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2a Pharmacology > Neuro > Flashcards

Flashcards in Neuro Deck (30):
1

Mannitol
Class

Osmotic diuretic

2

Mannitol
MofA

Mannitol elevates blood plasma osmolality, resulting in enhanced flow of water from tissues, including the brain and cerebrospinal fluid, into interstitial fluid and plasma.

As a result, cerebral oedema, elevated intracranial pressure, and cerebrospinal fluid volume and pressure may be reduced.

3

Carbamazepine
Uses

- 1st line in partial/focal epileptic seizures
- 3rd line in primary generalised epileptic seizures
- 1st line for trigeminal neuralgia

4

Carbamazepine
MofA

- Inhibits neuronal sodium channels
- Stabilises resting membrane potentials and reducing neuronal excitability
- Inhibits spread of seizure activity in epilepsy

5

Carbamazepine
Side effects

- GI upset - nausea/vomiting
- Neuro effects - dizziness and ataxia

6

Carbamazepine
Contraindications

- AVOID IN TONIC/CLONIC/MYOTONIC SEIZURES
- Pregnancy (neural tube defects, cleft palate, cardiac/urinary tract problems)
- Anti epileptic sensitivity syndrome
- Renal, hepatic, cardiac disease

7

Carbamazepine
Interactions

- Drugs metabolised by P450 (warfarin, oestrogens, progestogens)
- Cytochrome P450 inhibitors
- Other anti epileptic drugs
- SSRI's. tricyclic antidepressants, anti psychotics, tramadol

8

Valproate
Uses

- 1st line for absence/primary generalised seizures
- Bipolar disorder

9

Valproate
MofA

- A weak inhibitor of neuronal sodium channels, stabilising resting membrane potentials and reducing neuronal excitability
- Also increases brain content of GABA

10

Valproate
Side effects

- GI upset
- Neuro/psych effects -(tremor, ataxia, behavioural disturbances)
- Thrombocytopenia
- Increase in liver enzymes

11

Valproate
Contraindications

- Women of child bearing age (particularly around conception/1st trimester)
- Hepatic or renal impairment

12

Valproate
Interactions

- Drugs metabolised by P450 (warfarin)
- Cytochrome P450 inhibitors (macrolides)
- Other anti epileptic drugs
- SSRI's. tricyclic antidepressants, anti psychotics, tramadol

13

Dopaminergic drugs for Parkinsons

- Early Parkinson's --> Dopamine agonists may be preferred over levodopa
- Later Parkinson's --> Levodopa = integral part of management, with dopamine agonists as an option for add-on therapy
- Both are also options for secondary parkinsonism

14

Dopamine agonists
Examples

- Ropinirole
- Pramipexol

15

Dopamine agonists
MofA

Increases dopaminergic stimulation to the striatum

16

Levodopa (L-dopa)
MofA

- Precursor of dopamine
- Can enter the brain via a membrane transporter (unlike dopamine, which cannot cross the blood-brain barrier)
- Taken up by remaining dopaminergic neurons --> metabolised into dopamine and fired as usual
- Levodopa is ALWAYS given with a peripheral dopa-decarboxylase inhibitor (e.g. Carbidopa) to reduce its conversion to dopamine outside of the brain

17

Dopaminergic drugs
Side effects

- Nausea
- Drowsiness
- Confusion
- Hallucinations
- Hypotension
- Levodopa --> 'wearing off effect'
- Dopamine agonists --> 'soft' side effects such as tiredness, gambling, hypersexuality

18

Dopaminergic drugs
Contraindications

- Use cautiously in elderly
and those with existing cognitive or psych disease
- CVD

19

Dopaminergic drugs
Interactions

- Should not be combined with anti psychotics or metclopramide

20

COMT/MAO-B
MofA

- Prevents breakdown of dopamine by catechol-o-methyl transferase and monoamine-oxidase in the synaptic cleft
- Dopamine continues to bind to receptors
- Not very powerful, but helpful in some patients

21

What should you NOT use in Parkinsons?

ANTICHOLINERGICS
- too many side effects

22

Monoclonal antibodies in treating MS
Examples and MofA

- Alemtuzumab --> acts against T-cells
- Natalizumab --> stops lymphocytes moving across blood-brain barrier

23

Antiglutamatergic drugs
Example, Use and MoA

Example: Riluzole
Use: Treatment of motor neuron disease
MofA: Inhibits glutamate release and slows disease progression

24

What drug is used as an adjuvant chemo for people undergoing GBM resection?

Temozolomide

25

What class of drugs might you use to treat Alzheimer's?
Give three examples

Acetylcholine esterase inhibitors
E.g. Rivastigime or Donezepril or Galantamine

26

What thrombolytic drug might be used in the treatment of an ischaemic stroke?

Alteplase

27

Alteplase
MofA

Converts plasminogen to plasmin, so promotes the breakdown of a fibrin clot

28

MOA
2 examples

Rasagiline
Selegiline

29

Give two examples of anti-spasticity drugs

- Baclofen
- Tizanidine

30

Baclofen
MofA

- GABA analogue
- Reduces calcium influx
- Suppresses release of excitatory neurotransmitters