Week 2/3 Lectures Flashcards
1
Q
Nitrous Oxide has rapid/slow onset and offset.
A
rapid
2
Q
T/F NO is not a potent complete anesthetic alone.
A
T
3
Q
T/F Halogenated volatile agents can provide a complete general anesthesia at high doses.
A
T
4
Q
Anesthetic potency
A
how much you need for desired effect
5
Q
Anesthetic pungency
A
degree of noxious character
6
Q
Characteristics of general anesthesia
A
hypnosis, amnesia, analgesia, immobility/akinesia, areflexia blunting of autonomic reflexes
7
Q
Anesthetics increase/decrease metabolism and increase/decrease synchrony of brain activity
A
decrease metabolism and increase synchrony
8
Q
VRG
A
vessel rich group (brain, liver, kidney) receive anesthetic before muscle and then fat b/c of cardiac flow
9
Q
Inhaled anesthetic gas is eliminated by _______
A
pulmonary ventilation
10
Q
T/F there is almost no metabolic breakdown of inhaled agents.
A
T
11
Q
General inhaled anesthetic is most soluble in _____, somewhat soluble in____ and least soluble in ______, therefore low/high soluble drugs are ideal.
A
fat > muscle >VRG –> low solubility can be cleared fastest
12
Q
low solubility inhaled anesthesia is less/more potent, faster/slower onset.
A
less potent, faster onset/offset
13
Q
desfluorane is more/less soluble than isofluorane.
A
less
14
Q
inhaled agents increase/decrease cerebral blood flow
A
increase
15
Q
T/F inhaled agents have dose-dependent changes on EEG.
A
T
16
Q
inhaled agents are bronchodilators/constrictors
A
dilators
17
Q
inhaled agents increase/decrease respiratory rate and increase/decrease tidal volume.
A
increase rate and decrease volume
18
Q
inhaled agents increase/decrease ventilatory response to low blood O2 and high blood CO2
A
decrease
19
Q
Inhaled agents are vasodilators/constrictors
A
dilators
20
Q
Inhaled agents increase/decrease blood pressure
A
decrease
21
Q
T/F Inhaled agents do not affect contractile strength of heart muscle.
A
F –> impaired contractile strength
22
Q
the _____ is the dose at which 50% of patients will not move in response to surgical incision.
A
MAC –> minimal alveolar concentration
23
Q
T/F MAC is a physical property of the anesthetic agent.
A
F
24
Q
MAC fraction
A
the % of anesthetic gas of total gas exchanged in lungs is measured continuously
25
MAC increases/decreases with age.
decreases
26
Current theory of MOA of inhaled anesthetics
allosteric binding to specific binding sites in cell membrane
27
Key transmitter receptor in anesthetic effect
GABAa
28
_____ are used for induction and maintenance of general anesthesia
sedatives and hypnotics
29
how drugs get to effect site
pharmacokinetics --> route, metabolism, elimination, distribution
30
drug effect as a result of receptor binding
pharmacodynamics -->agonists/antagonists/partials, genetic variability in receptors, dose response, efficacy, potency, toxicity
31
the time it takes half of administered drug to eliminate from body
elimination half life
32
the time it takes half of administered drug to eliminate central compartment into other compartments
distribution halflife
33
most well perfused compartment
central compartment (vs. rapidly equilibrating muscle and slowly facilitating fat)
34
effect of a drug will be terminated by ______
redistribution from the central compartment to rest of compartments
35
context sensitive half time
the longer you infuse a drug, the longer it will take to eliminate
36
drugs that are most/least fat soluble have the highest context sensitive half time
most
37
T/F we essentially never get to steady state with fat soluble drugs
T
38
Which drug? milky white alkylphenol
propofol --> milk of amnesia
39
contraindication for propofol
egg allergy
40
induction agent of choice
propofol
41
Redistribution half time of propafol
2-8 minutes --> redistribution terminates effect after single dose
42
Most propofol is _____ or ____ prior to excretion
glucoronidated or sulfated
43
If central compartment increases in size, propofol concentration will increase/decrease so must increase/decrease dose.
decrease concentration, increase dose
44
Children need higher/lower doses of propofol.
higher --> larger central compartments
45
Propofol MOA
potentiates GABA effect by binding to B subunit // also affects alpha 2 adrenoreceptors, NMDA glutamate, and glycine receptors
46
T/F Propofal reduces pain
F
47
Propofol is a vasodilator/constrictor
vasodilator --> reduced BP, decreased sympathetic tone, variable HR
48
Propofol is a bronchodilator/constrictor and causes apnea and hypopnea.
bronchodilator
49
Propofol increases/decreases cerebral blood flow.
decreases
50
T/F Propofol suppresses bursts in the brain.
T
51
Adverse effects of propofol
pain on injection, PRIS, hypertriglyceridemia and pancreatitis, decreased PMN chemotaxis
52
Propofol is indicated/contraindicated in people with hemodynamic instability
contraindicated
53
T/F Propofol increases dopamine concentration in nucleus accumbens.
T
54
Major clinical use of etomidate.
induction of GA --> usually in people with hemodynamic instability (critically ill, cardiac anesthesia)
55
Redistribution half life of etomidate
2-8 minutes
56
Etomidate is excreted in _____
bile and urine
57
Etomidate is metabolized by _____
ester hydrolysis
58
MOA of Etomidate
potentiates effects of GABA
59
T/F Etomidate causes adrenocortical suppression.
T
60
Cardiovascular effects of Etomidate
mild
61
Neurologic effects of Etomidate
burst suppression and decreased cerebral blood flow, increased seizures
62
Etomidate increases/decreases post-op nausea/vomiting
increases
63
Contraindication to etomidate
allergy + (adrenal insufficiency, septic shock, post-op nausea/vomiting history)
64
Primary clinical use of thiopental
induction of general anesthesia (and methohexital in electroconvulsive therapy)
65
Redistribution half life of thiopental
5-10 minutes
66
T/F thiopental induces the enzymes that biotransform it in the liver
T
67
_____ is an exception to the rule of hepatic metabolism in thiopentals
phenobarbital --> mostly excreted unchanged
68
Contraindication to thiopental
acute intermittent porphyria
69
Thiopental MOA
potentiates GABA by binding to barbituate site on post-synaptic receptor --> increases duration of Cl channel opening w/wo GABA
70
Physiologic effects of thiopental
similar to propofol except not much bronchodilation and methohexital decreases seizure threshold
71
Adverse effects of thiopental
garlic taste, tissue irritation/necrosis, anti-analgesic
72
Which drug? causes dissociative hypnosis
Ketamine (phenylcyclidine derivative)
73
T/F Ketamine can be delivered non-IV
T
74
Redistribution half life of ketamine
11-16 minutes
75
T/F ketamine has a metabolite with clinical activity
T --> norketamine --> analgesia maintenance
76
Ketamine MOA
NMDA receptor antagonist but also affects many other receptors
77
T/F Ketamine does not affect sympathetic tone.
T --> no change in cardiac condition
78
T/F ketamine is a potent bronchodilator
T // preserves respiration
79
Adverse effects of ketamine
salivation, lacrimation, sympathetic stimulation, increased intracranial pressure, dysphoria
80
________ reverses benzodiazepines
flumazenil
81
Opioids are reversed by _______ and _____
naloxone and naltrexone // opioids are anesthetic adjuncts that reduce how much anesthetic is needed
82
Dexmedetomidine and clonidine are _____ antagonists
alpha 2 adrenoreceptor antagonists --> sleepiness
83
_____ and _____ are dopamine antagonists
deroperidol and haloperidol --> psychosis sedation/catatonia
84
____ and _____ are antihistamines
diphenhydramine and chlorpheniramine
85
_____ and ____ are Z drugs
zaleplon and zolpidem
86
_____ and ____ are melatonin agonists
melatonin and ramelteon
87
Which drug? partially metabolized in extrahepatic tissue?
propofol
88
Which drug? contraindication of porphyria
thiopental
89
Which drug? adrenocortical suppression
etomidate
90
Which drug? no requirement of IV access
ketamine
91
Which drug? potent analgesic
ketamine
92
Which drug? sympathetic stimulation
ketamine
93
Which drug? used in hemodynamically unstable patients
etomidate
94
Which drug? contraindicated in egg allergy
propofol
95
Local anesthetics are weak acids/bases.
weakly basic --> lipophilic aromatic ring + intermediate group + hydrophilic carbon chain with amino group
96
Two classes of local anesthetics differ in their ____
intermediate groups: esters vs. amides
97
Local anesthetics with two i's are amide/ester class
amide
98
Local anesthetics with one i are amide/ester class
ester
99
Racemic mixtures of local anesthetics affect _____ but do not affect ____
affect toxicity but do not affect ability to induce neural blockade
100
s isomer is more/less cardiotoxic than r form.
less
101
MOA of local anesthetics
cross neural membrane --> gain positive charge -->bind to internal membrane of Na channel --> block membrane permeability to Na in open and inactive states (but not closed)
102
Nerves that fire more/less frequently are more likely to be blocked by local anesthetics.
more frequently
103
Why does local anesthetic not work in abscesses?
local anesthetic binds to H+ in acidic environment, gains positive charge, and cannot cross cell membrane
104
T/F local anesthesia affects resting membrane potential
F --> only increases firing threshold but does not affect resting membrane potential or threshold potential
105
Local anesthetics have high/low first pass uptake in the lung
high
106
Local anesthetics bind to ____ in blood
alpha 1 glycoprotein and albumin --> less toxicity
107
Why is epinephrine delivered next to local anesthetic?
vasoconstrictor prolongs neural blockade by reduced absorption
108
____ phase involves redistribution to well perfused tissue
alpha
109
____ phase involves redistributino to less perfused tissue
beta
110
____ phase involves clearance representing metabolism and excretion
gamma
111
Metabolism of local anesthetic
esters hydrolyzed in plasma by pseudocholinesterase and amides in ER of hepatocytes
112
risk of toxicity is lower/higher with esters vs amides
lower --> hydrolyzed in plasma
113
Potency and duration are directly correlated to ______
lipid solubility
114
Rapidity of onset is correlated with ____
pKa
115
Drugs with pKa closer to body's pH will have more in unionized/ionized form.
unionized --> more uptake/faster onset
116
Allergy in local anesthetics is more common with ester/amide
ester --> PABA
117
CNS toxicity in local anesthetic occurs before/after cardiac toxicity
before except bupivacaine (same time)
118
Tx of cardiac toxicity
lipid emulsion with intralipid
119
T/F all local anesthetics are vasodilators
F --> all except cocaine
120
Levobupivacaine is produced as the ___ isomer
s --> less cardiotoxic
121
Which local anesthetic can cause methemoglobinemia?
prilocaine
122
Which anesthetic is typically applied as a cream an hour before procedure?
EMLA
123
T/F Social attachment bonds develop from the activation of a biologically based motivational system.
T
124
Attachment behaviors associated with:clinging, suckingling, cooing, separation response
infant-parent
125
Attachment behaviors associated with: nursing, retreival, nest building, grooming, defense
mother-infant
126
Attachment behaviors associated with: retrieval, nest building, grooming, defense
father-infant
127
Attachment behaviors associated with: shared territory, cohabitation, partner preference, mate guarding, separation response
pair bonding
128
T/F Imprinting happens immediately after birth.
F before and immediately after bith
129
Olfactory system for attachment is mediated by _____, enhanced by _____, and inhibited by ______.
norepinephrine, isoproterenol and propanolol
130
Which NTs are associated with odor preference?
dopamine and oxytocin
131
Maternal behavior is mediated via ____ and ____.
oxytocin and estrogen
132
Blockade of oxytocin enhances/eliminates maternal behavior
eliminates
133
Effect of estrogen on oxytocin
regulates # of CNS oxytocin receptors
134
In socially attaching animals like prairie voles, , oxytocin receptors are found in_____
reward centers: nucleus accumbens and prelimbic cortex
135
4 necessary conditions for development of attachment
sufficient interaction, discriminative abilities of infant, mirror neurons, object permanence
136
Phase of indiscriminate sociability
first two months --> anyone is good
137
Phase II of attachment formation
2-7 months attachment in the making
138
Phase III of attachment formation
7-24 months clear cut attachments
139
Phase IV of attachment formation
>24 months goal coordinated partnerships
140
At what phase of attachment do infants begin to differentiate between caregivers?
II
141
at what age does stranger anxiety manifest?
6-8 months
142
at what age does separation anxiety manifest?
10-18 months
143
Clinical syndrome manifest by difficulty forming long-lasting intimate relationships and characteristic absence of ability to be affectionate
reactive attachment disorder
144
Inhibited RAD
child appears fearful and restricted
145
Disinhibited RAD
indiscriminate in his interest in caregivers/displays shallow relationships
146
Constitutionally based individual differences in reactivity and self-regulation as observed within the domains of emotionality, motor activity, and attention.
Temperament
147
Temperament refers to inborn/learned characteristics.
inborn
148
Reciprocal interaction/circularity
parents and children interact with each other reciprocally
149
T/F Goodness of fit is crucial.
T --> consonance between parent's expectations/demand and child temperament
150
HPA Axis
stress signals from hypothalamus --> pituitary and then to adrenal --> cortisol release ---> detected by hippocampus --> binds GR receptor --> signal to shut down stress circuit
151
Vasopressin is expressed in a specific subset of neurons within the hypothalamic ____ nucleus
paraventricular
152
Stress signals increase synthesis and release of of pituitary ____ and ____
CRH and AVP
153
Methylation turns on/turns off GR gene and increases/decreases GR receptor which makes for more relaxation/agitation.
turns off GR, reduces GR protein, increases agitation. - -> poor nurturing
154
T/F history of child maltreatment is associated with shorter telomeres
T
155
The symptoms of neglect are profound in boys/girls whereas the symptoms of sexual abuse are more profound in girls/boys
neglect = boys, sexual abuse = girls
156
rt. temporal gyrus is vulnerable to
emotional abuse btwn ages 7-9
157
corpus callosum is vulnerable to
neglect in infancy, sexual abuse in elementary school years
158
Three adolescent growth routes
continuous, surgent, tumultuous
159
4 basic theories of personality
psychoanalytic, humanistic, social cognitive, trait
160
psychoanalytic theory
importance of unconscious processes and early childhood development
161
humanistic theory
+ psychology emphasizing self + fulfillment of potential
162
social cognitive theory
learning and conscious cognitive processes including beliefs about self, goal setting, and self regulation
163
trait theory
emphasizes description and measurement of personality differences among individuals
164
Freud's dynamic theory of personality
three conflicting psychological forces at three dimensions of conciousness --> ego defense mechanisms work to protect us from conflicts, unacceptable impulses
165
Repression
unconscious forgetting --> fundamental ego defense
166
Displacement
impulses are redirected to a substitute object or person
167
Three domains of positive psychology
pleasant life (of enjoyment), good life (of engagement), meaningful life (of affliation)
168
Five factor model "Big Five"
extraversion, neuroticism, conscientiousness, agreeableness, openness
169
paranoid personality disorder
pervasive and unwarranted belief that others intend to harm
170
schizoid personality disorder
detached loners --> limited social skills and no sense of humor --> "aspergers"
171
schizotypal personality disorder
look odd/act strange, uncomfortable with others, talk to selves, use words differently, vague in speech
172
antisocial personality disorder
no regard for others' rights, shirking responsibilities, irresponsible, lying, stealing --> lack of empathy
173
borderline personality disorder
instability --> intense fear of being abandoned; often child abuse, lack of respect in history
174
histrionic personality disorder
high drama, need approval, constantly seeking attention
175
narcissistic personality disorder
grandiosity about self --> see self as unique, feel entitled to admiration, recognition, and special privileges
176
dependent personality disorder
widespread and longstanding dependency on and submissiveness to others; complete passivity, sensitivity to disapproval
177
avoidant personality disorder
avoid social situations, no close friends, anxious about looking anxious
178
obsessive-compulsive personality disorder
perfectionistic and inflexible, focus on detail, order, structure, performance never good enough
179
Which dopamine receptor is associated with ADHD?
DRD4.7
180
dual system of attention
posterior (orients to and engages novel stimuli --> NE, superior colliculus, pulvinar) and anterior (PFC and anterior singulate that subserves executive system-->dopa)
181
Which part of the brain and which transporter is involved in the onset of paying attention?
posterior parietal cortex, NE1 alpha 2a
182
Which part of the brain is involved in planning a response to attention and what molecules/transporters are involved?
prefrontal, D1, D4, D5, and NET alpha 2a
183
Which part of the brain is involved in carrying out tasks and what transporters are implicated?
striatum and dat, d2
184
methylphenidate MOA
reversibly and partially blocks reuptake of norepinephrine or dopamine --> boosts signal
185
amphetamine MOA
diffuses into vesicles and increases dopamine release, inhibits reuptake of dopamine, and blocks vesicular uptake of dopamine --> speeds up the whole cycle
186
Which drug? chain substituted amphetamine derivative with a chemical structure similar to cocaine; binds to dopamine transporter and inhibits dopamine reuptake presynaptically
methylphenidate
187
Methylphenidate has a slow/fast uptake and clearance.
slow
188
Which class of compounds does methylphenidate belong to?
piperidine
189
Which drug? influences serotonin and norepinephrine
amphetamine
190
Parasympathetic nervous system is mediated by cholinergic/adrenergic receptors
cholinergic
191
the Sympathetic nervous system is mediated by cholinergic/adrenergic receptors
adrenergic alpha and beta
192
the ____ has a craniosacral outflow
PNS
193
the ____ has a thoracolumbar outflow
SNS
194
the ____ ganglia are located near the spinal cord with short preganglionic axons and long postganglionic axons
SNS
195
PNS ganglia have long/short preganglionic and long/short postganglionic axons
long pre and short post
196
T/F the preganglionic nt in SNS and PNS is ACh
T
197
Postganglionic sympathetic nt to renal vascular smooth muscle is ____
dopamine
198
Postganglionic sympathetic nt to cardiac and smooth muscle is _____
NE
199
Postganglionic sympathetic nt to sweat glands is _____
ACh M
200
Primary nt for SNS are ____
N/Epi, Dopamine, Serotonin
201
Contransmitters in the SNS are _____
ATP, galanin, neuropeptide Y
202
The rate limiting step in the production of catecholamines is _____
conversion of tyrosine to dopa via tyrosine hydroxylase
203
The precursor aa for catecholamines is ____
tyrosine
204
Dopa is converted to dopamine via the action of _____
LAD: l-aromatic aa decarboxylase
205
Dopamine hydroxylase converts dopamine to ______
norepinephrine
206
PNMT-Penylethanolamine N-methyltransferase converts _____ to _____
norepinephrine to epinephrine
207
What is the acute mechanism for increasing synthesis of catecholamines?
regulation of tyrosine hydroxylase by phosphorylation (PKA and PKC)
208
There is an immediate/delayed increase in tyrosine hydroxylase gene expression after nerve stimulation
delayed
209
T/F Autistic symptoms can change with age.
T --> optimal outcome
210
Autism triad of deficits
early impairment in language and communication, impairments in social and emotional reciprocity, restricted interests and repetitive and stereotyped behaviors
211
anxiety, ADHD, seizures, sleep disorders, and ID are common co-morbidities of ____
autisms
212
Autism vs. Asperger's
asperger's has no communication disability
213
Pervasive Disability Disorder NOS vs. Autism
signs and symptoms but not enough criteria to be autism
214
T/F autism subgroups are stable over time.
F
215
T/F autism runs in families
T
216
Which genetic disorder is primarily linked with autism?
Fragile X
217
The _____ pathway is implicated in autism, resulting in too little protein expression in tuberous sclerosis and too much in fragile x.
mGluR
218
T/F autisms are related to megalo and macrocephaly
T
219
Fusiform gyrus is responsible for _____ and is hyper/hypoactive in autisms
person perception hypo
220
Superior temporal sulcus is responsible for _____ and is hyper/hypoactive in autisms
facial expression perception hypo
221
Amygdala is responsible for _____ and is hyper/hypoactive in autisms
social arousal, attention/salience hypo
222
Superior frontal gyrus is responsible for _____ and is hyper/hypoactive in autisms
theory of mind hypo
223
Ventral striatum is responsible for _____ and is hyper/hypoactive in autisms
reward/motivation hypo
224
T/F Autisms tend to associate with cortical asynchrony
T
225
Mood/affect is the most observable descriptor of emotional state.
Affect
226
sadness/depression should be readily understandable in context and should be relived by activities that help engage in desired activities and distract from negative thoughts.
sadness
227
What kind of MDD? severe recrurrent depression in mid to late life
endogenous/melancholia
228
What kind of MDD? milder depression with reverse vegetative features; often chronic, strongly female dominant, s/w more common in bipolar
atypical
229
What kind of MDD? characteristic fall/winter onset, responsive to white light therapy, linked to bipolar
seasonal
230
What kind of MDD? associated with life events, anxiety, trauma
neurotic
231
What kind of MDD? most severe form with delusions and hallucinations
psychotic
232
What kind of MDD? duration of symptoms for at least two years or superimposition of a MDE on an antecedent dysthymia
chronic
233
What kind of MDD? onset after childbirth
postpartum
234
T/F Marriage is a protective factor for depression
T but for men only
235
T/F Life stress is more important in initial depressive events vs. later events.
T
236
Which brain area? executive functions, working memory, decisions
prefrontal cortex
237
Which brain area? rational cognitivie functiosn like reward, anticipation, empathy
anterior cingulate cortex
238
Which brain area? primary role in processing emotional reactions
amygdala
239
Which brain area? storage of associative and episodic memories
hippocampus
240
Which brain area? convergent information processing to develop emotionally relevant context for sensory experience
insular cortex
241
bipolar type ____ is associated with at least 1 manic episode
type 1
242
bipolar type ___ is associated with hypomania and depression without manic episodes
type 2
243
____ is used to describe a person who seems to have bipolar disorder but who never recovers back to a consistent baseline
schizoaffective disorder
244
A distinct period of abnormally elated or irritable mood is called ____
mania
245
T/F in mania, delusions are more common than hallucinations
T
246
Episodes that require hospitalization are manic/hypomanic
manic
247
Episodes that are associated with marked vocational or social impairment are manic/hypomanic
manic
248
Episodes that are associated with delusions or hallucinations are manic/hypomanic
manic
249
T/F hypomanic episodes can be short-lived
T
250
What kind of bipolar? 4+ episodes/year
rapid cycling
251
What kind of bipolar? concurrently meets criteria for mania/hypomania and depression
mixed features
252
What kind of bipolar? depression in fall/winter and mania in spring/summer
seasonal
253
T/F bipolar ii diagnosis is heavily dependent on the threshold for hypomania
t
254
Which presents earlier in life? bipolar vs. depressive
bipolar--> >25% of depressions prior to age 20 convert to bipolar
255
Which is more heritable? bipolar or depression
bipolar
256
Which has a greater impact across the board? bipolar or unipolar
bipolar
257
T/F suicide typically occurs during a depressive episode
T
258
T/F risk of completed suicide is greater in bipolar than in MDD
T
259
Major goal in bipolar
mood stabilization
260
T/F mood stabilizers prevent against future relapse of bipolar
T
261
What kind of drug? lithium, carbamazapine, divalproex, ect
mood stabilizers --> reduce mania and depression and do not cause mania or depression
262
T/F the effect of bipolar treatment can be evaluated within a few weeks.
F --> need several weeks
263
T/F monotherapy is standard for BPD
F --> bipolar requires combination therapy
264
T/F antidepressants are helpful in treating BPD
t --> but may worsen disease course
265
Where is serotonin found
10% platelets, 80% GI tract, 20% CNS
266
_____ cells in the GI tract produce serotonin
enterochromaffin cells
267
role of serotonin in platelets
causes aggregation/clotting
268
T/F serotonin is both a vasodilator and a vasoconstrictor
T --> dilator in healthy vessels, constrictor in damaged vessels
269
serotonin role in GI system
secretory and peristaltic reflexes
270
EC cells in gut release serotonin into _____
lamnia propria
271
In the CNS serotonin is released by ____
raphe nuclei --> rostral (B5-9) and caudal (b1-4)
272
Function of serotonin released by caudal raphe nuclei
spinal cord sensory, motor, and autonomic
273
Function of serotonin released by rostral raphe nuclei
cortex, basal ganglia, thalamus, hypothalamus --> limbic
274
serotonin is produced from what essential AA
tryptophan
275
rate limiting step in production of serotonin
tryptophan hydroxylase
276
serotonin is a precursor of what hormone
melatonin in pineal
277
Which enzyme degrades serotonin?
MAO
278
How many genes regulate serotonin synthesis?
2 --> Tph1 = periphery and Tph2 = CNS
279
short term regulators of tryptophan hydroxylase
pka, ca/camk2, pkc --> phosphorylation leads to increased enzymatic activity
280
long term regulators of tryptophan hydroxylase
exogenous signals like cAMP can up/down regulate total amount of protein via gene regulation --> neuronal activity, stress, drugs
281
Tryptophan depletion is achieved by ingestion of a drink of ___ AA
neutral --> reduced plasma tryptophan and subsequent reduced synthesis
282
Which protein is responsible for removal of serotonin from synaptic cleft
SERT
283
Which protein is responsible for vesicular concentration of catecholamines and serotonin
vesicular monamine transporters 1 and 2
284
SERT is inhibited by ____ and ____
SSRIs and fenfluramine
285
Vesicular monamine transporters are inhibited by _____ and _____
reserpine and fenfluramine
286
Which VMAT is responsible for vesicular uptake?
VMAT2
287
Fenfluramine MOA
stimulates release of 5HT by blocking VMAT and disrupting proton gradient in vesicles --> increase in intracellular 5HT --> reverse action of SERT | also inhibits inward function of SERT
288
T/F amphetamine will cause active release of serotonin
T
289
T/F polymorphism in 5HT transporter is associated with susceptibility to MDD and anxiety
T --> 44bp insertion (L) or deletion (S)
290
p-chloroamphetamine is a releaser/inhibitor of neurons
releases and depletes neurons
291
MDMA moa
reverses direction of SERT and blocks reuptake
292
T/F active releasing agent stimulates 10x more 5ht release than a reuptake inhibitor
T
293
Which genes encode MAO
MAO A (serotonergic neurons) and MAO B
294
____ regulates free intraneural concentration of NE or 5HT
MAO
295
Where is MOA produced?
mitochondria
296
Which serotonin receptor subtype? mostly CNS, some blood vessels, Gi coupled (cAMP)
5HT1R
297
Which serotonin receptor subtype? mainly CNS, some blood vessels, Gq (IP3/DAG)
5HT2R
298
Which serotonin receptor subtype? mainly peripheral, ion channel
5HT3R
299
Which serotonin receptor subtype? mainly enteric, some in CNS, Gs (cAMP)
5HT4R
300
5HT 1 receptor family have what in common?
inhibition of adenylyl cyclase as a signaling mechanism
301
5HT2 receptor family have what in common?
inhibition of IP3 as a signaling mechanism
302
Which serotonin receptors gate calcium?
5HT3
303
T/F serotonin receptors also also autoreactive
T --> 5HT 1A and 1B are presynaptic and gate the release of serotonin
304
Name a few medicinal uses for serotonin drugs
depression, anxiety, migraine, obesity
305
4 classes of antidepressants
TCA, SSRI, NRI, MAOI
306
Why are SSRIs better than TCAs?
no affinity for histamine, muscarinic, and adrenergic receptors --> fewer side effects
307
serotonin behavioral syndrome
when switching among ssri's or to other drug classes --> overactivation of central serotonin receptors --> abdominal pain, diarrhea, sweating, fever, tachycardia, increased blood pressure, AMS
308
SSRI antidepressant effect
1. increased 5HT levels from long-term reuptake inhibtion, 2. increased transcription of CREB, 3. increased production of neurotrophins like BDNF, 4. increased hippocampal neurogenesis
309
SSRI anxiolytic effect
1. downregulation of 5HT2c receptors, 2. increased GABA release in forebrain regions, 3. increased production of neurosteroids like allopregnanolone
310
Mechanism of serotonin migraine
vasoconstriction, reduce neuroinflammation, inhibit CGRP release
311
Where in the neuron do the final steps of epinephrine/norepinephrine synthesis take place?
in the vesicles
312
2 adrenal medulla cell types
those with NE only (no PNMT) and those with E (contain PNMT)
313
NE diffuses from ____, is methylated by ____ to epinephrine in the _____ which then reenters the _____
granules, PNMT, cytoplasm, granules
314
Synthesis of PNMT is regulated by _____ secreted in the ______
glucocorticoids in the adrenal cortex
315
Stress increases the release of _____ from adrenal cortex and ___ from adrenal medulla
cortisol and E
316
T/F diffusion of NT across vesicular membrane impacts neurotransmission
F
317
T/F neuroamines have a long halflife
F --> short
318
In nerve endings, catecholamines are stored in ___ which function to ____
vesicles, protection from degradation (granules in adrenal medulla)
319
Vesicle membranes contain an uptake pump called ____
VMAT
320
Vesicles contain what supporting molecules?
dopamine beta hydroxylase, PNMT, cotransmitters ATP and NPY
321
T/F Vesicle mediated activities like NT synthesis are ATP-dependent
T
322
Exocytic release of vesicle contents is ___ dependent
Calcium
323
calcium interacts with ____ proteins that trigger fusion of the vesicular membrane with the terminal membrane
vesicle associated membrane (VAMP)
324
_____ sit on the presynaptic nerve terminal and can bring about varied responses to NT release
autoreceptors
325
Alpha-1 receptor is Gq/Gi/Gs and binds _____ NT resulting in ____
Gq, epi/norepinephrine --> increased free Ca2+
326
Alpha-2 receptor is Gq/Gi/Gs and binds _____ NT resulting in ____
Gi, epi/norepinephrine --> decreased cyclic AMP
327
Beta-1 receptor is Gq/Gi/Gs and binds _____ NT resulting in ____
Gs, epi/norepinephrine --> increased cyclic AMP
328
Beta-1 receptor is Gq/Gi/Gs and binds _____ NT resulting in ____
Gs, epinephrine --> increased cyclic AMP
329
beta 1 and 2 receptors do what to cyclic AMP levels?
increase
330
Beta 1 and 2 receptors are Gq/gi/gs
Gs
331
______ of serine residues on Gprotein receptors allows binding of _____ which reduces ligand binding
phosphorylation and beta arrestin
332
T/F when ligand is no longer bound to receptor, affinity for beta arrestin drops.
T
333
T/F tyrosine's entry to the cytoplasm of the neuron is energy dependent
T
334
Where in the cell is tyrosine hydroxylase located?
cytoplasm
335
_____ refers to the reuptake of NE into nerve endings (high affinity, low capacity)
uptake 1 (NET)
336
_____ refers to mechanisms of extra-neuronal uptake (low affinity, high capacity)
uptake 2
337
which uptake system is important for removing circulating amines
uptake 2
338
5HT, NE, and tryptamine are substrates for which MAO
MAO A
339
Dopamine and tryptamine are substrates for which MAO
MAO B
340
___ functions as a safety valve to inactivate excess NT in the synaptic cleft or leaking NT
MAO
341
T/F MAO can degrade NT in extraneuronal sites
T --> all over body
342
T/F inhibiting tyrosine hydroxylase is not beneficial
T --> not selective
343
Which drug? inhibits L-aromatic AA decarboxylase
alpha methyldopa
344
Which drug? inhibits LAAD in the periphery
carbidopa
345
Which drug? inhibits dopamine beta hydroxylase
disulfiram/tetraethylthiuram
346
Reserpine MOA
blocks VMAT uptake of dopamine into vesicle --> tx of HTN and snakebite
347
Bretylium MOA
causes release of NE and thereafter blocks fusion of vesicles by preventing AP from reaching terminals --> tx of vfib
348
Guanethidine MOA
NE release inhibitor --> Tx HTN --> degradation of nerve endings
349
Dopamine MOA
sympathomimetic agonsit --> inotropic agent --> Tx shock (alpha and b1 adrenoceptor)
350
Dobutamine MOA
sympathomimetic agonist -> inotropic --> CHF --> b1
351
Ldopa MOA
precursor of dopamine administered with carbidopa (LAAD inhibitor)
352
Bromocriptine MOA
selective D2 agonist
353
Amphetamine MOA
promote NT release (lipid soluble and can penetrate brain), resistant to MAO b/c of alpha methyl group
354
Cocaine MOA
reuptake inhibitor of NE
355
Imipramine MOA
uptake inhibitor of NE and serotonin --> antideprx
356
Which uptake mechanism is blocked by cocaine and TCA?
uptake 1
357
Selegiline MOA
inhibits MAO B at low doses --> delayed breakdown of dopamine --> NT accumulation --> tx of antideprx
358
monoamine theory of depression
depression is a result of depletion of monoamines like 5HT, NE, and Da
359
Which neurotransmitter is associated with: obsessions, compulsions
serotonin
360
Which neurotransmitter is associated with: alertness
NE
361
Which neurotransmitter is associated with: attention, pleasure reward, motivation
dopamine
362
Which neurotransmitter is associated with: anxiety
serotonin, NE
363
Which neurotransmitter is associated with: mood
serotonin, NE, dopamine
364
NE neurons originate in ____ and innervate the brain except for _____
locus ceruleus, except nucleus accumbens
365
Dopamine originates in _______.
ventral tegmental area and substantia nigra
366
Phencyclidine and ketamine block ______ resulting in effects thought to mimic schizophrenia.
NMDA receptors
367
____ exerts inhibitory effect by increasing CL flow to hyperpolarize neurons
GABA
368
____ exerts inhibitory effect via allosteric modulation of NMDA receptor
glycine
369
sedative hypnotics (benzos) and some anticonvulsants (barbituates) act via unique binding sites on _____
GABA regulated Cl channels
370
Which NT is implicated in AD?
Ach
371
What class of drugs? shared pharmacological property of D2 receptor antagonism
antipsychotics --> opposite of agents like cocaine and amphetamines that increase synaptic dopamine --> reduce psychosis
372
overabundance of dopamine in the _____ pathway results in negative symptoms of schizophrenia like social isolation and poor hygiene.
mesocortical
373
overabundance of dopamine in the _____ pathway results in positive symptoms of schizophrenia like delusions and perceptual disturbances
mesolimbic
374
blocking dopamine in the _____ area results in side effects like dystonia, akathisia, TD, NMS
nigrostriatal
375
blocking dopamine in the ____ area results in prolactin side effects like galactorrhea and gynecomastia
tuberoinfundibular
376
T/F antipsychotics lower the seizure threshold
T
377
T/F antipscyhotics can prolong QT
true
378
T/F antipsychotics are major tranquilizers
T
379
2 types of first generation antipsychotics
high potency --> haloperidol vs low potency (more antihistamine, antiadrenergic, anticholinergic) --> chlopromazine
380
____ antipsychotics block D2 as well as 5HT receptors.
atypical/2nd generation --> not more effective but better tolerated
381
Which generation of antipsychotics is better tolerated?
atypicals/2nd generation
382
What major risk do atypical antipsychotics pose?
agranulocytosis
383
diabetes, dyslipidemia, weight gain are associated with _____ syndrome which is a side effect of ______ antipsychotics
metabolic syndrome --> 2nd generation/atypicals
384
____ is a partial DA agonist
abliify --> risk of worsening psychosis
385
torsade de pointe
TCA fatal overdose
386
which antidepressant class is best tolerated?
ssri
387
which antidepressant class is used for a comorbid pain syndrome
snri
388
which antidepressant requires food restrictions?
MAOI
389
T/F antidepressants increase suicidality
F --> may unmask suicidal thoughts
390
_____ is thought to enhance monaminergic function by inhibiting the recylcing of neuronal membrane phosphoinositides involved in generation of IP3 and DAG
lithium
391
_____ are associated with side effects like weight gain and neural tube defects and often require therapeutic blood monitoring and have numerous drug interactions
mood stabilizers
392
______ result in inhibitory neurotransmission by increasing the frequency of GABA Cl channel ion opening and causing neuronal hyperpolarization --> promote sleep onset and duration --> REM
Benzos -->treat symptoms via GABA A
393
which receptor is modulated by benzodiazepines?
GABA A
394
what are the most common sedatives used
benzodiazepines
395
T/F some benzodiazepines get processed by liver once and others twice
T --> some get glucoronidated AND oxidized
396
which benzodiazepines only undergo glucoronidation in the liver?
loraze, oxaze, temazepam --> use them for alcohol withdrawal or in people with bad livers
397
T/F risk of abuse in benzodiazepines has to do with onset and duration of action
T
398
the only medications useful in treating dementia are ____
AChEI and NMDA receptor antagonist (namenda)
399
T/F dementias can only be treated for symptoms and to slow progression
T
400
the standard size of an alcoholic drink is
12 g ethanol
401
BAL
blood alcohol content by percentage
402
legal limit for bal is what in us
80-100 mg/dL = 0.08%
403
one drink will yield BAL of
30 mg/dL = 0.03%
404
alcohol has a high/low diffusion coefficent
high --> can be measured in expired air
405
T/F Alcohol is both lipid and water soluble
T --> hydrophilic = large volume of distribution
406
Alcohol has a large/small volume of distribution
large
407
T/F Absorption is accelerated by CO2
T
408
Alcohol is absorbed passively/actively
passively
409
T/F Rate of absorption partially predicts BAL
T
410
Rate of absorption of alcohol depends on what 3 factors
concentration (shot > wine > beer), food in stomach (fat>cho>protein), habitual vs occasional drinking pattern
411
Why do women achieve a higher BAL for a given dose than men?
greater body fat content, lower total body water content --> higher Vd
412
T/F volume of distribution partially predicts BAL
T
413
Maximum BAL depends on what 3 factors
Vd, absorption rate, rate of metabolism
414
___% of alcohol is metabolized
90
415
Primary alcohol metabolic pathway
oxidative pathway in the liver --> 2E1 cytochrome p450 --> MEOS (microsomal ethanol oxidizing system)
416
Which enzyme? converts ethanol to acetaldehyde
Alcohol dehydrogenase --> mainly in liver (also in GI endothelial cells and brain)
417
which gender has higher ADH activity in GI tract?
men
418
T/F ADH is saturable
T --> can be exhausted
419
Which enzyme? converts ethanol to acetaldehyde when ADH is saturated
MEOS/CYP2E1 --> byproducts = h2o2, toxins, free radicals
420
T/F Cyps are induced in response to increased exposure
T
421
Which enzyme? converts acetaldehyde to acetate and then to CO2 and H2O
ALDH
422
Which group of people have lower GI ADH activity?
women and asians
423
Which enzyme do people of asian decent have a deficiency in (alcohol metabolism)
ALDH
424
which drug causes flushing upon drinking alcohol?
disulfuram --> inhibits breakdown of acetaldehyde
425
What order kinetics does alcohol follow
first order up to BAL 100 mg/dL (saturation of ADH) --> zero order kinetics at 8 grams/hour
426
In habitual drinkers _____ enzyme is upregulated --> can result in what interaction?
CYP 2E1 --> tolerance --> upregulation of metabolism of drugs (e.g. OCP)
427
In occasional drinkers, competitive inhibition may result in reduced metabolism of ____
warfarin
428
Chronic alcoholism effects
frontal lobe white/gray loss, reduced brain metabolism, wernicke/korsakoff amnestic syndrom, neuropathy (saturday night palsy)
429
Acute cardiovascular effects of alcohol
vasodilation, reduced myocardial contractility, atrial and ventricular arrhythmias
430
Chronic cardiovascular effects of alcohol
hypertension, dilated cardiomyopathy, atherosclerosis, increased TAG
431
French paradox
30g/d of alcohol is cardioprotective --> increases HDL cholesterol, antioxidant content of alcohol beverages, increases in tissue plasminogen activator
432
Increasing BAL increases/decreases ADH secretion
decreases --> diuresis and kaluriesis
433
Alcohol increases/decreases uric acid excretion
decreases -->gout
434
Alcohol increases/decreases incidence of PUD
increases --> stimulates secretion of gastrin, pepsin, histamine, gastric acide --> PUD, pancreatitis, cancer (from acetaldehyde)
435
T/F alcohol is directly hepatotoxic
T
436
T/F alcohol suppresses immunity
T --> reduced platelets from marrow suppression, reduced folate metabolism (macrocytosis), reduced neutrophil/t cell function
437
Increased BAL increases/decresease the ventilatory response to increased CO2 acutely.
decreases
438
Alcohol increases/decreases sleep latency
decreases
439
Alcohol's empty calories
alcohol suppresses gluconeogenesis which leads to hypoglycemia concomittant with hypokalemia
440
T/F Alcohol freely crosses placenta and enters breast milk
T
440
T/F metabolic pathway for alcohol is not developed in fetus and neonate
T --> fetal alcohol syndrome
441
Alcohol dependence with physiological dependence
alcohol dependence accompanied by tolerance and/or withdrawal
441
alcohol treatment stages
1. id, 2. detox/withdrawal, 3. rehab, 4. aftercare
442
Which drug? In alcohol withdrawal treatment, decreases severity, stabilizes vitals, prevents seizures and delirium tremens, addictive.
benzodiazepines
443
Which drug? In alcohol withdrawal treatment improves vital signs, reduce cravings
beta blocker
444
Which drug? In alcohol withdrawal treatment decrease withdrawal symptoms only
alpha agonists
445
Which drug? In alcohol withdrawal treatment decrease severity and may prevent seizures
anticonvulsants
446
Naltrexone's effect on alcohol consumption
opiate blocker reduces risk of heavy drinking
447
contraindications for naltrexone
current use of opioids, pregancy/breastfeeding
448
Any chemical compound with pharmacologic actions similar to those of morphine (narcotic analgesic)
opiate
449
Opioids are pupillary constrictors/dilators
constrictors
450
T/F Opiods are ineffective analgesics
F --> very effective
451
morphine is an agonist of the ____ receptor causing ____
mu, analgesia, euphoria
452
ketocylcazocine is an agonist of the ____ receptor causing ____
kappa, dysphoria, analgesia
453
Opioid dependence treatment
1. detox- agonist taper, 2. substitution-methadone, buprenorphine, 3. antagonist- naltrexone, 4. relapse prevention-naltrexone
454
Which drug? Opiod orally active antagonist
naltrexone
455
Which drug? parenterally active antagonist of opioids, orally inactive
naloxone
456
_____ functions by inhibition of local axonal conduction
local anesthesia (e.g. cocaine)
457
_____ inhibits pain perception in cortical and subcortical brain
opioid analgesic
458
____ receptors mediate both spinal (DRG) and supra spinal analgesia in periaqueductal gray matter, thalamus, sensory cortex.
Mu
459
___ receptors mediate spinal analgesia for pain C fibers in spinothalamic tract.
delta
460
Which opioid receptors are in the DRG/dorsolateral funiculus
delta
461
Euphoria is produced by actions on the ____ dopaminergic neurons which project to the n. accumbens and medial prefrontal cortex.
VTA
462
nausea is produced at the ____
area postrema
463
respiratory depression is produced at the ____ decreasing neuronal sensitivity pco2
brainstem
464
anti-tussive action is produced in the ____
brainstem
465
opioid mediated decreased propulsion in Gi tract/constipation is produced by actions at the ____
local gut ganglia
466
opioid constriction of the pupil is produced by actions at the ____
3rd motor nucleus
467
opioid peripheral vaso-dilation is produced by action at the ____
vagal nucleus
468
3 main endogenous opioid receptor ligands in CNS
endorphin, enkephalin, dynorphin
469
___ and ____ receptors bind enkephalins and endorphins preferentially
mu and delta
470
____ receptors bind dynorphin
kappa
471
acute cellular response to morphine
morphine/b endorphin binds to mu receptor --> gi activation ---> inhibition of cAMP --> decreased activation of PKA --> hyperpolarization of cell via receptor linked K+ channels, reduced CREB phosphorylation
472
____ is administered IV with very rapid onset, lasting several hours- -> opioid antagonist
naloxone
473
2 mechanisms of opioid tolerance
mu receptor phosphorylation by 1. src kinase --> increase in cAMP levels --> signal reversal (binding to Gs vs Gi), 2. gprotein kinase --> mu receptor internalization (reduced receptors on surface)
474
Chronic response to morphine
uncoupling of gi by phosphorylation --> increase in cAMP levels + binding of beta arrestin --> endocytosis of receptors
475
Desensitization of mu opioid receptors
beta arrestin mediated MOR internalization --> will need to increase morphine levels over time for pain management
476
Fate of internalized MOR
degradation in lysosomes or resensitizaiton and reinsertion via release of beta arrestin
477
____ linkes MOR c terminus to actin to mediate internalization
FILA
478
____ inhibits g protein activation by MOR
PPL
479
T/F opioid tolerance has a ceiling
T --> 200mg heroine/day
480
T/F opioid withdrawal can begin 12 hours after last dose of morphine
T
481
T/F physical symptoms of opioid withdrawal are mild
T --> anxiety, agitation, diarrhea, pupillary dilation, craving (cued)
482
T/F 50% of risk for opioid addiction is inherited
T
483
T/F 85% of drug-free rehab for opioid relapse in 1 year
T
484
Gordian knot of opioid addiction
relapse initiated by craving --> must control craving
485
3 advantages of methadone opioid addiction tx vs. drug-free rehab
1. lower rate of HIV and hepatitis, 2. lower rate of re-arrest, 3. increased employment
486
_____ is an orally active partial mu agonist which dissociates very slowly from the mu opioid receptor causing less sever withdrawal symptoms
buprenorphine
487
T/F buprenorphine/naloxine is a promising new treatment for opioid addiction treatment
T -->Naloxone is not absorbed into the bloodstream to any significant degree when Suboxone is taken correctly by allowing it to dissolve under the tongue. However, if a Suboxone tablet is crushed and then snorted or injected the naloxone component will travel rapidly to the brain and knock opioids already sitting there out of their receptors. This can trigger a rapid and quite severe withdrawal syndrome. Naloxone has been added to Suboxone for only one purpose – to discourage people from trying to snort or inject Suboxone.
488
N118 A-G polymorphism in MOR effect
AA > translation of MOR than AG or GG --> more euphoria with GG
489
____ is able to block effect of alcohol euphoria among people with G allele in MOR
naltrexone
490
Naltrexone effect on alcohol addiction
blunts euphoria by blocking opioid receptor --> reduces relapse for heavy drinking but does not influence probability of abstinence outcome
491
Does A118G genotype affect treatment response to naltrexone among alcohol addicted patients?
relapse is blunted among alcohol addicted people with G allele on naltrexone --> genotype specificity
492
____ is produced in ventral tegmental area whereas ____ is thalamic/cortical/spinal
euphoria vs. analgesia
493
T/F Addiction is a chronic disease that is responsive to treatment
T
494
T/F Addiction has a predictable morbidity and mortality and can be fatal
T
495
T/F The chronic medical consequences of addiction are late developments of the disease
T
496
```
The following are signs of withdrawal from what drug?
Tachycardia
Increased BP
Increased temperature
Anxiety
Headache
Tremor
Diaphoresis
Nausea/vomiting/loose stool
Photophobia/phonophobia
Hallucinations
Seizures
Delirium
```
Alcohol if with delirium tremens, sedatives
497
```
The following are signs of intoxication by what drug?
Slurred speech
Ataxia
Nystagmus
Respiratory depression – can be fatal
```
Barbituates
498
The following are signs of intoxication by what drug?
Slurred speech
Sedation
Respiratory depression not usually fatal unless mixed with alcohol
benzodiazepines
499
```
The following are signs of withdrawal from what drugs?
Tachycardia
Pupil dilation
Runny nose
Diaphoresis
Yawning
Muscle/joint aches
Goose pimples/piloerection
Restlessness
Anxiety
Tremors
Abdominal cramps/diarrhea
```
opiates
500
The following are complications of what drugs?
Vasospasm, increased BP/HR, increased O2 needs
MI, stroke, dissecting aneurysm, spontaneous abortion, renal failure, bowel ischemia
```
Electrophysiological disturbance
Seizures, arrhythmias
Hyperthermia
Hyperactivity
Rhabdomyolysis, trauma
Aggression, paranoia, grandiosity
Trauma and other risky behaviors (STDs…)
```
stimulants
501
```
The following are signs of intoxication with what drug?
Dry mouth, red eyes, relaxed muscles
Cognitive disturbances
Trauma
Tachycardia and arrhythmia
```
marijuana
502
```
The following are sequelae of using what drug?
Pulmonary disease
Decreased libido & sperm count
Immunosuppression
Anhedonia
```
marijuana
503
T/F depression is associated with an increase in death rate at any age, independent of suicide, smoking, or other risk factors
T
504
Depression leads to increased/decreased neurogenesis, increased/decreased HR variability, increased/decreased platelet activatoin, increased/decreased sympathetic tone
decreased, decreased, increased, increased
505
Depression leads to an increased/decreased CRF, increased/decreased HPA activity, increased/decreased insulin resistance, increased/decreased cell mediated immunity, increased/decreased cytokines, increased/decreased bone formation/density, increased/decreased bone resorption
increased, increased, increased, decreased, increased, decreased, increased
506
T/F women are more resistant to minor depression than men and don't tend to die as much.
T
507
Depression and cardiovascular disease have a bi/unidirectional relationship
bidrectional --> depression is a significant independent risk factor for CAD; MI increases depression
508
hypercoagulability and depression
evidence that increased density in platelet serotonin receptors might increase coagulation in depression
509
increased cortisol and depression
depression increases cortisol which increases HPA axis --> promotes atherosclerosis, hypertension, injury to vascular endothelia, loss of suppression of inflammatory cytokines from insufficent glucocorticoid signaling which disrupts negative feedback
510
Which cytokines are elevated in depression?
IL1, 6, TNF alpha
511
Which cytokines are associated with insulin resistance, diabetes, and obesity?
IL6 and TNF alpha
512
___ is an index of inflammation in the body
c reactive protein
513
T/F men and women are affected by cancer equally
T
514
Can depression be prevented?
Yes --> prophylactic ssri can prevent interferon therapy caused depression | also after stroke
515
```
a
perceived difficulty
or dissatisfaction with sleep and typically
entai
ls a constellation of several
daytime
symptoms (exhaustion, poor concentration, irritability and, or reduced interest in
activities)
```
insomnia
516
_____ is c
haracterized by social isolation and extreme individualism without
craving human contact
schizoid
517
__________ is characterized by magical thinking, odd beliefs (numerology,
psychic hotline)
schizotypal
518
________ is characterized by extreme suspicion and distrust of others
paranoia
