NERVOUS SYSTEM Flashcards

Question

What triggers the release of neurotransmitters in neurons?

Answer 1

Trigger ## Footnote Triggers are often action potentials or changes in membrane potential.

Answer 2

transmitter ## Footnote Transmitters are chemical messengers that carry signals across synapses.

Answer 3

Action potential ## Footnote Action potentials are essential for neuronal communication.

Answer 4

overshoot ## Footnote This is the phase where the membrane potential becomes positive.

Answer 5

AHP ## Footnote AHP occurs following the action potential and results in a temporary increase in negativity.

Answer 6

Rising phase ## Footnote This phase is crucial for the depolarization of the neuron.

Answer 7

33% Na+ ## Footnote This percentage indicates the contribution of sodium ions during depolarization.

Answer 8

~ -70 mV ## Footnote This value represents the stable state of a neuron when it is not transmitting signals.

Answer 9

open ## Footnote Open Na+ channels allow for the influx of sodium ions, leading to depolarization.

Answer 10

Inside: 12 mM, Outside: 120 mM ## Footnote This gradient is essential for the movement of Na+ during action potentials.

Answer 11

concentration gradient + electrical gradient ## Footnote Both gradients contribute to the net movement of sodium ions during depolarization.

Answer 12

Synaptic transmission: EPSPs ## Footnote Excitatory postsynaptic potentials are crucial for neuronal activation.

Answer 13

regenerative depolarisation ## Footnote This leads to a rapid increase in membrane potential.

Answer 14

repolarisation ## Footnote Repolarization is necessary to prepare the neuron for the next action potential.

Answer 15

Neurone cannot be re-stimulated ## Footnote During this period, Na+ channels are inactivated and cannot reopen.

Answer 16

Greater stimulation required to trigger action potential ## Footnote Some Na+ channels may be inactive, but K+ channels remain active.

Answer 17

~ -70 mV ## Footnote This is the baseline electrical state of a neuron at rest.

Answer 18

Hyperpolarising ## Footnote Hyperpolarization occurs when K+ ions flow out of the neuron.

Answer 19

Depolarising ## Footnote Depolarization is crucial for the generation of action potentials.

Answer 20

A neural pathway that controls a reflex action ## Footnote Reflex arcs involve sensory neurons, interneurons, and motor neurons.

Answer 21

Auto-immune disease ## Footnote Conditions like Multiple Sclerosis can lead to demyelination.

Answer 22

Activated by changes in voltage (depolarisation) ## Footnote These channels are crucial for the propagation of action potentials.

Answer 23

Nerves that extend from the brain and spinal cord, including spinal nerves (31 pairs) and cranial nerves (12 pairs) ## Footnote The PNS is considered separate in structure and function from the CNS.

Answer 24

Sensory (afferent) division and Motor (efferent) division ## Footnote The sensory division conveys impulses to the CNS, while the motor division transmits impulses from the CNS to effector organs.

Answer 25

Conducts impulses from the CNS to skeletal muscles, allowing voluntary control ## Footnote It is often referred to as the voluntary nervous system.

Answer 26

Smooth muscle, cardiac muscle, and glands ## Footnote It is known as the involuntary nervous system.

Answer 27

Sympathetic and Parasympathetic ## Footnote These subdivisions work in opposition to each other.

Answer 28

Fight or Flight

Answer 29

Rest and Digest

Answer 30

Acetylcholine (ACh) ## Footnote ACh is the primary neurotransmitter for the parasympathetic division.

Answer 31

They lie close to the target site and often within the tissue of the target organ ## Footnote This anatomical arrangement allows for a localized response.

Answer 32

Pre-ganglionic neurons are the first neurons in the autonomic pathway, while post-ganglionic neurons are the second neurons that synapse in an autonomic ganglion.

Answer 33

False ## Footnote Post-ganglionic nerves in the sympathetic system are not myelinated.

Answer 34

Constrict blood vessels ## Footnote This leads to an increase in blood pressure.

Answer 35

Relaxation of smooth muscle ## Footnote This includes dilation of bronchi and relaxation of the GIT.

Answer 36

Increase heart rate and force of contraction ## Footnote This is primarily mediated by β1-adrenoceptors.

Answer 37

Increased peripheral vasodilation ## Footnote This effect facilitates increased blood flow to the muscles.

Answer 38

Decrease release of norepinephrine ## Footnote This is a presynaptic effect that provides negative feedback.

Answer 39

A condition where circulating antibodies block ACh at nicotinic receptors at the neuromuscular junction ## Footnote This leads to muscle weakness.

Answer 40

Nicotinic and Muscarinic receptors

Answer 41

Blocks the re-uptake of choline ## Footnote This affects the synthesis of acetylcholine.

Answer 42

Blocks the uptake of ACh into vesicles

Answer 43

Nicotinic and muscarinic receptors

Answer 44

IONOTROPIC

Answer 45

Five (2α, β, δ, ε)

Answer 46

At neuromuscular junctions and in autonomic ganglia

Answer 47

They activate the nicotinic receptor and produce an initial contraction of muscle fibers

Answer 48

They act as competitive antagonists, reducing end-plate potential

Answer 49

An increase in acetylcholine concentration, e.g., by administration of anticholinesterases

Answer 50

Widespread effects including hypotension and dry mouth

Answer 51

A direct channel blocker that competitively blocks ganglionic nicotinic receptors

Answer 52

They are members of the G-protein-coupled receptor family

Answer 53

Five (M1-M5), with three well characterized

Answer 54

Inhibit adenylate cyclase and open K+ channels

Answer 55

Bethanechol

Answer 56

M1 (Neural), M2 (Cardiac), M3 (Glandular/Smooth Muscle)

Answer 57

Increase IP3 and DAG

Answer 58

Produces bradycardia and potassium efflux

Answer 59

May produce a depolarising block at the ganglion

Answer 60

10 minutes

Answer 61

Some antimuscarinic activity

Answer 62

Stimulate calcium release and contraction

Answer 63

Cardiac inhibition

Answer 64

They stimulate the receptors

Answer 65

They may experience dry mouth and tachycardia

Answer 66

2% ## Footnote The brain consumes approximately 20% of the body's resting energy.

Answer 67

Glucose ## Footnote The brain also requires nutrients such as amino acids, monocarboxylates (e.g., lactate, pyruvate), and vitamins.

Answer 68

650 km ## Footnote 85% of these vessels are capillaries.

Answer 69

40 μm ## Footnote Ensures that neurons are 8-20 μm from blood vessels.

Answer 70

Ions, neurotransmitters, neuromodulators, neuropeptides ## Footnote Neurons communicate using electrical signals (synaptic and action potentials).

Answer 71

To maintain the homeostasis of the brain ## Footnote It acts as a physical, metabolic, and immunological barrier.

Answer 72

Ehrlich and Lewandosky ## Footnote They demonstrated that certain dyes did not stain the brain when injected intravenously.

Answer 73

Brain capillary endothelial cells (BCECs) ## Footnote Other cell types such as pericytes, astrocytes, and neuronal cells also contribute.

Answer 74

Tight junctions ## Footnote These junctions are formed by brain capillary endothelial cells.

Answer 75

Drug efflux pumps ## Footnote They transport materials from within the brain to BCECs or from BCECs into the systemic circulation.

Answer 76

They have phagocytotic activity that contributes to the BBB's properties.

Answer 77

Xenobiotics/drugs ## Footnote These transporters recognize a wide diversity of substances.

Answer 78

Lipophilicity determines passive diffusion through the BBB ## Footnote A molecule must be lipophilic to cross the hydrophobic phospholipid bilayer.

Answer 79

Under 400 to 500 Da ## Footnote Molecules above this threshold have significantly reduced permeability.

Answer 80

False ## Footnote Poor BBB penetration applies to approximately 98% of new small molecule drugs.

Answer 81

Trojan horse strategy, nanomedicine ## Footnote These methods involve coupling substances that can cross the BBB with those that cannot.

Answer 82

A process where essential nutrients and carrier proteins cross the BBB via receptors on BCECs.

Answer 83

It carries iron across the BBB and is explored for delivering protein therapeutics.

Answer 84

Focussed ultrasound ## Footnote This method can generate microbubbles that transiently open tight junctions.

Answer 85

Continuous tight junctions of endothelial cells in brain capillaries ## Footnote This contrasts with capillaries in other organs that have small pores.

Answer 86

Anxiety, Depression, Bipolar Disorder ## Footnote These topics were previously taught in Pharmacy 302.

Answer 87

* List symptoms of depression * Discuss diagnostic criteria for depression using ICD-10 and DSM-V * Discuss pharmacology and clinical use of common antidepressants * Explain treatment options for depression * Select appropriate treatment based on guidelines * Identify pharmaceutical care issues for patients ## Footnote These objectives aim to equip students with necessary skills in managing depressive disorders.

Answer 88

An affective disorder characterized by depressed mood and/or loss of pleasure in most activities ## Footnote Anhedonia refers to the loss of pleasure.

Answer 89

Persistent sadness and loss of interest in activities for at least two weeks ## Footnote This includes an inability to carry out daily activities.

Answer 90

Depression is more than just feeling unhappy or fed up for a few days ## Footnote It involves significant functional impairment.

Answer 91

* Melancholia * 'the blues' * Living with/having 'the black dog' ## Footnote These terms reflect various cultural perceptions of depression.

Answer 92

Depressed mood and/or loss of pleasure for at least 2 weeks ## Footnote This includes irritability in children.

Answer 93

Dysthymia ## Footnote Characterized by a depressed mood for most of the time for at least two years.

Answer 94

By the number and severity of symptoms plus the degree of functional impairment ## Footnote This can classify Major Depression as mild, moderate, or severe.

Answer 95

A rare form of severe major depression with psychotic symptoms like delusions or hallucinations ## Footnote It is associated with significant disability.

Answer 96

More than 300 million people worldwide suffer from depression ## Footnote It is the leading cause of disability globally.

Answer 97

* Half of people with depression do not seek help * Half of those who seek help are not correctly diagnosed * Half of those diagnosed receive treatment * Half of those receiving treatment do not complete it ## Footnote This highlights the challenges in diagnosis and treatment adherence.

Answer 98

* Genetics * Personality * Early environment * Precipitating factors * Monoamine hypothesis ## Footnote These factors may increase the risk of developing depression.

Answer 99

Depression is related to reduced levels of biogenic amines (monoamines) ## Footnote This includes neurotransmitters like serotonin and noradrenaline.

Answer 100

Increased risk in first-degree relatives and higher concordance in monozygotic twins ## Footnote It suggests a polygenic inheritance pattern.

Answer 101

Events that can act as precipitating factors for depressive episodes ## Footnote Social vulnerability factors can increase risk.

Answer 102

16-23 weeks ## Footnote About 12% of individuals do not achieve full remission.

Answer 103

True ## Footnote This pattern is observed worldwide.

Answer 104

disability ## Footnote It is often under-recognized.

Answer 105

A neurotransmitter that plays a key role in mood regulation ## Footnote Serotonin is often linked to feelings of well-being and happiness.

Answer 106

Monoamine oxidase inhibitors, a class of antidepressants ## Footnote MAOIs work by preventing the breakdown of neurotransmitters like serotonin.

Answer 107

Serotonin-norepinephrine reuptake inhibitors, a class of antidepressants ## Footnote SNRIs increase levels of serotonin and norepinephrine in the brain.

Answer 108

Tricyclic antidepressants ## Footnote TCAs are an older class of antidepressants that affect neurotransmitter levels.

Answer 109

Antidepressants can increase the risk of self-harm and suicidal thoughts ## Footnote This is particularly important in the early stages of treatment.

Answer 110

Deliberate pain or damage caused to one's own body ## Footnote It can be either suicidal or non-suicidal in intent.

Answer 111

To relieve or express distressing feelings, thoughts, or memories ## Footnote Other reasons may include feelings of guilt or shame.

Answer 112

False ## Footnote Most individuals who self-harm do not intend to end their lives.

Answer 113

Approx 75% ## Footnote This statistic highlights the gender disparity in suicide rates.

Answer 114

8.7 per 1000 population ## Footnote This is significantly higher compared to females, who have a rate of 2.9.

Answer 115

25-34 years, 15-24 years, and 35-44 years ## Footnote These age groups show the highest prevalence of suicidal behaviors.

Answer 116

Combination of recent events, personal factors, and genetic predisposition ## Footnote Depression is usually multifactorial.

Answer 117

Persisting low mood and anhedonia ## Footnote Anhedonia refers to the inability to feel pleasure.

Answer 118

* Hopelessness * Low mood * Anhedonia * Negative thinking/pessimism * Worthlessness * Guilt ## Footnote These symptoms often overlap and can vary in intensity.

Answer 119

6 months ## Footnote This duration can vary significantly between individuals.

Answer 120

To standardize care and interpretation of trials and studies ## Footnote These criteria help in consistent diagnosis and treatment.

Answer 121

* Psychoeducation * Psychosocial interventions * Pharmacotherapy * Physical therapy such as ECT ## Footnote Lifestyle changes can also significantly impact treatment outcomes.

Answer 122

* Establish regular sleep and wake times * Avoid stimulants before bed * Create a proper sleep environment ## Footnote Good sleep hygiene is crucial for managing depression.

Answer 123

A psychological therapy that helps patients identify unhelpful thoughts and behaviors ## Footnote CBT teaches patients to view challenging situations more clearly.

Answer 124

Mild: Few symptoms; Moderate: Symptoms between mild and severe; Severe: Several symptoms with significant impairment ## Footnote Severity is determined by the number of symptoms and their impact on functioning.

Answer 125

[unknown] ## Footnote Depression is typically multifactorial.

Answer 126

Helping patients to identify unhelpful or distorted thoughts, emotions, and behaviours. ## Footnote CBT teaches patients to view challenging situations more clearly and respond effectively.

Answer 127

Helping patients to identify and understand interpersonal problems contributing to their condition. ## Footnote IPT often focuses on areas of grief, interpersonal disputes, deficits, and role transitions.

Answer 128

Helping the patient to articulate personal problems and develop solutions from which they can systematically select the most appropriate solution.

Answer 129

Helping patients to reconnect with sources of positive reinforcement by scheduling activities to increase pleasant activities.

Answer 130

Counselling. ## Footnote In this therapy, patients discuss concerns and receive empathy.

Answer 131

Repetitive internal struggles and conflicts by examining past experiences and conflicts.

Answer 132

A physical therapy used in severe cases of depression.

Answer 133

To guide treatment options for depression based on severity and complexity.

Answer 134

Medication, high-intensity psychological interventions, electroconvulsive therapy, crisis services, combined treatments, multiprofessional and inpatient care.

Answer 135

Continue treatment for at least 6 months after symptom resolution to reduce the risk of relapse.

Answer 136

At least 6 months, and possibly up to 2 years or longer based on risk factors.

Answer 137

* TCA (Tricyclic antidepressants) * SSRI (Selective serotonin reuptake inhibitors) * SNRI (Serotonin and noradrenaline reuptake inhibitors) * MAOI (Monoamine oxidase inhibitors) * RIMA (Reversible inhibitor of MAO-A) * NARI (Noradrenaline reuptake inhibitors) * NASSA (Noradrenaline and specific serotonin antidepressants)

Answer 138

Inhibition of the serotonin transporter (SERT) pre- and post-synapse.

Answer 139

False. ## Footnote Antidepressants are not associated with addiction, though stopping abruptly may increase withdrawal symptoms.

Answer 140

* Nausea * Parkinsonian side effects * Sexual dysfunction * Prolonged QTc (for Citalopram) * Discontinuation syndrome (for Paroxetine)

Answer 141

Cardiotoxicity, especially in overdose. ## Footnote TCAs also have a range of adverse effects due to their action on various receptors.

Answer 142

More than 2 weeks.

Answer 143

Comparable efficacy to TCA and SSRI in moderate to severe depression.

Answer 144

Limited effect for monotherapy but increased effect when added to antidepressant therapy.

Answer 145

70-80% may report a marked improvement after one month.

Answer 146

Tricyclic antidepressant.

Answer 147

Consider lifelong treatment for multiple episodes.

Answer 148

* Age * Comorbid conditions * Other risk factors

Answer 149

Psychotic depression

Answer 150

Limited effect

Answer 151

St John's Wort

Answer 152

Benefit in mild to moderate depressive episodes compared to placebo

Answer 153

Unstandardised preparations

Answer 154

* Oral contraceptive pill * Theophylline * Ciclosporin

Answer 155

Serotonin Syndrome

Answer 156

* Shivering * Sweating * Autonomic instability * Tachycardia * Agitation * Confusion * Delirium * Tremor * Myoclonus

Answer 157

£100 million

Answer 158

30-60%, up to 75%

Answer 159

* Explore * Educate * Empower * Enable

Answer 160

* Flu-like * Paraesthesia * Electric shock sensation * Insomnia * Headache * Excessive dreaming * Agitation

Answer 161

Dose reduction at end of treatment period

Answer 162

* Paroxetine * Venlafaxine

Answer 163

* Efficacy * Tolerability * Cost-effectiveness * Guidelines

Answer 164

* Allergy * Drug history * Medical history/Co-morbidities * Previous response * Social history * Overdose risk * Patient choice and understanding

Answer 165

Depression itself

Answer 166

Psychological therapy

Answer 167

SSRIs (not paroxetine)

Answer 168

Sertraline

Answer 169

Fluoxetine

Answer 170

Active monitoring

Answer 171

CBT or IPT

Answer 172

Susceptibility to suicidal thoughts and activation symptoms

Answer 173

* Falls risk * Renal and hepatic function * Bleeding risk * SIADH * QT prolongation * Sensitivity to SADRs * Polypharmacy

Answer 174

BAP Consensus Guidelines

Answer 175

About 7% ## Footnote This figure represents the estimated prevalence of anxiety disorders in the general population.

Answer 176

~25% ## Footnote This indicates that a significant number of individuals do not seek or receive appropriate treatment for their anxiety.

Answer 177

Some common symptoms include: * Excessive worry * Restlessness * Fatigue * Difficulty concentrating * Irritability * Muscle tension * Sleep disturbance ## Footnote Symptoms can vary based on the specific type of anxiety disorder.

Answer 178

False ## Footnote While anxiety is a natural response to stress, it becomes pathological when excessive or interfering with normal functioning.

Answer 179

The three components of anxiety are: * Physiological * Cognitive * Behavioral ## Footnote Each component represents a different aspect of the anxiety experience.

Answer 180

Some recognized risk factors include: * Family history * Life events causing emotional stress * Personality traits like perfectionism and shyness * Childhood adversity * Being female * Social isolation * Unemployment or poverty ## Footnote These factors can contribute to the development of anxiety disorders.

Answer 181

GABA is an important inhibitory neurotransmitter that regulates excitability and is linked to fear and anxiety responses. ## Footnote Even mild attenuation of GABA transmission can lead to increased anxiety and related symptoms.

Answer 182

Some secondary causes include: * Neurologic conditions (e.g. Parkinson's Disease) * Endocrine disorders (e.g. Cushing's disease) * Cardiovascular issues (e.g. Angina) * Inflammatory diseases (e.g. RA) * Gastrointestinal disorders (e.g. IBS) * Chronic infections (e.g. HIV) ## Footnote Understanding these secondary causes is essential for accurate diagnosis and treatment.

Answer 183

diagnosis ## Footnote The DSM-5 provides criteria and guidelines for diagnosing various mental health disorders, including anxiety.

Answer 184

GAD is characterized by excessive anxiety and worry about multiple life circumstances occurring more days than not for over 6 months. ## Footnote It is the second most common psychiatric disorder after depression.

Answer 185

1-5% ## Footnote This rate reflects the proportion of the population affected by GAD.

Answer 186

False ## Footnote Anxiety disorders can also present with physical symptoms, which may lead individuals to seek medical help for physical rather than psychological issues.

Answer 187

Key neurotransmitters involved include: * Serotonin * Noradrenaline (norepinephrine) * Dopamine * Glutamine * Neurokinin ## Footnote Dysregulation of these neurotransmitters is linked to the development of anxiety disorders.

Answer 188

Failure to diagnose anxiety disorders is associated with overuse of healthcare resources and increased morbidity and mortality. ## Footnote This highlights the importance of accurate diagnosis and effective treatment.

Answer 189

Types of anxiety disorders include: * Generalized Anxiety Disorder (GAD) * Obsessive Compulsive Disorder (OCD) * Panic Disorder * Post-Traumatic Stress Disorder (PTSD) * Phobic Disorders * Social Anxiety Disorder ## Footnote Each type has distinct features and diagnostic criteria.

Answer 190

* Restlessness or feeling on edge * Easily fatigued * Difficulty concentrating or mind going blank * Irritability * Muscle tension * Sleep disturbance ## Footnote Symptoms must be present for at least 6 months for diagnosis.

Answer 191

Neurotransmitter dysregulation in the basal ganglia, cortex, thalamus, and limbic system ## Footnote Includes NA overactivity, 5HT receptor dysregulation, and reduced BZD binding sites on GABA.

Answer 192

Psychological intervention, specifically Cognitive Behavioral Therapy (CBT) ## Footnote CBT is more efficacious than anxiety management therapy alone.

Answer 193

* SSRIs * Venlafaxine * Duloxetine * Imipramine * Buspirone * Benzodiazepines ## Footnote SSRIs are often recommended as first-line pharmacological treatment.

Answer 194

Up to 2.5% in adults ## Footnote The prevalence in children is about 0.5%.

Answer 195

* Obsessions * Compulsions ## Footnote Obsessions are unwanted thoughts, while compulsions are repetitive behaviors or mental acts.

Answer 196

Symptoms must: * Create marked distress * Consume more than 1 hour per day * Significantly affect normal function * Not be related to medications or other conditions ## Footnote This ensures that the diagnosis is specific to OCD.

Answer 197

* SSRIs * Clomipramine ## Footnote Therapeutic response generally increases over 6-12 weeks.

Answer 198

Recurrent, unexpected panic attacks associated with intense cardiac and nervous symptoms ## Footnote Patients often fear losing control or dying.

Answer 199

Major depressive episode (50-60% risk) ## Footnote Panic Disorder often co-occurs with agoraphobia.

Answer 200

Psychological intervention, particularly education and CBT ## Footnote SSRIs and Venlafaxine are first-line pharmacotherapy.

Answer 201

* Intrusive phenomena (recollections, nightmares, flashbacks) * Hyperarousal phenomena (exaggerated startle responses, irritability, anger) * Avoidance of reminders/emotional numbing ## Footnote These clusters help in identifying PTSD symptoms.

Answer 202

NA overactivity and dysregulation of α2-AR and 5HT ## Footnote Cortisol secretion dysregulation is also present.

Answer 203

Psychological intervention, specifically Cognitive Behavioral Therapy (CBT) ## Footnote Pharmacotherapy is not generally recommended.

Answer 204

Marked and persistent fear and avoidance of social situations ## Footnote This condition often leads to embarrassment or humiliation.

Answer 205

Cognitive Behavioral Therapy (CBT) incorporating exposure-based therapy ## Footnote SSRIs or Venlafaxine may also be used.

Answer 206

6-12 ## Footnote Some improvement may be seen within the first month.

Answer 207

True ## Footnote Age of onset is crucial for diagnosis.

Answer 208

Trouble falling asleep, fitful sleep, waking up early, constant worry, inability to concentrate, and forgetfulness ## Footnote Symptoms began after her daughter was diagnosed with health issues.

Answer 209

Psychological treatment aimed at modifying thinking and behaviours

Answer 210

Computer-assisted and internet-based therapy

Answer 211

* Antidepressant agents * Benzodiazepines

Answer 212

A common class of antidepressant agents used for anxiety disorders

Answer 213

* Reduction in alcohol/smoking * Moderate exercise * Engagement in hobbies/activities

Answer 214

A group of medications with anxiety-relieving effects

Answer 215

GABA (gamma aminobutyric acid)

Answer 216

* Sedation * Cognitive impairment * Difficulty concentrating * Problems with balance/coordination

Answer 217

* Reduction in anxiety * Induction of sleep * Muscle relaxation * Anticonvulsant effects

Answer 218

It influences their duration of action and clinical use

Answer 219

They potentiate inhibitory action by binding to benzodiazepine receptors

Answer 220

* Higher risk of falls * Increased risk of CNS side effects

Answer 221

glucuronide conjugates

Answer 222

Changes to the GABA A receptor

Answer 223

* Respiratory depression * Severe hepatic impairment * Myasthenia gravis

Answer 224

Provide individualized and respectful care, develop trustworthy relationships with consumers

Answer 225

Associated with a 60-80% increase in risk of traffic accidents

Answer 226

An anxiolytic with minimal sedation

Answer 227

Hypnotics with minimal anxiolytic effects, e.g., zolpidem and zolpiclone

Answer 228

Evidence of their addictive nature and the development of alternative treatments

Answer 229

Difficult to demonstrate in humans. ## Footnote May occur but is debated.

Answer 230

A complex condition including BZD addiction and abuse.

Answer 231

A cluster of behavioural, cognitive, and physiological changes ranging from mild to severe.

Answer 232

Severity of symptoms is variable.

Answer 233

Not a preoccupation and craving for BZDs, generally no adverse social consequences.

Answer 234

Approximately 15-30%.

Answer 235

High dosage and long-term use.

Answer 236

* Anxiety * Insomnia * Irritability * Paraesthesia * Tinnitus * Headaches * Dizziness * Poor memory * Poor concentration * Perceptual distortions * Menstrual disturbances * Nausea * Depression * Ataxia * Rarely psychosis and seizures.

Answer 237

By tapering the dose gradually over a period of at least 2-3 weeks.

Answer 238

Greater risk of rebound and withdrawal.

Answer 239

Hours to days.

Answer 240

Calculate an equivalent dose of diazepam and substitute.

Answer 241

* Diarrhoea * Dizziness (common) * Hallucinations * Acute rage * Agitation (rare)

Answer 242

* Myasthenia gravis * Concomitant alcohol intake * Acute/severe pulmonary insufficiency.

Answer 243

Acts at specific serotonin (5HT1A) receptors.

Answer 244

* Mood stabiliser * Olanzapine * Adjunctive therapy (antipsychotics, benzodiazepines).

Answer 245

At least 1 full manic episode and 1 full major depressive episode.

Answer 246

0.5-1%, more common in women.

Answer 247

Unclear, but involves structural abnormalities in the amygdala, basal ganglia, and prefrontal cortex.

Answer 248

Drugs that increase catecholamine levels.

Answer 249

Severity and duration.

Answer 250

* Elevated mood * Increased motor activity * Accelerated thoughts and speech * Irritability * Decreased sleep * Increased or decreased appetite * Distractibility * Grandiose ideas.

Answer 251

Almost completely absorbed from GIT, peak effect in 2-4 hours, half-life of 18-24 hours.

Answer 252

Slowly taper off adjunctive therapy.

Answer 253

DA release ## Footnote DA stands for dopamine.

Answer 254

5HT release ## Footnote 5HT stands for serotonin.

Answer 255

18-24 hours

Answer 256

Unchanged in the urine

Answer 257

t½ typically 25% longer

Answer 258

0.6-1.0 mmol/L

Answer 259

0.6-0.8 mmol/L

Answer 260

>1.2 mmol/L

Answer 261

>2.0 mmol/L

Answer 262

1.2-1.5 mmol/L

Answer 263

* GI (N&V, diarrhea) * Cardiac (ECG changes, arrhythmias, prolonged QT interval)

Answer 264

* Ataxia * Confusion * Tremor * Cardiac symptoms * Renal impairment

Answer 265

* Drug interactions * Renal impairment * Dehydration * Reduced fluid intake * Persistent vomiting/diarrhea * Excessive sweating

Answer 266

* Thiazides (up to 50%) * NSAIDs (20-60%) * ACEI/calcium channel blockers

Answer 267

Cease lithium therapy

Answer 268

Saline infusion to induce diuresis

Answer 269

Renal dialysis

Answer 270

* Metallic taste * Nausea * Diarrhea * Polydipsia * Polyuria * Cognitive impairment * Tremor

Answer 271

* Diabetes * Hypothyroidism * Hypercalcemia * Weight gain * Maculopapular rash

Answer 272

* Acute hyponatraemia * Psoriasis * Concurrent serotonin-enhancing drugs * Renal impairment * Surgery * Elderly

Answer 273

* Severe renal impairment * Breastfeeding

Answer 274

Malformation of heart and large vessels

Answer 275

Antipsychotics or antidepressants

Answer 276

* TDM * ECG * Renal function test * Thyroid function test

Answer 277

Do not stop taking suddenly

Answer 278

Maintain normal diet with standard amounts of sodium & fluid intake

Answer 279

* Olanzapine * Lamotrigine * Carbamazepine * Sodium Valproate * Gabapentin * Topiramate

Answer 280

When lithium therapy has failed or is contraindicated

Answer 281

* GI disturbance * Weight gain * Sedation * Tremor

Answer 282

* Acute pancreatitis * Hypersensitivity syndrome * Thrombocytopenia * Hepatotoxicity

Answer 283

* Valproate hypersensitivity * Severe hepatic dysfunction * Pancreatic dysfunction * Porphyria * Urea cycle disorders

Answer 284

Take with/after food

Answer 285

When lithium therapy has failed or is contraindicated

Answer 286

Stabilises hyperexcited nerve membranes

Answer 287

* Drowsiness * Vertigo * Ataxia * Diplopia * Blurred vision

Answer 288

* Renal function * Liver function tests * Electrolytes * Full blood count

Answer 289

Highly variable; maintenance therapy recommended after two episodes

Answer 290

* Daily mood chart * Medication adjustments * Education and counselling

Answer 291

Perceived inefficacy

Answer 292

Perceived inefficacy, S/Es, belief that medication is no longer necessary ## Footnote S/Es refers to side effects.

Answer 293

Education of both the individual with BPAD and their family ## Footnote BPAD stands for Bipolar Affective Disorder.

Answer 294

A strategy to maintain mental health, may include a daily mood chart ## Footnote A daily mood chart helps identify triggers.

Answer 295

Triggers ## Footnote Triggers can include various lifestyle factors.

Answer 296

* Overseas travel * Excessive coffee * Recreational drugs * Life events * Disrupted sleep pattern ## Footnote These factors can significantly affect mood stability.

Answer 297

More easily through a daily mood chart ## Footnote Tracking mood can clarify the impact of medication.

Answer 298

About 1/3 of patients will respond to a single mood-stabilizer, 1/3 will respond to multiple mood-stabilizers, and 1/3 will have a problematic course ## Footnote This indicates the varying effectiveness of treatments.

Answer 299

Frequent medication adjustments ## Footnote Adjustments may be necessary to find effective treatment.

Answer 300

Neurones and glial cells ## Footnote Neurones transmit messages; glial cells support neurones.

Answer 301

Destroy invading microorganisms, remove cell debris, and promote tissue repair ## Footnote Microglia are a type of glial cell.

Answer 302

Macroglia ## Footnote They have supportive functions in the nervous system.

Answer 303

Contains the cellular machinery that keeps the neurone alive ## Footnote Includes the nucleus.

Answer 304

Increases the transmission speed of an action potential along the axon ## Footnote Myelinated axons are wrapped in myelin.

Answer 305

Regions at the end of an axon that release neurotransmitters ## Footnote They facilitate communication between neurones.

Answer 306

Receive information from other neurones ## Footnote Each neurone typically has multiple dendrites.

Answer 307

Relay station for all sensory information (except smell) from the PNS to the cerebral cortex ## Footnote It plays a crucial role in sensory processing.

Answer 308

Regulates internal body functions such as eating, drinking, and sleep cycles ## Footnote It also influences motivation and reward behaviors.

Answer 309

The ‘seat of intelligence’ ## Footnote It is divided into two hemispheres.

Answer 310

Posture, head and eye movements, and fine-tuning of muscle movements ## Footnote It is crucial for learning motor skills.

Answer 311

Involuntary functions such as blood pressure and breathing ## Footnote It is located between the spinal cord and the cerebrum.

Answer 312

Gyri are raised ridges of tissue; sulci are shallow grooves ## Footnote They characterize the surface of the cerebral cortex.

Answer 313

Grey matter consists of neuronal cell bodies and dendrites; white matter consists of glial cells and myelinated axons ## Footnote Grey matter is involved in processing, while white matter relays messages.

Answer 314

Cerebral cortex, underlying white matter, and several subcortical structures ## Footnote The basal ganglia are part of the subcortical structures.

Answer 315

A signal generated by a neurone that transmits information ## Footnote It is transmitted through the nervous system via axons.

Answer 316

Neurotransmitters are released and bind to receptors on the postsynaptic neurone ## Footnote This process is crucial for communication between neurones.

Answer 317

Excite or inhibit the generation of action potentials ## Footnote They can also induce other biochemical processes.

Answer 318

Reuptake into the presynaptic neurone, removal by astrocytes, diffusion, or breakdown by enzymes ## Footnote These processes ensure neurotransmitter availability and action.

Answer 319

GABA A, GABA B, and GABA C ## Footnote GABA is the major inhibitory neurotransmitter in the brain.

Answer 320

It is the principal excitatory neurotransmitter ## Footnote Glutamate is an amino acid produced from glutamine.

Answer 321

5-HT receptors (5-HT 1A-F, 5-HT 2A-C, 5-HT 3-7) ## Footnote Serotonin is involved in mood regulation and other functions.

Answer 322

glutamine ## Footnote This process allows for the recycling of glutamate.

Answer 323

False ## Footnote There is a gap known as the synaptic cleft.

Answer 324

GABA is an ionotropic chloride channel and a major inhibitory neurotransmitter in the brain. ## Footnote GABA is involved in many inhibitory synapses, with a significant number utilizing it.

Answer 325

Glutamate ## Footnote Glutamate is an excitatory neurotransmitter that is converted into GABA.

Answer 326

Glycine ## Footnote Glycine is primarily found in the spinal cord and acts as a co-factor on NMDA receptors.

Answer 327

By specific transporters ## Footnote These transporters ensure that GABA is recycled and prevents prolonged inhibitory signaling.

Answer 328

5-HT ## Footnote Serotonin is a neurotransmitter found throughout the body, especially in the CNS.

Answer 329

CNS, platelets, and certain cells in the gastrointestinal tract ## Footnote These areas are crucial for various physiological functions.

Answer 330

Raphe nuclei of the brainstem ## Footnote These neurons project widely throughout the brain.

Answer 331

True ## Footnote Pain regulation is one of the roles of serotonergic projections.

Answer 332

Regulates sleep and wakefulness ## Footnote Serotonin is crucial for maintaining circadian rhythms.

Answer 333

Mediates motor movements, especially tremor ## Footnote This highlights the importance of noradrenaline in motor control.

Answer 334

Blood pressure ## Footnote This indicates the role of noradrenaline in autonomic functions.

Answer 335

Regulate mood and mediate attention ## Footnote These functions link noradrenaline to cognitive processes.

Answer 336

Prioritize competing incoming stimuli ## Footnote This includes focusing attention on threats or pain.

Answer 337

Noradrenaline (norepinephrine) ## Footnote This neurotransmitter is crucial for arousal and attention.

Answer 338

Movement control, motivation, reward, and reinforcement ## Footnote Dopamine is affected by many addictive substances.

Answer 339

DOPA (dihydroxyphenylalanine) ## Footnote DOPA is converted into dopamine by DOPA decarboxylase.

Answer 340

By specialized dopamine transporters ## Footnote It is also catabolized by monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT).

Answer 341

Influencing perception, cognition, and social behavior ## Footnote This pathway links dopamine to higher cognitive functions.

Answer 342

Control of fine movements and initiation of movement ## Footnote This pathway is critical for motor function.

Answer 343

Release of prolactin ## Footnote Prolactin is important for lactation and reproductive health.

Answer 344

Emotion, memory, pleasurable sensations, and reward ## Footnote It is also associated with psychotic symptoms like delusions and hallucinations.

Answer 345

Conus medullaris ## Footnote The conus medullaris is the tapered end of the spinal cord.

Answer 346

Fibrous extension of conus covered with pia mater, anchors spinal cord ## Footnote The filum terminale extends to the coccyx.

Answer 347

Extensions of pia mater that secure cord to dura mater

Answer 348

* Dura mater * Arachnoid mater * Pia mater

Answer 349

Inflammation of meninges

Answer 350

22 individual bones, 14 facial and 8 cranial bones

Answer 351

Cover and protect CNS, protect blood vessels, and enclose venous sinuses

Answer 352

Continuous central hollow cavities filled with cerebrospinal fluid (CSF)

Answer 353

2 paired C-shaped ventricles

Answer 354

Controls automatic behaviors necessary for survival

Answer 355

Awakening/sleeping cycle and filtering incoming stimuli

Answer 356

Coordinate movements, maintain posture and equilibrium

Answer 357

* Equilibrium information * Proprioceptive information * Cerebral cortex input

Answer 358

* Gives buoyancy to CNS structures * Reduces weight by 97% * Protects CNS from trauma * Nourishes brain and carries chemical signals

Answer 359

Approximately 150 ml

Answer 360

Hydrocephalus

Answer 361

Cushion of fat and network of veins in space between vertebrae and spinal dura mater

Answer 362

Delicate vascularized connective tissue that clings tightly to the brain

Answer 363

Produces cerebrospinal fluid (CSF) at a constant rate

Answer 364

Return cerebrospinal fluid to the dural sinus

Answer 365

* Periosteal layer * Meningeal layer

Answer 366

Separates the two cerebral hemispheres in the longitudinal fissure

Answer 367

Forms the roof of the third ventricle and regulates sleep-wake cycles

Answer 368

Controls the autonomic nervous system and regulates various bodily functions

Answer 369

Suprachiasmatic nucleus ## Footnote Known as the biological clock.

Answer 370

Endocrine system ## Footnote It controls secretions of the anterior pituitary gland.

Answer 371

Posterior pituitary hormones

Answer 372

Blood pressure, rate and force of heartbeat, digestive tract motility, pupil size

Answer 373

Emotional responses such as pleasure, fear, and rage

Answer 374

Through sweating and shivering

Answer 375

Hunger and satiety in response to nutrient blood levels or hormones

Answer 376

Water balance and thirst

Answer 377

Cerebrum, cerebellum, brainstem, spinal cord, diencephalon, basal ganglia

Answer 378

Cushion of fat and network of veins

Answer 379

Subarachnoid space ## Footnote The spinal cord is absent there.

Answer 380

Median longitudinal fissure

Answer 381

Cerebral hemisphere from the cerebellum

Answer 382

MRI and CT

Answer 383

Blood flow or glucose utilization in the brain

Answer 384

Gateway to the cortex

Answer 385

* Commissures * Association fibers * Projection fibers

Answer 386

Complex cognitive behavior, decision making, social behavior, personality expression

Answer 387

Regulate intensity of voluntary movements

Answer 388

Conscious control of precise, skilled, skeletal muscle movements

Answer 389

Visual processing ## Footnote Located at the extreme posterior tip of the occipital lobe.

Answer 390

Auditory association area

Answer 391

Conscious awareness of overall somatic sensation

Answer 392

Involved in planning movements

Answer 393

Speech production

Answer 394

Neuroleptic ## Footnote The term neuroleptic is derived from their ability to produce neurolepsis.

Answer 395

* Psychomotor slowing * Affective indifference * Emotional quieting

Answer 396

Extrapyramidal side effects ## Footnote This is currently under debate as newer antipsychotics show varied side effects.

Answer 397

* Positive symptoms * Negative symptoms

Answer 398

* Delusions * Hallucinations * Bizarre behavior

Answer 399

* Decline in normal function * Reduced speech * Flattened affect * Loss of motivation * Social withdrawal * Anhedonia

Answer 400

Overactivity of the mesolimbic pathway is involved in positive symptoms, while underactivity in the mesocortical pathway is linked to negative symptoms.

Answer 401

Nigrostriatal pathway ## Footnote Antagonism of D2 receptors in this pathway increases the risk of extrapyramidal symptoms.

Answer 402

* Mesolimbic pathway * Mesocortical pathway * Nigrostriatal pathway * Tuberoinfundibular pathway

Answer 403

Regulation of prolactin hormone release

Answer 404

* Chlorpromazine * Clozapine * Haloperidol * Thioridazine * Ziprasidone

Answer 405

A condition resulting from long-term use of antipsychotic medications, characterized by repetitive, involuntary movements.

Answer 406

More than 1 positive symptom and 1 negative symptom present most of the time for at least 1 month.

Answer 407

* Hallucinations * Delusions * Thought disorders

Answer 408

* Emotional apathy * Social withdrawal * Poverty of speech * Loss of motivation * Self-neglect * Severely disorganized or catatonic behavior

Answer 409

Dysfunction is associated with cognitive impairments and disturbances of emotions and affect.

Answer 410

Postsynaptic D2 receptor antagonism

Answer 411

Dopamine inhibits prolactin release; D2 blockade increases prolactin levels.

Answer 412

[psychosis]

Answer 413

They block dopamine receptors

Answer 414

Secondary negative symptoms and cognitive effects

Answer 415

Potential cognitive effects and exacerbation of negative symptoms.

Answer 416

* Genetic vulnerability * Environmental influences * Viral infections * Early life stress * Obstetric complications * Substance use (e.g., alcohol, cannabis)

Answer 417

Apathy, withdrawal, reduced care in appearance, agitation, sleep disturbance, decline in function, incoherent or paucity of speech, hallucinations, delusional thoughts ## Footnote Symptoms can also include trauma, financial worries, abuse, isolation, physical health triggers, depression/anxiety, transient/attenuated psychotic symptoms, drug or alcohol use, PTSD, and family history of schizophrenia.

Answer 418

FBC, U+Es, LFT, TFT, B12, urine drug testing, HIV, syphilis, anti-NMDA receptors (if neurological features present), BMI, waist circumference, CVD risk screen, prolactin level, ECG if CVD risk is high, echo for those with cardiac problems ## Footnote These investigations help rule out organic causes.

Answer 419

Identification, referral, and supporting long-term health needs ## Footnote GPs should not start antipsychotics without consultant psychiatric advice.

Answer 420

At least 2 years ## Footnote This is important for effective management of schizophrenia.

Answer 421

Weight gain, extrapyramidal effects, cardiovascular problems, hormonal imbalance (prolactin rise) ## Footnote Side effects vary by antipsychotic class.

Answer 422

Typical (first-generation) antipsychotics are more likely to cause extrapyramidal side effects, while atypical (second-generation) are less likely but have a higher risk of metabolic adverse effects ## Footnote Atypical antipsychotics are also known for their lower risk of tardive dyskinesia.

Answer 423

Aripiprazole, Clozapine ## Footnote Other examples include Olanzapine, Paliperidone, Quetiapine, and Risperidone.

Answer 424

Leads to better outcomes ## Footnote Early identification of symptoms can improve management and prognosis.

Answer 425

CVD risk, smoking cessation, adherence to medication plan, relapse prevention plan, carer support ## Footnote This review helps in ongoing management and support.

Answer 426

atypical antipsychotics ## Footnote This term reflects their lower risk of extrapyramidal effects compared to first-generation.

Answer 427

5HT2A receptor antagonism, rapid dissociation from D2 receptors ## Footnote These mechanisms contribute to their therapeutic effects and side effect profiles.

Answer 428

False ## Footnote First-generation antipsychotics are primarily dopamine antagonists, while second-generation are known as dopamine-serotonin antagonists.

Answer 429

* Extrapyramidal side effects (EPS) * Sedation * Orthostatic hypotension * Weight gain * Hormonal changes (amenorrhea, galactorrhea) * Gynaecomastia * Tardive dyskinesia * Neuroleptic Malignant Syndrome (NMS) ## Footnote These side effects can significantly impact patient quality of life.

Answer 430

The hypothesis suggests that increased dopaminergic activity is linked to the positive symptoms of schizophrenia ## Footnote This is a foundational concept in understanding the pathophysiology of the disorder.

Answer 431

* Mesolimbic * Mesocortical * Nigrostriatal * Tuberoinfundibular ## Footnote Blocking D2 receptors in these pathways influences both therapeutic and adverse effects.

Answer 432

They are drugs that block serotonin receptors. ## Footnote This is a key feature of their mechanism of action.

Answer 433

They act as 5HT2A antagonists and dissociate rapidly from D2 receptors.

Answer 434

Clozapine.

Answer 435

It has a very high affinity for 5HT2A and lower D2 affinity than Haloperidol.

Answer 436

The 5HT2A/D2 hypothesis.

Answer 437

It can increase dopaminergic neurotransmission in the nigrostriatal pathway, reducing the risk of extrapyramidal symptoms.

Answer 438

It could theoretically improve negative and cognitive symptoms by increasing dopamine release in the prefrontal cortex.

Answer 439

Clozapine.

Answer 440

* Schizophrenia * Bipolar disorder

Answer 441

* Weight gain * Hypertriglyceridemia * Hypercholesterolemia * NMS * Somnolence * EPS * Hyperprolactinemia * VTE * Hyperglycemia * DKA * Diabetic coma * Seizures

Answer 442

* Schizophrenia (including adolescent schizophrenia) * Schizoaffective disorder * Bipolar disorder * Autism

Answer 443

* Somnolence * Agitation and anxiety * Headache * Tachycardia * Orthostatic hypotension * NMS * Hyperprolactinemia * Gynaecomastia (in children) * Dyspepsia * Nausea * Vomiting * Seizures * DM type 2 * TTP * Agranulocytosis

Answer 444

An atypical antipsychotic and a partial D2 agonist.

Answer 445

A drug whose effects depend on the anatomical location and cell-type expressing the D2-type receptor.

Answer 446

Aripiprazole.

Answer 447

It shows differences in potency and efficacy.

Answer 448

It can stimulate D2 receptors where synaptic DA levels are limited or decrease dopaminergic activity when dopamine concentrations are high.

Answer 449

A reduction in serum prolactin levels.

Answer 450

* D2 * D3 * 5-HT1A * 5-HT2C

Answer 451

They rest on receptor profile, incidence of extrapyramidal side effects, and efficacy in treatment-resistant patients.

Answer 452

_________ ## Footnote Provide specific examples in context.

Answer 453

_________ ## Footnote Provide specific examples in context.

Answer 454

_________ ## Footnote Indicate based on the drug's structure.

Answer 455

_________ ## Footnote Indicate the specific substituent or region of the drug.

Answer 456

Pharmacology, genetics, and clinical implications of smoking in people living with schizophrenia.

Answer 457

About 1% ## Footnote Schizophrenia is a severe, chronic, disabling brain disorder.

Answer 458

Men: 15-24 years; Women: 25-34 years ## Footnote Men usually experience an earlier onset than women.

Answer 459

* Positive * Negative * Cognitive

Answer 460

False ## Footnote Patients experience different combinations of the main symptoms.

Answer 461

Disintegration of thought processes and emotional responsiveness ## Footnote Common manifestations include auditory hallucinations and bizarre delusions.

Answer 462

* Catatonic Type * Disorganized Type * Paranoid Type * Residual Type * Undifferentiated Type

Answer 463

* Rare * Poorer prognosis * Similar gender ratio * No gender difference in age of onset

Answer 464

* Positive Symptoms * Negative Symptoms * Cognitive Symptoms

Answer 465

* Disturbances of thought processes * Delusions * Hallucinations * Erratic emotions * Disorganized speech and behavior

Answer 466

* Lack of interest/enjoyment * Low energy/motivation * Blank facial expression * Difficulty initiating activities * Social isolation

Answer 467

Disturbed functioning in the dopamine system, particularly excess dopamine activity at certain synaptic sites ## Footnote Supportive evidence includes the effects of phenothiazines and L-Dopa.

Answer 468

* Mesolimbic pathway * Tuberoinfundibular pathway * Nigrostriatal pathway * Mesocortical pathway * D2 subtype

Answer 469

Diminish positive symptoms and prevent relapses ## Footnote There is no clear drug of choice; clozapine is noted as the most effective.

Answer 470

Auditory hallucinations ## Footnote They may include hearing voices that comment on one's behavior.

Answer 471

Inability to feel pleasure or lack of interest in activities ## Footnote It is a common negative symptom associated with schizophrenia.

Answer 472

Physical and lab exams rule out other disorders; diagnosis is commonly made from history and mental status exam. ## Footnote Currently, there are no reliable biomarkers for diagnosis.

Answer 473

At least 6 months ## Footnote This includes social/occupational dysfunction and exclusion of schizoaffective and mood disorders.

Answer 474

* Extrapyramidal side effects (EPS) * Tardive dyskinesia

Answer 475

False ## Footnote Positive symptoms are generally more responsive to treatment.

Answer 476

Excitatory amino acids like glutamate could play a role; NMDA antagonists can induce psychotic symptoms ## Footnote Increased NMDA receptors have been observed in post-mortem studies of schizophrenic brains.

Answer 477

The amount and type of disability is related to the symptoms of the individual’s illness and how responsive these symptoms are to treatment.

Answer 478

Antipsychotics diminish the positive symptoms and prevent relapses.

Answer 479

Clozapine.

Answer 480

* Social skills training * Cognitive-behavioral therapy * Cognitive remediation * Social cognition training

Answer 481

* Conventional * Atypical

Answer 482

Antagonise dopamine receptors, resulting in anti-psychotic effects.

Answer 483

* Phenothiazines * Thioxanthenes

Answer 484

* Parkinsonism * Dystonia * Akathisia * Tardive dyskinesia

Answer 485

Chlorpromazine.

Answer 486

* Sedation * Weight gain

Answer 487

Enhance adherence.

Answer 488

* Associated with worse side effects? * Patients’ acceptance? * Reduced patient autonomy? * Nursing involvement?

Answer 489

* Drowsiness * Lethargy * Mental confusion * Parkinson’s syndrome * Acute akathisia * Acute dystonia

Answer 490

Neuroleptic Malignant Syndrome (NMS).

Answer 491

* Orthostatic hypotension * Increased heart rate * Dizziness

Answer 492

multireceptor

Answer 493

Could result in amenorrhea, menstrual cycle disorders, breast enlargement, galactorrhea, sexual effects.

Answer 494

Clozapine.

Answer 495

At least 6 months.

Answer 496

Serotonin opposes the release of dopamine.

Answer 497

Dopamine blockade in the 'limbic system' and in mesocortical areas is responsible for the antipsychotic actions.

Answer 498

* Agranulocytosis * Weight gain * Sedation

Answer 499

Start low & go slow, titrate over longer periods.

Answer 500

Observed neonatal adverse effects include developmental issues.

Answer 501

Weight gain is a precursor to metabolic syndrome.

Answer 502

Chlorpromazine, levomepromazine, promazine, pericyazine, pipothiazine, trifluoperazine, fluphenazine, haloperidol, benperidol, flupentixol, zuclopenthixol, pimozide, fluspirilene, sulpiride, amisulpride ## Footnote These drugs are primarily used to treat schizophrenia and other psychotic disorders.

Answer 503

Aripiprazole, Clozapine, Olanzapine, Paliperidone, Quetiapine, Risperidone, Sertindole ## Footnote Atypical antipsychotics are considered to have a different side effect profile compared to typical antipsychotics.

Answer 504

Clozapine ## Footnote Clozapine is particularly effective in patients who do not respond to other treatments.

Answer 505

Previous response to a drug, co-morbid illness, potential for drug interactions, potential for side effects, prescriber, patient or carer preference ## Footnote Patient choice is important as it can affect treatment adherence.

Answer 506

Use lowest possible dose, dose increase only after 2 weeks of assessment, use of a single antipsychotic recommended ## Footnote In exceptional circumstances, augmentation with another antipsychotic may be acceptable.

Answer 507

* 70% of patients respond, achieving partial or complete remission * Familiar drugs with predictable side effects * Multiple formulations available * Reduce relapse in most patients * Mostly inexpensive * Wide choice of drugs ## Footnote The choice of drug often depends on the side effect profile.

Answer 508

* Generally ineffective against negative and cognitive symptoms * Low efficacy in many people * Slow response (up to 6-8 weeks) * Not liked by patients due to many side effects ## Footnote Side effects include extrapyramidal symptoms (EPSE), anticholinergic effects, and endocrine problems.

Answer 509

D2 and 5-HT2A antagonism ## Footnote This antagonism helps reduce the risk of extrapyramidal side effects.

Answer 510

True ## Footnote Sedation is commonly observed, especially in the first few months of treatment.

Answer 511

[dopamine] ## Footnote Dopamine receptor antagonism is crucial for their therapeutic effects.

Answer 512

Acute or tardive motor symptoms caused by D2 antagonism in the striatum ## Footnote Symptoms include tremor, rigidity, bradykinesia, dystonia, akathisia, and dyskinesia.

Answer 513

Increased prolactin secretion due to D2 antagonism in the tuberoinfundibular pathway ## Footnote It can lead to menstrual disturbances, reduced bone mineral density, and sexual dysfunction.

Answer 514

* Extrapyramidal symptoms (EPSE) * Weight gain * Sedation * Dry mouth * Constipation * Tachycardia ## Footnote Monitoring for these side effects is essential for patient safety.

Answer 515

Dietary advice, lifestyle changes, and/or treatment with statins ## Footnote Monitoring baseline weight and regular assessments are important for managing weight.

Answer 516

Every 1 to 4 weeks ## Footnote These injections are indicated for patients with poor compliance.

Answer 517

* Flupentixol decanoate * Fluphenazine decanoate * Haloperidol decanoate * Pipotiazine palmitate * Zuclopenthixol decanoate * Olanzapine pamoate * Paliperidone palmitate * Risperidone ## Footnote These formulations may differ in their base and administration requirements.

Answer 518

Generalized seizures, focal seizures, absence seizures, tonic-clonic seizures, myoclonic seizures.

Answer 519

Refractory period and ion channel inactivation.

Answer 520

Excitatory postsynaptic potentials.

Answer 521

Inhibitory postsynaptic potentials.

Answer 522

A sudden and intense depolarization of a neuron that can lead to seizure activity.

Answer 523

Seizures are transient events; epilepsy is a disorder characterized by recurrent seizures.

Answer 524

The process by which a normal brain develops epilepsy.

Answer 525

* Phenytoin * Carbamazepine * Lamotrigine * Valproic acid * Ethosuximide * Gabapentin * Felbamate.

Answer 526

Action potential upstroke and repetitive action potential firing.

Answer 527

Repetitive action potential firing.

Answer 528

Action potential downstroke.

Answer 529

Possible epilepsy.

Answer 530

Sets refractory period and limits repetitive firing.

Answer 531

Transmitter release and carries depolarizing charge.

Answer 532

Initiates fast EPSP.

Answer 533

Maintains PDS and activates intracellular processes.

Answer 534

Limits excitation.

Answer 535

Prolonged IPSP; limits excitation.

Answer 536

Ultrafast excitatory transmission and synchronization of neuronal firing.

Answer 537

Restores ionic balance and prevents K+-induced depolarization.

Answer 538

* Cerebral dysgenesis * Post-traumatic scar * Mesial temporal sclerosis.

Answer 539

Decreased GABA synthesis; B6 is a co-factor for GAD.

Answer 540

Nonketotic hyperglycinemia.

Answer 541

* Enhance inhibition * Prevent spread of synchronous activity.

Answer 542

* Barbiturates * Benzodiazepines.

Answer 543

By prolonging Na+ channel inactivation.

Answer 544

Self-sustaining cycle of activity between thalamic and cortical cells.

Answer 545

Prevent burst activity of thalamic relay neurons.

Answer 546

A disorder characterized by an enduring predisposition to generate epileptic seizures.

Answer 547

Two or more seizures.

Answer 548

Drinking a slain gladiator's blood could cure epilepsy.

Answer 549

* Fear * Masturbation * Drunkenness.

Answer 550

The Sakikku, a Babylonian cuneiform medical text from 1067–1046 BC.

Answer 551

Focal seizures, Generalized seizures ## Footnote Seizures can be classified based on their origin and spread.

Answer 552

A pictorial representation of the anatomical divisions of the primary motor cortex and the primary somatosensory cortex ## Footnote It represents the movement and exchange of sensory and motor information in the brain.

Answer 553

GABA and Glutamate ## Footnote GABA is inhibitory, while Glutamate is excitatory.

Answer 554

Stops action potentials ## Footnote GABA is an inhibitory neurotransmitter that helps regulate neuronal excitability.

Answer 555

Starts action potentials or keeps them going ## Footnote Glutamate is an excitatory neurotransmitter critical for synaptic transmission.

Answer 556

Groups of neurons, e.g., cortical pyramidal cells, firing trains of action potentials ## Footnote This abnormal activity can lead to seizures.

Answer 557

A sustained depolarization characterized by a train of action potentials ## Footnote It is observed in neurons within the epileptic focus.

Answer 558

Focal seizures and Generalized seizures ## Footnote This classification is based on the site of origin and pattern of spread.

Answer 559

Related to the function ordinarily subserved by the area of the brain where they arise ## Footnote Symptoms can vary based on the specific brain region affected.

Answer 560

Begins simultaneously in both hemispheres ## Footnote They often display a bilateral synchronous spike-wave pattern on EEG.

Answer 561

* Absence epilepsy * Tonic * Clonic * Tonic-clonic * Atonic * Myoclonic ## Footnote Generalized seizures can involve loss of consciousness.

Answer 562

sodium ion ## Footnote These channels are critical for the propagation of action potentials.

Answer 563

Brain Tumours and Strokes ## Footnote These conditions are more prevalent in older populations.

Answer 564

The sequence of events that turns a normal neuronal network into a hyperexcitable network ## Footnote This process can lead to the development of epilepsy.

Answer 565

* Single gene mutations * Multiple genes + environment ## Footnote Genetic disorders such as Down syndrome and Dravet syndrome can increase the risk of epilepsy.

Answer 566

Contributes to rapid bilateral synchrony ## Footnote It facilitates communication between the two hemispheres of the brain.

Answer 567

* Birth Traumas * Infections (e.g., Meningitis) * Congenital abnormalities * High fevers ## Footnote These factors can trigger seizures in pediatric populations.

Answer 568

Activates glutamate receptors leading to neurotoxicity ## Footnote Domoic acid can cause excessive glutamate release, resulting in neuronal degeneration.

Answer 569

Simple: no loss of consciousness; Complex: impairment of consciousness ## Footnote This distinction is crucial for diagnosis and treatment.

Answer 570

A basic unit of the nervous system that transmits signals.

Answer 571

It conducts electrical impulses away from the neuron's cell body.

Answer 572

The end part of an axon where neurotransmitters are released.

Answer 573

* Treatment of a single seizure by specialists * Treatment of underlying abnormalities * Consideration of precipitating factors

Answer 574

Precipitating factors such as drug abuse (e.g., cocaine) and sleep deprivation.

Answer 575

Epilepsy can affect driving eligibility as assessed by DVLA.

Answer 576

* Sleep hygiene * Diet * Stress management

Answer 577

* The type of seizure or epilepsy syndrome * The side effect profile of AEDs * Vigilance about drug-drug interactions

Answer 578

* Serum anticonvulsant levels * Patient counselling * Acute problems (e.g., infection)

Answer 579

Evaluation of appropriate doses of anticonvulsants.

Answer 580

* Voltage-gated Na+ Channels * HVA Ca2+ Channels * LVA Ca2+ Channels * Voltage-gated K+ Channels * GABA A receptor * GABA Turnover * Glutamate receptor * Synaptic vesicle protein 2A

Answer 581

* Phenytoin * Ethosuximide * Carbamazepine * Lamotrigine * Levetiracetam

Answer 582

[GABA A receptor]

Answer 583

* Nature Reviews Neurology * Foye's Principles of Medicinal Chemistry * Essentials of Human Physiology for Pharmacy

Answer 584

* Na+ Channels * Ca2+ Channels * K+ Channels

Answer 585

A seizure is a brief, temporary disturbance in the electrical activity of the brain.

Answer 586

Epilepsy is a disorder characterized by recurring seizures.

Answer 587

* Head trauma * Brain tumor and stroke * Lead poisoning * Infection of brain tissue * Heredity * Prenatal disturbance of brain development

Answer 588

3400 per 100,000 men (3.4%) and 2800 per 100,000 women (2.8%).

Answer 589

Around 60 million people have epilepsy.

Answer 590

Approximately 45/100,000.

Answer 591

* Flashing lights * Stress * Alcohol * Not taking medication

Answer 592

2-3 times higher.

Answer 593

* 70-80% will eventually become seizure free * 50% will successfully withdraw medication * 20-30% may develop chronic epilepsy

Answer 594

* Simple (no loss of consciousness) * Complex (consciousness impaired) * With or without aura * With or without automatisms

Answer 595

Apparent start over wide areas of the brain.

Answer 596

Grand mal seizure.

Answer 597

* Loss of consciousness * Sudden stiffness * Rhythmical shaking * Possible temporary cessation of breathing

Answer 598

Approximately 80/100,000.

Answer 599

Sudden, brief, involuntary muscle contractions.

Answer 600

* Head injury * Alcohol withdrawal * Drugs * Metabolic disturbance * Stroke

Answer 601

* Abnormal discharges spread to other parts of the brain * Imbalance between excitatory and inhibitory forces in cortical neurons

Answer 602

46% report difficulties.

Answer 603

Focal-onset seizures.

Answer 604

Brief lapses in consciousness.

Answer 605

[excitatory], [inhibitory]

Answer 606

Considerations include age, gender, and comorbid conditions.

Answer 607

Atonic seizures.

Answer 608

Tonic-clonic seizure.

Answer 609

Defective activation can lead to decreased inhibition.

Answer 610

Convulsion ## Footnote May also include temporary breathing cessation and cyanosis.

Answer 611

Myoclonic seizure ## Footnote Can vary in intensity and may affect only part of the body.

Answer 612

Momentary lapse in awareness ## Footnote Often involves staring or blinking and is more common in children.

Answer 613

Differentiate between events that mimic epileptic seizures ## Footnote Examples include syncope, vertigo, migraine, and psychogenic non-epileptic seizures.

Answer 614

Achieve complete seizure control with a single drug ## Footnote Ideally taken once or twice daily without side effects.

Answer 615

* Type of seizure or epilepsy syndrome * Pharmacokinetic profile * Interactions/other medical conditions * Efficacy & safety * Treatment cost

Answer 616

Never stop AEDs suddenly ## Footnote A minimum of 2 seizure-free years is required in patients without risk factors.

Answer 617

Review the diagnosis ## Footnote Consider adding another first-line drug while withdrawing the first one.

Answer 618

Partial and generalized tonic-clonic seizures ## Footnote It is an enzyme-inducing drug and can interact with other medications.

Answer 619

Teratogenic effects causing spina bifida ## Footnote Especially important to avoid in women of child-bearing age.

Answer 620

Absence seizures ## Footnote It is safer for women of child-bearing age compared to other AEDs.

Answer 621

First-line treatment for absence seizures ## Footnote Can be used as monotherapy or adjunctive treatment.

Answer 622

* Sedation * Drug interactions * Narrow therapeutic range

Answer 623

Potent enzyme inducer ## Footnote It has a narrow therapeutic range and can cause serious side effects.

Answer 624

Focal seizures with or without secondary generalization ## Footnote Examples include Gabapentin and Pregabalin.

Answer 625

Ketogenic diet ## Footnote High in fat and low in carbohydrates and protein.

Answer 626

Used as adjuvants in emergency cases ## Footnote Particularly for uncontrolled seizures like status epilepticus.

Answer 627

Blood disorders and sedation levels ## Footnote Particularly important for drugs like Phenobarbital and Phenytoin.

Answer 628

High fat, low carbohydrate and protein intake ## Footnote This dietary approach is known as the ketogenic diet.

Answer 629

Delivers electrical stimulation to the vagus nerve in the neck ## Footnote This method relays impulses to widespread areas of the brain to control seizures.

Answer 630

Partial seizures ## Footnote Used when medication does not work.

Answer 631

* Behavioral therapy (Biofeedback, Relaxation, Positive reinforcement) * Cognitive therapy * Aromatherapy

Answer 632

* Puberty * Menopause * Monthly cycle

Answer 633

All antiepileptic drugs carry teratogenic risks ## Footnote Polytherapy increases this risk.

Answer 634

5 mg ## Footnote This is advised to help mitigate risks.

Answer 635

They tend to metabolize the drugs faster than adults.

Answer 636

Lower initial and maintenance doses ## Footnote Due to slowed hepatic metabolism and decreased renal clearance.

Answer 637

* Phenytoin * Carbamazepine * Valproic acid * Felbamate

Answer 638

Drug-drug interactions caused by hepatic enzyme induction or inhibition.

Answer 639

Polycystic ovary syndrome

Answer 640

False ## Footnote Most produce normal children despite risks.

Answer 641

* Slowed hepatic metabolism * Decreased renal clearance * Decreased volumes of distribution

Answer 642

Dose adjustments for drugs like Gabapentin, pregabalin, levetiracetam, and lacosamide.

Answer 643

* Anti-depressants * Antipsychotics * Antimalarial

Answer 644

Attention Deficit Hyperactivity Disorder

Answer 645

Excessive activity, inattention, and impulsivity

Answer 646

Prefrontal Cortex

Answer 647

Basal Ganglia

Answer 648

Communication between the two brain hemispheres

Answer 649

Anterior Cingulate

Answer 650

* Frontal lobe * Temporal lobe * Limbic system * Cerebellum

Answer 651

* Genetic factors * Environmental factors

Answer 652

Genotypes affecting serotonin and dopamine pathways

Answer 653

* Maternal alcohol and substance abuse * Low birth weight * Nutritional deficiencies * Environmental toxin exposure * Early psychosocial adversity

Answer 654

* Inattentive Type * Hyperactive-Impulsive Type * Combined Type

Answer 655

Before age 7 years

Answer 656

* Reduce symptoms * Improve academic performance * Improve quality of life

Answer 657

* Lack of attention to details * Lack of sustained attention * Poor listener * Failure to follow through on tasks * Poor organization * Easily distracted * Forgetful

Answer 658

* Fidgeting or squirming * Leaving seat * Difficulty with quiet activities * Excessive talking * Blurting answers * Can't wait turn

Answer 659

* Low self-esteem * Low school performance * Social disability

Answer 660

Around 50%

Answer 661

Increase synaptic concentration of Noradrenaline and Dopamine

Answer 662

Dopamine and Noradrenaline dysregulation

Answer 663

* Mood * Anxiety * Attention * Motivation * Cognition

Answer 664

Regulates dopamine clearance from the synaptic cleft

Answer 665

It is responsible for the catabolism of Dopamine

Answer 666

* Mood and Anxiety disorders * Specific learning disabilities * Iron deficiency anemia

Answer 667

Dopamine Transporter Protein (DAT1), Monoamine Oxidase A (MAO-A), Catechol-O-Methyl-Transferase (COMT) ## Footnote DAT1 is responsible for rapid uptake of dopamine, while MAO-A and COMT are involved in dopamine catabolism.

Answer 668

Noradrenaline (NA) and Dopamine (DA) ## Footnote Genetic studies of ADHD have focused on candidate genes coding for elements of dopamine metabolism.

Answer 669

Dorsolateral prefrontal cortex (PFC) ## Footnote Studies in non-human primates have shown its sensitivity to NA and DA.

Answer 670

Acts on post-synaptic Alpha-2 receptors ## Footnote The A subtype of alpha-2 receptors is most important for noradrenaline action in the PFC.

Answer 671

Dampens noise, enhances executive operations, increases inhibition ## Footnote This modulation helps focus on preferred or relevant inputs.

Answer 672

In cognitive performance and the treatment of ADHD ## Footnote Their activity is thought to be an inverted U-shaped function in relation to catecholaminergic systems.

Answer 673

Reduce symptoms, improve academic performance, improve quality of life ## Footnote Drug treatment should be initiated by qualified healthcare professionals.

Answer 674

Comprehensive assessment and diagnosis ## Footnote Continued prescribing may be performed by general practitioners under shared care arrangements.

Answer 675

For preschool children, as first-line treatment for all school-age children and young people ## Footnote It should be reserved for those with severe symptoms or moderate impairment who refuse non-drug interventions.

Answer 676

Stimulants like Methylphenidate or dextroamphetamine ## Footnote These increase levels of dopamine and noradrenaline in the prefrontal cortex.

Answer 677

Selective inhibition of noradrenaline reuptake ## Footnote Atomoxetine is a non-stimulant option for ADHD.

Answer 678

Dry mouth, loss of appetite, weight loss, slower growth, sleep disturbance ## Footnote These side effects were reported in various studies.

Answer 679

Amplification of extracellular dopamine in the basal ganglia ## Footnote Variability in responses may be due to differences in dopamine tone between individuals.

Answer 680

Modified-release preparations ## Footnote They improve adherence and reduce stigma associated with taking medication at school.

Answer 681

Potential for suicidal thinking and liver damage ## Footnote Symptoms include abdominal pain, unexplained nausea, malaise, dark urine, or jaundice.

Answer 682

May reduce sleep onset ## Footnote Evidence comes from small randomized controlled trials.

Answer 683

They may reduce sleep onset latency in children with sleep onset insomnia and ADHD by approximately 20 minutes. ## Footnote Unlicensed melatonin products have shown potential in short-term use for specific sleep issues.

Answer 684

15 to 20 minutes. ## Footnote This improvement was noted in children with sleep onset insomnia.

Answer 685

They are small, and longer-term efficacy is unclear. ## Footnote Only two small RCTs and one follow-up study were referenced.

Answer 686

Prolonged-release tablets for the short-term treatment of primary insomnia in adults aged 55 years or over. ## Footnote Circadin is the only licensed form mentioned.

Answer 687

Improvement in ADHD-related behaviour, cognition, or quality of life. ## Footnote The evidence did not support significant behavioral benefits.

Answer 688

It appeared well tolerated with only transient mild to moderate adverse effects reported. ## Footnote This indicates a favorable safety profile.

Answer 689

Consider reduction of TV usage to less than two hours a day and none for children under 2. ## Footnote This is part of behavioral recommendations for managing ADHD.

Answer 690

No, it is not recommended as a generally applicable treatment. ## Footnote This reflects the current stance on dietary interventions.

Answer 691

Abnormalities in melatonin physiology and the circadian rhythm. ## Footnote These abnormalities may affect sleep patterns in individuals with ASD.

Answer 692

Lower nighttime melatonin concentrations. ## Footnote This may relate to sleep issues commonly seen in ASD.

Answer 693

Significant improvements in total sleep duration and sleep onset latency with large effect sizes. ## Footnote This indicates the potential effectiveness of melatonin supplementation.

Answer 694

Attention, hyperactivity, and impulsivity. ## Footnote These symptoms can lead to various functional impairments.

Answer 695

3% to 7%. ## Footnote This prevalence highlights the commonality of the disorder.

Answer 696

Genetic factors. ## Footnote Genetics plays a significant role in the development of ADHD.

Answer 697

Significant differences in their brains compared to those without ADHD. ## Footnote These differences are often linked to specific brain circuits controlling attention and behavior.

Answer 698

Cortical-striatal-thalamic-cortical circuit. ## Footnote This circuit is crucial for controlling attention, motoric output, impulsivity, and executive functions.

Answer 699

Use of a drug in an inappropriate, but perhaps well-intentioned, way. ## Footnote Often used interchangeably with drug abuse, but implies a lack of intentional harm.

Answer 700

Deliberately using a drug outside of its license to achieve an inappropriate aim. ## Footnote This term is often associated with intentional harm or disregard for the consequences.

Answer 701

Not having control over doing, taking, or using something to the point where it could be harmful. ## Footnote Addiction can involve physical and psychological dependence.

Answer 702

Varied and can include genetic, environmental, and psychological factors. ## Footnote Specific risk factors can vary widely among individuals.

Answer 703

* Class A * Class B * Class C ## Footnote These classes are based on penalties for possession, supply, or manufacture.

Answer 704

Legislation that classifies controlled drugs and establishes rules for their legal supply and possession. ## Footnote It also provides penalties for violations.

Answer 705

Around 8%. ## Footnote This statistic highlights the prevalence of drug misuse in the population.

Answer 706

* Alcohol * Tobacco * Illicit drugs * OTC medicines * Prescription drugs * Non-drug products ## Footnote This includes a wide range of substances across various categories.

Answer 707

Substances not controlled under the Misuse of Drugs Act. ## Footnote They may mimic the effects of illegal drugs but are not classified as such.

Answer 708

The process of discontinuing substance use and managing withdrawal symptoms. ## Footnote This is often the first step in treatment.

Answer 709

* Relapse is common * Patients may remain in a community of drug users * Side effects from treatment * Illicit use of prescribed substances ## Footnote These challenges can complicate recovery efforts.

Answer 710

* Reducing harm * Discontinuation of substance use * Addressing social issues * Reintegration into societal roles ## Footnote Treatment is holistic and addresses multiple aspects of a patient's life.

Answer 711

To provide advice to the government on drug misuse issues. ## Footnote Established as part of the Misuse of Drugs Act 1971.

Answer 712

Use of any Class A drug was around 10 times higher among people who had visited a nightclub at least 4 times in the past month. ## Footnote This suggests a correlation between nightlife activities and drug use.

Answer 713

It outlines specific regulations regarding the supply and management of controlled drugs. ## Footnote This legislation complements the Misuse of Drugs Act 1971.

Answer 714

* Constipation * Sweating * Withdrawal symptoms ## Footnote These side effects can affect compliance with treatment.

Answer 715

Drug misuse can lead to a range of social issues, including homelessness, unemployment, and family breakdown. ## Footnote Addressing these issues is a critical component of rehabilitation.

Answer 716

A person's diminished response to a drug, occurring with repeated use. ## Footnote This can lead to increased consumption to achieve the same effect.

Answer 717

A service where medication is administered under the supervision of a healthcare professional.

Answer 718

Programs that provide sterile injecting equipment and facilitate the safe disposal of used equipment.

Answer 719

The inappropriate use of drugs, either by taking them in a manner not prescribed or taking substances for non-medical purposes.

Answer 720

* Supervised consumption * Needle exchange services * Counseling and support programs

Answer 721

To reduce street diversion, aid compliance, improve control/safety, and prevent harm to others.

Answer 722

* Provision of sterile injecting equipment * Disposal of used injecting equipment * Provision of advice on safer injecting

Answer 723

* Size of instalments * Instructions for pharmacy closed days * Management of missed doses

Answer 724

* Soft tissue infections * Septicaemia and endocarditis * Pulmonary complications * Blood borne viruses

Answer 725

A prescription form specifically for controlled drugs.

Answer 726

To provide guidance on the ethical and legal aspects of medication dispensing.

Answer 727

Consult the prescriber.

Answer 728

The method of providing medication in specified doses over a period of time.

Answer 729

The Misuse of Drugs Regulations 2001.

Answer 730

* 10 x 1ml combined needle & syringe * 10 x cooking spoons * 10 x citric acid sachets

Answer 731

It regulates the supply of substances that can be misused.

Answer 732

* Normal CD requirements * Size of instalments * Instructions for supply

Answer 733

Dispense the amount for any remaining days of that instalment.

Answer 734

It addresses issues related to drug trafficking and related offenses.

Answer 735

A chronic progressive behavioral disorder characterized by compulsive drug use despite adverse consequences. ## Footnote Addiction involves alterations in the brain's reward systems due to chronic drug use.

Answer 736

A minimum of 2-3 criteria is required for a mild substance use disorder diagnosis. ## Footnote Criteria include taking larger amounts than intended, wanting to cut down but unable to, and spending a lot of time obtaining the substance.

Answer 737

A strong urge to use the substance or a strong desire that one cannot think of anything else. ## Footnote It includes difficulty resisting the urge to use.

Answer 738

The reward pathway is activated by food, water, sex, and drugs/alcohol. ## Footnote It is involved in reinforcing behaviors that promote survival.

Answer 739

70% of people who use drugs are employed. ## Footnote Drug use can lead to workplace deaths, absenteeism, and reduced productivity.

Answer 740

Pharmacists support substance addiction treatment by ensuring medication management and patient counseling.

Answer 741

Tolerance involves needing markedly increased amounts to achieve intoxication or a diminished effect with continued use. ## Footnote In older adults, tolerance may involve using less to achieve the same effect.

Answer 742

The ACC is involved in decision-making based on reward values and generates new actions based on past rewards/punishments.

Answer 743

Common comorbidities include mental health disorders, chronic pain, and other substance use disorders.

Answer 744

False. ## Footnote Eight of the ten diagnostic criteria in DSM-V are behavioral.

Answer 745

Addiction can lead to failure to fulfill role obligations and continued use despite social or interpersonal problems.

Answer 746

Alcohol is involved in 40% of traffic fatalities.

Answer 747

The limbic system is involved in emotional responses and is critical in the development and maintenance of addictive behaviors.

Answer 748

The IC is important for emotional awareness and interceptive representation, impacting craving and addiction denial.

Answer 749

Impaired control over substance use.

Answer 750

* Alcohol * Opiates/Opioids * Cocaine * Amphetamines * Cannabinoids * Nicotine * Caffeine

Answer 751

Chronic drug use hijacks the brain's reward circuits.

Answer 752

Factors include the type of substance, the severity of the disorder, and the presence of comorbidities.

Answer 753

Pleasure and pain ## Footnote These aspects arise in the Limbic areas of the brain.

Answer 754

Eustress (positive) and Distress (negative) ## Footnote These states are controlled by the hypothalamic structures.

Answer 755

Hunger, thirst, reproductive drive, temperature, blood pressure ## Footnote It maintains hormonal balance.

Answer 756

Dopamine ## Footnote Dopamine projections occur from the Ventral Tegmental Area (VTA) to the nucleus accumbens (Nac).

Answer 757

5HT2A and 5HT2C ## Footnote Functions include mood, impulsivity, anxiety, sleep, and cognition.

Answer 758

Kappa, Mu, Delta ## Footnote Their function is related to pain management.

Answer 759

Cocaine blocks reuptake, while amphetamines facilitate DA release ## Footnote Both increase levels of dopamine in the nucleus accumbens.

Answer 760

Around 50% ## Footnote This is similar to rates found in asthma, hypertension, and diabetes.

Answer 761

How many times in the past year have you had 5 or more drinks on one occasion? ## Footnote For women, the question is about having 4 or more drinks.

Answer 762

* Aggressive behavior in childhood * Lack of parental supervision * Poor social skills * Drug experimentation * Availability of drugs at school * Community poverty ## Footnote These factors contribute to the development of addiction.

Answer 763

* Good self-control * Parental monitoring and support * Positive relationships * Academic competence * School anti-drug policies * Neighborhood pride ## Footnote These factors can mitigate the risk of developing addiction.

Answer 764

Should include assessment of objective signs and subjective symptoms ## Footnote For nicotine, consider likelihood of withdrawal; for alcohol, use CIWA-Ar; for opioids, use COWS.

Answer 765

* Tremor * Nausea * Sweating * Vomiting * Agitation * Headache * Insomnia ## Footnote Severe dependence can lead to seizures and delirium tremens.

Answer 766

Thiamine deficiency ## Footnote It is a progressive neurological condition often seen in alcoholics.

Answer 767

Maintenance, detoxification, and abstinence ## Footnote Individual regimens are required based on symptoms.

Answer 768

Activates α4β2 and α7 nicotinic receptors, leading to dopamine release ## Footnote This mechanism contributes to the reinforcing effects of nicotine.

Answer 769

Nicotine activates α4β2 and α7 nicotinic receptors, leading to dopamine release ## Footnote This activation contributes to the reinforcing effects of nicotine.

Answer 770

They become desensitised, resulting in a temporary loss of function ## Footnote This desensitisation contributes to cravings and withdrawal symptoms.

Answer 771

Delivers nicotine by alternate routes to reduce cravings without receptor upregulation ## Footnote It helps mitigate withdrawal symptoms during cessation.

Answer 772

It is a noradrenaline and dopamine reuptake inhibitor used as an antidepressant and for smoking cessation ## Footnote It increases dopamine in the nucleus accumbens, satisfying cravings.

Answer 773

Dry mouth, headaches, insomnia ## Footnote There is also a warning for seizure risk and suicide risk.

Answer 774

A selective α4β2 nicotinic receptor partial agonist that stabilises the nicotinic channel partially open without desensitisation ## Footnote This mechanism helps reduce cravings for nicotine.

Answer 775

Dry mouth, headaches, insomnia ## Footnote It also carries warnings for seizures, suicide risk, and myocardial infarction.

Answer 776

Alcohol enhances inhibition at GABA synapses and reduces excitation at glutamate synapses ## Footnote This results in a euphoric relaxation effect.

Answer 777

A benzodiazepine that enhances GABA transmission ## Footnote It is often used for managing alcohol withdrawal symptoms.

Answer 778

Doses may start at 30mg QDS and taper down ## Footnote The regimen is based on local protocol and CIWA-Ar.

Answer 779

Stimulates GABAergic neurotransmission and antagonises glutamate ## Footnote It helps restore balance after chronic alcohol use.

Answer 780

Irreversible inhibition of aldehyde dehydrogenase, causing unpleasant reactions with alcohol ## Footnote Side effects include headache, tachycardia, and hypotension.

Answer 781

An opioid antagonist that blocks the dopamine reward pathway ## Footnote It is used for risk reduction rather than immediate abstinence.

Answer 782

An opioid antagonist thought to block the dopamine reward pathway ## Footnote It is also used for risk reduction rather than immediate abstinence.

Answer 783

An opioid partial agonist given sublingually ## Footnote It has a long duration of action, allowing for once-daily dosing.

Answer 784

Risk of fatal overdose increases with alcohol and benzodiazepines ## Footnote It also has a long half-life and can lead to QTc prolongation.

Answer 785

Start with 5-10mg and monitor withdrawal syndrome ## Footnote Adjustments can be made based on patient response.

Answer 786

Anticholinergics (e.g., procyclidine), antihistamines (e.g., cyclizine), gabapentinoids ## Footnote Healthcare professionals should be vigilant for misuse.

Answer 787

Yes, it is illegal to drive if unfit due to drug use ## Footnote This includes both legal substances like alcohol and illegal drugs.

Answer 788

Provide information about laws and drug-driving risks, and monitor for side effects ## Footnote They should direct patients to proper resources.

Answer 789

Pain is a subjective experience that includes sensory discriminative, affective (emotional), and cognitive components ## Footnote Pain is not merely a stimulus but an experience interpreted by the brain.

Answer 790

* Nociceptive pain * Neuropathic pain

Answer 791

* Physical trauma * Chemicals * Excessive heat or cold * Stretching beyond normal range * Ischaemia

Answer 792

The neural process of encoding noxious stimuli triggered by harmful stimuli acting on specialized peripheral nerve endings ## Footnote Nociception does not always result in the perception of pain.

Answer 793

* Mechanical nociceptors * Thermal nociceptors * Chemical nociceptors

Answer 794

* First pain: sharp and brief, carried by myelinated Aδ neurons * Second pain: delayed and dull, carried by unmyelinated C fibers

Answer 795

* Triggers reflex activity * Conveys information to the brain regarding location and intensity

Answer 796

* Somatosensory cortex: sensory discrimination * Limbic system: affective-motivational function * Prefrontal cortex: cognitive evaluation

Answer 797

Localizes the site, quality, and intensity of the stimulus

Answer 798

Pain modulation refers to the processes that influence the perception of pain, often through the interaction between peripheral and central nervous systems ## Footnote It is more complex than a simple relationship between these systems.

Answer 799

The sensory nervous system prioritizes information about potentially harmful stimuli.

Answer 800

A simplistic view that does not fully explain the complexities of pain perception and experience.

Answer 801

The ability of the brain to adapt and change in response to pain experiences.

Answer 802

They influence the perception of pain from the brain to the spinal cord.

Answer 803

* Subjective experience * Influenced by context * Not solely a physiological response

Answer 804

The process by which nociceptive neurons convert harmful stimuli into electrical signals.

Answer 805

It processes the emotional aspects of pain and influences attention and memory of pain.

Answer 806

Specialist input is crucial due to the complexity of pain management.

Answer 807

It illustrates the immediate reflexive response to nociceptive stimuli.

Answer 808

An individual's mood can influence how pain is perceived and interpreted.

Answer 809

Pain and suffering are not the same.

Answer 810

It does not explain the whole story; things are more complex.

Answer 811

It proposes that C-fibre nociceptor signals are inhibited at the spinal cord level by large nerve fibres before being transmitted to the brain.

Answer 812

Transcutaneous Electrical Nerve Stimulator (TENS) is used for pain management.

Answer 813

* Physical therapies * Spinal cord stimulators * Heat * Cold * Massage * Manipulation * Acupuncture

Answer 814

They inhibit or facilitate nociceptive signals in the spine.

Answer 815

* Opioids * Serotonin (5HT) * Noradrenaline * Gamma Amino Butyric Acid (GABA)

Answer 816

It involves cognition, mood, experience, and attention.

Answer 817

An unpleasant sensory and emotional experience with actual or potential tissue damage.

Answer 818

More than 50%.

Answer 819

Pain that arises from the activation of nociceptors due to noxious stimuli.

Answer 820

* Somatic * Visceral

Answer 821

Pain resulting from damaged sensory nerves.

Answer 822

* Acute * Chronic * Persistent

Answer 823

* Aspirin and other NSAIDs * Morphine and other opioids/cannabinoids * Transcutaneous Electrical Nerve Stimulation (TENS) * Deep brain stimulation * Placebo * Acupuncture * Hypnosis

Answer 824

Primary afferent neuron -> dorsal root ganglion -> second order neurons -> to brain stem and thalamus.

Answer 825

* Non-opioid drugs (e.g., paracetamol, NSAIDs) * Opioids (pure mu agonist and agonist-antagonist drugs) * Adjuvant analgesics

Answer 826

It matches the multi-sources of pain and perception in our neurobiology.

Answer 827

It refers to an increased responsiveness of nociceptive neurons to their normal input.

Answer 828

An increased sensitivity to painful stimuli.

Answer 829

Pain due to a stimulus that does not normally provoke pain.

Answer 830

* Acute muscle contraction (tension) headache * 'Ice-cream'/'ice-pick' headache * Chronic daily headache * Cluster headache * Sinister headache

Answer 831

Tension headache ## Footnote Thought to be due to muscle spasm in neck/scalp.

Answer 832

* Mild to moderate pain * Non-throbbing, vice-like * Feeling of tightness or squeezing * Usually affects both sides of the head

Answer 833

* Moderate to severe pain * Usually unilateral * Pulsating * Aggravated by normal activity

Answer 834

* OTC analgesic * Non-drug interventions (Relaxation, Massage, Hot bath)

Answer 835

Eating cold food or drinks

Answer 836

Occurs for more than 4 hours on more than 15 days in a month

Answer 837

* Excruciating severe unilateral headache * Accompanied by red eye, lacrimation, nasal congestion * Sudden onset, may wake the patient from sleep * Duration: between 10 mins to 3 hours

Answer 838

* Prophylactic treatment if attacks are frequent * Options include: 100% Oxygen, Sumatriptan S/C, High-dose verapamil

Answer 839

* Meningitis * Subarachnoid haemorrhage * Temporal arteritis * Trigeminal neuralgia * Depression * Glaucoma * Raised intracranial pressure

Answer 840

* Unresponsive to analgesics * In children under 12 years with stiff neck or skin rash * Lasted for more than 2 weeks * Accompanied by nausea and vomiting without classical migraine symptoms

Answer 841

* Sudden, disabling onset * Accompanying symptoms (loss of consciousness, rash, neck stiffness) * Worsening pattern on awakening

Answer 842

* Prodrome * Aura * Headache * Postdrome

Answer 843

* Lateralized and pulsating headache * Associated with nausea and vomiting, photophobia, phonophobia

Answer 844

* Foods (alcohol, caffeine, chocolate) * Hormonal changes (HRT, contraceptive pill) * Emotional and environmental factors

Answer 845

Repeated attacks of headaches lasting 4-72 hours with specific features

Answer 846

* Galcanezumab (Injection) * Fremanezumab (Injection) * Erenumab (Injection) * Rimegepant (Oral)

Answer 847

* Simple analgesics * Oral triptan (sumatriptan) alone or with NSAID or paracetamol

Answer 848

Consider a non-oral formulation such as zolmitriptan nasal spray or subcutaneous sumatriptan

Answer 849

Consider adding an anti-emetic even in the absence of nausea and vomiting

Answer 850

* Metoclopramide * Domperidone * Prochlorperazine

Answer 851

900 mg every 4–6 hours up to a maximum of 4 g daily

Answer 852

10 mg three times a day

Answer 853

18-65 years old

Answer 854

Consider a non-oral anti-emetic preparation

Answer 855

* Tiredness * Dizziness * Heaviness on chest and throat

Answer 856

Medication overuse headache

Answer 857

Limit painkillers for headache to <15 days/month

Answer 858

Stop current therapy

Answer 859

Preventing headaches before they occur

Answer 860

Headache diaries

Answer 861

* Topiramate * Propranolol

Answer 862

Risk of foetal malformations

Answer 863

Relaxes muscles and blocks pain feedback

Answer 864

* Galcanezumab * Fremanezumab * Erenumab

Answer 865

4 or more migraine days a month and at least 3 preventive drug treatments have failed

Answer 866

* Raise awareness of migraine * Signpost patients for improved management * Identify OTC analgesic overuse * Help doctors with management strategies * Educate patients on realistic expectations

Answer 867

Wait two hours before the 2nd dose

Answer 868

6-12 months

Answer 869

Taper or discontinue therapy

Answer 870

CGRP receptor antagonist

Answer 871

Difficulty getting to sleep or staying asleep, early morning wakening, non-restorative sleep, and daytime functioning impairment.

Answer 872

At least one of the following symptoms: * Difficulty getting to sleep * Difficulty staying asleep * Early morning wakening * Non-restorative sleep * Daytime functioning impairment.

Answer 873

A restorative physiological process characterized by alterations in brainwave activity.

Answer 874

Alteration in brainwave activity, as shown via an electroencephalograph (EEG).

Answer 875

Arousal system of the brain that is continuously stimulated by impulses, maintaining wakefulness.

Answer 876

Endogenous neurochemical factors reduce the activity of ARAS.

Answer 877

1. Inhibitory: * GABA 2. Excitatory: * Glutamate

Answer 878

An inhibitory neurotransmitter that stops action potentials.

Answer 879

Orexin (Hypocretin).

Answer 880

The body's internal circadian biological clock (CBC) and hunger/satiety signals.

Answer 881

An endogenous cycle of around 24 hours influenced by melatonin and environmental cues.

Answer 882

Adenosine levels in the pre-frontal cortex.

Answer 883

adenosine levels.

Answer 884

Four stages: * N1: Light sleep * N2: Deeper, memory-forming sleep * N3: Deep, restorative sleep * REM: Rapid eye movement sleep.

Answer 885

Characterized by rapid eye movement (REM) and accounts for 25% of sleep time.

Answer 886

Difficulty in getting to sleep, difficulty staying asleep, early wakening, or non-restorative sleep, despite adequate time and opportunity to sleep.

Answer 887

About 1/3 of the UK population; prevalence in primary care is estimated between 10% and 50%.

Answer 888

Sleep requirements reduce with age, but older people report poorer sleep.

Answer 889

A structured program that helps individuals identify and replace thoughts and behaviors that cause or worsen sleep problems.

Answer 890

Misunderstanding patient expectations and reliance on sedative prescriptions.

Answer 891

When initial management strategies fail or when there are underlying medical conditions.

Answer 892

About 1/3 of the UK population. ## Footnote Insomnia prevalence in primary care is estimated between 10% and 50%.

Answer 893

Difficulty getting to sleep or staying asleep, early wakening, or non-restorative sleep despite adequate time to sleep. ## Footnote Significant insomnia results in impaired daytime functioning.

Answer 894

Primary insomnia and Secondary (Comorbid) insomnia. ## Footnote Primary insomnia (15-20% of cases) has no associated comorbidity, while secondary insomnia (80%) is associated with other conditions.

Answer 895

* Anxiety and depression * Chronic pain * Physical health conditions (e.g., CVD, thyroid disorders) * Other sleep disorders * Circadian rhythm disorders * Environmental factors * Situational stress * Drug and substance misuse

Answer 896

* Antidepressants (SSRIs, SNRIs) * Antiepileptics (lamotrigine, phenytoin) * Antihypertensives (beta-/calcium-channel blockers) * NSAIDs * Hormones (corticosteroids, thyroid hormones) * Stimulants (methylphenidate, modafinil) * Sympathomimetics (salbutamol, theophylline) * Substance misuse (alcohol, caffeine, nicotine)

Answer 897

Less than 30 minutes. ## Footnote Variability in sleep patterns exists with age.

Answer 898

* Reduced quality of life * Increased risk of mental health conditions (e.g., depression, anxiety) * Poor work performance * Increased risk of CVD and diabetes

Answer 899

Cognitive Behavioral Therapy for Insomnia (CBT-I). ## Footnote CBT-I is the most effective and lasting treatment.

Answer 900

* Regular sleep schedule * Creating a comfortable sleep environment * Limiting screen time before bed * Reducing caffeine and alcohol intake

Answer 901

acute insomnia

Answer 902

Tolerance and dependence may develop. ## Footnote Withdrawal can lead to anxiety, depression, and impaired concentration.

Answer 903

False. ## Footnote No difference was found between melatonin and placebo groups for sleep efficiency.

Answer 904

1 to 4 weeks.

Answer 905

* Excessive time spent in bed * Irregular sleep schedules * Daytime napping

Answer 906

Not longer than 2 weeks. ## Footnote Only consider if daytime impairment is severe.

Answer 907

To establish patterns and identify useful behavioral targets for change.

Answer 908

They are used as hypnotics to treat insomnia. ## Footnote Examples include zopiclone and zolpidem.

Answer 909

dysfunctional

Answer 910

Improving quality of life.

Answer 911

A sleep disorder characterized by difficulty falling asleep, staying asleep, or waking up too early

Answer 912

* Difficulty falling asleep * Waking up frequently during the night * Feeling tired upon waking

Answer 913

stress or anxiety

Answer 914

* Acute insomnia * Chronic insomnia

Answer 915

Cognitive Behavioral Therapy for Insomnia (CBT-I)

Answer 916

Withdrawal symptoms or rebound insomnia

Answer 917

* Sleep hygiene practices * Relaxation techniques * Stimulus control therapy

Answer 918

sleep quality

Answer 919

To inform about the risks of dependence-forming medications

Answer 920

A degenerative brain disorder and the most common form of dementia.

Answer 921

Memory, language, problem-solving, and other cognitive skills.

Answer 922

Loss of neurons, especially pyramidal cells, in brain regions responsible for cognitive function.

Answer 923

Walking and swallowing.

Answer 924

For seconds to a minute.

Answer 925

Limited capacity.

Answer 926

Vast information for a lifetime.

Answer 927

* Semantic: Facts & general knowledge * Episodic: Personal experiences.

Answer 928

Implicit memory is unconscious; explicit memory is conscious.

Answer 929

* Procedural: Motor & cognitive skills * Priming: Enhanced object/word recognition * Classical Conditioning: Learned associations.

Answer 930

Specific to each task, e.g., tools and the motor cortex.

Answer 931

Entorhinal cortex and hippocampus.

Answer 932

Early loss in episodic and semantic memory.

Answer 933

Implicit perceptual memory.

Answer 934

* Amyloid plaques: Dystrophic neurites around amyloid core * Neurofibrillary tangles: Abnormal tau protein filaments in neurons.

Answer 935

* Enlarged ventricles * Neocortex shrinkage * Extreme hippocampal atrophy.

Answer 936

* Pyramidal * Cholinergic * Noradrenergic * Serotonergic.

Answer 937

Only postmortem.

Answer 938

Presents as amnesic mild cognitive impairment.

Answer 939

Entorhinal cortex.

Answer 940

Loss of GABAergic interneurons leading to widespread dysfunction.

Answer 941

Develop treatments to slow or stop neurodegeneration.

Answer 942

* Anti-Aβ monoclonal antibodies * Enzyme inhibitors (β- and γ-secretase) * Tau-targeted therapies.

Answer 943

Aβ deposits drive AD progression.

Answer 944

Hyperphosphorylated tau destabilizes microtubules and forms NFTs.

Answer 945

A neurodegenerative condition affecting the brain and spinal cord, leading to the degeneration of motor neurones and resulting in progressive weakness of limb or bulbar muscles while sensory function remains largely unaffected.

Answer 946

4-7/100,000.

Answer 947

Between ages 50–60.

Answer 948

* High levels of physical activity * Recurrent concussive or cervical trauma.

Answer 949

10–16 months.

Answer 950

* Progressive muscular weakness * Muscle wasting * Focal weakness * Dysarthria and dysphagia.

Answer 951

The commonest type of motor neurone disease characterized by progressive weakness and muscle wasting.

Answer 952

* Progressive weakness * Muscle atrophy * Spasticity.

Answer 953

3 to 5 years from onset for most cases.

Answer 954

[multidisciplinary team (MDT) specialist support].

Answer 955

Degeneration of upper and lower motor neurons.

Answer 956

It allows for timely referrals and interventions that can improve quality of life.

Answer 957

The scarred appearance of the spinal cord caused by loss of lateral corticospinal tract neurons.

Answer 958

Recognizing early, unexplained muscular weakness and making timely referrals to neurology.

Answer 959

* Dysarthria * Dysphagia.

Answer 960

A type of motor neurone disease characterized by upper motor neuron degeneration without lower motor neuron involvement.

Answer 961

UMN signs include spasticity; LMN signs include muscle atrophy.

Answer 962

The group of signs and symptoms produced by a specific disease process.

Answer 963

About 95% of ALS patients feature abnormalities in TDP-43.

Answer 964

[unrecognized].

Answer 965

70% present with limb symptoms such as focal weakness and muscle wasting.

Answer 966

Those who smoke are at higher risk for developing ALS.

Answer 967

* Upper motor neurons * Lower motor neurons.

Answer 968

A sign is an objective manifestation of a disease, whereas a symptom is a subjective manifestation of a disease.

Answer 969

The group of signs and symptoms produced by a specific disease process.

Answer 970

Dysarthria, dysphagia.

Answer 971

Shortness of breath, orthopnoea, sleep disruption, early morning headaches, daytime somnolence.

Answer 972

Behavioral change, emotional lability, memory impairment, dementia.

Answer 973

Head drop, posture.

Answer 974

Wasting, fasciculation, reduced tone, depressed reflexes, weakness (focal).

Answer 975

Increased tone, brisk reflexes, jaw jerk, weakness (pyramidal).

Answer 976

Anterior horn cell death, muscle wasting (amyotrophy).

Answer 977

Corticospinal tracts, lateral sclerosis or gliosis in spinal cord (and motor cortex).

Answer 978

Amyotrophic lateral sclerosis (ALS).

Answer 979

Pure form of MND with no/little UMN signs clinically.

Answer 980

Pure form of MND with no wasting after 4 years.

Answer 981

Muscle wasting/lack of nourishment.

Answer 982

Clinical diagnosis based on history and physical examination, supported by electrophysiological findings.

Answer 983

Blood tests, NCS/EMG, MRI, lumbar puncture.

Answer 984

FBC, U, E & Cr, LFTs, Ca, B12, folate, SEP, CK.

Answer 985

To show normal motor & sensory nerve conduction, fibrillation & fasciculation potentials, reduced motor unit potentials.

Answer 986

Up to 10%.

Answer 987

Accounts for 20% of familial and 2% of sporadic MND, associated with autosomal dominant inheritance.

Answer 988

Excitotoxicity, protein aggregation, axonal transport breakdown, reduced ATP production, neuroinflammation, triggering of cell death pathways.

Answer 989

* Inhibition of voltage-dependent Na+ presynaptic neuron * Increase in glutamate re-uptake in astrocytes.

Answer 990

To provide comprehensive care and a single point of contact for patients.

Answer 991

Support groups, online forums, referral to counselling/psychological services, provision of respite care.

Answer 992

Patient's communication ability, cognitive status, and mental capacity.

Answer 993

limb features.

Answer 994

It may be appropriate for social care needs.

Answer 995

Problematic saliva ## Footnote Antimuscarinics are medications that help reduce saliva production.

Answer 996

Progressive, asymmetrical features ## Footnote Commonly limb or bulbar features.

Answer 997

Limb features ## Footnote Weakness and wasting without sensory symptoms indicate MND.

Answer 998

Refer directly to neurology and specifically query the diagnosis ## Footnote Care should be provided by a specialist MND multidisciplinary team.

Answer 999

Quinine ## Footnote Quinine can be used effectively for muscle spasms.

Answer 1000

* Baclofen * Dantrolene * Tizanidine * Gabapentin ## Footnote These medications help manage muscle tone issues.

Answer 1001

It is crucial for managing the progressive nature of the disease ## Footnote Helps ensure appropriate care and resources are in place.

Answer 1002

Gray and white matter ## Footnote Gray matter contains neuronal cell bodies, while white matter consists of myelinated axons.

Answer 1003

* Corticospinal (upper) motor neurons in the motor cortex * Bulbar and spinal (lower) motor neurons ## Footnote These components innervate skeletal muscle.

Answer 1004

Gliosis (scarring) ## Footnote This describes the scarring seen in the lateral columns of the spinal cord.

Answer 1005

Degeneration and disappearance of myelin replaced by gliosis ## Footnote This leads to atrophy and decreased volume of the spinal cord.

Answer 1006

They are projections originating from the motor neurons ## Footnote Located in the posterior columns of the spinal cord.

Answer 1007

True ## Footnote Bulbar onset refers to symptoms starting in the bulbar region.

Answer 1008

decreased ## Footnote This atrophy is associated with degeneration in MND.

Answer 1009

An objective manifestation of a disease.

Answer 1010

A subjective manifestation of a disease.

Answer 1011

The group of signs and symptoms produced by a specific disease process.

Answer 1012

* Relapsing-remitting MS (RRMS) * Primary-progressive MS (PPMS) * Secondary-progressive MS (SPMS) * Progressive-relapsing MS (PRMS)

Answer 1013

To reduce neuroinflammation by restraining the activity of immunoreactive cells and/or enhancing immune tolerance.

Answer 1014

The protein in myelin produced by oligodendrocytes in the CNS.

Answer 1015

A condition that should lead a person diagnosed by an ophthalmologist to be referred to a neurologist for assessment.

Answer 1016

An autoimmune condition characterized by optic neuritis and transverse myelitis.

Answer 1017

* Fatigue * Numbness * Headache * Coordination problems * Bladder and bowel problems * Vision problems * Dizziness * Sexual dysfunction * Pain * Cognitive dysfunction * Emotional changes * Spasticity

Answer 1018

Symptoms are similar to several other disorders.

Answer 1019

Lesions in at least two areas of the CNS or optic nerves.

Answer 1020

Inflammatory processes.

Answer 1021

Tests for demyelination/myelination of the optic nerve.

Answer 1022

Within 6 weeks of diagnosis.

Answer 1023

* Smoking * Exercise * Flu jab * Pregnancy

Answer 1024

Vitamin D is thought to be protective against MS.

Answer 1025

They vary in efficacy and offer modest reductions in rates of relapse.

Answer 1026

From £6000 to £35,000.

Answer 1027

[autoimmune]

Answer 1028

* Viral infections * Toxic chemicals * Vitamin B12 deficiency * Guillain-Barré syndrome

Answer 1029

Diagnosis should ALWAYS be made by a neurologist.

Answer 1030

* Baclofen * Benzodiazepines * Dantolene * Gabapentin * Tizanidine * Botulinum toxin * Sativex

Answer 1031

They may be required during a relapse.

Answer 1032

Encouraged, especially aerobic exercise for those with mobility problems/fatigue.

Answer 1033

There is a risk of relapse after flu immunization.

Answer 1034

Care should be provided by a multidisciplinary team.

Answer 1035

Amitriptyline.

Answer 1036

* Loss of vision in one eye with painful eye movements * Double vision * Ascending sensory disturbance and/or weakness * Problems with balance or clumsiness * Altered sensation when bending forward

Answer 1037

It helps ensure the accuracy of diagnosis and treatment.

Answer 1038

A severe form of multiple sclerosis characterized by frequent relapses and significant disability progression ## Footnote Highly-active relapsing MS often requires aggressive treatment options.

Answer 1039

The drugs licensed in the UK include: * Ocrelizumab * Interferon beta (1a and 1b) * Glatiramer acetate * Mitoxantrone * Natalizumab * Fingolimod * Teriflunomide ## Footnote These drugs vary in effectiveness and safety profiles.

Answer 1040

They reduce the frequency and severity of relapses and accumulation of lesions.

Answer 1041

It increases suppressor T-cell function, maintaining tolerance to self-antigens and decreasing self-attack.

Answer 1042

A synthetic protein that simulates myelin protein and may work by blocking T cells.

Answer 1043

It suppresses components of the immune system, including T cells, B cells, and macrophages.

Answer 1044

A monoclonal antibody that hampers the movement of T cells across the blood-brain barrier.

Answer 1045

It is a sphingosine 1-phosphate receptor modulator that causes retention of lymphocytes in lymph nodes.

Answer 1046

It is a pyrimidine synthesis inhibitor that inhibits the function of specific immune cells.

Answer 1047

They are used to treat acute exacerbations affecting ability to perform at home or work.

Answer 1048

Side effects include: * Stomach irritation * Elevated blood sugar * Water retention * Insomnia * Mood swings

Answer 1049

Medications include: * Antidepressants * Pain medications * Drugs for bladder and bowel dysfunction

Answer 1050

A potassium channel blocker used to treat walking dysfunction, with side effects including risk of seizures.

Answer 1051

Non-drug treatments include: * Physical therapy * Occupational therapy * Speech/language therapy * Cognitive rehabilitation * Assistive devices

Answer 1052

If you suspect MS, refer the patient to a multi-professional team.

Answer 1053

Recognizing relapses is crucial as some require treatment while others do not.

Answer 1054

Always rule out other causes, especially urinary and respiratory infections.

Answer 1055

Disease-modifying treatments are used by secondary care.

Answer 1056

A movement disorder characterized by a combination of hypo and hyperactive movements, including slowness, dyskinesia, and tremor.

Answer 1057

Increases with age, predominantly affecting individuals over 70, though some cases occur in those under 50.

Answer 1058

Neurodegeneration of dopamine-producing neurons in the substantia nigra leads to motor dysfunction when there is significant neuron loss.

Answer 1059

50% loss in substantia nigra reticulata and 80% loss of dopamine in the striatum.

Answer 1060

Inclusion bodies containing alpha-synuclein, significant for PD pathology and associated with non-motor symptoms.

Answer 1061

In the gut, with the aetiological agent ascending via the vagus nerve to the substantia nigra.

Answer 1062

* Slowness (bradykinesia) * Stiffness (rigidity) * Shaking (resting tremor)

Answer 1063

It goes against the diagnosis of idiopathic Parkinson's disease.

Answer 1064

* Early imbalance * Difficulty swallowing * Early memory problems * Autonomic failure * Poor eye movements * Early hallucinations

Answer 1065

Facilitates normal motor activity by acting on dopamine receptors in the striatum.

Answer 1066

They remain intact but develop abnormal responses as the disease progresses.

Answer 1067

It provides more dopamine into the terminals to improve motor function.

Answer 1068

* Monoamine oxidase B (MAOB) * Carboxy-o-methyl transferase (COMT)

Answer 1069

Resting tremor that improves with posture and action.

Answer 1070

Reveals dopaminergic degeneration by showing reduced re-uptake of pre-synaptic dopamine.

Answer 1071

* Multi-system atrophy (MSA) * Progressive supranuclear palsy (PSP) * Cortico-basal degeneration (CBD)

Answer 1072

To identify alternative causes of parkinsonian syndrome.

Answer 1073

They significantly affect the quality of life and are often present before motor symptoms.

Answer 1074

* Cognitive impairment * Depression * Gastrointestinal issues (constipation) * Autonomic dysfunction * Sleep disorders

Answer 1075

* Stage 1: Unilateral disease * Stage 2: Bilateral disease * Stage 3: Impaired balance * Stage 4: Motor complications * Stage 5: Total dependence

Answer 1076

Clinical features of Parkinsonian syndrome not due to idiopathic PD, including conditions like Parkinson's plus syndromes.

Answer 1077

* Early detection * Disease modification * Effective symptom control * Preventing complications

Answer 1078

To attempt to prevent the onset of motor disorder through preventive measures.

Answer 1079

No confirmed advances have been made in altering the course of the disease.

Answer 1080

Levodopa, which is rapid acting and effective for symptom control.

Answer 1081

Fluctuations and dyskinesia.

Answer 1082

Converted into dopamine by dopa-decarboxylase in the brain

Answer 1083

Within a few days

Answer 1084

Fluctuations and dyskinesia

Answer 1085

* Dose of LD * Timing and fragmentation of dose * Low body weight * Weight loss * Female gender * Genetic factors

Answer 1086

More effective for symptom control

Answer 1087

Does not necessarily prolong the effect of medication

Answer 1088

Reduce degradation of dopamine in synaptic cleft

Answer 1089

Selegiline

Answer 1090

Does not lead to a rise in nor-adrenaline

Answer 1091

Tolcapone due to severe and fatal hepato-toxicity

Answer 1092

Can be administered with each dose of levodopa

Answer 1093

* Ropinirole * Pramipexole * Rotigotine

Answer 1094

* Hallucinations * Confusion * Psychosis * Impulse compulsive disorders

Answer 1095

Reduces LD induced dyskinesia and helps with fluctuations

Answer 1096

Subcutaneous route

Answer 1097

* Advanced PD * Early PD with drug intolerance * Dyskinesia * Intolerance to oral medications and apomorphine

Answer 1098

* Not suitable for older patients * Complications related to procedure * May lead to cognitive impairment

Answer 1099

Levodopa gel treatment infused directly into jejunum

Answer 1100

No single drug of choice

Answer 1101

Acetylcholinesterase inhibitors or memantine

Answer 1102

Dyskinesia

Answer 1103

An overview of Parkinson’s disease including pathology, diagnosis, pharmacology, motor symptoms, and non-motor symptoms.

Answer 1104

Abnormal movements in the absence of weakness or spasticity.

Answer 1105

* Hyperkinesia * Dyskinesia

Answer 1106

* Bradykinesia * Akinesia * Hypokinesia

Answer 1107

Clinical and neuropathological entity characterized by bradykinesia, rigidity, and tremor.

Answer 1108

Usually asymmetric and responsive to dopaminergic treatment.

Answer 1109

Any bradykinetic-rigid syndrome that is not Parkinson’s disease.

Answer 1110

Dopamine-containing nerve cell bodies within the nigrostriatal and mesocorticolimbic pathways are selectively and progressively destroyed.

Answer 1111

Clinical signs of Parkinson’s disease become evident.

Answer 1112

* Caudate nucleus * Lentiform nucleus * Putamen * Globus pallidus * Substantia nigra * Subthalamic nucleus

Answer 1113

Tyrosine is a precursor that is converted to L-Dopa by tyrosine hydroxylase.

Answer 1114

Rest tremor.

Answer 1115

Difficulty with planning, initiating, and executing movements.

Answer 1116

Increased resistance, often associated with the 'cogwheel' phenomenon.

Answer 1117

* Flexed neck and trunk posture * Flexed elbows and knees

Answer 1118

Loss of postural reflexes, generally a manifestation of the late stages of Parkinson's disease.

Answer 1119

The pull-test.

Answer 1120

* Bradykinesia * Rigidity * Rest tremor * Postural instability not caused by other dysfunctions

Answer 1121

* Prominent postural instability in the first 3 years * Freezing phenomenon in the first 3 years * Hallucinations unrelated to medications in the first 3 years * Dementia preceding motor symptoms

Answer 1122

All criteria for probable Parkinson’s are met and histopathological confirmation is obtained at autopsy.

Answer 1123

It is necessary for the diagnosis of probable Parkinson’s disease.

Answer 1124

A medication used to treat Parkinson's disease by replenishing dopamine levels ## Footnote Levodopa is often used in combination with other treatments.

Answer 1125

At least two of the four features in group A are present, at least one is tremor or bradykinesia, and either none of the features in group B is present or symptoms have been present for 3 years with none of the features in group B present ## Footnote Group B features may include atypical symptoms.

Answer 1126

A form of akinesia that occurs in ~47% of patients, affecting legs during walking ## Footnote Freezing can also affect arms and eyelids.

Answer 1127

* Start hesitation * Turn hesitation * Hesitation in tight quarters * Destination hesitation * Open space hesitation ## Footnote Episodes may be more severe in the OFF state.

Answer 1128

True ## Footnote It has substantial social and clinical consequences.

Answer 1129

* Autonomic dysfunction * Cognitive and neurobehavioural abnormalities * Sleep disorders * Sensory abnormalities ## Footnote These symptoms are often underappreciated.

Answer 1130

Cognitive decline in 84% of patients and dementia in 48% ## Footnote Neuropsychiatric comorbidities may include depression, apathy, and anxiety.

Answer 1131

* REM behavior disorder * Insomnia * Excessive daytime sleepiness ## Footnote Sleep fragmentation may contribute to fatigue.

Answer 1132

It is thought to be associated with the evolution of PD ## Footnote Staging of this pathology may help in understanding the disease progression.

Answer 1133

* Tremor * Bradykinesia * Rigidity * Postural instability ## Footnote These are cardinal features for diagnosis.

Answer 1134

* Idiopathic Parkinson's Disease * Symptomatic parkinsonism * Atypical parkinsonism ## Footnote Atypical forms include Multiple System Atrophy and Progressive Supranuclear Palsy.

Answer 1135

Includes drug-induced parkinsonism, vascular disease, and neurodegenerative disorders ## Footnote Examples of drug-induced causes include neuroleptics and antidepressants.

Answer 1136

It differentiates PD (reduced olfaction) from other parkinsonian syndromes (preserved olfaction) ## Footnote This can aid in early diagnosis.

Answer 1137

Diagnostic error is common, with rates of 10% in Movement Disorder clinics and 50% in primary healthcare ## Footnote NICE guidelines recommend timely referral to specialists.

Answer 1138

* Motor fluctuations * Dyskinesias * Cognitive impairment * Hallucinations and delirium ## Footnote These complications can significantly affect quality of life.

Answer 1139

A collection of symptoms present in PD and other disorders, collectively called parkinsonian conditions ## Footnote It can be idiopathic, genetic, or environmental.

Answer 1140

* Early stage * Motor complication period * Cognitive decline period ## Footnote Each stage presents unique challenges and symptoms.

Answer 1141

Increased diagnostic accuracy through the use of standard criteria can lead to better management and outcomes ## Footnote Early intervention is crucial for effective treatment.

Answer 1142

1. Idiopathic PD 2. Genetic forms 3. Environmental forms (e.g. caused by toxins) 4. Other atypical forms including: * Progressive supranuclear palsy * Multiple systems atrophy * Corticobasal degeneration ## Footnote References to forms of Parkinson's Disease based on etiology.

Answer 1143

1. Early detection in pre-motor stage 2. Disease modification 3. Diagnosis 4. Effective motor control 5. Symptomatic treatment 6. Delay of motor complications 7. Managing motor problems 8. Managing non-motor complications ## Footnote Various therapeutic challenges faced in Parkinson's Disease management.

Answer 1144

1. Physiotherapy 2. Pharmacotherapy 3. Neurosurgical therapy 4. Psychosocial measures 5. Orthopaedics 6. Psychologic support 7. Creation of support/understanding by family 8. Patient-support groups 9. Stereotactic interventions 10. Implantation of pacemakers ## Footnote Different therapeutic approaches to manage Parkinson's Disease.

Answer 1145

1. L-Dopa 2. Dopa decarboxylase inhibitor 3. MAO-B inhibitor 4. COMT inhibitor 5. Dopamine agonists: * Ergolinics: bromocriptine, pergolide, cabergoline * Non-ergolinics: pramipexole, ropinirole, rotigotine ## Footnote Overview of pharmacological treatments targeting dopamine metabolism.

Answer 1146

Restores depleted dopamine and prolongs the duration of L-Dopa's effects. ## Footnote L-Dopa is considered the 'gold standard' treatment for Parkinson's symptoms.

Answer 1147

Enhances the effect of endogenous dopamine in the central nervous system and prolongs the effect of dopamine derived from L-Dopa. ## Footnote MAO-B inhibitors play a critical role in preserving dopamine availability.

Answer 1148

False ## Footnote Dopamine agonists generally have a longer half-life and duration of action than L-Dopa.

Answer 1149

1. Levodopa 2. Dopamine agonists 3. MAO-B inhibitors 4. Anticholinergics (lack of evidence) 5. Beta-blockers (lack of evidence) 6. Amantadine (lack of evidence) ## Footnote NICE recommendations for treating early-stage Parkinson's Disease.

Answer 1150

Levodopa ## Footnote Levodopa's role as a primary treatment option for managing Parkinson's Disease.

Answer 1151

Pros: * Effective at preventing slow movements and stiffness * Reduces tremor Cons: * Efficacy reduction over time * Common side effects include: * Dyskinesia * Nausea/vomiting * Low blood pressure on standing * Sleepiness * Hallucinations * Vivid dreams * Prolonged use may be linked to weight loss ## Footnote Summary of advantages and disadvantages of Levodopa therapy.

Answer 1152

1. Relative drug efficacy 2. Adverse effects 3. Comorbidity 4. Patient preference ## Footnote Factors influencing the selection of initial pharmacotherapy in Parkinson's Disease management.

Answer 1153

Long-lasting effect due to irreversible inhibition of MAO-B, prolongs the effect of dopamine derived from L-Dopa. ## Footnote Rasagiline's role in enhancing dopamine availability in patients.

Answer 1154

Rasagiline (Azilect®), Safinamide, Selegiline (Eldepryl®), Fast dissolving tablet (Zelapar®) ## Footnote These drugs are used in the treatment of Parkinson's disease.

Answer 1155

* Useful in early treatment * Delay the need for levodopa * Once daily administration * Can be used in combination with levodopa * May protect brain cells and slow disease progression * Generally well tolerated ## Footnote These benefits make MAO-B inhibitors an essential option in managing Parkinson's disease.

Answer 1156

* Headache * Nausea * Constipation * Dry mouth * Sleeping disorders * Low blood pressure on standing ## Footnote Monitoring for these side effects is crucial in patients receiving MAO-B inhibitors.

Answer 1157

Blocking COMT prevents the conversion of LD to 3-O-methyldopa, allowing more LD to enter the brain ## Footnote This prolongs the duration of levodopa action but does not increase its peak effect.

Answer 1158

It refers to the gradual diminishing response to levodopa, leading to fluctuations in PD symptoms before the next scheduled dose ## Footnote This phenomenon can significantly affect patient quality of life.

Answer 1159

* Mood changes * Anxiety * Fatigue * Pain * Cognitive and sensory problems ## Footnote These fluctuations are now acknowledged as important in the overall management of Parkinson's disease.

Answer 1160

Activities of Daily Living ## Footnote ADL assessment is crucial in evaluating the impact of Parkinson's disease on patient quality of life.

Answer 1161

People with suspected PD should be referred quickly and untreated to a specialist ## Footnote This guideline emphasizes the importance of early diagnosis and treatment initiation.

Answer 1162

* Ropinirole (ReQuip®) * Pramipexole (Mirapexin®) * Rotigotine (Neupro® - adhesive skin patch) * Apomorphine (Apo-Go® - injection) * Cabergoline (Cabaser®) * Bromocriptine (Parlodel®) * Pergolide (Celance®) ## Footnote These formulations help manage motor symptoms in Parkinson's disease.

Answer 1163

* Useful in early stages * Can be used in combination with levodopa * Fewer dyskinesias and ON-OFF fluctuations than levodopa in the first 5 years ## Footnote These advantages make dopamine agonists a valuable option in the early treatment of Parkinson's disease.

Answer 1164

* Nausea/vomiting * Low blood pressure on standing * Confusion and hallucinations * Dyskinesia * Constipation * Oedema * Vivid dreams * Fatigue * Compulsive disorders ## Footnote Awareness of these side effects is important for patient management.

Answer 1165

Acute withdrawal symptoms similar to those seen in cocaine addicts, causing significant distress, affecting 1 in 3 patients ## Footnote Understanding DAW is crucial for managing treatment in patients on dopamine agonists.

Answer 1166

It compared Pramipexole vs Levodopa in motor function, showing that Levodopa is more effective for control of motor symptoms ## Footnote This highlights the effectiveness of Levodopa as a primary treatment.

Answer 1167

Early treatment improves quality of life and may have some neuromodulation efficacy ## Footnote Studies like ADAGIO support the benefits of starting treatment soon after diagnosis.

Answer 1168

Early-start Azilect group experienced significantly less deterioration compared to delayed-start group ## Footnote This trial emphasizes the benefits of early intervention in Parkinson's disease management.

Answer 1169

Severe physical and psychological symptoms ## Footnote Correlate with DA withdrawal and cause clinically significant distress or social/occupational dysfunction

Answer 1170

Affects 1 in 5 patients

Answer 1171

An antiviral drug with mild symptomatic benefit that acts as an NMDA receptor inhibitor

Answer 1172

Better in akinetic-rigid syndrome patients

Answer 1173

Dyskinesia

Answer 1174

Diminished motor response as the disease advances

Answer 1175

Dyskinesia threshold and magnitude of response

Answer 1176

Weight losers are at increased risk of dyskinesia, higher mortality, and reduced quality of life

Answer 1177

ropinirole-initiated

Answer 1178

Early disease: DA > placebo; Late disease: DA < Levodopa

Answer 1179

Prevents complications from using too much of one drug

Answer 1180

Targets thalamus, globus pallidus, and subthalamic nucleus to disrupt pathologic network

Answer 1181

* May prevent or reverse motor complications * May improve sleep quality * May reduce gastric dysfunction

Answer 1182

Use the minimum dose of levodopa per kilogram body weight to achieve a desired clinical response

Answer 1183

Positively correlated; identical doses cause larger changes as PD progresses

Answer 1184

* Motor fluctuations * Dyskinesia * Confusion * Falls * Non-motor issues

Answer 1185

Effective treatment in select patients with motor complications

Answer 1186

Acute withdrawal symptoms similar to those seen in cocaine addicts

Answer 1187

They provide additional benefit when combined with other medications

Answer 1188

30% – 50%

Answer 1189

Thalamus, Globus pallidus, Subthalamic nucleus ## Footnote DBS is used to treat various neurological conditions, particularly Parkinson's disease.

Answer 1190

Hyperpolarization of cell membrane, Reduced excitability, Disruption of pathologic network ## Footnote It essentially 'jams' signal flow in the targeted brain areas.

Answer 1191

Reversible, Adjustable, Can be removed, Turned off, Reduces drug cost in long term ## Footnote Despite its effectiveness, DBS is an expensive procedure.

Answer 1192

Posterior commissure ## Footnote This placement is critical for effective stimulation.

Answer 1193

Effective for the relief of tremor, significant risk of complications, only used rarely in current practice ## Footnote Thalamotomy has largely fallen out of favor due to risks.

Answer 1194

Targeting the globus pallidus internus, widely indicated for relief of symptoms related to Parkinson's disease ## Footnote It can lead to relief of tremor, rigidity, bradykinesia, motor fluctuations, dyskinesia, and uncoordination.

Answer 1195

Several symptoms associated with Parkinson's disease ## Footnote This option is viable in regions where DBS is not available.

Answer 1196

1. Increase bioavailability of levodopa - COMTi, MAO-B I 2. Enhance receptor stimulation with continuous dopaminergic stimulation - Dopamine agonists 3. Combination of all options usually needed ## Footnote This multi-faceted approach helps manage symptoms effectively.

Answer 1197

Choking, Dyskinesia, Urinary incontinence, Post hypotension, Depression, Hallucinations, Dementia, Cognitive decline, Fractures, Falls ## Footnote These issues can significantly impact quality of life.

Answer 1198

Increase levodopa CR Madopar, Add COMT inhibitor, Add a Dopamine agonist, Add MAO-B inhibitor, Add Amantadine ## Footnote These adjustments can help manage worsening symptoms.

Answer 1199

MAO-B inhibitor, Prolongs effect of endogenous dopamine, Long-lasting effect (irreversible inhibition) ## Footnote It is used to enhance the effects of L-DOPA in Parkinson's treatment.

Answer 1200

False ## Footnote Due to significant risks, it is rarely performed.

Answer 1201

posterior commissure

Answer 1202

Tremor, Rigidity, Bradykinesia, Motor fluctuations, Dyskinesia, Uncoordination ## Footnote Pallidotomy is particularly effective for Parkinson's disease symptoms.

Answer 1203

Increase Neupro, Add MAO-B I - Rasagiline vs Selegiline ## Footnote Adjustments in medication can help manage these symptoms.

Answer 1204

Levodopa is converted to dopamine in the brain, helping to alleviate symptoms of Parkinson’s disease. ## Footnote Levodopa is often administered with a peripheral dopa decarboxylase inhibitor to prevent its conversion to dopamine outside the brain.

Answer 1205

Levodopa is effective in reducing motor symptoms and is considered the most effective treatment for Parkinson’s disease. ## Footnote It significantly improves quality of life for many patients.

Answer 1206

Long-term use can lead to decreased effectiveness and side effects such as dyskinesia and motor fluctuations. ## Footnote Patients may experience a phenomenon known as 'wearing-off'.

Answer 1207

'Wearing-off' refers to the gradual loss of effectiveness of levodopa, leading to a return of symptoms before the next dose. ## Footnote This can occur as the disease progresses.

Answer 1208

Dyskinesia refers to involuntary movements, while motor fluctuations are variations in the ability to move. ## Footnote Both can be side effects of long-term levodopa use.

Answer 1209

* Dopamine agonists * MAO-B inhibitors * COMT inhibitors * Anticholinergics * Amantadine ## Footnote Each class of medication works differently to manage symptoms.

Answer 1210

Holistic medicine focuses on treating the whole person and may include complementary therapies alongside conventional treatment. ## Footnote A multi-disciplinary approach is often beneficial.

Answer 1211

Exercise can improve mobility, balance, and overall quality of life. ## Footnote Regular physical activity is recommended as part of a comprehensive treatment plan.

Answer 1212

Treatment focuses on symptom management, maintaining quality of life, and considering palliative care options. ## Footnote Advanced care may involve a multi-disciplinary team.

Answer 1213

Deep brain stimulation is a surgical treatment that involves implanting electrodes in specific brain areas to alleviate symptoms. ## Footnote It is typically considered for patients with advanced Parkinson’s disease.

Answer 1214

* Globus pallidus pars interna (GPi) * Subthalamic nucleus (STN) ## Footnote The choice of target depends on individual patient needs and symptoms.

Answer 1215

Deep brain stimulation can significantly improve motor symptoms and quality of life for patients with Parkinson’s disease. ## Footnote It can also reduce the need for medication.

NERVOUS SYSTEM Flashcards

(1295 cards)