Principles of neuropharmacology

Question 1

in which order are these drugs taken up by the brain - phenobarbital, diazepam, ethanol, gulcose, morphine

Answer 1

diazepam > ethanol > glucose > phenobarbital > morphine

Question 2

role of multi-drug transporters

Answer 2

mediate transmembrane transport of lipophilic drugs

Question 3

in patients with pharmacoresistant epilepsy is p-glycoprotein (PGP) over/underexpressed

Answer 3

over expressed

Question 4

drugs can alter threshold for a seizure true/false

Answer 4

true

Question 5

starting treatment

Answer 5

monotherapy
seizure freq may influence choice of AED
monitor plasma levels
owner compliance

Question 6

limitations of AEDs

Answer 6

toxicity
tolerance
inappropriate pharmacokinetics
expense

Question 7

phenobarbital - side effects - dogs - general

Answer 7

sedation
PD, polyphagia
TT4 + fT4 reduction
withdrawal seizures

Question 8

phenobarbital - side effects - liver

Answer 8

ALP elevation
hepatotoxicity
more likely with higher serum conc

Question 9

phenobarbital - side effects - idiosyncratic reactions

Answer 9

behavioural alterations
immune-mediated neutropenia, thrombocytopaenia, anaemia
superficial necrolytic dermatitis

Question 10

potassium bromide - side effects

Answer 10

sedation
weakness
PU, PD
GI irritation

Question 11

potassium bromide - dietary effect

Answer 11

high cl diet - decr serum conc

Question 12

potassium bromide - bromide toxicity

Answer 12

rare

severe ataxia, sedation, somnolence, skin reactions

Question 13

potassium bromide - bromide toxicity - treatment

Answer 13

i.v saline to incr renal excretion

Question 14

imepitoin - side effects

Answer 14

no idiosyncratic reactions seen
polyphagia, hyperactivity, PU, PD, somnolence, hypersalivation, emesis, ataxia, apathy, diarrhoea, prolapsed nicitating membrane, decr sight + sensitivity to sound

Question 15

imepitoin - use

Answer 15

1st line treatment for dogs with newly diagnosed idiopathic epilepsy
used in less severe epilepsy cases earlier
in dogs with severe side effects on phenobarbitone

Question 16

reasons for treatment failure

Answer 16

incorrect diagnosis
incorrect AED/dose
newly developed disease
refractory seizures
monotherapy insufficient 
patient tolerance to drug

Question 17

first choice of AED in cats

Answer 17

phenobarbital

Question 18

phenobarbital - side effects - cats

Answer 18

polyphagia
bone marrow suppression
cutaneous hypersensitivities

Question 19

second choice of AED in cats

Answer 19

diazepam

Question 20

diazepam - side effects - cats

Answer 20

hepatotoxicosis - idiosyncratic reactions

Question 21

other AEDs in cats

Answer 21

KBr
Levatiracetam
Gabapentin

Question 22

effects of seizures on the body - 30 mins

Answer 22

arterial hypertension
incr cerebral blood flow
hypoxaemia
hypercarbaemia
hyperglycaemia + hypoglycaemia (energy depletion)
lactic acidosis

Question 23

effects of seizures on the body - >30 mins

Answer 23

continuous muscle contraction
hyperthermia
acidosis + myolysis
hypotension
cardiac arrhythmias

Question 24

3 steps in treatment

Answer 24

stop seizures
protect the brain
think about the future

Question 25

stopping the seizures - 5 phases

Answer 25

``` ABC i.v catheter bloods fluid therapy AED - diazepam, phenobarbitone, potassium bromide ```

Question 26

second line AEDs

Answer 26

diazepam midazolam propofol

Question 27

what to treat to minimise brain injury

Answer 27

hypotension | hypoxaemia