Central Nervous System + Anaesthesia

Question 1

Dopaminergics

Basal Ganglia Disorders

Answer 1

Levodopa (precursor); Pramipexole, Ropinirole, Rotigotine (synthetic agonists)

MoA:
Increased dopamine synthesis and dopaminergic function

Indication:
Parkinson’s Disease

Adverse Effects/Interactions:
Confusion, agitation (MAOI)

Question 2

Dopa-decarboxylase inhibitor

Basal Ganglia Disorders

Answer 2

Carbidopa, Benserazide

MoA:
Stops breakdown of Levodopa in the periphery by inhibiting dopa-decarboxylase

Indication:
Parkinson’s Disease

Adverse Effects/Interactions:
Confusion, agitation

Question 3

Inhibitors of Monoamine Oxidase B (MAOI)

Basal Ganglia Disorders

Answer 3

Selegiline, Rasagaline

MoA:
Inhibition of dopamine breakdown

Indication:
Parkinson’s Disease

Adverse Effects/Interactions:

Question 4

Inhibitor of COMT (catechol-O-methyl transferase)

Basal Ganglia Disorders

Answer 4

Entacapone, Tolcapone

MoA:
Blockade of dopamine precursor breakdown by inhibition of COMT

Indication:
Parkinson’s Disease

Adverse Effects/Interactions:
Nausea, vomiting

Question 5

Anticholinergics

Basal Ganglia Disorders

Answer 5

Orphenadrine, Procyclidine, Trihexphenidyl

MoA:
Muscarinic cholinergic receptor antagonist

Indication:
Parkinson’s Disease, muscle rigidity, side effects of anti-psychotics

Adverse Effects/Interactions:
Dry mouth, constipation

Question 6

Dopamine-depleting drugs

Basal Ganglia Disorders

Answer 6

Tetrabenazine

MoA:
Blocks VMAT, preventing uptake of DA into vesicles

Indication:
Huntington’s Chorea

Adverse Effects/Interactions:

Question 7

Selective serotonin reuptake inhibitors (SSRIs)

Drugs for mental health treatment including dementia

Answer 7

Sertraline, Citalopram, Fluoxetine

MoA:
Inhibition of serotonin (5HT) reuptake pump in synaptic cleft

Indication:
Depression, generalised anxiety disorder

Adverse Effects/Interactions:
Insomnia, nausea
NSAIDs, lithium

Question 8

Reversible Inhibitor of Monoamine Oxidase type A (RIMA)

Drugs for mental health treatment including dementia

Answer 8

Moclobemide

MoA:
Inhibits monoamine oxidise A, preferentially decreases breakdown of serotonin and noradrenaline

Indication:
Depression

Adverse Effects/Interactions:
Tachycardia

Question 9

Tricyclic antidepressants (TCAs)

Drugs for mental health treatment including dementia

Answer 9

Amitriptyline, Nortriptyline, Dosulepin

MoA:
Inhibition of noradrenaline and serotonin reuptake in synaptic cleft, H1 antagonist, M1 antagonist, Adrenergic antagonist

Indication:
Depression

Adverse Effects/Interactions:
Anticholinergic syndrome

Question 10

Atypical antidepressants

Drugs for mental health treatment including dementia

Answer 10

Roboxetine, Venlafaxine, Bupropion, Agomelatine, Mirtazapine

MoA:
Noradrenaline reuptake inhibitor (Reboxetine); Noradrenaline/serotonin reuptake inhibitor (Venlafaxine); Noradrenaline /Dopamine reuptake inhibitor (Buproprion); Melatonin agonist (Agomelatine); Alpha-2 antagonist (Mirtazepine)

Indication:
Depression

Adverse Effects/Interactions:

Question 11

Antipsychotics - Classical (First Generation)

Drugs for mental health treatment including dementia

Answer 11

Chlorpromazine, Haloperidol

MoA:
Selective D2 dopamine receptor blockade

Indication:
Schizophrenia

Adverse Effects/Interactions:
Blurred vision, tremor,
Extrapyramidal symptoms, hypotension

Question 12

Antipsychotics - Atypical (Second Generation)

Drugs for mental health treatment including dementia

Answer 12

Olanzapine, Risperidone, Quetiapine, Clozapine, Amisulpride

MoA:
Selective D2 dopamine and 5-HT receptor blockade

Indication:
Schizophrenia

Adverse Effects/Interactions:
Extrapyramidal symptoms (less than classical antipsychotics), hypotension

Question 13

Mood stabiliser

Drugs for mental health treatment including dementia

Answer 13

Lithium carbonate

MoA:
Unclear – possible neuronal calcium channel blockade

Indication:
Bipolar disorder

Adverse Effects/Interactions:
Tremor, hypothyroidism
NSAIDs, ACE inhibitors

Question 14

Cholinesterase inhibitors

Drugs for mental health treatment including dementia

Answer 14

Donepezil, Galantamine, Rivastigmine

MoA:
Inhibition of acetylcholinesterase (reversible)

Indication:
Alzheimer’s Disease, mild to moderate dementia

Adverse Effects/Interactions:
Nausea, vomiting

Question 15

NMDA receptor antagonist

Drugs for mental health treatment including dementia

Answer 15

Memantine

MoA:
VD blocker of NMDA receptors

Indication:
Alzheimer’s Disease, moderate to severe dementia

Adverse Effects/Interactions:
Constipation, hypertension

Question 16

Anxiolytics

Drugs for mental health treatment including dementia

Answer 16

Benzodiazepines (see below), Buspirone

MoA:
GABA PAM (γ-subunit); 5-HT1A partial agonist (Buspirone)

Indication:
Anxiety and related disorders

Adverse Effects/Interactions:

Question 17

Non-benzodiazepine Hypnotic

Drugs for mental health treatment including dementia

Answer 17

Zopiclone

MoA:
GABA PAM (γ-subunit)
Enhanced effects of GABA

Indication:
Insomnia

Adverse Effects/Interactions:

Question 18

Anti-Epilepsy Drugs (AEDs)

Drugs used to treat epilepsy

Answer 18

Sodium Valproate, Lamotrigine, Carbemezapine, Ethosuximide

MoA:
Na+ channel blockers;
(Ethosuximide – Ca2+ channel blocker)

Indication:
Epilepsy

Adverse Effects/Interactions:
Nausea, blurred vision
Macrolide antibiotics

Question 19

Benzodiazepines (BDZs)

Drugs used to treat epilepsy

Answer 19

Lorazepam, Midazolam, Diazepam, Zolpidem (BDZ-like)

MoA:
GABA PAM (γ-subunit)
Enhanced effects of GABA

Indication:
Epilepsy, Acute seizures

Adverse Effects/Interactions:
Drowsiness, dependence
Sedatives

Question 20

BDZ Antagonist

Drugs used to treat epilepsy

Answer 20

Flumazenil

MoA:
Antagonises GABA signalling

Indication:
Reversal of BDZ sedation

Adverse Effects/Interactions:

Question 21

Barbiturates

Drugs used to treat epilepsy

Answer 21

Phenobarbitone, Pentobarbitone, Primidone

MoA:
GABA PAM (β-subunit)
Enhanced effects of GABA

Indication:
Epilepsy, Acute seizures

Adverse Effects/Interactions:
Drowsiness, fainting
Sedatives, anti-coagulants

Question 22

Weak analgesic/antipyretic

Analgesics

Answer 22

Paracetamol

MoA:
Unclear – possible COX inhibitor in CNS

Indication:
Mild-moderate pain, pyrexia

Adverse Effects/Interactions:
Constipation
Warfarin

Question 23

Non-steroidal anti-inflammatory drugs (NSAIDs)

Analgesics

Answer 23

Ibuprofen, Diclofenac, Naproxen

MoA:
Non-selective COX inhibitors, blockade of prostaglandin synthesis

Indication:
Mild-moderate pain, inflammation

Adverse Effects/Interactions:
GI disturbance, hypertension, Aspirin not suitable for under 16s
Diuretics, ACE inhibitors,

Question 24

COX2-selective NSAIDs

Analgesics

Answer 24

Etoricoxib, Celecoxib

MoA:

COX-2 inhibition, localised prostaglandin blockade

Indication:
Pain, inflammation

Adverse Effects/Interactions:
Indigestion
ACE inhibitors, SSRIs

Question 25

Weak opioid analgesics | Analgesics

Answer 25

Codeine, Dihydrocodeine MoA: Stimulation of analgesic opioid receptors Indication: Mild-moderate pain Adverse Effects/Interactions: Constipation, nausea Sedatives

Question 26

Strong opioid analgesics | Analgesics

Answer 26

Morphine, Diamorphine, Pethidine, Fentanyl MoA: Stimulation of analgesic opioid receptors Indication: Severe pain Adverse Effects/Interactions: Constipation, nausea Sedatives

Question 27

Partial/mixed agonist opioid analgesics | Analgesics

Answer 27

Buprenorphine, pentazocine MoA: Modulation of analgesic opioid receptors (µ and k) Indication: Moderate to severe pain Adverse Effects/Interactions: Constipation, nausea Sedatives

Question 28

Opioid antagonist | Analgesics

Answer 28

Naloxone, Naltrexone MoA: Opioid receptor antagonist Indication: Opiate overdose, respiratory depression Adverse Effects/Interactions: Nausea, tachycardia

Question 29

Opioid addiction management | Analgesics

Answer 29

Methadone, Buprenorphine MoA: Narcotic opioid replacement; opioid receptor agonist/modulator Indication: Opiate addiction Adverse Effects/Interactions: Constipation Sedatives

Question 30

Drugs for neuropathic pain | Analgesics

Answer 30

Gabapentin, Pregabalin, Amitriptyline, ``` MoA: VDCC antagonist (gabapentin, pregabalin)/ TCA (amitriptyline) ``` Indication: Neuropathic pain Adverse Effects/Interactions: Dizziness, fatigue Antidepressants

Question 31

Inhaled analgesics | Analgesics

Answer 31

Nitrous oxide + oxygen mixture (“Gas & Air”) Entonox MoA: Unclear Indication: Analgesia during childbirth Adverse Effects/Interactions: Decreased vitamin B12 synthesis

Question 32

General anaesthetic | Anaesthesia

Answer 32

Propofol, isoflurane, sevoflurane; Ketamine MoA: Unclear - possible enhancement of GABA function (Propofol, isoflurane, sevoflurane) NMDA receptor blockade (ketamine) Indication: Induction of anaesthesia throughout major surgery Adverse Effects/Interaction: Hypotension

Question 33

Local anaesthetic | Anaesthesia

Answer 33

Lidocaine, Bupivacaine, Levobupivacaine MoA: Voltage-gated sodium channel blockade Indication: Local anaesthesia Adverse Effects/Interaction: Rash

Question 34

Neuromuscular blockers | Anaesthesia

Answer 34

Atracurium besilate, Vecuronium (non-depolarising) Suxamethonium (depolarising) MoA: Competitive antagonist at AChR Initially depolarisation and desensitisation of AChR Indication: Tracheal intubation and mechanical ventilation during surgery Adverse Effects/Interaction: Hypotension, skin flushing

Question 35

Drugs for reversing neuromuscular block | Anaesthesia

Answer 35

Sugammadex; Neostigmine MoA: Oligosaccharide that forms a complex with NMBs removing them from NMJ (Sugammadex) Peripheral acetylcholinesterase inhibitor Indication: Immediate reversal of NMB to reduce post-operative pulmonary complications (sugammadex) (Neostigmine also used for myasthenia gravis) Adverse Effects/Interaction:

Question 36

Muscle relaxants & sedatives | Anaesthesia

Answer 36

Temazepam (BDZ), Zolpidem, Dexmedetomidine (alpha-2 agonist) Alfentanil, Fentanil, Remifentanil (opioids) MoA: See BDZs Alpha-2 agonists inhibit sympathetic activity See Opioids Indication: Maintain sedation and relaxed muscle tone Adverse Effects/Interaction: Bradycardia (alpha-2 agonist)

Question 37

H1-receptor antagonist | Anti-emetics

Answer 37

Cyclizine MoA: Histamine H1 receptor blockade Indication: Nausea, vomiting Adverse Effects/Interactions: Dry mouth, sedation Sedatives

Question 38

D2-receptor antagonist | Anti-emetics

Answer 38

Domperidone MoA: Dopamine D2 receptor blockade in the Chemoreceptor Trigger Zone Indication: Nausea, vomiting Adverse Effects/Interactions: Cardiac disease