Neurology Flashcards
Carbamazepine
Anticonvulsant- blocks voltage gated and use dependent sodium channels preventing repetitive neuronal discharges
I- Epilepsy (inc simple and complex focal and generalised seizures), trigeminal and glossopharyngeal neuraglias, bipolar disorder
D- 400mg-1.2g daily in 2 or more doses (max 2g)
M- changes in mood behaviour, FBC (agranulocytosis), concentration monitoring (clinical control is more important, but can be used to assess compliance), BMD, blood vit D and calcium, sedation, hypersensitivity and skin reactions (SJS, TEN, DRESS, HSS), LFTs (avoid in hepatic impairment), contraception for women (IUD, hormonal methods may be ineffective due to CYP3A4 induction), serum sodium (hyponatreamia)
AE- drowsiness, dizziness, blurred vision, diplopia, headache, GI upset, drug induced rash
C- Take with food, AE reduce with use once tolerance develops, CAL 12- drowsiness/dizziness and increase effects of alcohol, CAL 9- dont stop abruptly, CAL-18 grapefruit juice, see dr asap for severe rash fever lmphadenopathy mouth ulcers severe sore throat or bruising, ask dr or pharm before starting any new medications
CAL- 5, 9, 12, 13, 18, 21, B (A for CR)
Gabapentin
Antiepileptic/ adjudicative analgesic- unknown mechanism binds alpha2 delta subunit of high threshold voltage gated Ca channels, reduce Ca influx and NT release
I- focal seizures (with or without secodary generalised seizures) when not controlled by other antiepieptics, adjunct in neuropathic pain
D- focal seizure 0.9-1.8g daily in 3 doses (up to 3.6g/d), Neuropathic pain 1.8-3.6g/d in 3 doses
M- pain management, seizure control, BMI
AE- fatigue, dizziness, ataxia, tremor, diplopia, hypertension, dry mouth, weight gain
C- drowsiness dizziness and increase effects of alcohol if affected dont drive, CAL9 dont stop abruptly, pain- can take 2-4 weeks for effect
CAL-1, 9, 12
Lamotrigine
Antiepileptic/mood stabilizer- blocks use dependent and voltage gated sodium channels and inhibits Glu release
I- focal and generalised seizures (adjunct or monotherapy), bipolar (prevention of depressive episode)
D- monotherapy or with valproate 100-200mg/d in 1 or 2 doses (with enzyme inducer 200-400mg d in 2 doses max 700mg)
M- changes in mood/behaviour, epilepsy or bipolar control, steven johnsons syndrome, serum lamotrigine concentration
AE- blurred vision, headaches, dizziness, N (these usually decrease with use)
C- tablets can be swallowed whole, chewed or dispersed in a small volume of water, CAL 1- drowsiness dizziness and increase effects of alcohol, CAL 9- dont stop abruptly, see dr asap for rash fever or swollen glands
CAL- 1, 9, 21
Phenytoin
Antiepileptic- blocks use dependent and sodium gated ion channels
I- Epilepsy simple and complex focal seizures and generalised seizures
D- 200-500mg/d in 1 or 2 doses. Status epilipticus- 15-20mg/kg IV (additional dose 5mg/kg can be given at 12 hours)
M- TDM (important to consider free phenytoin conc), changes in mood behaviour, FBC, bone density (IV- BP, ECG and resp function)
AE- NV, constipation, dizziness, headache, insomnia, gum enlargement
C- many DDIs ask HCP before taking anything, see dr asap for fever rash sore throat bruising bleeding joint pain jaundice, drowsiness dizziness and increase effects of alcohol- dont drive if affected, see dentist regularly to prevent gum enlargement, CAL 9- dont stop abruptly, consider calcium and vit D supplementation
CAL- 5, 9, 12, 13, 21 (A for CR)
Pregabalin
Antiepileptic/ adjudicative analgesic- unknown mechanism binds alpha2 delta subunit of high threshold voltage gated Ca channels, reduce Ca influx and NT release
I- Neuropathic pain, epilepsy- focal seizures with or without secondary generalisation (adjunctive)
D- 75-300mg bd (start at 75mg/d (25mg in elderly) and titrate up)
M- renal function, changes in mood/behaviour, BMI
AE- dizziness, drowsiness, confusion, visual disturbance, ataxia, lethargy, weight gain, dry mouth, constipation
C- CAL 1- drowsiness dizziness and increase effect of alcohol, CAL 9- dont stop abruptly, can take severe weeks for pain relief
CAL-1, 9, 12
Valproate
Antiepileptic- blocks sodium use dependent and voltage gated ion channels, enhance GABA, inhibit Glu and blocks t-type Ca channels
I- epilepsy all seizure types, bipolar disorder, migraine prophylaxis were other treatments have failed, status epilipticus
D- 1-2g/d in 2 doses (max 2.5mg/d)
M- changes in mood/behaviour, TDM (for compliance and toxicity but poor relationship with clinical effect), BMI
AE- drowsiness, DNV, abdo pain
C- swallow whole with food, do not crush or chew, see dr asap for severe abdo pain vomiting loss of appetite jaundice weakness lack of energy bruising bleeding, drowsiness dizziness and increase effect of alcohol, can increase appetite pay attention to diet, CAL 9 dont stop abruptly
CAL- 9, 10a, 12, 13, 21, B (A for CR)
Donepezil
Anticholinesterase- decrease ACh breakdown filling ACh deficiency in alzheimers
I- alzheimers disease
D- 5-10mg od
M- cholinergic AE, blood pressure, cognitive decline
AE- VND, weight loss, fatigue, muscle cramps, urinary incontinenace, tremor
C- take at same time each day (preferably at bed time unless it causes insomnia or vivid dreams), dizziness drowsiness and increase effects of alcohol- caution with driving
CAL- 12, 16
Levodopa (with carbidopa/benserazide/entacapone)
Dopamine precursor + decarboxylase inhibitor- converted to active dopamine in brain and periphery (decarboxylase inhibitor prevents peripheral metabolism which decrease AE)
I- parkinsons disease
D- 300-800mg/d in 2 or more doses (max 2g/d)
Stalevo 200/50/200mg- max 7 tablets daily, max 10 tablets/day for other strengths
M- impulse control disorders, melanoma, dose efficacy (long term use is associated with end of dose failure), angle closure glaucoma (can be rarely precipitated), PUD CVD arrythmia and psychiatric disorders (risk of precipitation), use of dopamine antagonists (metoclopramide, antipsychotics, prochorperazine0 worsen parkinsons), BP (orthostatic hypotension), dopamine dysregulation syndrome (dyskinesia, psychiatric effects),
C- take at same time each day, empty stomach gives best absorption but food reduces GI AE (may require empty stomach at end stage with dose failure), drowsiness- dont drive if affected, see dr for episodes of sudden onset sleep or stiffness, get up slowly from sitting or lying and sit down if you feel dizzy from standing to quickly, dont stop taking unless doctor advice CR swallow whole do not crush or chew, AE- NV++, constipation, muscle cramps, insomnia, palpitations
CAL- 4a (delete dairy products), 9, 16, (A for MR)
