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Y3 DRUGS PROFILES > NEUROLOGICAL DRUGS > Flashcards

NEUROLOGICAL DRUGS Flashcards

1
Q

what is levodopa?

A

dopamine precursor

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2
Q

how can levodopa act centrally on the brain?

A

crosses blood brain barrier

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3
Q

where in the brain does levodopa replaces the deficit in dopamine?

A

basal ganglia

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4
Q

give an ophthalmological contraindication of levodopa

A

closed angle glaucoma as levodopa can cause further increase in intraocular pressure

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5
Q

what kind of parkinsonism contraindicates use of levodopa

A

drug induced

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6
Q

give a circulatory side effect of levodopa

A

Postural Hypotension, syncope and drowsiness

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7
Q

what can occur to the urine of a patient taking levodopa?

A

discolouration

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8
Q

why shouldn’t levodopa be used with anaesthetics?

A

increases the risk of dysrhythmias

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9
Q

why shouldn’t levodopa be used with MAOI antidepressants?

A

increase the risk of hypertension

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10
Q

what type of drug is phenytoin?

A

anti-convulsant

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11
Q

how does phenytoin work?

A

block voltage gated sodium channels which prevents influx of sodium and prevents action potential formation for a seizure. Prevent the spread of neuronal excitability and therefore inhibits seizure activity spread

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12
Q

which seizures is phenytoin not active against?

A

absent

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13
Q

apart from epilepsy, give a condition that phenytoin is used to treat

A

trigeminal neuralgia

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14
Q

what is the metabolism of phenytoin?

A

cytochrome p450

also induces p450

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15
Q

what type of drug is carbamazepine?

A

anti-convulsant

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16
Q

how does carbamazepine work?

A

increases release of GABA which inhibits the CNS by blocking sodium channels - stops action potential

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17
Q

What is carbamazepine 1st line treatment for?

A

Generalised tonic clonic seizure
Focal seizures
Trigeminal neuralgia= Controls the pain, reduces the frequency and severity of the attacks

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18
Q

carbamazepine is contraindicated in what abnormality that causes immune depression?

A

bone marrow depression

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19
Q

carbamazepine is contraindicated in what heart abnormality?

A

AV node conduction abnormality

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20
Q

carbamazepine and sodium valproate are contraindicated in which disease?

A

acute porphyria ( metabolic disorders)

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21
Q

use of carbamazepine can lead to which organ insufficiencies?

A

renal

hepatic

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22
Q

give 2 blood disorders that can be caused by carbamazepine

A

agranulocytosis

thrombocytopenia

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23
Q

how does carbamazepine interact with cytochrome p450?

A

Metabolised and induced by it

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24
Q

what type of drug is sodium valproate?

A

anti-convulsant

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25
Q

how does sodium valproate work? (3 things)

A

increase GABA by preventing re-uptake
Blocks sodium channels
Decreases plasma conc of aspartate (excitatory neurotransmitter)

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26
Q

If a patient is taking sodium valproate and has
a) renal impairment
b) hepatic impariment
what should be the recommendation?

A

a) reduce the dose

b) stop taking sodium valproate

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27
Q

give 3 other side effects of sodium valproate

A

weight gain
sedation
hair loss

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28
Q

why shouldn’t sodium valproate be given with neuroleptics?

A

decrease effect

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29
Q

why shouldn’t sodium valproate be given with TCAs?

A

reduce effect

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30
Q

what type of drug is lamotrigine?

A

anti-convulsant

31
Q

Except for epilepsy and seizures, give 2 instances when lamotrigine can be used

A

lennox-gastaut syndrome

Depression in Bipolar disorder

32
Q

what type of drug is levitaracetam?

A

anti-convulsant

33
Q

how does levitaracetam work?

A

selectively prevents epileptic burst firing and propagation of seizures without affecting normal neuronal activity

34
Q

aside from a tablet, how can levitaracetam be given?

A

injection

35
Q

why should caution be taken when stopping a patient on levitaracetam?

A

withdrawal seizures

36
Q

give 4 side effects of levitaracetam

A

Abdo pain
Anorexia
co-ordination difficulties
sedation/fatigue

37
Q

why should levitaracetam be given with caution in pregnancy

A

can be difficult to maintain seizure control when pregnant

38
Q

Why should the use of L-dopa be used with caution in patients with cardiovascular disease?

A

Due to the risk of hypotension

39
Q

What is the risk of using L-dopa in elderly patients or patients with existing cognitive or psychiatric disease?

A

This is due to the further risk of confusion and hallucinations

40
Q

What physiological affect does L-dopa have?

A

Can cause confusion and hallucinations

41
Q

What is a long term complication of using L-dopa?

A

Increase wearing off effect which causes the notion off the on-off symptoms of parkinsons

42
Q

What common GI symptoms do you get with L-dopa

A

Nausea and vomiting

43
Q

What affect can L-dopa have on a person weight?

A

Can cause anorexia

44
Q

What is the side effect of giving L-dopa to frequently or to high of a dose?

A

Dyskinesia –> involuntary movement

45
Q

What drug is given in conjunction with L-dopa and why?

A

Carbidopa = Peripheral dopa-decarboxylase inhibitor to prevent the conversion to dopamine outside of the brain

46
Q

Why should you not give L-dopa with antihypertensives?

A

Due to the risk of further hypotension

47
Q

When is phenytoin used for status epilepticus?

A

When BZDP does not work

48
Q

Is phenytoin the first line treatment for generalised and focal seizures?

A

No it’s not as other anticonvulsants have less side effects and interactions

49
Q

What is the consequence of phenytoin having a low therapeutic index?

A

The chance of phenytoin toxicity is high as missing a dose or taking to much can have severe effects

50
Q

Why shouldn’t pregnant ladies take phenytoin?

A

Fetal Hyuntain syndrome = abnormal cranialfacial features and lower IQ

51
Q

What should patients take before conception when on phenytoin or Carbamazepine?

A

High dose of folic acid

52
Q

What does long term use of phentyoin do to the skin?

A

Cause coarse skin, acne and gum hypertrophy

53
Q

What are the dose related neurological effects of phentyoin?

A

Cerebellar toxicity ( ataxia, nystagmus and discoordination) and impaired cognition and consciousness

54
Q

How does phentyoin cause osteomalacia and haematological disorders

A

It induces vitamin d and folic acid metabolism

55
Q

What happens in hypersensitivity reaction of phentyoin or Carbamazepine?

A

From mild rash to life threatening rare antiepileptic hypersensitivity syndrome

56
Q

Phenytoin toxicity caused by overdose can cause death by what mechanism?

A

Respiratory depression and cardiovascular collapse

57
Q

What drugs effect the efficacy of phenytoin, carbamazepine, levetiracetam and sodium valproate?

A 
Drugs that reduce the seizure threshold such as
SSRI's
TCA antidepressants
Tramadol
Antipsychotics
58
Q

What happens in life threatening antiepileptic hypersensitivity syndrome?

A

Clinical features include severe skin reactions , fever and lymphadenopathy with systemic (e.g.
haematological, hepatic, renal) involvement and mortality of about 10%.

59
Q

Carbamazepine is used as a alternative treatment of what two conditions?

A

Prophylaxis of Bipolar disorder ( lithium uneffective)

Chronic neurogenic pain

60
Q

What are the potential consequence of carbamazepine exposure in utero?

A

Neural tube defect, cardiac and urinary abnormalities and cleft palate

61
Q

What are common side effects of carbamazepine?

A

Nausea and vomiting

Ataxia and dizziness

62
Q

What type of seizures is sodium valproate first line choice for?

A

Generalised seizures and absence seizures

63
Q

Except for seizures what else is sodium valproate used for?

A

Migraine

Bipolar disorder for acute treatment of manic episodes or prevention of relapse

64
Q

Which anti epileptic drug has the greatest risk of fetal abnormality?

A

Sodium valproate

65
Q

At what points in pregnancy should sodium valproate definitely be avoided?

A

Contraception and first trimester

66
Q

What is the potential fetal abnormalities caused by sodium valproate?

A

Neural tube defect
Craniofacial, cardiac and limb abnormalities
Developmental delay

67
Q

What affect does sodium valproate have on cytochrome p450?

A

inhibitor

68
Q

What is Lennox-Gastaut Syndrome ?

A

It is type of epilepsy with many different types of seizures

69
Q

What are the two main types of seizures in which lamotrigine is used for?

A

Monotherapy and adjuvant therapy for generalised seizure and focal seizure

70
Q

What condition can be exacerbated by lamotrigine?

A

Parkinsons

71
Q

What two drugs decrease plasma conc of lamotrigine?

A

Oestrogen and rifmapicin

72
Q

What drug increases plasma conc of lamotrigine?

A

Sodium Valproate

73
Q

What is the interaction between levetiracetam and methotrexate?

A

Increases the plasma conc of methotrexate

74
Q

What fibres does phentyoin have affect on that causess the antiarrhythmic and cardiotoxic effects?

A

cardiac Purkinje fibres

Y3 DRUGS PROFILES (9 decks)

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