Neurology and Pain Management Flashcards

Flashcards covering key vocabulary and concepts in neurology, pain management, and related pharmacology.

Central Nervous System (CNS)

Brain and spinal cord

Peripheral Nervous System (PNS)

Sensory, motor, and autonomic components

Sensory (Afferent): 1st order

Receptors to spinal cord

Sensory (Afferent): 2nd order

Spinal cord to thalamus

Sensory (Afferent): 3rd order

Thalamus to cortex

Motor (Efferent): Upper motor neurons

Cortex to spinal cord

Motor (Efferent): Lower motor neurons

Spinal cord to skeletal muscle

Sympathetic Nervous System (SNS)

"Fight or flight" (↑HR, BP, RR, ↓digestion); pre: ACh, post: NE/Epi

Parasympathetic Nervous System (PNS)

"Rest and digest" (↓HR, ↑digestion); pre: ACh, post: ACh

Cholinergic

ACh-related effects

Adrenergic

E/NE-related effects

Opioids (Natural)

Morphine, Codeine

Opioids (Synthetic)

Meperidine

Opioids (Endogenous)

Endorphins

Opioids Side Effects

Drowsiness, nausea, constipation, impaired judgment

Opioids Caution

Risk for addiction, especially with psychiatric comorbidity

NSAIDs & Salicylates

Ibuprofen, Aspirin, Ketorolac, Celecoxib

NSAIDs & Salicylates Uses

Inflammation, arthritis, pain

NSAIDs & Salicylates Side Effects

GI bleeding, renal issues, fluid retention → ↑ BP

NSAIDs & Renal Perfusion Note

↓ prostaglandin → ↓ renal perfusion

Acetaminophen

Analgesic & antipyretic, not anti-inflammatory

Acetaminophen Risk

Hepatotoxicity, especially with alcohol use

Tricyclic Antidepressants (e.g.)

Amitriptyline

Tricyclic Antidepressants (e.g.) Use

Treats both pain & mood

Tricyclic Antidepressants (e.g.) Effectiveness

Effective for burning/tingling pain

Gabapentin & Anticonvulsants (Examples)

Gabapentin, Carbamazepine, Valproic acid

Gabapentin & Anticonvulsants Use

Used for shooting/electric pain

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Migraine Treatment (Abortive)

Analgesics, Triptans (e.g., Sumatriptan), Ergots

Migraine Treatment (Prophylactic)

Beta-blockers, TCAs, Valproic acid, MAOIs

Migraine Treatment (Mechanism)

Triptans & Ergots → 5-HT1B/1D agonists → Vasoconstriction + ↓ inflammation

Headache Management (Non-Pharmacological)

Trigger avoidance, biofeedback, psychotherapy

Hydantoins (Example)

Phenytoin

Hydantoins (Mechanism)

Blocks voltage-gated sodium channels in neurons

Succinimides (Example)

Ethosuximide

Succinimides (Mechanism)

Inhibits T-type Ca++ channels (absence seizures)

GABA analogs (Example)

Gabapentin, Vigabatrin, Baclofen

GABA analogs (Mechanism)

↑ GABA or act on Ca++ channels

doesn’t bind directly to GABA-A or GABA-B receptors like GABA itself.

it affects related pathways (e.g., calcium channels) to reduce neuronal excitability.

trigeminal neuralgia, epilepsy, and bipolar disorder, but monitor labs closely due to hematologic and hepatic risks.

Carbamazepine

carbamazepine moa

Blocks voltage-gated sodium channels; risk of SJS/TEN (esp. in Asians)

Dopaminergic (Example)

Levodopa only not carbidopa b/c it does not act or change into dopamine

Dopaminergic (Mechanism)

↑ Dopamine in CNS

Dopamine Agonists (Example)

Pramipexole (Mirapex) also used in rls

Dopamine Agonists (Mechanism)

Stimulate dopamine receptors

Anticholinergics (Example)

Benztropine (Cogentin)

Anticholinergics (Mechanism)

↓ ACh (balances dopamine deficiency) the imbalance between dopamine and acetylcholine (ACh) in the basal ganglia is a key cause of tremor and rigidity in Parkinson’s disease.

COMT Inhibitors (Example)

Tolcapone, Entacapone

COMT Inhibitors (Mechanism)

Prolong Levodopa effect

Antipsychotics Mechanism

↓ Dopamine

Typical Antipsychotic (Example)

Haloperidol —> D2 receptor antagonism, eps symptoms

Atypical Antipsychotics (Examples)

Risperidone, Olanzapine, Quetiapine

Antipsychotics Side effects

Extrapyramidal symptoms (EPS) with typical

Mood Stabilizers

For bipolar disorder, used long-term with interdisciplinary care

Benzodiazepines (Example)

Lorazepam

Benzodiazepines effects

CNS depressants; cause amnesia

Barbiturates (Example)

Phenobarbital

Barbiturates cause

CNS depression, high abuse potential

Serotonergic (Example)

Buspirone anxiolytic

Serotonergic moa

No CNS depression; acts on 5-HT receptors, partial agonist

SSRIs (Examples)

Zoloft, Paxil

SSRIs (Notes)

↑ Serotonin; 1st line

TCAs (Example)

Amitriptyline

TCAs (Notes)

↑ NE, 5-HT; sedating, more side effects

MAOIs (Example)

Selegiline

MAOIs (Notes)

↑ all 3 monoamines; block the breakdown of serotonin, NE, and dopamine; serious interactions

SNRIs (Examples)

Venlafaxine, Duloxetine

SNRIs (Notes)

↑ NE & 5-HT; useful for pain + mood

Appetite Suppressants

CNS stimulants, act on catecholamine or serotonin pathways

Appetite Suppressants Use

Use only with structured weight loss programs

Cholinesterase Inhibitors (Examples)

Donepezil, Rivastigmine

Cholinesterase Inhibitors (Mechanism)

↑ ACh in brain

NMDA Antagonists (Example)

Memantine - decreases excitocity

used in alzeheimers

NMDA Antagonists (Mechanism)

Modulate glutamate; protect neurons

Barbiturates (Example Sleep Aid)

Amobarbital

Barbiturates (Mechanism Sleep Aid)

Potentiate GABA(A) → CNS depression

at high doses, they can directly activate the GABA-A receptor unlike benzos

Benzodiazepines (Example Sleep Aid)

Temazepam

Benzodiazepines (Mechanism Sleep Aid)

CNS depression; risk of dependence

Non-benzodiazepines (Example Sleep Aid)

Zolpidem

Non-benzodiazepines (Mechanism Sleep Aid)

Bind selective GABA(A) subtypes; less hangover effect

Autonomic Nervous System (ANS)

Regulates involuntary functions (e.g., HR, digestion, secretion)

SNS

Fight or Flight

PNS

Rest and Digest

Preganglionic fiber of PNS

Long, originates in CNS

Postganglionic fiber of PNS

Short, releases acetylcholine (ACh)

Preganglionic fiber of SNS

Short

Postganglionic fiber of SNS

Long, typically releases norepinephrine (NE)

Adrenal Medulla (SNS-related)

Functions as a modified sympathetic ganglion

Upper motor neurons -

Pyramidal tracts (within brain) - voluntary movement

Upper motor neurons -

Extrapyramidal tracts (originate in brainstem) - muscle tone, involuntary movements

Upper Motor Neurons (UMN)

Originate in brain (cortex or brainstem)

Lower Motor Neurons (LMN)

Connect spinal cord to muscles

Amyotrophic Lateral Sclerosis (ALS)

Affects both UMNs and LMNs

Spinal Muscular Atrophy (SMA)

Genetic, affects LMNs in spinal cord

Progressive Bulbar Palsy

Affects LMNs in brainstem

Multiple Sclerosis (MS)

Demyelinating disease of CNS, primarily affecting UMNs

Cerebral Palsy (CP)

Non-progressive brain damage affecting UMNs

Astrocytes

Help to establish BBB, glycogen stores for neurons, mop up excess extracellular K+

Oligodendrocytes

Myelinate axons in the cns

Microglia

Function as macrophages in CNS,

Ependymal Cells

Involved in production of CSF, line ventricles and central canals