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OV3017 Eye Disease > 22 - Systemic Drugs II - CNS > Flashcards

22 - Systemic Drugs II - CNS Flashcards

1
Q

what CNS drugs are used for mental health

A
  1. antidepressants (anti-cholonergic effects, pupilary dilation, impact on accomodation and blurred vision)
  2. anxiolytics and hypnotics (sedatives)
  3. antipsychotics
  4. antiepileptics
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2
Q

who should anti depressants be considered for

A
  • past history of moderate/severe depression
  • subthreshold depressive symptoms present for long time
  • suqbthreshold depressive symptoms or mild depression that persist after other interventions
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3
Q

first line choice of drug for prescribing in depression

A
  • SSRI
    as effective as TCAs and much safer in overdose
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4
Q

depression is associated with low levels of?

A

monoamine neutrotransmitters in brain

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5
Q

name some of the neutotransmitters

A
  • serotonin 5HT
  • noradrenalin
  • dopamine
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6
Q

what should the drugs do to the levels of these monoamines

A

maintain the levels

low = depression

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7
Q

selective serotonin re uptake inhibitors (SSRI)

A

They restore the levels of 5HT in the synaptic cleft by binding at the 5HT reuptake transporter -preventing the reuptake and subsequent degradation of 5HT

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8
Q

simply how does the drug SSRI work

A

by blocking the receptor and increasing the levels of 5HT

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9
Q

examples of SSRI

A
  • citalopram
  • escitalopram
  • fluoxetine
  • paroxetine
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10
Q

tricylic anti- depressants TCAs

A
  • TCA bind to 5HT and noradrenalin re-uptake transporters: prevents re-uptake of these monoamines from the synaptic cleft
  • leads to accumulation of 5HT and noradrenalin in synaptic cleft, conc returns to normal range
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11
Q

what is the half life of a TCA

A

long, allows single daily dose regime, given at night when sedative effect might be helpful

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12
Q

examples of TCA

A
  • amitriptyline
  • clomipramine
  • imipramine
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13
Q

serotonin and noradrenaline reuptake inhibitors

A

Next generation of anti depressant drugs
Similar to tricyclics

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14
Q

-serotonin-norepinephrine reuptake inhibitors? work by

A

block re-uptake

increasing concentration of these neurotransmitters at synaptic cleft

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15
Q

examples of serotonin and noradrenaline reuptake inhibitors

A
  • venlafaxine
  • duloxetine
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16
Q

Monoamine oxidase inhibitors (MAOI’s)

A
  • treatment resistant depression - use limited due to dietry restrictions
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17
Q

examples of MAOI

A

Phenelzine (Nardil), Isocarboxazid. Moclobemide (Manerix)

18
Q

monoamine oxidase A - What is it and what does it do

A

an enzyme involved in metabolism of the monoamines 5-HT and noradrenalin

  • converts monoamines into their corresponding carboxylic acid

-MAOI inhibit monoamine degradation and result in greater stores being available for release

19
Q

what are hypnotics used for

A

short-term managment of insomnia
- tolerance occurs in 1-3 nights

20
Q

what are anxiolotyics for

A

short term relief of anxiety that is severtr

21
Q

what to use for chronic anxiety (>4 weeks)

A

antidepressant

22
Q

what are some hypnotics (sleeping tabs)

A

benzodiapenes
-short half life
nitrazepam, flurazepam

non-benzodiazepene hypnotics
- zomplicone

23
Q

what are some anxiolytics

A

benzodiapenes with a long half life
- diazepam
- lorazepam
- oxazepam

muscle relaxers
more effective as longer half life

24
Q
A
24
Q

how do benzodiazepines work

A
  • enhnace the action of GABA at GABA-A receptors when they bind
  • makes GABA more effective at calming down nerve activity
25
Q

antipsychotics are also known as

A

neuroleptics or major tranquillisers

26
Q

what are antipsychotics used for

A
  • schizophrenia
  • mania
  • psychotic depression

useful for short term sedation in aggression/agitation

27
Q

what effects do antipsychotics have in schizophrenia

A

prophylactic - prevents something from happening

28
Q

what type of antipsychotics are there

A

typical and atypical

29
Q

where do typical (conventional) antipsychotics act

A
  • dopamine receptors
30
Q

what are the side effects of typical antipsychotics

A
  • sedation
  • extrapyramidial effects
  • anticholinergic effects
31
Q

examples of typical antipsychotics

A

-Phenothiazines e.g. chlorpromazine

-Thioxanthenes e.g.flupentixol

-Butyrophenones e.g. haloperidol

32
Q

where do atypical antipsychotics act on

A
  • other receptors as well as dopamine
  • less likely to cause movement disorders as a side effect as more modern
33
Q

examples of atypical antipsychotics

A

-Amisulpride

-Clozapine

-Olanzapine

-Quetiapine

-Risperidone

34
Q

how is psychosis induced

A

increased levels of dopamine activity

35
Q

how do most antipsychotic drugs work

A
  • block post synaptic dopamine receptos
    (D2)
36
Q

what are bipolar drugs used for

A

to control acute attacks and also to prevent their recurrence

37
Q

which drugs are used for bipolar disorder

A

Acute attack
-Benzodiazepines
-Antipsychotics

Prophylaxis
-Lithium (Priadel)

38
Q

what is the objective treatment of antiepilectics

A

prevent recurrence of epileptiform events (seizures)

39
Q

what occurs in a epileptiform event

A

a sudden, excessive depolarisation of cerebral neurones which may remain localised (focal epilepsy) or spread (generalised epilepsy)

40
Q

what do anti-epileptic agents prevent

A

depolarisation of neurones

-inhibition of excitatory neurotransmitters

-direct membrane stabilisation

-stimulation of inhibitory neurotransmittersq

41
Q

what are common anti-epileptics

A

-Carbamazepine

-Lamotrigine

-Sodium Valproate )

Antiepileptics with significant ocular adverse reactions

-Vigabatrin
-Topiramate

OV3017 Eye Disease (19 decks)

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