Neuro Flashcards
(30 cards)
Mannitol
Class
Osmotic diuretic
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.
Carbamazepine
Uses
- 1st line in partial/focal epileptic seizures
- 3rd line in primary generalised epileptic seizures
- 1st line for trigeminal neuralgia
Carbamazepine
MofA
- Inhibits neuronal sodium channels
- Stabilises resting membrane potentials and reducing neuronal excitability
- Inhibits spread of seizure activity in epilepsy
Carbamazepine
Side effects
- GI upset - nausea/vomiting
- Neuro effects - dizziness and ataxia
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
Carbamazepine
Interactions
- Drugs metabolised by P450 (warfarin, oestrogens, progestogens)
- Cytochrome P450 inhibitors
- Other anti epileptic drugs
- SSRI’s. tricyclic antidepressants, anti psychotics, tramadol
Valproate
Uses
- 1st line for absence/primary generalised seizures
- Bipolar disorder
Valproate
MofA
- A weak inhibitor of neuronal sodium channels, stabilising resting membrane potentials and reducing neuronal excitability
- Also increases brain content of GABA
Valproate
Side effects
- GI upset
- Neuro/psych effects -(tremor, ataxia, behavioural disturbances)
- Thrombocytopenia
- Increase in liver enzymes
Valproate
Contraindications
- Women of child bearing age (particularly around conception/1st trimester)
- Hepatic or renal impairment
Valproate
Interactions
- Drugs metabolised by P450 (warfarin)
- Cytochrome P450 inhibitors (macrolides)
- Other anti epileptic drugs
- SSRI’s. tricyclic antidepressants, anti psychotics, tramadol
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
Dopamine agonists
Examples
- Ropinirole
- Pramipexol
Dopamine agonists
MofA
Increases dopaminergic stimulation to the striatum
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
Dopaminergic drugs
Side effects
- Nausea
- Drowsiness
- Confusion
- Hallucinations
- Hypotension
- Levodopa –> ‘wearing off effect’
- Dopamine agonists –> ‘soft’ side effects such as tiredness, gambling, hypersexuality
Dopaminergic drugs
Contraindications
- Use cautiously in elderly
and those with existing cognitive or psych disease - CVD
Dopaminergic drugs
Interactions
- Should not be combined with anti psychotics or metclopramide
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
What should you NOT use in Parkinsons?
ANTICHOLINERGICS
- too many side effects
Monoclonal antibodies in treating MS
Examples and MofA
- Alemtuzumab –> acts against T-cells
- Natalizumab –> stops lymphocytes moving across blood-brain barrier
Antiglutamatergic drugs
Example, Use and MoA
Example: Riluzole
Use: Treatment of motor neuron disease
MofA: Inhibits glutamate release and slows disease progression
What drug is used as an adjuvant chemo for people undergoing GBM resection?
Temozolomide
