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).

BB EOYS6 Flashcards by patrick ellis

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)

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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.

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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

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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

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Which structures are the arrows pointing to? [5]

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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).

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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

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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

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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

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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

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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)

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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

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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

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

SSRIs
SNRIs
Benzodiazepines
5-HT1A agonists
β-adrenoceptor antagonists

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Name 3 benzodiazepines used as anxiolytics

clonazepam, alprazolam, lorazepam

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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

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

5-HT1A agonists: buspirone ipsapirone

β-adrenoceptor antagonists: propranolol

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Which muscle does the trochlea nerve innervate? [1]

What movement does this cause? [1]

superior oblique muscle: downward and laterally

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The opthalmic nerve divides into which nerves? [3]

Frontal nerve
Nasocilliary nerve
Lacrimal nerve

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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