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Pharm > Chapter 14B > Flashcards

Chapter 14B Flashcards

1
Q

What is epilepsy?

A

Neurological disorder that produces brief disturbances in the normal electrical activity in the brain

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2
Q

Symptoms of epilepsy

A

Sudden, brief seizures, which the nature and intensity vary from person to person

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3
Q

Seizure

A

A sudden alteration of behavior that is caused by CNS dysfunction
Sudden and transiet

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4
Q

Epileptic Seizure

A

Seizure caused by primary CNS dysfunction due to excess depolarization and hypersychronization of neurons

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5
Q

Non-epileptic seizure

A

A seizure-like episode that is not the result of abnormal electrical activity of the brain

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6
Q

Epilepsy

A

A tendency for recurrent spontaneous epileptic seizures

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7
Q

Status Epilepticus

A

A single unremitting seizure duration longer than 30 minutes OR frequent seizures without recovery of awareness in between
Is an emergency

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8
Q

What are the three classifications for the etiology of epilepsy:

A

1) Symptomatic epilepsy - arising from an identified physical cause like brain tumour, stroke, infection or injury
2) Idopathic epilepsy - no identifiable cause - possible family history
3) Cryptogenic epilepsy - likely to have an underlying cause that has not been identified

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9
Q

What is the seizure threshold?

A

Balance between excitable and inhibitory forces in the brain
Everyone has one - affects how susceptible a patient is to having a seizure
Factors that affect it: stroke, head injury, drug/alcohol withdrawl, infection, tumor, severe fever and visual stimuli

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10
Q

Antiepileptic drugs (AEDs) work by what four mechanisms:

A

1) Blocking sodium channels
2) Blocking voltage-dependent calcium channels
3) Glutamate antagonists
4) Potentiating the actions of GABA

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11
Q

What do sodium channel blocker AEDs aim to do?

A

Prolong the inactivation state of sodium channel - therefore not allows neurons to fire at a high frequency

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12
Q

An example of sodium channel blockers:

A

Phenytoin
Useful for all seizures except absence seizures
Non-linear kinetics because of limited metabolism by liver
Narrow therapeutic range

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13
Q

Adverse effects of phenytoin:

A

sedation
gingival hyperplasia
skin rash

teratogenic

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14
Q

What does blocking voltage-dependent calcium channels do?

A

Suppresses neurotransmitter release

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15
Q

What to glutamate antagonists do?

A

Block NMDA and AMPA receptors which blocks glutamate (neurotransmitter) and thus decreases CNS excitation

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16
Q

What is the GABA receptor?

A

Inhibitory CNS neurotransmitter

Binding of GABA to it’s receptor causes chloride ions to rush in

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17
Q

How is potentiating the actions of GABA receptors helpful for epilepsy?

A

Increased negative charge in the cell makes it more difficult for action potential to be reached

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18
Q

Drugs that potentiate the actions of GABA can mediate their effect four ways:

A

Enhance binding of GABA to receptor
Stimulating GABA release
Inhibiting GABA reuptake
Inhibiting GABA metabolsim

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19
Q

Two classes of AEDs are:

A

Traditional (phenytoin, valproic acid)

Newer (lamotrigine) - less side effects and able to induce enzymes

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20
Q

Depression

A

Symptoms are prolonged and interfere with everyday life
Occurs to 1/3 of people at some time in their life
3% of Canadians

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21
Q

For a diagnosis of depression, at least five of the following symptoms must occur for at least two weeks:

A

Depressed mood most of the day, every day
Loss of interest or pleasure in all or almost all activities
Singificant weight loss or gain
Insomnia or hypersomnia
Psychomotor agitation or retardations
Fatigue and energy loss
Feelings of worthlessness or excessive guilt
Decreased ability to think, concentrate, or excessive indecisiveness
Recurrent thoughts of death or suicidal ideations

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22
Q

Two types of depression

A

Exogenous

Endogenous

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23
Q

Two forms of exogenous depression:

A

Pathological grief - prolonged grieving coupled with excessive guilt

Adjustment disorder - prolonged depression following failure or rejection

24
Q

Forms of endogenous depression:

A 
Major depression
Severe depression
Atypical depression
Dysthymia
Seasonal affective disorder
Postpartum depression
Bipolar disorder
25
Q

What is the Monoamine Hypothesis?

A

Exact cause of depression is unknown

Suggests altered monoamine release, receptor sensitivity or post-synpatic function lead to symptoms of depression

26
Q

What do antidepressants try to do?

A

increase the synaptic levels of one or more monoamine neurotransmitters
Difficult to assess efficacy b/c effects take months to occur

27
Q

Antidepressant drugs mediate their effects by what two mechanisms:

A

1) Inhibiting monoamine reuptake

2) Inhibiting monoamine metabolism

28
Q

What are the four classes of antidepressants?

A

1) Tricyclic (TCA) antidepressants
2) Selective serotonin reuptake inhibitors (SSRIs)
3) Selective serotonin/norepinephrine reuptake inhibitors (SNRIs)
4) Monoamine oxidase inhibitors (MAOIs)

29
Q

What do TCAs do?

A

Inhibit the reuptake of both serotonin and norepinephrine

30
Q

Adverse effects of TCAs?

A 
Anticholinergic
Sedation
Orthostatic hypotension
Decreased seizure threshold
Cardiac toxicity
Weight gain
Sexual dysfunction
31
Q

What do SSRIs do?

A

Block serotonin reuptake
Similar efficacy to TCAs but incidence of side effects is lower
Most commonly used to treat major depression

32
Q

Adverse effects of SSRIs?

A

Weight gain
Sexual dysfunction
Insomnia
Serotonin syndrome - agitation, confusion, anxiety, hallucinations and incoordination

33
Q

What do SNRIs do?

A

Block reuptake of norepinephrine and serotonin

Faster onset of action

34
Q

Adverse effects of SNRIs

A

Nausea
Diastolic hypertension
Sexual dysfunction

35
Q

What do MAOIs do?

A

Inhibits monoamine oxidase which is an enzyme that inactivates monoamine neurotransmitters (occurs at pre-synaptic neuron)
Non-selective - inhibit both A and B

36
Q

What are the two major types of MAO?

A

MAO-A - metabolizes serotonin and norepinephrine
MAO-B - metabolizes dopamine
Treat atypical depression and dysthymia

37
Q

Adverse effects of MAOIs?

A

CNS excitation - anxiety, insomnia, agitation
Orthostatic hypotension
Hypertensive crisis if take with tyramine containing foods

38
Q

What is bipolar disorder?

A

Severe illness characterized by recurrent fluctuations between episodes of mania and depression

39
Q

When do the symptoms for bipolar disorder show?

A

Adolescence or early adulthood

40
Q

The manic phase symptoms of bipolar disorder are:

A 
Irritation
Inflated self-esteem
Little need for sleep
Poor control of temper
Reckless behavior
Easily distracted
41
Q

On average, patients with bipolar disorder exprience approximately 2 episodes every _ years

A

5

42
Q

What are the three major groups of drugs treated by bipolar disorder?

A

1) Mood stabilizers
2) Antipsychotics
3) Antidepressants

43
Q

What do mood stabilizers do?

A

Relieve symptoms during manic or depressive episodes
and
Prevent recurrence of manic or depressive episodes

44
Q

What are the primary drugs used as mood stabilizers?

A

lithium and valproic acid

45
Q

How does lithium work?

A

Alters uptake/release of glutamate
and
Blocks binding of serotonin

Narrow therapeutic range
Plasma concentrations altered by sodium

46
Q

What at the symptoms of toxicity caused by decrease in sodium and increase in lithium?

A

GI upset
tremor
sedation
hypotension

47
Q

What do antipsychotics do?

A

Acutely control symptoms during manic episodes
Long term to stabilize mood
Atypical preferred to conventional because decreased extrapyramidal symptoms

48
Q

Why are antidepressants used to treat bipolar disease?

A

To treat depressive episodes

Always combined with mood stabilizer (if not they might have manic episode)

49
Q

What is anxiety?

A

Normal physiological response to stress

Anxiety disorder is when symptoms of anxiety create impairment in patient’s life

50
Q

What are the physiological effects of anxiety?

A 
Fear
Breathlessness
Choking sensation
Palpations of heart
Restlessness
Increased muscular tension
51
Q

Name the 7 types of anxiety

A

General anxiety disorder (lasts 6+ months)
Panic disorder (often confused with heart attack)
Agoraphobia (feels judged)
Obsessive-compulsive disorder
Social anxiety disorder
Post-traumatic stress disorder
Simple phobia

52
Q

What are the three major classes of drugs used to treat anxiety?

A

Benxodiazepines (BDZs)
Buspirone
Antidepressants

53
Q

What do BDZs do?

A

Potentiating the actions of GABA at the GABA receptor
They are NOT GABA agonists (bind to a different site on receptor)
Cause increased binding of GABA to the receptor - lets chloride ions in - CNS depression

54
Q

BDZs are used to treat?

A 
Anxiety
Seizures
Insomnia
Alcohol withdrawal
Muscle spasm
55
Q

What are the adverse effects of BDZs?

A 
CNS depression
Anterograde amnesia (can't remember events before dosing)
Respiratory depression
Teratogenic
Tolerance
Withdrawal
56
Q

What is Buspirone and what does it do?

A

Treats anxiety
Mechanism is unclear - involves modulation of sertonin and/or dopaminergic neurotransmission
No tolerance or physical dependence
Con: effects are slow

57
Q

What are the adverse effects of buspirone?

A

Well-tolerated
May have:
dizziness, lightheadedness and excitement

does NOT cause CNS depression like BDZs

Pharm (8 decks)

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