neurological

Question 1

madopar

Answer 1

L-DOPA/levodopa + benseraizde

antiparkinsonian agent - dopaminergic drug for parkinsons

Question 2

sinemet

Answer 2

levodopa + carbidopa

antiparkinsonian agent

Question 3

how does sinemetwork?

Answer 3

levodopa changes to dopamine in the brain - helps control movement

carbidopa prevents breakdpwn of levodopa in bloodstream

Question 4

how does madopar work?

Answer 4

levodopa is changed to dopamine in the brain

benserazide allows more Ldopa to get to brain before changed to dopamine

Question 5

indications for sinemet

Answer 5

parkinsons disease

Question 6

contraindications for sinemet

Answer 6

elderly with existing cognitive or psychiatric disease - risk of confusion and hallucinations

caution in CVD - hypotnesion risk

Question 7

side effects of sinemet

Answer 7

nausea
drowisness
confusion
hallucinations
hypotension
dyskinesia at beginning of dosage interbal
on-off effect

Question 8

interactions of sinemet

Answer 8

not combined with antipsychotics or metoclopramide due to contraictory effects on dopamine receptos

Question 9

levodopa always give with??

why?

Answer 9

dopa decarboxylase inhibitor (carbidopa) to reduce conversion to dopamine outside tje brain

Question 10

inidcations for madopar

Answer 10

parkinsons disease

Question 11

contraindications of madopar

Answer 11

elderly with existing cognitive or psychiatric disease

Question 12

sife effects of madopar

Answer 12

nausea
drowsiness
confusion
hallucinations
hypotension
dyskenesia at beginning of dosage interval - on-off effect

Question 13

interactions of madopar

Answer 13

not used with antipsychotics or metoclopramide due to effects on dopamine receptors are contradictory

Question 14

phenytoin

Answer 14

antiepileptic/anticonvuslant

Question 15

how does phenytoin work?

Answer 15

phenytoin reduces neruonal excitability and electrical conductance among brain cells- inhibits seizure activity

bind to neuronal Na+ channels in inactive state - promoting inactivity and preventing influx

Question 16

indications of phenytoin

Answer 16

control seizures in status epilepticus where benzodiazepines are ineffective

reduce freq of generalised or focal seizures in epilepsy

Question 17

contraindications of phenytoin

Answer 17

margin between therapeutic and toxic dose is low

dose reduced in hepatic impariemtn

not in pregnancy - or take high dose folic acid

Question 18

side effects of phenytoin

Answer 18

change in appearance - skin coasening, acne, hirtusim, gum hypetrophy

neurological effects - cerebellar toxicity and impaired cognition

hypersensitivity reactions to

toxicity- cdeath thorugh cardiovascular collapse and repsiratory depression

Question 19

interactions of phenytoin

Answer 19

reduces efficact of drugs metabolised by P450 enzymes

Efficacy of phenytoin is reudced by drugs that lower seizure threshold - SSRIs, tricyclics, antihyschocitcs, tamadol

Question 20

carbamazepine

Answer 20

antiepileptic/anticonvulsant

Question 21

how does carbamazepine work?

Answer 21

inhibits neuronal sodium channels - stabilising membrane potentials and reducing neuronal excitability

= inhibit spread of seizure activity in epilepsy, controls neruralgic pain

Question 22

Indications for carbamazepine

Answer 22

epilepsy - first choice for focal seizures with and without secondary generalisation

trigeminal neuralgia- first line to control pai and reduce freq of attakcs

bipolar disorder fpr prophylaxis in paients reisstant to or intolerant of other meds

Question 23

contraindications of carbamazepine

Answer 23

pregnancy - high dose folic acid for conception

antiepileptic hypersensitivity syndrome is contraindication

caution in hepatic, renal or cardiac disease

Question 24

interactions of carbamazepine

Answer 24

durgs metabolised by P450 enzymes

efficacy reduced by durgs that lower seizure threshold - SSRIs, tricyclics, antipsychotics, tramadol

Question 25

side effects of carbamazepine

Answer 25

GI upset - neausea and vomiting neuroligical effects - dizziness and ataxia hypersensitivity - rash

Question 26

sodium valproate

Answer 26

antiepile[tic/anticonvulsant

Question 27

how does sodium valproate work?

Answer 27

inhibitor of sodium channels - stabilise resting membrane potential and reduce neuronal excitability increases brain content of GABA - principal inhibitory enurotransmitter = regulates neuronal excitability

Question 28

indications for sodium valproate

Answer 28

epilepsy - first choice drug of generalised or absence seizures and option for focal seizures bipolar disorder - acute treatment of manic episodes and prophylaxis against reucrrance

Question 29

contraindications of sodium valproate

Answer 29

pregnancy | hepatic impairment and renal impairment

Question 30

side effects of sodium valproate

Answer 30

GI upset - nausea, gastric iiration, diarrhoea neurological and psychiatric effects -- tremor, ataxia, behavioural disturbances thrombocytopenia hypersensitivity - hair loss rare, lifethreatneing idiosyncratic adverse efffects - severe liver injury, pancreatitis, bone marow failure, antiepileptic hypersensitivity syndrome

Question 31

possible interactions of sodium valproate

Answer 31

drugs metabolised by P450 enzymes efficacy lowered by drugs that decrease seizure threshold

Question 32

do not drive if got epilepsy unless seizure free for ___ months or sleep only seizures for ___ years dotn drive for __ months after stopping or changing treatment

Answer 32

12 months 3 years 6 months

Question 33

lamotrigine

Answer 33

anti epileptic/convulsant

Question 34

how does lamotrigine work?

Answer 34

sodium channel blocker, leading to stabilisation of neuronal membranes blocks some calcium channels

Question 35

indicatiosn fo lamtrigine

Answer 35

on own or in combination to treat focal and generalised seizures, inc tonic-clonic seizures seizures associated w lennox-gastaut syndrome absent seizures in children and prevention of depressive episodes associated with bipolar disorder

Question 36

side effects of lamotrigine

Answer 36

nausea, vomiting, diarhhoea, dry mouth aggression, agitation, headache, drowsiness, dizziness, tremor, insomnia, ataxia back pain,arthralgia, nystag,mus, diplopia, blurred vision, rash

Question 37

interactions of lamtrigine

Answer 37

carbamazepine - rasies plasma concentration of an active metaoblite of it interacts with all other antiepileptics

Question 38

levetiracetam

Answer 38

anti-epileptic/convulsant

Question 39

how does levetiracetam work?

Answer 39

reduces abdnormal conduction signals in brain by binding to syndaptic vesicle glycoprotein 2A

Question 40

indications for levetiracetam

Answer 40

on own or in combination to treat focal seizures with or without secondary generalisation adjuvant therapy of myoclonic seizures in patints with juvenile myoclonic epilepsy and primary generalised tonic-clonic seizures sometimes used in myoclonic or absent seizures (not licensed for these)

Question 41

what to not do when taking levetiracetam

Answer 41

avoid abrupt withdrawal

Question 42

side effects for levetiracetam

Answer 42

anorexia, abdo pain, nausea, vomiting, dyspepsia, diarrhoea, cough, nasopharyngitis, vertigo, drowsiness, ataxia, convulsion, dizziness, headache, tremor, malaise, aggression, depression, insomnia, anxiety, irritability, rash

Question 43

interactions of levetiracetam

Answer 43

increase in plasma conc of carbamexapine and methotrexate