CNS Flashcards
4 main signs of PD
tremor
rgidity
bradykinesia
postural instability
what treats rapid eye movement (REM) sleep behaviour disorder (RBD)
clonzepam
its a benzodiazepine
moa: enhancing GABA-A receptor activity, increasing neuronal inhibition
early PD pharmacological treatment
MAO-B inhibitors
example: Selegiline
standard symptom treatment: levodopa + carbidopa (Sinemet)
- dopamine agonist following treatment with levodopa
example: ropinirole - helps treat dyskinesia
anticholinergic: to treat tremor
examples: atropine, benztropine, diphenhydramine
advanced PD phamrmacological treatment
dopa decarboxylase inhibitor (carbidopa) for symptomatic treatment
- amantadine for dyskinesia
- COMT inhibitors to treat motor fluctuations (entacapone, tolcapone)
- or even MAO B inhibitors
AD symptomatic treatment
Acetylcholineesterase inhibitors (donepezil, rivastigmine, galantamine)
NMDA antagonists (memantine)
non pharmacological: viatain B and folic acid intake
diagnosis and incestigations for epilepsy
MRI, CT scan
ECG
EEG
blood tests
genetic testing
caution in pregnancy with AEDs
foetus malformation
to prevent neural tube defects folic acid 5mg OD is given
4 processes of neuroceptive pain
1) transduction
2) transmission
3) perception
4) modulation
opioid side effects
nausea, vomit, pruitus, constipation, seadation
severe: respiratory depression
^ treat with naloxone 0.4mg/10ml sodium chloride 0.9% (adminstered every 1-2 mins)
Gabapentinoids (neuropathic pain drugs)
example: gabapentin
moa: Inhibits voltage-gated calcium channels, reducing nerve excitability
dose: Start 300 mg/day, titrate to 3600 mg/day (divided doses)
contraindications: Severe renal impairment, hypersensitivity
Side Effects: Dizziness, drowsiness, weight gain, peripheral oedema
TCAs (neuropathic pain drugs)
example: amitriptyline
moa: inhibits serotonin and norepinephrine reuptake, moduulating pain signal
dose: Start 10–25 mg at bedtime, titrate to 75 mg/day
Contraindications: Recent MI, arrhythmias, glaucoma
Side Effects: Dry mouth, sedation, constipation, weight gain, cardiac toxicity
Capsaicin
regimen: one patch every 3 months for localised pain
Contraindications: Broken skin, hypersensitivity
Side Effects: Burning, erythema at application site
Tramadol
moa: weak μ-opioid receptor agonist + SNRI activity
dose: 50-100mg every 4-6 hours (max 400mg/day)
Contraindications: Opioid abuse history, respiratory depression
Side Effects: Nausea, constipation, sedation, addiction risk
whats first line for acute migraine attaks
triptans (sumatriiptan, zolmitriptan)
Rimegepant if triptan dont work
mild tp moderate migraine treatment
paracetamol, ibuprofen, and aspirin
what reduces freq and severity of migraine attack
propranolol, topiramate, and amitriptyline
or
CGRP inhibitors (e.g., erenumab, fremanezumab, galcanezumab) if other prophylatic treatment dont work
what is given for chronic migraine
Botulinum toxin type A
cluster headache treatment
oxygen therapy
sumatriptan 6mg SC
zolmitriptan 5mg nasal spray
verapamil (off label): 80mg tds, regular ECG monitoring required
tension headache treatment
paracetamol: 500-1000mg every 4-6 hours
aspirin: 600-900 mg every 4-6 hours
ibuprofen: 200-400mg every 4-6 hours
amitriptyline: 10-25 mg at night (max 75mg/day)
MOH
medication overuse headache
- advised to stop all overused acute headache medication for 1 month
cluster headache signs and symtoms
red or watery eye
runny nose
swollen eyelid
forehead and fcial sweating
drooping eyelid
what ssri is used in paediatric
fluoxetine
first line depression treatment
SSRI
then SNRI
second line and third depression treatment
- switching to another SSRI or SNRI
- TCAs
- SSRI + mirtazapine
- add antiphyscotic (aripiprazole, quetiapine)
third line: MAOIs (phenelzine)
- interaction with foods containing tyramine
ECT
what SSRI causes QT prolongation
citalopram
Symptoms of Generalized Anxiety Disorder (GAD)
Psychological Symptoms:
Persistent, excessive worry
Difficulty controlling worry
Restlessness or feeling on edge
Difficulty concentrating
Physical Symptoms:
Fatigue
Muscle tension
Sleep disturbances
Irritability
Sweating, nausea, headaches
Symptoms of Schizophrenia
hallucinations
delusions
diorgannised speech and behabbiour
pharmalogical treatment schizophrenia
haloperidol
chlorpromazine
risperidone
olanzapine
quetiapine
aripiprazole
clozapine
haloperidol
TYPICAL d2 ANTAGONIST
side effects: tremor, rigidity, QT prolongation
contraindcations: avoid in cardiovascular disease, parkinsons
Cobenfy
muscarinic receptor modulator
indication: schizophrenia
side effects: dry mouth, constipation, nausea.
3 bipolar phases
acute mania
acute bipolar depression
long term maintenence
acute mania treatmet
first line: haloperidol, olanzapine, quetiapine, risperidone
monitor: patient health, side effects
acute bipolar depression treatmetn
first line: fluoxetine +olanzapine combo, or quetiapine on its own
second line: lamotrigine
- SSRI monotherapy avoided to reduce risk of inducing mania.
- CBT
monitoring: mood elevation or maniac symptoms
Long term maintenence treatment ( bi polar)
first line: lithium
second line: valporate, olaznapine, quitiapine
- combo therapy
CBT
regular blood tests, monitor lithium levels and kidney and thyroid function.
Insomnia drug treatment
1) Benzodiazepine (diazepam)
2) non-beznodiazepines hypnotics (zopiclone)
3) melatonin
4) orexin receptor antagonists (daridorexant)
Benzodiazepines (insomnia)
Mechanism of Action:
Enhance GABA-A receptor activity
Side Effects:
- Drowsiness, dizziness
- decreased alertness
- Risk of dependence and tolerance
Monitoring: Regular review to prevent tolerance, dependence, and misuse
Contraindications & Cautions:
Avoid in substance abuse history
severe respiratory insufficiency
sleep apnea
Use caution in elderly patients
Z-Drugs (e.g., Zopiclone, Zolpidem, Zaleplon) (insomnia)
Mechanism of Action:
Non-benzodiazepine hypnotics that act on GABA-A receptors
Promote sedation
Side Effects:
Bitter taste (zopiclone), dizziness,
headache
Risk of dependence
Monitoring: Assess for misuse and side effects
Contraindications & Cautions:
Caution in respiratory conditions,
liver impairment, history of substance abuse
Melatonin (insomnia)
Mechanism of Action:
Hormone that regulates the sleep-wake cycle
Used for primary insomnia in adults ≥55 years
Side Effects
Headache
sore throat
back pain
asthenia (weakness)
Contraindications & Cautions:
Caution in autoimmune diseases
Orexin Receptor Antagonists (e.g., Daridorexant) (insmonia)
moa: blocks orexin neuropeptides, reducing wakefulness promoting sleep
side effects: headache, fatigue
contraindications: avoid in narcolepsy
caution in severe hepatic impairment.
case study questions
near end of pack
