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ESA 5 > CPT S11 - Neurological Disorders > Flashcards

CPT S11 - Neurological Disorders Flashcards

1
Q

What are the two types of seizure?

A

Partial (AKA focal)

Generalised

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2
Q

Describe a partial seizure

A

Can be defined as simple or complex, based on the level of consciousness
Can escalate to generalised

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3
Q

What is the pathological process of epilepsy?

A

Loss of excitatory:inhibitory homeostasis

Increased discharges in focal cortical area

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4
Q

What are the symptoms of partial seizures?

A 
Depends on the area affected
Can include;
-Involuntary motor disturbance
-Behavioural change
-"Aura"
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5
Q

Describe generalised seizures

A

Generated centrally and spread through both hemispheres
Loss of consciousness
Many types

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6
Q

What are the main sub-categories of generalised seizures?

A

Tonic-clonic (Grand mal)

Absence (Petit mal)

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7
Q

What is status epilepticus?

A

Prolonged seizure (>5 minutes) or a series of seizures without a recovery interval
Medical emergency
Can lead to death or brain damage
Can occur for any type of epilepsy

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8
Q

What are the dangers of epilepsy?

A 
Physical injury relating to a fall
Hypoxia
SUDEP
Brain damage/dysfunction
Cognitive impairment
Psychiatric disease
ADRs
Stigma
Loss of livelihood (lorry drivers etc)
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9
Q

What is the cause of epilepsy?

A 
Primary;
-No identifiable cause
Secondary;
-Medical conditions affecting the brain
-Vascular disease
-Tumours
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10
Q

What can precipitate seizures?

A

Sensory stimli (strobes)
Brain disease/trauma (stroke, drugs, alcohol)
Metabolic disturbances (hypo/hyperglycaemia)
Infections (infantile febrile convulsions)
Therapeutics

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11
Q

Give some therapeutic targets for epilepsy

A

Voltage-gated sodium channels

GABA-mediated inhibition

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12
Q

What is the mechanism of action of VGSC blockers in epilepsy?

A

Can only access binding site during depolarisation
Prolongs inactivation state
So help return rapid discharge rate to normal

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13
Q

Give some examples of VGSC blockers used in epilepsy

A

Carbamazepine
Phenytoin
Lamotrigine

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14
Q

Give some ADRs for carbamazepine

A 
CNS;
-Dizziness
-Drowsiness
-Ataxia
-Motor disturbance
-Numbness
-Tingling
GI;
-Upset
-Vomiting
CV;
-BP variation
Other;
-Rash
-Hyponatraemia
-Neutropenia (rare)
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15
Q

Give some DDIs for carbamazepine

A

CYP450 inducer so many many

Basically just check BNF because if they take anything at all it probably interferes

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16
Q

What types of epilepsy may be treated with carbamazepine?

A

Generalised tonic-clonic

Partial

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17
Q

Give some ADRs for phenytoin

A 
CNS;
-Dizziness
-Ataxia
-Headache
-Nystagmus
-Nervousness
Other;
-Gingival hyperplasia
-Rash
-Stevens Johnson hypersensitivity reaction
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18
Q

Give some DDIs for phenytoin

A

Another CYP inducer, though not of itself
Therefore many interactions
BNF this because so many

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19
Q

What is the most dangerous thing about phenytoin?

A

Has zero-order kinetics at therapeutic range

Must monitor free plasma concentration

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20
Q

What types of epilepsy may be treated with phenytoin?

A

Generalised tonic-clonic

Partial

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21
Q

Give some ADRs for lamotrigine

A 
Less than other VGSC blockers
CNS;
-Dizziness
-Ataxia
-Somnolence
Other;
-Rashes
NB - increased ADR profile in children
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22
Q

Give some DDIs for lamotrigine

A

Not a CYP inducer so fewer than other VGSC blockers
Oral contraceptives reduce LTG plasma concentration
Valproate increases LTG plasma concentration due to competitive binding

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23
Q

Give some examples of GABA enhancing drugs used in epilepsy

A

Sodium Valproate

Benzodiazepines

24
Q

What are the ways in which the actions of GABA may be enhanced?

A

Inhibition of GABA inactivation
Inhibition of GABA re-uptake
Stimulation of GABA synthesis

25
Give some ADRs for sodium valproate
``` Generally milder than other AEDs CNS; -Sedation -Ataxia -Tremor Hepatic; -Increased transaminases -Failure ```
26
Give some DDIs for valproate
Again, check BNF Many drugs antagonise its effects esp the psychoactive ones Crazy shenanigans can occur when combined with other AEDs
27
What types of epilepsy may be treated with valproate?
Partial | Generalised (both tonic-clonic and absence)
28
Give some ADRs for benzodiazepines
``` CNS; -Sedation -Confusion -Impaired coordination -Aggression -Tolerance -Withdrawal seizures Other; -Respiratory depression -CNS depression ```
29
Give some DDIs for benzodiazepines in epilepsy
Very few | May even be used as an adjunct
30
What types of epilepsy may benzodiazepines be used to treat?
Lorazepam and diazepam are used in status epilepticus | Clonazepam may be used for absence seizures in the short term
31
What are the basic rules of prescribing AEDs?
Aim for monotherapy ITU sedation is an option in status Must keep patients under review Always check the BNF
32
Are AEDs safe in pregnancy?
No | Must balance risk of teratogenicity and status epilepticus
33
What needs to be done if a patient is in status epilepticus?
``` ABC Exclude hypoglycaemia Give lorazepam IV if possible Give PR if not possible Can give phenytoin IV if unsuccessful If still unsuccessful, send to ITU, ventilate, sedate and paralyse ```
34
What are the motor features of parkinsons?
Tremor Rigidity Bradykinesia Postural instability
35
What are some non-motor symptoms of parkinsons?
``` Mood changes Pain Cognitive change Urinary symptoms Sleep disorder Sweating ```
36
What are causes or parkinsonism?
``` Parkinsons Disease Drug-induced parkinsonism Vascular parkinsonism Progressive supranuclear palsy Multiple systems atrophy Corticobasal degeneration ```
37
How is PD differentiated from other causes of parkinsonisms?
Response to treatment Structural neuroimaging normal Functional neuroimaging
38
Describe the pathology of PD
Loss of dopaminergic neurones in the substantia nigra results in reduced inhibition in neostriatum Reduced inhibition allows increased ACh production Chain of abnormal signalling leads to impaired mobility
39
What are the types of treatment in PD?
Symptomatic relief; - Movement disorders - Non-motor features - Neuroprotection - Surgery
40
What drug classes are used in PD?
``` L-DOPA Dopamine receptor antagonisrs MAOI type B inhibitors COMT inhibitors Anticholinergics Amantidine ```
41
What are the ADRs of L-DOPA?
Nausea/anorexia (interferes with vomiting centres) Hypotension (central and peripheral interference) Psychosis (schizophrenia-like) Tachycardia
42
What are the benefits of L-DOPA?
Highly efficacious | Low side-effect profile if taken with a peripheral DOPA-decarboxylase inhibitor eg co-careldopa
43
What are the disadvantages of L-DOPA?
``` It's a precursor so requires enzyme conversion Long term loss of efficacy as destruction of dopaminergic neurones continues Causes involuntary movement Motor complications including; -On/off function between doses -Dystonia -Dyskinesia -Freezing ```
44
Give some examples of dopamine receptor antagonists
``` Ergot; -Pergolide -Bromocryptine Non-ergot; -Ropinirole -Pramipexole ```
45
Give some dopamine receptor agonist advantages
Direct acting Fewer dyskinesias and motor complications Possible neuroprotection
46
Give some disadvantages of dopamine receptor agonists
Less efficacious than L-DOPA Impulse control disorders More psychiatric ADRs (these are dose-limiting) Expensive
47
What are impulse control disorders?
``` Also called dopamine dysregulation syndrome Pathological gambling Hypersexuality Compulsive shopping Desire to increase dosage ```
48
Give some dopamine receptor agonist ADRs
``` Sedation Hallucinations Confusion Nausea Hypotension ```
49
What is the action and mechanism of Catechol-O-methyl Transferase (COMT) Inhibitors in PD treatment?
Reduces the peripheral breakdown of L-DOPA to 3-O-methyldopa and so enhances the actions of L-DOPA within the CNS
50
What is the action of MAO B Inhibitors in PD?
MAO B metabolises dopamine | Inhibition potentiates it
51
What is the role of anticholinergics in the treatment of PD?
Minor Treats tremor No effect on bradykinesia Significant side effects
52
What is the role of Amantidine in the treatment of PD?
Poorly effective Uncertain mechanism Few side effects
53
What are the main symptoms of myasthenia gravis?
``` Fluctuation Fatiguable Weakness Commonly; -Extraoccular muscles -Bulbar involvement -Limb weakness -Respiratory muscle involvement ```
54
Give examples of drugs which can exacerbate myasthenia gravis
Aminoglycosides Beta blockers ACEi Basically anything affecting neuromuscular transmission
55
What are the complications of myasthenia gravis?
``` Acute exacerbation (myasthenic crisis) Overtreatment (cholinergic crisis) ```

ESA 5 (17 decks)

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