Unit 3 Pharm Guiding Questions

Question 1

What is the blood brain barrier?

Answer 1

refers to the unique structure and function of CNS capillaries, which act as a selective filter and protects the CNS by limiting the substances that enter the brain and spinal cord

Question 2

What is the blood brain barrier’s role in clinical pharmacotherapeutics?

Answer 2

-nonpolar, lipid-soluble drugs are able to cross the barrier by passive diffusion
-polar and lipophobic compounds are usually unable to enter the brain but exceptions occur because of the presence of carrier-mediated transport systems

Question 3

central neurotransmitters that have an excitation effect

Answer 3

-acetylcholine
-glutamate, aspartate
-substance P
-enkephalins

Question 4

central neurotransmitters that have an inhibition effect

Answer 4

-norepinephrine
-dopamine
-serotonin
-GABA
-glycine

Question 5

the majority of CNS drugs work by modifying synaptic transmission in some way.
list the sites at which drugs can alter transmission at a CNS synapse.

Answer 5

1. action potential
2. synthesis
3. storage
4. release
5. reuptake
6. degradation
7. postsynaptic receptor
8. presynaptic “autoreceptor”
9. membrane

Question 6

drugs that attempt to rectify CNS-related disorder do so by either ___ or ___ transmission at specific synapses.

Answer 6

increasing or decreasing

Question 7

a drug that modifies synaptic transmutation must somehow alter the ___ of the neurotransmitter that is released from the presynaptic terminal or affect the ___ of postsynaptic receptors, or both.

Answer 7

quantity, stimulation

Question 8

Why are barbiturates effective sedative hypnotics?

Answer 8

because of their specificity for neurons in the midbrain portion of the reticular formation as well as some limbic system structures

Question 9

how to nonbenzodiazepine sedative hypnotics work?

Answer 9

they bind to the GABA receptors in the brain which causes GABA to bind more effectively thus increasing chloride conductance and the level of inhibition in the neuron. increased inhibition results in less arousal and promotion of sleep.

Question 10

how do nonbenzodiazepines work?

Answer 10

they promote relaxation and sleep via depressing the CNS

Question 11

pharmacokinetics of benzodiazepines and nonbenzodiazepine sedative hypnotics

Answer 11

usually highly lipid soluble
administered orally and absorbed easily from the GI tract
metabolized primarily by the liver
excretion occurs through the kidney after metabolism in the liver

Question 12

pharmacokinetics of benzodiazepines and nonbenzodiazepine sedative hypnotics

Answer 12

usually highly lipid soluble
administered orally and absorbed easily from the GI tract
metabolized primarily by the liver
excretion occurs through the kidney after metabolism in the liver

Question 13

what is the primary problem associated with sedative hypnotic use

Answer 13

residual effects that occur the day after (drowsiness and decreased motor performance)

Question 14

define drug tolerance

Answer 14

the need to take more of a drug to exert the same effect

Question 15

define drug dependence

Answer 15

the onset of withdrawal symptoms if drug administration is ceased

Question 16

what are some other side effects of sedative hypnotics?

Answer 16

GI discomfort, dry mouth, sore throat, and muscular incoordination
cardiovascular and respiratory depression

Question 17

primary drugs used to treat many forms of anxiety

Answer 17

benzodiazepines

Question 18

pros and cons of buspirone

Answer 18

pros: produces less sedation and psychomotor impairment, smaller risk of developing tolerance and dependence
cons: may not take effect as quickly in patients with severe anxiety

Question 19

most common side effect of anxiolytic benzodiazepines

Answer 19

sedation

Question 20

problems and side effects associated with buspirone

Answer 20

dizziness, headache, nausea, and restlessness

Question 21

when would it be beneficial to schedule a patient if they are on anxiolytic benzodiazepines

Answer 21

2-4 hours after oral administration (peak blood levels) may improve participation in treatment

Question 22

examples of nonpharmacological interventions that may help decrease anxiety and improve sleep

Answer 22

regular exercise, massage, relaxation techniques, yoga, and other complementary therapies

Question 23

affective disorder

Answer 23

innappropriate disposition, feeling unreasonably sad and discouraged, or fluctuating between periods of depression and excessive excitation and elation

Question 24

the drugs that are currently used to treat depression are grouped into several categories, according to chemical or functional criteria:

Answer 24

selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclics, monoamine oxidase inhibitors, other compounds

Question 25

most common side effects associated with SSRIs and SNRIs

Answer 25

GI symptoms such as nausea, vomiting, and diarrhea or constipation
may cause serious and fatal adverse effect - serotonin syndrome

Question 26

serotonin syndrome

Answer 26

characterized by array of symptoms such as sweating, agitation, restlessness, shivering, increased heart rate and neuromuscular hyperexcitability

Question 27

major problem with the tricyclic antidepressant

Answer 27

sedation
2nd - anticholinergic properties: dry mouth, constipation, urinary retention, confusion, and tachycardia

Question 28

side effects of MAO inhibitors

Answer 28

CNS excitation: restlessness, irritability, agitation, and sleep loss

Question 29

major problem with lithium

Answer 29

danger of accumulation within the body
not metabolized elimination takes place exclusively through excretion in the urine