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2060 Pharmacology > Module 14B CNS > Flashcards

Module 14B CNS Flashcards

(78 cards)

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1
Q

Epilepsy

A
  • Neurological disorder
  • Brief disturbances in brain electrical activity
  • Sudden brief seizure
  • Varying intensities
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2
Q

Seizure

A
  • Alteration of behaviour
  • Caused by CNS dysfunction
  • Sudden & transient
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3
Q

Epileptic Seizure

A
  • Caused by primary CNS dysfunction
  • Excess depolarization
  • Hypersynchronization of neurons
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4
Q

Non-Epileptic Seizure

A
  • Seizure like episode
  • Not caused by abnormal electrical brain activity
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5
Q

Status Epilepticus

A
  • Unremitting epileptic seizure
  • Duration longer than 30 mins
  • Frequent seizures without recovery/awareness
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6
Q

Focal/Partial Seizures

A
  • Occur in 1 area of brain
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7
Q

Simple Partial Seizure

A
  • No loss of consciousness
  • Symptoms dependent on area of seizure activity
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8
Q

Complex Partial Seizure

A
  • Involves loss of consciousness
  • Awake but not aware of surroundings
  • Symptoms dependent on area of seizure activity
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9
Q

Generalized Seizure

A
  • Bilateral diffuse onset, arise from all brain areas
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10
Q

Types of Generalized Seizures

A
  • Absence
  • Tonic/clonic
  • Myoclonic
  • Tonic
  • Atonic
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11
Q

Absence Seizures

A
  • Loss of consciousness
  • Behavioural arrest/staring
  • Brief, occur in clusters (multiple per day)
  • No association with automatisms
  • Common in childhood
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12
Q

Tonic/Clonic Seizures

A
  • Abrupt loss of consciousness
  • Tonic period of 1 min (rigid muscles)
  • Clonic period of 2-3 mins (involuntary muscle contraction)
  • Incontinent state/tongue biting
  • Drowsy/confused/headache post seizure
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13
Q

Myoclonic Seizures

A
  • Sudden, brief muscle contraction (any muscle group)
  • No loss of consciousness
  • Associated with later development of tonic/clonic seizure
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14
Q

Tonic Seizures

A
  • Sudden muscle rigidity
  • Consciousness impairment
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15
Q

Atonic Seizures

A
  • Sudden loss of muscle tone
  • Duration 15 secs
  • Drop to ground (fall injury risk)
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16
Q

Secondary Generalized Seizures

A
  • Begins in 1 are of brain and spreads
  • Focal phase (primary) referred to as ‘aura’
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17
Q

Frontal Lobe

A
  • Simple repetitive motor movements (primary motor cortex)
  • Tonic posturing (supplemental motor structures)
  • Behavioural automatisms with bilateral movement
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18
Q

Parietal Lobe

A
  • Localized paresthesia (somatosensory cortex)
  • Complex/widespread paresthesia (somatosensory association cortex)
  • Multisensory hallucinations (high order sensory association areas)
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19
Q

Occipital Lobe

A
  • Visual hallucinations
  • Temporary blindness
  • Reflex nystagmus (involuntary eye movement)
  • Simple seizures mistaken for migraines (similar symptoms)
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20
Q

Temporal Lobe

A
  • Emotions & psychic symptoms
  • Auditory, olfactory, gustatory hallucinations
  • Visual distortions
  • Paresthesia (numbness)
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21
Q

Epileptogenesis Classes

A
  • Symptomatic (identified physical cause)
  • Idiopathic (no identified cause)
  • Cryptogenic (underlying cause likely but not identified)
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22
Q

Seizure Threshold

A
  • Balance between excitable/inhibitory forces in brain
  • Susceptibility to having a seizure
  • Threshold must be reached & AP fired to generate seizure
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23
Q

Affecting Factors of Seizure Threshold

A
  • Stroke
  • Head injury
  • Drug/alcohol withdrawal
  • Infection
  • Tumour
  • Severe fever
  • Visual stimuli
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24
Q

Actions of AntiEpileptic Drugs (AED)

A
  • Blocking sodium channels
  • Blocking voltage-dependent calcium channels
  • Glutamate antagonists
  • Potentiating actions of GABA
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25
Sodium Channel Blocking
- Prolong inactivation state of Na+ channel - Neurons fire at low frequency
26
Phenytoin
- Most common AED - Blocks sodium channels - Treatment for all seizure types (excludes absence) - Non-linear kinetics (limited liver metabolism) - Narrow therapeutic range (monitoring) - Teratogenic
27
Adverse Effects of Phenytoin
- Sedation - Gingival hyperplasia - Skin rash
28
Blocking Voltage-Dependent Calcium Channels
- Inhibition of Ca++ channels - Suppress neurotransmitter release
29
Glutamate Antagonists
- Decreases CNS excitation - Treatment target AED's - Binds to NMDA/AMPA receptor acts as block
30
GABA Receptor
- Inhibitory CNS neurotransmitter - Binding to receptor causes Cl- ions into cell - More difficult to reach threshold
31
Potentiating Actions of GABA
- Increase inhibitory stimuli - Suppress seizure activity
32
Types of GABA Potentiating Actions
- Enhancing GABA binding to receptor - Stimulating GABA release - Inhibiting GABA reuptake - Inhibiting GABA metabolism
33
AntiEpileptic Drugs
- Classified as traditional or newer - Effects similar between classes - Newer have decrease side effects - Decrerased induction of hepatic metabolizing enzymes
34
Depression Diagnosis
- 5+ of following symptoms present - Depressed mood most of day, everyday - Loss of interest/pleasure - Weight gain/loss - Insomnia/hypersomnia - Psychomotor agitation/retardation - Fatigue/energy loss - Worthlessness - Excessive guilt - Death/suicidal thoughts - Decreased ability to think, concentrate
35
Exogenous Depression
- Prolonged grieving & excessive guilt (pathological) - Prolonged depression following failure/rejection (adjustment)
36
Endogenous Depression
- Major depression - Severe depression - Atypical depression - Dysthymia - Seasonal affective disorder (SAD) - Postpartum depression - Bipolar
37
Major Depression
- Loss of interest - Lack of response to positive stimuli - Insomnia - Weight loss - Worse in AM
38
Severe Depression
- Similar to major - In addition, suicidal ideation & psychoses
39
Atypical Depression
- Similar to major - Hypersomnia & hyperphagia - Obesity
40
Dysthymia
- Mood regularly low (less severe than major) - Noticeable to those close to patient - Response psychotherapy over drugs
41
Seasonal Affective Disorder (SAD)
- Mild or moderate depression symptoms - Associated with lack of sunlight (winter months)
42
Postpartum Depression
- Moderate to severe depression after giving birth - 3 months-1 year after birth
43
Bipolar Disorder
- Alternating periods of elevated/irritable mood - Periods of depression
44
Monoaime Hypothesis
- Altered monoxime release - Receptor sensitivity - Post-synaptic function - Lead to depression symptoms
45
Antidepressants
- Increase synaptic levels of monoamine neurotransmitters - Inhibiting monoamine reuptake or metabolism
46
Antidepressant Classes
- Tricyclic antidepressants - Selective serotonin reuptake inhibitors (SSRI) - Selective serotonin/norepinephrine reuptake inhibitors (SNRI) Monoamine oxidase inhibitors (MAOI)
47
Tricyclic Antidepressants
- Inhibit reuptake of serotonin & norepinephrine - Effective treatment of major depression - Chemical structure has three rings
48
Adverse Effects of Tricyclic Antidepressants
- Anticholinergic effects - Sedation - Orthostatic hypotension - Decreased seizure threshold - Cardiac toxicity - Weight gain - Sexual dysfunction
49
Selective Serotonin Reuptake Inhibitors (SSRI)
- Similar efficacy to TCAs - Block only serotonin reuptake - Less side effects than TCAs - Common major depression treatment
50
Adverse Effects of SSRIs
- Weight gain - Sexual dysfunction - Insomnia - Serotonin syndrome (agitation, confusion, anxiety, hallucinations)
51
Selective Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)
- Block reuptake of serotonin & norepinephrine - Effective treatment of major depression - Faster onset of action - Mechanism of action similar to TCA's
52
Adverse Effects of SNRIs
- Nausea - Diastolic hypertension - Sexual dysfunction
53
Monoamine Oxidase Inhibitors (MAOI)
- Inactivates monoamine neurotransmitters A&B - MAO-A metabolizes serotonin & norepinephrine - MOA-B metabolizes dopamine - Treatment of atypical & dysthymia Inhibiting monoamine metabolism is pre-synaptic neuron
54
Adverse Effects of MAOIs
- CNS excitation - Orthostatic hypotension - Hypertensive crisis (combined with tyramine foods)
55
Manic Phase Symptoms
- Irritation - Inflated self-esteem - Little need for sleep - Poor control of temper - Reckless behaviour - Easily distracted
56
Bipolar Drug Treatment
- Mood stabilizers - Antipsychotics - Antidepressants
57
Mood Stabilizers
- Relieve symptoms during manic/depressive episodes - Prevent recurrence of episodes - Doesn't worsen or alter rate of episodes Lithium & valproic acid
58
Lithium Usage
- Alters uptake/release of glutamate - Blocks serotonin binding - Narrow therapeutic range - Plasma conc altered by Na+ - Na+ loss increase lithium conc
59
Antipsychotics
- Control symptoms during manic episodes - Stabilize mood (long term) - Lower risk of extrapyramidal symptoms
60
Antidepressants
Antidepressants - Treatment of depressive episode - Combined with mood stabilizer
61
Anxiety
- Normal physiological response to stress - Symptoms create functional impairment on daily living - Linked closely with depression
62
Anxiety Types
- General anxiety disorder - Panic disorder - Agoraphobia - Obsessive-compulsive disorder (OCD) - Social anxiety disorder - Post-traumatic stress disorder (PTSD) - Simple phobia
63
General Anxiety Disorder
- Overwhelmed with uncontrollable worrying - Unrealistic/excessive worry - Last 6+ months
64
Panic Disorder
- Sense of impending doom unrelated to stressors - Panic attacks (SOB, chest pain, dizziness) - Confused with heart attack
65
Agoraphobia
- Feeling judged - Situational escaping feels difficult/embarrassing
66
Obsessive Compulsive Disorder (OCD)
- Obsession/compulsion - Interfere with daily life
67
PTSD
- Anxiety occurring after traumatic event - Re-experiencing event - Insomnia
68
Simple Phobia
- Related to specific fear
69
Anxiety Drug Treatment
- Benzodiazepines (BDZ) - Buspirone - Antidepressants
70
Benzodiazepines (BDZ)
- First line therapy for anxiety - Potentiating actions of GABA & GABA receptor - Increased binding of GABA to receptor - Cl- moves into cell - CNS depression
71
Benzodiazepine Uses
- Anxiety (generalized & social) - Seizures - Insomnia (higher dose) - Alcohol withdrawal - Muscle spasm
72
Adverse Effects of Benzodiazepines
- CNS depression (drowsiness, concentration difficulty) - Anterograde amnesia (impaired memory following dosing) - Respiratory depression (combined with alcohol) - Teratogenic - Tolerance - Withdrawal
73
Buspirone
- Modulation of serotonergic/dopaminergic neurotransmission - Treatment of generalized anxiety - No signs of tolerance/physical dependence - Anxiolytic effects develop slowly - Well tolerated
74
Generalized Anxiety Treatment
- SSRI & SNRI - Buspirone - Slow to generate effect
75
Panic/Agoraphobia Treatment
- SSRI, TCA, MAO inhibitor - 6-12 weeks to take effect - SSRIs tolerated best
76
OCD Treatment
- SSRIs - Behavioral therapy
77
Social Anxiety Treatment
- SSRIs long term - BDZs immediate relief
78
PTSD Treatment
- No evidence of effective drug treatment - Therapy

2060 Pharmacology (18 decks)

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