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CPT - Other Drugs > Nervous System > Flashcards

Nervous System Flashcards

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1
Q

What are 3 examples of anxiolytics?

A

Diazepam
Lorezepam
Midazolam

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2
Q

How do anxiolytics work?

A

Increase GABA activity - inhibit neurotransmission

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3
Q

When can anxiolytics be used?

A
  • Epilepsy

* Anxiety

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4
Q

What drug classes can be used for nausea and vomiting?

A
  • H1 antagonists
  • D2 antagonists
  • 5HT3 antagonists
  • Neurokinin-1 antagonists
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5
Q

Give an example of a H1 antagonist.

A

Cyclizine

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6
Q

Give an example of two D2 antagonists.

A

Domperidone

Metoclopramide

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7
Q

What is an example of a 5HT3 antagonist?

A

Ondansetron

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8
Q

What is the mechanism of action of ondansetron peripherally and centrally?

A

Peripherally - reduces GI motility and GI secretions

Centrally - inhibits the chemoreceptor trigger zone (CTZ)

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9
Q

Who is ondansetron good for?

A

Almost everyone - often 1st line treatment

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10
Q

What are some side effects of ondansetron?

A

Uncommon - constipation, headache, increased liver enzymes, prolonged QT interval, extra-pyramidal effects e.g. dystonia and parkinsonism

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11
Q

What is an example of a muscarinic antagonist used to treat nausea and vomiting?

A

Hyoscine hydrobromide

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12
Q

What is the mechanism of action of hyoscine hydrobromide?

A

Competitively block EACh receptors in the vestibular nuclei and at the CTZ

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13
Q

What are some side effects of the muscarinic antagonist hyoscine hydrobromide?

A
  • Sedation
  • Memory problems
  • Glaucoma
  • Dry mouth
  • Constipation

(ACh receptors all over body, part of parasympathetic nervous system)

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14
Q

What are the common indications for hyoscine hydrobromide?

A
  • Motion sickness
  • Bowel obstruction

Good for those who can’t take tablets - available as patches

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15
Q

What is an example of a neurokinin-1 antagonist?

A

Aprepitant

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16
Q

What is the mechanism of action of aprepitant?

A
  • Prevents substance P action at CTZ and in peripheral nerves
  • Boosts effects of 5HT3 receptors antagonists
  • Anxiolytic and antidepressant properties
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17
Q

What is aprepitant often used for?

A
  • Chemotherapy (especially delayed emesis)
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18
Q

What are some side effects of aprepitant?

A
  • Headache
  • Diarrhoea/constipation
  • Stevens-Johnson syndrome - rash
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19
Q

Give two examples of antipsychotic drugs.

A
  • Chlorpromazine

* Haloperidol

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20
Q

What can chlorpromazine and haloperidol be used for aside being antipsychotics?

A

Can be used as anti-emetics

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21
Q

What is the mechanism of action of chlorpromazine and haloperidol?

A

D2 receptor antagonists (post synaptic D2 receptors)

Act on CTZ

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22
Q

What circumstances is haloperidol good and not good for?

A

Chemo and palliation (esp due to sedative action)

Not good if someone has Parkinson’s (Parkinsonism side effects)

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23
Q

What is chlorpromazine good for?

A

Motion sickness and vertigo

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24
Q

Give 9 examples of analgesics.

A
  • Aspirin
  • Paracetamol
  • Buprenorphine
  • Codeine
  • Diamorphine
  • Fentanyl
  • Methadone
  • Morphine
  • Tramadol
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25
What is the mechanism of aspirin as an analgesic?
Inhibits prostaglandin synthesis
26
What is the mechanism of action of paracetamol?
COX-2 inhibition in the spinal cord?
27
What do you give in paracetamol overdose?
N-acetylcysteine
28
What metabolite is it that builds up when you take paracetamol, that causes the overdose?
NAPQI - at normal doses, conjugates with glutathione, but hepatic glutathione is limited
29
What dose of paracetamol is sufficient to cause irreversible damage?
150mg/kg
30
What class of drugs are buprenorphine, codeine, diamorphine, fentanyl, methadone and tramadol?
Opioid receptor agonists
31
By which two mechanisms can people develop tolerance to opioids?
* Phosphorylation and uncoupling - phosphorylation modulates the neuroreceptors * cAMP production - if you remove the opioid, there's a rebound effect, increased cAMP production, increased excitability so withdrawal symptoms
32
Which three opioids are the strong agonists?
* Methadone * Morphine * Fentanyl
33
Which opioid is a moderate agonist?
Codeine
34
Which opioid is a mixed agonist/antagonist or partial agonist?
Buprenorphine
35
Which opioid is "other"?
Tramadol
36
Does fentanyl have more or less side effects than morphine? Why?
Less, due to less histamine release and less sedation and constipation
37
What should you prescribe alongside codeine?
A laxative
38
How is buprenorphine eliminated?
Mostly in the biliary system (over renally)
39
When is buprenorphine used?
* Moderate to severe pain | * Opioid addiction treatment
40
What are some of the side effects of buprenorphine?
* Respiratory depression * Low BP * Nausea * Dizziness
41
How does buprenorphine work?
It's a partial agonist, so has a low Kd and a high affinity for mu receptors Not easily displaced, so harder to reverse an overdose with buprenorphine, but this isn't as likely
42
How does N-aceytlcysteine work?
Glutathione donation (glutathione precursor), so glutathione can then bind to NAPQI
43
What is used to treat opioid overdose?
Naloxone
44
How does naloxone work?
It's a opioid receptor antagonist (binds competitively) Infusion rather than quick delivery, otherwise wears off quickly as has a short-half life
45
Name 3 antiepileptic drugs that work by blocking sodium channels.
* Carbamazepine * Lamotrigine * Phenytoin
46
What is an AED that increases GABA synthesis?
Sodium valproate
47
What is levetiracetam?
An AED, that possibly blocks presynaptic calcium activity
48
When is phenytoin used?
* Status epilepticus | * Adjunct in generalised seizures
49
What's unique about phenytoin?
Zero order kinetics
50
What are specific side effects if phenytoin?
* Myelosuppression * Hypotension * Arrhythmias if given by IV
51
What drug is good for focal epilepsy?
Lamotrigine
52
Which AED is most safe in pregnancy?
Levetiracetam
53
Which 3 AEDs are CYP inducers?
* Phenytoin * Carbamazepine * Barbituates
54
Which AED is a CYP inhibitor?
Sodium valproate
55
What is the initial management of a seizure?
ABCDE, get help, start a clock
56
What is the pharmacological staging in status epilepticus?
* 0-5 mins - benzodiazepine * 0-15 mins - second benzodiazepine dose * 15-45 mins - Phenytoin or levetiracetam * 45+ mins - Thiopentone/anaesthesia and support (consider IV thiamine if with alcohol use)
57
What classes of drugs are used to treat Parkinson's disease?
* Dopamine receptor agonists * Monoamine oxidase (MAO) type B inhibitors * Catechol-O-methyl transferase (COMT) inhibitors * Anticholinergics
58
Give 6 examples dopamine receptor agonists.
* Amantadine * Apomorphine * Ropinirole * Rotigotine Pre-cursors of dopamine * Levodopa (L-DOPA) * Co-careldopa * Co-beneldopa
59
Give two examples of MAO type B inhibitors.
* Rasagiline | * Selegiline
60
Give an example of a COMT inhibitor.
Entacapone
61
Give two examples of anticholinergics used to treat Parkinson's.
* Orphenadrine | * Procyclidine
62
Only when is apomorphine used?
In patients with severe motor fluctuations
63
What are the advantages and disadvantages of dopamine receptor agonists?
* direct acting * less dyskinesia/motor complications * some neuroprotection * less efficient than L-DOPA * lead to impulse control disorders * more psychiatric side effects * expensive
64
What are the ADRs of dopamine receptor agonists?
* Sedation * Hallucinations * Confusion * Nausea * Hypotension
65
What is the mechanism of action of MAO B inhibitors?
Prevent breakdown of dopamine
66
Why don't you give COMT inhibitors alone?
No therapeutic effect alone - only act to increase the amount of dopamine present, by reducing it's peripheral breakdown
67
Why can you use anticholinergics to treat Parkinson's?
ACh may have antagonistic effects to dopamine
68
What are the ADRs of anticholinergics?
* Confusion * Drowsiness * Anticholinergic side effects - dry mouth, constipation, blurry visions, problems urinating (esp. an issue in the elderly)
69
What are two advantages of using anticholinergics to treat Parkinson's? What is a disadvantage?
Doesn't act on dopamine systems and treats the tremor No effect on the bradykinesia

CPT - Other Drugs (11 decks)

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