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NU643 Week 8 – Questions & Detailed Solutions
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NU643 Week 8 – Questions & Detailed Solutions
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NU643 Week 8 – Questions & Detailed SolutionsAmygdala ✔️Ans - controls anxiety/fear/worry - anxiety d/o, phobias,
PTSD, result from malfunctions w/n these circuits. Flight or fight - motor
response - PAG (periaqueductal gray) located in brain stem
Locus Coeruleus ✔️Ans - Home of noradrenergic cell bodies
Autonomic response
Inc BP, Inc HR, Inc RR,
- Prolonged activation = inc risk of atherosclerosis, MI, CAD, Stroke,
fear amygdala. ✔️Ans - Motor response = brain stem(periaqueductal
gray) - fight or flight
Endocrine response = hypothalamus
Fear conditioning ✔️Ans - associate feat with neutral stimulus
VMPFC and hippocampus info passes to amygdala
Amygdala can remember stimuli w/ glutamate transmission
Glutamate ✔️Ans - inhibitory stimuli
conditioned-fear response ✔️Ans - Memories do not get erased but can
be rewired
Anxiety can be suppressed but IS NOT REMOVED ENTIRELY
Fear extinction ✔️Ans - progressive reduction of response to stimuli to
reduce symptoms
first-line treatment for GAD ✔️Ans - SSRIs, SNRIs
d/t prolonged effectivness - BZ can be used for acute symptoms until
effective
Buspar (serotonin) ✔️Ans - 5HT1a affects - Post synaptincally - decreases
5HT activity-
Can help with relaxation - FDA for GAD
clonidine and propranolol ✔️Ans - To tx physical response - decreased
BP, HR - monitor VS for safety
, To reduce risk of falls, syncope issues when your BP or HR get low.
Typically used during the day...avoid at night to minimize risk of
hypotension.
Avoid with eating DO as hydration can be an issue
Buspirone/anxiety D/O ✔️Ans - GAD - indicated GAD
Used in other type in practice...but FDA indicated in
benzodiazepine GABA ✔️Ans - Inhibitory - influx of Cl - decreases anxiety
SSRI/SNRI ✔️Ans - Zoloft,
paxil, prozac - not mentioned in discussion but is also used for anxiety as
well as MDD
hydroxyzine ✔️Ans - 1. alcohol dependence and anxiety disorder.
Antihistamine affect
Calms withdrawal s/s in ETOH dependence, insomnia, and anxiety
Can be used short term - use like you use BZ - gradual taper
short- and long-acting benzodiazepine risk ✔️Ans - LT use - increase risk
of dementia - on long acting - valium more strongly associated with
dementia.
Beer's Criteria - avoid prescribing Long acting, long term use to minimize
dementia
abrupt benzo cessation ✔️Ans - Abrupt cessation = withdrawal, SZ,
psychosis
oxcarbazepine (Trileptal) s/e ✔️Ans - hyponatremia
benzodiazepines with mood stabilizers ✔️Ans - Short term use to allow
MS become effective
-manic patient to help them calm and sleep until MS takes effect..
NEVER USED AS MONOTHERAPY
Acute mania: ✔️Ans - - Lithium - ruins kidneys, Thyroid, when used long
term - check lithium levels d/t narrow therapeutic window
- Valproate - bad for liver
- Atypical AP - monitor for metabolic syndrome
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