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Yr 2 EOYS ^2 > BB EOYS6 > Flashcards

BB EOYS6 Flashcards

1
Q

DBS has NICE approval (NHS funded) for which three diseases? [3]

A
  • Parkinson’s disease (Hypokinetic movement disorder)
  • Essential Tremor (Hyperkinetic movement disorder)
  • Dystonia (Hyperkinetic movement disorder)
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2
Q

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]

A

Idiopathic PD: with 4 classical symptoms: tremor, bradykinesia, rigidity, postural instability.

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3
Q

DBS for PD

DBS directly impacts which two symptoms? [2]

DBS improves which symptom due to less drug being required? [1]

A

Directly decreases bradykinesia and rigidity

Improves dyskinesia as less L-DOPA required.

Reduced but not totally eliminated

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4
Q

Brain regions for DBS

Which areas of the brain targeted for tremor? [3]

Which areas of the brain targeted for Dystonia? [1]

A

Tremor:
* Zona incerta
* Subthalamic nucleus
* GPin

Dystonia:
* GPin

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5
Q
A
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6
Q

Which structures are the arrows pointing to? [5]

A
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7
Q

Name 3 risks of DBS

A
  • 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).
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8
Q

Mechanisms of DBS

Explain the inhibition hypothesis [2]

A

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

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9
Q

Mechanisms of DBS

Explain the excitation hypothesis [2]

A

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

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10
Q

Mechanisms of DBS

Explain the disruption hypothesis

A

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

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11
Q

Which potential mechansim for DBS is depicted by the figure?

1- Inhibition hypothesis
2- Excitation hypothesis
3- Disruption hypothesis
4- Neuro-network modulation hypothesis

A

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

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12
Q

Name drugs & the drug class they belong to, to treat short term [2]& long term insomina [2]

A

Short-term use:
* lorazepam (benzo)
* temazepam (benzo)

Long-term use:
* eszopiclone (benzo)
* Zolpidem (Z-drug)

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13
Q

What are 5 side effects of using benzodiazepines used as hypnotics? [5]

A
  • 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
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14
Q

These are indications that [] transmission is involved in the
genetic risk for anxiety disorders

Dopamine
Glutamate
GABA
5HT

A

These are indications that [] transmission is involved in the
genetic risk for anxiety disorders

Dopamine
Glutamate
GABA
5HT

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15
Q

Name 5 classes of drugs that can act as anxiolytics [5]

A

SSRIs
SNRIs
Benzodiazepines
5-HT1A agonists
β-adrenoceptor antagonists

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16
Q

Name 3 benzodiazepines used as anxiolytics

A

clonazepam, alprazolam, lorazepam

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17
Q

Name two SNRIs and two SSRIs used as anxiolytics [4]

A

SSRIs
* fluoxetine, escitalopram, paroxetine
* can be used to treat panic and social phobias

SNRIs:
* venlafaxine, duloxetine

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18
Q

Name two 5HT-1A agonists and one B-adrenoreceptor antagonists used as anxiolytics [3]

A

5-HT1A agonists: buspirone ipsapirone

β-adrenoceptor antagonists: propranolol

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19
Q

Which muscle does the trochlea nerve innervate? [1]

What movement does this cause? [1]

A

superior oblique muscle: downward and laterally

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20
Q

The opthalmic nerve divides into which nerves? [3]

A

Frontal nerve
Nasocilliary nerve
Lacrimal nerve

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21
Q

What are the two branches of the mandibular (V3) nerve? [2]

Describe the role of these nerves

A

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.

22
Q

Which is the only muscle of the tongue that is not innervated by the hypoglossal nerve? [1]

Which nerve is it innervated by? [1]

A

palatoglossus is the only of these muscles to be innervated by the vagus nerve (CNX).

23
Q

Label A-E

A

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)

24
Q

Phenelzine belongs to which drug class

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

A

Phenelzine belongs to which drug class

MOAI (irreversible)

25
Q

Tranylcypromine belongs to which drug class

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

A

Tranylcypromine belongs to which drug class

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

26
Q

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

A

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

27
Q

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)

A

noradrenaline reuptake inhibitor (NARI)

28
Q

GI side effects are most common to which drug class

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

A

SSRI

29
Q

Which drugs would you prescribe for treatment resistant:

  • Schizophrenia [1]
  • Depression [1]
A

Schizophrenia: Clozapine
Depression: Esketamine

30
Q

Which of the following causes an increase in photosensitivity?

thioridazine
flupenthixol
chlorpromazine
fluphenazine
haloperidol

A

thioridazine
flupenthixol
chlorpromazine
fluphenazine
haloperidol

31
Q

Olanzapine is a atypical antipsychotic. State which disease that prescribing this drug can cause [1]

A

Diabetes ( & metabolic syndrome)

32
Q

Which is most toxic in an overdose?

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

A

Which is most toxic in an overdose?

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

33
Q

Describe the MoA of TCAs [2]

A
  • Inhibit reuptake of amines on the presynaptic terminal, so 5HT or NA cannot be taken back into neuron
34
Q

Important AEs of TCAs? [4]

A
  • 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!

35
Q

Phenelzine, tranylcypromine belong to which drug class? [1]

A

Irreversible MONOAMINE OXIDASE INHIBITORS

36
Q

What is the benefit of using SSRIs (citalopram, fluoxetine, paroxetine) with regards to AEs [3]

A

No anticholinergic activity
No cardiotoxic effects
Safe in overdose

37
Q

What are the different targets for reverible MAOIs compared to irreversible MOAIs? [2]

Describe the benefits of reversible MAOIs compared to irreversible MAOs [2]

A

Drug targets:
* Reversible MAOI targets: MOA-A
* Irreversible MAOI targets: MAOA & MAOB

Differences:
* Reversible is safer than irreversible MAOIs
* Can switch drug classes quicker

38
Q

Depression drugs

Name a noradrenaline reuptake inhibitor used for depression treatment [1]

A

Reboxetine

39
Q

Depression Drugs

Name a serotonergic antagonist and reuptake inhibito (SARI) [1]

A

Trazodone

40
Q

Depression drugs

Name a noradrenergic and specific serotonergic antidepressant (NaSSA) [1]

A

Mirtazapine

41
Q

Name 4 non-pharmacological approaches for mood disorders

A

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)

42
Q

30% schizophrenic patients do not respond to treatment. Which drug would you provied for those who have drug resistance? [1]

A

Clozapine

43
Q

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?

A

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.

44
Q

Atypical antipsychotic drugs target which receptor/s

D1 receptors
D2 receptors
D1 & D2 receptors
D1 & 5-HT2 receptors
D2 & 5-HT2 receptors

A

Atypical antipsychotic drugs target which receptor/s

D1 receptors
D2 receptors
D1 & D2 receptors
D1 & 5-HT2 receptors
D2 & 5-HT2 receptors

45
Q

Name 3 extrapyramidal effects that occur due to antipsychotic drugs. [3]

Why do these occur? [1]

A

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

46
Q

Which anti-psychotics can be adminstered by IM injections? [2]

A

fluphenazine decanoate

haloperidol decanoate

47
Q

Describe what neuroleptic malignant syndrome is a combination of [6]

A

Due to typical anti-psychotics

hyperpyrexia
muscle rigidity
tremor
confusion
autonomic instability

48
Q

Label A-C

A

A: Anterior commissure
B: Amygdala
C: Hippocampal

49
Q

State the main function of the:

Hippocampus [1]
Parahippocampal gyrus [1]
Amygdala: [1]
Septal nucleus [1]
Cingulate cortex [1]

A

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

50
Q

Describe the route of Papez’s circuit

A

Cingulate cortex –> parahippocampal cortex –> hippocampus –> fornix –> mamillary bodies –> hypothalamus -> anterior thalamus –> cingulate cortex.

51
Q

Describe the pathway in which amygdala controls the startle reflex [4]

A

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

52
Q

What is 13?

Hypothalamus
Fornix
Amygdala
Hippocampus
Thalamus

A

What is 5?

Hypothalamus
Fornix
Amygdala
Hippocampus
Thalamus

Yr 2 EOYS ^2 (42 decks)

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