CNS Flashcards by T S

4 main signs of PD

tremor
rgidity
bradykinesia
postural instability

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what treats rapid eye movement (REM) sleep behaviour disorder (RBD)

clonzepam

its a benzodiazepine

moa: enhancing GABA-A receptor activity, increasing neuronal inhibition

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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

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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

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AD symptomatic treatment

Acetylcholineesterase inhibitors (donepezil, rivastigmine, galantamine)

NMDA antagonists (memantine)

non pharmacological: viatain B and folic acid intake

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diagnosis and incestigations for epilepsy

MRI, CT scan
ECG
EEG
blood tests
genetic testing

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caution in pregnancy with AEDs

foetus malformation

to prevent neural tube defects folic acid 5mg OD is given

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4 processes of neuroceptive pain

1) transduction

2) transmission

3) perception

4) modulation

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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)

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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

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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

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Capsaicin

regimen: one patch every 3 months for localised pain

Contraindications: Broken skin, hypersensitivity

Side Effects: Burning, erythema at application site

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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

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whats first line for acute migraine attaks

triptans (sumatriiptan, zolmitriptan)

Rimegepant if triptan dont work

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mild tp moderate migraine treatment

paracetamol, ibuprofen, and aspirin

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what reduces freq and severity of migraine attack

propranolol, topiramate, and amitriptyline

CGRP inhibitors (e.g., erenumab, fremanezumab, galcanezumab) if other prophylatic treatment dont work

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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

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