BB EOYS6 Flashcards
DBS has NICE approval (NHS funded) for which three diseases? [3]
- Parkinson’s disease (Hypokinetic movement disorder)
- Essential Tremor (Hyperkinetic movement disorder)
- Dystonia (Hyperkinetic movement disorder)
Criteria in DBS for Parkinson’s disease
What type of PD makes you elligible for DBS? [1]
What are the 4 classic symptoms for this? [4]
Idiopathic PD: with 4 classical symptoms: tremor, bradykinesia, rigidity, postural instability.
DBS for PD
DBS directly impacts which two symptoms? [2]
DBS improves which symptom due to less drug being required? [1]
Directly decreases bradykinesia and rigidity
Improves dyskinesia as less L-DOPA required.
Reduced but not totally eliminated
Brain regions for DBS
Which areas of the brain targeted for tremor? [3]
Which areas of the brain targeted for Dystonia? [1]
Tremor:
* Zona incerta
* Subthalamic nucleus
* GPin
Dystonia:
* GPin
Which structures are the arrows pointing to? [5]
Name 3 risks of DBS
- 2-3% risk of brain haemorrhage
- small risk of cerebrospinal fluid leakage
- 15% risk of temporary problems with transplantation (e.g. infection, allergy to implant).
Mechanisms of DBS
Explain the inhibition hypothesis [2]
Theory: PD due to overactive basal ganglia neurons in the STN and/or GPi.
DBS can block this and remove spontaneous discharge from GPi neurones
Mechanisms of DBS
Explain the excitation hypothesis [2]
DBS can excite afferent axons antidromically resulting in ‘jamming’ the spontaneous activity
DBS inhibits the local neuronal firing removing the spontaneous discharge from subthalamic nucleus
Mechanisms of DBS
Explain the disruption hypothesis
DBS in GPi can activate axon terminals causing extensive release of NTs (i.e. GABA & glutamate)
DBS dissociates inputs and outputs in the stimulated nucleus, thus disrupting/blocking the abnormal information flow through the GPi.
DBS disrupts abnormal information flow through the GPi
Which potential mechansim for DBS is depicted by the figure?
1- Inhibition hypothesis
2- Excitation hypothesis
3- Disruption hypothesis
4- Neuro-network modulation hypothesis
3- Disruption hypothesis
DBS activates axon terminals in the stimulated nucleus, induces extensive release of neurotransmitters, such as GABA and glutamate (Glu), and dissociates inputs and outputs in the stimulated nucleus
Name drugs & the drug class they belong to, to treat short term [2]& long term insomina [2]
Short-term use:
* lorazepam (benzo)
* temazepam (benzo)
Long-term use:
* eszopiclone (benzo)
* Zolpidem (Z-drug)
What are 5 side effects of using benzodiazepines used as hypnotics? [5]
- Change in sleep patterns (suppress deep sleep and REM sleep - which is the period you become most rested in)
- Daytime sedation
- Rebound insomnia
- Tolerance
- Dependence
These are indications that [] transmission is involved in the
genetic risk for anxiety disorders
Dopamine
Glutamate
GABA
5HT
These are indications that [] transmission is involved in the
genetic risk for anxiety disorders
Dopamine
Glutamate
GABA
5HT
Name 5 classes of drugs that can act as anxiolytics [5]
SSRIs
SNRIs
Benzodiazepines
5-HT1A agonists
β-adrenoceptor antagonists
Name 3 benzodiazepines used as anxiolytics
clonazepam, alprazolam, lorazepam
Name two SNRIs and two SSRIs used as anxiolytics [4]
SSRIs
* fluoxetine, escitalopram, paroxetine
* can be used to treat panic and social phobias
SNRIs:
* venlafaxine, duloxetine
Name two 5HT-1A agonists and one B-adrenoreceptor antagonists used as anxiolytics [3]
5-HT1A agonists: buspirone ipsapirone
β-adrenoceptor antagonists: propranolol
Which muscle does the trochlea nerve innervate? [1]
What movement does this cause? [1]
superior oblique muscle: downward and laterally
The opthalmic nerve divides into which nerves? [3]
Frontal nerve
Nasocilliary nerve
Lacrimal nerve
What are the two branches of the mandibular (V3) nerve? [2]
Describe the role of these nerves
Inferior alveolar nerve
* supplies the lower dentition and gives off the mental nerve which passes through the mental foramen.
Lingual nerve
* supplies somatosensory fibres to the anterior 2/3 of the tongue. The chorda tympani is a branch of the facial nerve and“hitches a lift” with the lingual nerve to supply special sensory fibres of tast to the anterior 2/3 of the tongue.
Which is the only muscle of the tongue that is not innervated by the hypoglossal nerve? [1]
Which nerve is it innervated by? [1]
palatoglossus is the only of these muscles to be innervated by the vagus nerve (CNX).
Label A-E
A: Oculomotor nerve (n. III)
B: Trigeminal nerve (n. V)
C: Abducent nerve (n. VI)
D: Facial nerve (n. VII)
E: Vestibulocochlear nerve (n. VIII)
Phenelzine belongs to which drug class
SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)
Phenelzine belongs to which drug class
MOAI (irreversible)
Tranylcypromine belongs to which drug class
SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)
Tranylcypromine belongs to which drug class
SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)
Describe the mechanism of action of agomelatin
Binds to MT1 and MT2 receptors only
Binds to MT1 and MT2 receptors; 5HT agonist
Binds to MT1 and MT2 receptors; 5HT antagonist
5HT agonist
5HT antagonist
Describe the mechanism of action of agomelatin
Binds to MT1 and MT2 receptors only
Binds to MT1 and MT2 receptors; 5HT agonist
Binds to MT1 and MT2 receptors; 5HT antagonist
5HT agonist
5HT antagonist
Reboxetine is a drug used to treat depression that has the mechanism of action of which of the below?
noradrenaline reuptake inhibitor (NARI)
serotonergic reuptake inhibirot (SARI)
noradrenergic and specific serotonergic antidepressant (NaSSA)
noradrenaline reuptake inhibitor (NARI)
GI side effects are most common to which drug class
SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)
SSRI
Which drugs would you prescribe for treatment resistant:
- Schizophrenia [1]
- Depression [1]
Schizophrenia: Clozapine
Depression: Esketamine
Which of the following causes an increase in photosensitivity?
thioridazine
flupenthixol
chlorpromazine
fluphenazine
haloperidol
thioridazine
flupenthixol
chlorpromazine
fluphenazine
haloperidol
Olanzapine is a atypical antipsychotic. State which disease that prescribing this drug can cause [1]
Diabetes ( & metabolic syndrome)
Which is most toxic in an overdose?
SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)
Which is most toxic in an overdose?
SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)
Describe the MoA of TCAs [2]
- Inhibit reuptake of amines on the presynaptic terminal, so 5HT or NA cannot be taken back into neuron
Important AEs of TCAs? [4]
- Dangerous (cardiotoxic) in overdose
- Anti-cholinergic: dry mouth; blurred vision, constipation, urinary retention, aggravation of narrow angle glaucoma, fatigue, postural hypotension, dizziness, loss of libido, arrhythmias
- Antihistaminic: sedation, weight gain.
- Block alpha 1 adrenoreceptors: orthostatic hypotension - blood pressure drops on standing, cardiac effects
As a result aren’t the first choice!
Phenelzine, tranylcypromine belong to which drug class? [1]
Irreversible MONOAMINE OXIDASE INHIBITORS
What is the benefit of using SSRIs (citalopram, fluoxetine, paroxetine) with regards to AEs [3]
No anticholinergic activity
No cardiotoxic effects
Safe in overdose
What are the different targets for reverible MAOIs compared to irreversible MOAIs? [2]
Describe the benefits of reversible MAOIs compared to irreversible MAOs [2]
Drug targets:
* Reversible MAOI targets: MOA-A
* Irreversible MAOI targets: MAOA & MAOB
Differences:
* Reversible is safer than irreversible MAOIs
* Can switch drug classes quicker
Depression drugs
Name a noradrenaline reuptake inhibitor used for depression treatment [1]
Reboxetine
Depression Drugs
Name a serotonergic antagonist and reuptake inhibito (SARI) [1]
Trazodone
Depression drugs
Name a noradrenergic and specific serotonergic antidepressant (NaSSA) [1]
Mirtazapine
Name 4 non-pharmacological approaches for mood disorders
Electroconvulsive therapy (treatment-refractory severe depression with suicide risk)
Cognitive behavioural therapy (CBT) (can augment the effects of pharmacological treatment)
Vagal nerve stimulation (especially in chronic depression)
Deep brain stimulation (DBS); subcallosal cingulate white matter – Brodmann area 25)
30% schizophrenic patients do not respond to treatment. Which drug would you provied for those who have drug resistance? [1]
Clozapine
The drugs used to treat schizophrenia are [] receptor [antagonists / agonists] [2]
They can be divided into typical and atypical drug treatments; what are the difference between them?
The drugs used to treat schizophrenia are D2 (dopamine) receptor antagonists
Typical:’ are older and cause generalised dopamine receptor blockade.
Atypical: are more selective in their dopamine blockade and also block serotonin 5-HT2A receptors.
Atypical antipsychotic drugs target which receptor/s
D1 receptors
D2 receptors
D1 & D2 receptors
D1 & 5-HT2 receptors
D2 & 5-HT2 receptors
Atypical antipsychotic drugs target which receptor/s
D1 receptors
D2 receptors
D1 & D2 receptors
D1 & 5-HT2 receptors
D2 & 5-HT2 receptors
Name 3 extrapyramidal effects that occur due to antipsychotic drugs. [3]
Why do these occur? [1]
Extrapyramidal effects (EPS):
* acute dystonias
* parkinsonism
* tardive dyskinesia
Approx. 60% D2 receptor occupancy required for
antipsychotic efficacy; if >80% D2 receptors are blocked, then potential for EPS
Which anti-psychotics can be adminstered by IM injections? [2]
fluphenazine decanoate
haloperidol decanoate
Describe what neuroleptic malignant syndrome is a combination of [6]
Due to typical anti-psychotics
hyperpyrexia
muscle rigidity
tremor
confusion
autonomic instability
Label A-C
A: Anterior commissure
B: Amygdala
C: Hippocampal
State the main function of the:
Hippocampus [1]
Parahippocampal gyrus [1]
Amygdala: [1]
Septal nucleus [1]
Cingulate cortex [1]
Hippocampus = Memory acquisition and recall, formation of long-term memory. Formation of memory not storage
Parahippocampal gyrus: storage and conversion of new experiences into memories
Amygdala = Emotional content of stimuli: fear, anxiety and danger
Septal nucleus = Pleasure and reward
Cingulate cortex = Affective significance
Describe the route of Papez’s circuit
Cingulate cortex –> parahippocampal cortex –> hippocampus –> fornix –> mamillary bodies –> hypothalamus -> anterior thalamus –> cingulate cortex.
Describe the pathway in which amygdala controls the startle reflex [4]
Sensory information feeds into the basolateral amygdala
Feeds into the central amygdala
Central amygdala sends output to the central gray area of the midbrain
Information is relayed to the nucleus in the pons responsible for the startle reflex
What is 13?
Hypothalamus
Fornix
Amygdala
Hippocampus
Thalamus
What is 5?
Hypothalamus
Fornix
Amygdala
Hippocampus
Thalamus
