
353
where are dopa cell bodies and projections located that are affected in parkinsons
"mesolimbic" - substantia nigra projecting to striatum
354
where are dopa cell bodies and projections located that are affected in schizophrenia
ventral tegmental area projecting to nucleus accumbens
355
dopa and addiction correlation
dopa projections to nucleus accumbens related to addiction
356
what direction do Ach projections go (and from what nucleus)
ascending (from septal nuclei and nucleus basalis)
357
is Ach excitatory or inhibitory in CNS
excitatory
358
where do Ach fibers project to, and what brain functions are they involved in
1. cortex (learning)
| 2. hippocampus and amygdala (memory)
359
Ach neurons degenerate in what disease
Alzheimer's
360
what kind of drug do you avoid in elderly to avoid confusion
anticholinergic
361
what kind of neurons increase in tone in parkinsons
cholinergic
362
how does GABA get increased in parkinsons and what symptom does it cause
because Ach tone is increased (due to decreased dopa tone), GABA gets stiumated by Ach, which is inhibitory, and causes "frozen" motion in patient
363
what direction do NE projections go (and from what nucleus)
ascend (from locus coeruleus)
364
what areas do NE project to (3)
1. cortex
2. hippocampus
3. cerebellum
365
role of NE in CNS (3)
1. attentiveness
2. mood (target for antidepressants)
3. withdrawal (hyperactive)
366
what direction do serotonin projections go (and from what nucleus)
ascending (from raphe)
367
what areas do serotonin project to (3)
1. cortex
2. hippocampus
3. cerebellum
368
what disease processes are treated with increasing serotonin (4)
1. depression
2. migraine
3. anxiety
4. sleep
369
what direction do histamine projections go (and from what nucleus)
ascending (from tuberomamillary nucleus of hypthalamus)
370
role of histamine in CNS (1)
wakefulness (antihistamines make you sleepy)
371
when do the pharyngeal arches appear - what week
4-5 weeks
372
what is week of pregnancy for embryological week 4 of development
6 weeks of pregnancy
373
what bones make up the orbit (superior, lateral, and inferior walls)
frontal
temporal
maxillary
374
what is opening between eyelids called
palpebral fissure
375
function of tarsal glands
secrete lipids that prevent eye from sticking together. can become clogged
376
function of tarsal plates (3)
1. provide structure for eyelids
2. secrete lipids that prevent eye from sticking together.
3. site of muscle attachment (LPS)
377
what is sensory info to partoid gland
somatic sensory from cervical plexus
378
functional innervation to parotid (2)
parasymp pvia glossopharyngeal
symp from spinal cord
379
3 SSRI prototypes
1. fluoxetine
2. escitalopram
3. seteraline
380
3 SSRI prototypes
1. fluoxetine (prozac)
2. escitalopram (lexapro)
3. seteraline (zoloft)
381
1 SNRI prototype
duloxetine (cymbalta)
382
1 MAOI prototype
tranylcypromine
383
antidepresant drug timecourse - when do adverse effects occur and when do mood changes occur
mood changes don't occur until ~6 weeks
| adverse effects happen pretty immediately
384
mech of action of buproprion (and trade name)
wellbutrin - dopa reuptake inhibitor (DAT) and NET
385
mech of action of mirtaxapine (and trade name)
remeron - autoreceptor antagonist - enhances NE release and seratnonin release
386
what does serotonin get converted into and where
melatonin, in pineal gland
387
does GABA stimulation relate to depression
no
388
what are the benzo receptor agonists (2)
zolpidem
| eszopiclone
389
what is a benzo receptor antagonist (1)
flumazenil
390
what is a melatonin congener (1)
ramelteon
391
what drug is a 5-HT1a receptor agonist/ non-sedative anxioloytic
buspirone
392
what receptors do the Benzos and barbituates work at
GABA
393
difference between sedatives and hyptonics
sedaives = calming. at high enough doses can produce sleep
hypnotics = sleep-inducing. some hypnotics are NOT sedative
394
dose response of benzos vs barbituates
barbituates (and alcohol) have linear dose response - easier to cause coma and death with increased dosage
benzos plateau so it's a lot harder to cause coma or death (have to combine with other sedatives to do so)
395
what GABA receptor subtype do the anxiolytic drugs bind to
GABA - A, pentamer:
always has 2 alpha subunits and 3 other subunits (beta or gamma)
most common subsubtype is
alpha1 (2) beta2 (2) gamma1
396
mech of action of barbituates (2)
1. enhance duration of GABA-mediated chloride flux)
2. at high doses DIRECTLY open GABA-A chloride channels
this leads to neuronal inhibition (via hyperpolarization of neuron) and suppression of glutamate transmission
397
how many pharygeal arches, clefts, and pouches are there
6 arches, 5 clefts and pouches
398
what are the embryoogic cell derivaties for the pharyngeal arches, clefts and pouches
mesoderm/mesenchyme arches
ectoderm clefts
endoderm pouches
399
what are the cartilagenous and skeletal structures from first arch (2)
from MECKEL'S cartilage - makes malleus and incus
400
main muscle from first arch
muscles of mastication
401
nerve in first arch
trigeminal
402
second arch AKA
hyoid
403
innervation of second arch
facial
404
cartillage of second, and what skeletal structures (4) and ligamentous structure (1)
REICHERT cartilage, turns into:
1. stapes
2. styloid process
3. lesser cornu of hyoid bone
4. upper part of body of hyoid
ligament:
1. stylohyoid ligament
405
what muscles from second arch
muscles of facial expression
406
what innervation of third arch
glossopharyngeal
407
what muscle in third arch
stylopharyngeus
408
what bone from third (2)
greater cornus of hyoid
| lower part of body of hyoid
409
4th and 5th arches - what cartilage
cartilages of larynx (becomes thyorid, cricoid etc. ALL cartilage)
410
4th and 5th arches - what innervation
1. superior laryngeal branch of vagus
| 2. reccurent laryngeal branch of vagus
411
mandibulofacial dystotosis - what is the mechanism
lack of neural crest migration to 1st pharyngeal arch
412
mandibulofacial dystotosis - symptoms and intelligence
craniofacial abnormalities and conductive hearing loss
| - normal intelligence
413
what does the first pharyngeal POUCH become (2)
1. typanic or middle ear (lateral/distal part)
| 2. auditory tube (medial/proxila part)
414
what does the first pharyngeal MEMBRANE become
typanic membrane
415
what does first pharyngeal CLEFT become
external auditory meatus
416
what does second parhyngeal POUCH become
medial becomes tonsillar fossa and surface of palatine tonsil
417
what does third pharyngeal POUCH become (2)
1. dorsal becomes INFERIOR parathyroids
2. ventral becomes thymus
they both migrate caudally
418
what does fourth pharyngeal POUCH become (2)
1. dorsal becomes SUPERIOR parathyroids
| 2. ultimobranchial body becomes C-cells of thyroid
419
which bones in skull are formed by endochondral ossificaton (4)
1. ethmoid
2. sphenoid
3. lower occipital
4. petrous temporal bone
420
see a kid with frontal bossing, syndactyly
plagiocephay
421
2 types of plagiocelphaly
1. synostotic - premature fusion or failure to form
| 2. deformational - too many babies in uterus etc. sleeping on the back of yor head
422
what is Apert syndrome and symptoms (5)
GOF mutation in osteoblasts in suture mesenchyme:
see:
1. craniofacial abnormalities
2. hearing/vision disturbances
3. syndactlyly
4. sweating and acne
5. normal to delayed intelligence
423
how does nose change at 4.5, 5, and 6 weeks
```
4.5 = nasal placode (dent)
5 = nasal pit
6 = nasal pit with medial and lateral nasal prominences
```
424
how does nose/face change at 7 weeks (2)
1. medial prominences fuse and form upper lip,
| 2. nasolacrimal duct forms from fusion of lateral prominences and maxillary prominence
425
how does face change at 10 weeks
fusion of palatine shelves and primary palate from
426
what is fusion point of palate where a little opening remains
incisive foramen
427
gender predominance for rates of cleft lip and palate
lip more common in girls
| palate more common in boys
428
what is smooth philtrum indicative of
fetal alcohol exposure
429
what is number 1 cause of cleft lip and palate (genetically)
22q11 deletion syndrome (for example digeorge's)
430
superior tarsal innervated by what?
sympathetic innervation
431
damage to superior cervical sympathetic ganglion causes what
Horner syndrome - partial ptosis - lack of innervation to superior tarsal
432
parts of outer (Fibrous) layer of eye (2)
1. sclera
| 2. cornea
433
parts of middle (vascular) layer of eye (4)
1. choroid (from retina to ciliary body)
2. ciliary body (from choroid to iris)
3. iris
4. ciliary muscle/ciliaris (changes thickness of lens)
434
what structure is at the apex of the orbit (relates to the extraocular muscles)
common tendinous ring
435
what nerve structures travel outside of common tendinous ring
"little fairy tots"
lacrimal nerve
frontal nerve
trochlear nerve
436
which eye muscles attach on atnerior half of eye
rectus muscles (medial, lateral, superior, inferior)
437
which eye muscles attach on posterior half of eye
oblique muscles
438
which muscle controls intorsion
superior oblique
439
which muscle controls extorsion
inferior oblique
440
branches of V1 in eye, providing sensory innervation
1. frontal
2. lacrimal
3. nasociliary
441
components of neurological exam from start to finish
1. general
2. CN
3. motor
4. sensory
5. reflexes
442
what is the parasymp ganglion by the parotid gland
otic
443
infection and stones of parotid gland called what
sialoadenitis
| sialolithiasis
444
what are the 5 branches of the facial nerve
Ten Zebras Bit My Cupcake:
```
Temporal
Zygomatic
Buccal
Marginal Mandibular
Cervical
```
445
where does the facial nerve exit the skull - what foramen
stylomastoid foramen (on inferior skull by bottom of ear)
446
what are the muscles innervated by facial nerve (4)
1. facial expression muscles
2. sylohyoid muscle
3. posterior belly of digastric
4. tensor tympani
447
what are the major muscles of facial expression (5)
1. orbicularis oculi
2. orbicularis oris
3. occipitofrontalis
4. buccinator
5. platysma
448
portions of orbicularis oculi (3)
1. orbital (voluntary)
2. palpebral (involuntary)
3. lacrimal - tear movement
449
where/how is damage caused by bells palsy
virally caused compression of facial nerve as it leaves sylomastoid foramen
450
what fissure in skull does opthalamic branch (V1) go through
superior orbital fissure
451
what foramen in skull does V2 go through
rotundum
452
what foremen in skull does V3 go through
ovale
453
what is the branch of V3 that exits on chin
mental nerve - from mental foramen
454
what is the branch of V3 that exits by temple
auriculotemporal nerve (innervates parotid parasymp)
455
what main artery supplies the face and what is it a branch off of
facial artery - branch of the external carotid
456
what artery is associated with parotid gland, and what artery does it come from
superficial temporal artery, which is a continuation of the external carotid
457
what are 2 first branches off of the facial artery and what is facial artery called after nose
1. inferior labial
2. superior labial
facial becomes angular artery at hose
458
what veins drain face (2) and what do they become
facial vein and retromandibular vein, become internal jugular
459
what is "danger triangle"
around your nose - if an infection here happens it can drain into cavernous sinus and cause issues
460
gradient of SSRI drug-drug interactions - most to least
all inhibit P450 enzymes (CYP2D6), so can have drug-drug
fluoxetine>sertraline>escitalopram
461
fluoxetine and cancer tx relationship
fluoxetine decreases efficacy of tamoxifen (tx for breast cancer)
462
adverse effects of SSRI (6)
1. CNS stimulation (insomnia, headache)
2. sexual dysfunction
3. GI tract - nausea, diarrhea
4. platelet - bleeds
5. prolong QT - excitalopram
6. serotonin syndrome (usually when in combo with TCA or MAOI)
463
tolerance and adverse effects of SSRIs
all wane with time except for sexual dysfunction
464
what transporters do SNRIs block
NET and SERT
465
Adverse effects of duloxetine
1. discontinuation syndrome because they're shorter acting
2. CNS stim
3. sexual dysfunction
4. increase BP at high doses (alpha 1)
466
what is unique indication for duloxetine
neuropathic pain
467
mech of action of TCAs
block NET and SERT, but block other neurotransmitters too
468
difference between tertiary and secondary amines (TCAs) and where does amitryptyline fit
secondary amines block NET preferentially
tertiary amines block SERT preferentially
amitriptyline is a tertiary amine, but gets metabolized to noretryptyline which is a secondary amine
469
cardiac adverse effects of TCAs (3)
1. tachycardia from NET block
2. conduction block from Ach block
3. arrhytmias from non-receptor mechanism (can cause death in overdose)
470
which antidepressive meds cause weight gain
TCAs, mirtazapine
471
which antidepressive meds are sedative
TCAs (antihistaminergic effect)
472
which antidepressive meds cause dry mouth and constipation
TCAs (anticholinergic effect)
473
why is halflife of MAOIs so long, and what is a potential consequence of that
because they bind irreversibly to MAO- so you have to wait for the body to synthesize more.
can cause seratonin syndrome
474
drug interactions with MAOIs
1. alpha 1 agonist phenylephrine (cold med) cause HTN crisis due to increased NE
2. sympathomimetics pseudoephedrine (cold med) or tyramine foods (wine and cheese) will also cause HTN crisis
3. dextromethorphan (cough med), meperidine will cause seratonin syndrome
475
timing of MAOI admin changes, and why is that important
give more than 2 weeks after stopping MAOI to give a new drug, and at least 2 weeks after stopping SSRI/SNRI/TCAs to start MAOI
because serotonin syndrome
476
tyramine and MAOIs - what's the risk
MAOI block tyramine breakdown. tyramine buildup causes enhanced NE release (hypertensive crisis)
477
unique use of bupropion
smoking cessation (antagonist at nicotinic receptor)
478
adverse effect of bupropion (2)
1. CNS stim - ANXIETY
| 2. seizures at high doses
479
mirtazapine side effects (3)
1. sedation
2. weight gain
3. posteurl hypotension
480
which anti-depressive drugs don't have sexual side effects
burpropion and mirtazapine
481
which is best choice of antidepressive drug in pregnancy
amitriptyline
482
which is best choice of antidepressive drug in childhood (8-12)
fluoxetine (only FDA approved)
483
which are best choices of antidepressive drug in adolescents (2)
escitalopram and fluoxetine
484
what are the mood stabilizing maintenance drugs used to treat bipolar disorder (4)
1. lithium
2. olanzapine
3. valproate
4. lamotrigine
485
what drugs would you use for ACUTE manic emergency (3)
1. olanzapine (antypsychotic)
2. benzos
3. sodiul valproate (anticonvulsant)
lithium is too slow
486
what mood stabilizer do you need to monitor when adjusting renal clearance
lithium - does what sodium does
487
adverse effects of lithium (3)
1. tremor (treat with beta-blockers)
2. renal - polydipsia, polyuria or nephrogenic diabetes insipidus
3. fetal cardiac anomalies
488
what mood stabilizer do you use in pregnancy
lamotrigine
489
anticonvulsants that are used in treatment of bipolar disorder
1. lamotrigine
| 2. valproic acid (depakote)
490
side effect of lamotrigine
stevens johnson syndrome
491
adverse effect of barbituates
linear dose-response - can lead to coma and death due to respiratory depression
492
drug interactions of barbituates (2)
1. ethanol - additive CNS depression
| 2. induce CYP enzymes
493
benzos to know (5)
1. alprazolam (xanax)
2. clonaxepam (klonapin)
3. diazepam (valium)
4. midaxolam (versed)
5. triazolam (halcion)
494
benzos mech of action
increase frequency of chloride channel opening
no direct effect on chloride channel (won't work without GABA present)
495
receptor specificity for benzos
benzos will only bind on GABA-A receptors that have alpha (1,2,3 or 5) and a gamma subunit
496
alpha 1 subunit stimulation effect
sedation (zolpidem)
497
alpha 2/3 subunit stiumation effect
anxiolysis
498
alpha 5 subunit stimulation efect
cognitive impairmnt
499
what disease is a contraindication for benzos
obstructive sleep apnea
500
why don't you use benzos chronically
tolerance, abuse and withdrawal (esp with alprazolam which has short halflife)
501
which benzo is used in sleep disroders (1)
triazolam
502
which benzos are used in epilepsy (2)
clonazepam and diazepam
503
which benzo is used in anesthesia (1)
midazolam
504
whcih benzos are long acting vs medium vs short acting
long: diazepam, clonazepam
medium: alprazolam
short: triazolam, midazolam
505
flumazenil mech of action
competititve antagonist for benzo site on GABAa - can reverse effects of BENZOS to reverse overdose
506
what do you give buspirone to treat
generalized anxiety - not useful in panic disorders
507
buspirone and admin timing
may take a few weeks to start working
508
ramelteon mech of action and use
binds melatonin receptors - long term use for sleep aid
509
benzo receptor agonists mech of action
bind to GABA-a receptors with alpha1 subunit
510
benzo receptor agonist use and benefit
sleep aid - don't affect sleep stages (don't have day after sedation
511
examples of benzo receptor agonists (2)
zolpidem (ambien)
| eszopiclone (lunesta)
