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ESA 5 > CPT S11 - Neurological Disorders > Flashcards

CPT S11 - Neurological Disorders Flashcards

1
Q

What are the two types of seizure?

A

Partial (AKA focal)

Generalised

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2
Q

Describe a partial seizure

A

Can be defined as simple or complex, based on the level of consciousness
Can escalate to generalised

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3
Q

What is the pathological process of epilepsy?

A

Loss of excitatory:inhibitory homeostasis

Increased discharges in focal cortical area

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4
Q

What are the symptoms of partial seizures?

A 
Depends on the area affected
Can include;
-Involuntary motor disturbance
-Behavioural change
-"Aura"
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5
Q

Describe generalised seizures

A

Generated centrally and spread through both hemispheres
Loss of consciousness
Many types

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6
Q

What are the main sub-categories of generalised seizures?

A

Tonic-clonic (Grand mal)

Absence (Petit mal)

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7
Q

What is status epilepticus?

A

Prolonged seizure (>5 minutes) or a series of seizures without a recovery interval
Medical emergency
Can lead to death or brain damage
Can occur for any type of epilepsy

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8
Q

What are the dangers of epilepsy?

A 
Physical injury relating to a fall
Hypoxia
SUDEP
Brain damage/dysfunction
Cognitive impairment
Psychiatric disease
ADRs
Stigma
Loss of livelihood (lorry drivers etc)
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9
Q

What is the cause of epilepsy?

A 
Primary;
-No identifiable cause
Secondary;
-Medical conditions affecting the brain
-Vascular disease
-Tumours
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10
Q

What can precipitate seizures?

A

Sensory stimli (strobes)
Brain disease/trauma (stroke, drugs, alcohol)
Metabolic disturbances (hypo/hyperglycaemia)
Infections (infantile febrile convulsions)
Therapeutics

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11
Q

Give some therapeutic targets for epilepsy

A

Voltage-gated sodium channels

GABA-mediated inhibition

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12
Q

What is the mechanism of action of VGSC blockers in epilepsy?

A

Can only access binding site during depolarisation
Prolongs inactivation state
So help return rapid discharge rate to normal

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13
Q

Give some examples of VGSC blockers used in epilepsy

A

Carbamazepine
Phenytoin
Lamotrigine

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14
Q

Give some ADRs for carbamazepine

A 
CNS;
-Dizziness
-Drowsiness
-Ataxia
-Motor disturbance
-Numbness
-Tingling
GI;
-Upset
-Vomiting
CV;
-BP variation
Other;
-Rash
-Hyponatraemia
-Neutropenia (rare)
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15
Q

Give some DDIs for carbamazepine

A

CYP450 inducer so many many

Basically just check BNF because if they take anything at all it probably interferes

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16
Q

What types of epilepsy may be treated with carbamazepine?

A

Generalised tonic-clonic

Partial

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17
Q

Give some ADRs for phenytoin

A 
CNS;
-Dizziness
-Ataxia
-Headache
-Nystagmus
-Nervousness
Other;
-Gingival hyperplasia
-Rash
-Stevens Johnson hypersensitivity reaction
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18
Q

Give some DDIs for phenytoin

A

Another CYP inducer, though not of itself
Therefore many interactions
BNF this because so many

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19
Q

What is the most dangerous thing about phenytoin?

A

Has zero-order kinetics at therapeutic range

Must monitor free plasma concentration

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20
Q

What types of epilepsy may be treated with phenytoin?

A

Generalised tonic-clonic

Partial

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21
Q

Give some ADRs for lamotrigine

A 
Less than other VGSC blockers
CNS;
-Dizziness
-Ataxia
-Somnolence
Other;
-Rashes
NB - increased ADR profile in children
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22
Q

Give some DDIs for lamotrigine

A

Not a CYP inducer so fewer than other VGSC blockers
Oral contraceptives reduce LTG plasma concentration
Valproate increases LTG plasma concentration due to competitive binding

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23
Q

Give some examples of GABA enhancing drugs used in epilepsy

A

Sodium Valproate

Benzodiazepines

24
Q

What are the ways in which the actions of GABA may be enhanced?

A

Inhibition of GABA inactivation
Inhibition of GABA re-uptake
Stimulation of GABA synthesis

25
Q

Give some ADRs for sodium valproate

A 
Generally milder than other AEDs
CNS;
-Sedation
-Ataxia
-Tremor
Hepatic;
-Increased transaminases
-Failure
26
Q

Give some DDIs for valproate

A

Again, check BNF
Many drugs antagonise its effects esp the psychoactive ones
Crazy shenanigans can occur when combined with other AEDs

27
Q

What types of epilepsy may be treated with valproate?

A

Partial

Generalised (both tonic-clonic and absence)

28
Q

Give some ADRs for benzodiazepines

A 
CNS;
-Sedation
-Confusion
-Impaired coordination
-Aggression
-Tolerance
-Withdrawal seizures
Other;
-Respiratory depression
-CNS depression
29
Q

Give some DDIs for benzodiazepines in epilepsy

A

Very few

May even be used as an adjunct

30
Q

What types of epilepsy may benzodiazepines be used to treat?

A

Lorazepam and diazepam are used in status epilepticus

Clonazepam may be used for absence seizures in the short term

31
Q

What are the basic rules of prescribing AEDs?

A

Aim for monotherapy
ITU sedation is an option in status
Must keep patients under review
Always check the BNF

32
Q

Are AEDs safe in pregnancy?

A

No

Must balance risk of teratogenicity and status epilepticus

33
Q

What needs to be done if a patient is in status epilepticus?

A 
ABC
Exclude hypoglycaemia
Give lorazepam IV if possible
Give PR if not possible
Can give phenytoin IV if unsuccessful
If still unsuccessful, send to ITU, ventilate, sedate and paralyse
34
Q

What are the motor features of parkinsons?

A

Tremor
Rigidity
Bradykinesia
Postural instability

35
Q

What are some non-motor symptoms of parkinsons?

A 
Mood changes
Pain
Cognitive change
Urinary symptoms
Sleep disorder
Sweating
36
Q

What are causes or parkinsonism?

A 
Parkinsons Disease
Drug-induced parkinsonism
Vascular parkinsonism
Progressive supranuclear palsy
Multiple systems atrophy
Corticobasal degeneration
37
Q

How is PD differentiated from other causes of parkinsonisms?

A

Response to treatment
Structural neuroimaging normal
Functional neuroimaging

38
Q

Describe the pathology of PD

A

Loss of dopaminergic neurones in the substantia nigra results in reduced inhibition in neostriatum
Reduced inhibition allows increased ACh production
Chain of abnormal signalling leads to impaired mobility

39
Q

What are the types of treatment in PD?

A

Symptomatic relief;

  • Movement disorders
  • Non-motor features
  • Neuroprotection
  • Surgery
40
Q

What drug classes are used in PD?

A 
L-DOPA
Dopamine receptor antagonisrs
MAOI type B inhibitors
COMT inhibitors
Anticholinergics
Amantidine
41
Q

What are the ADRs of L-DOPA?

A

Nausea/anorexia (interferes with vomiting centres)
Hypotension (central and peripheral interference)
Psychosis (schizophrenia-like)
Tachycardia

42
Q

What are the benefits of L-DOPA?

A

Highly efficacious

Low side-effect profile if taken with a peripheral DOPA-decarboxylase inhibitor eg co-careldopa

43
Q

What are the disadvantages of L-DOPA?

A 
It's a precursor so requires enzyme conversion
Long term loss of efficacy as destruction of dopaminergic neurones continues
Causes involuntary movement
Motor complications including;
-On/off function between doses
-Dystonia
-Dyskinesia
-Freezing
44
Q

Give some examples of dopamine receptor antagonists

A 
Ergot;
-Pergolide
-Bromocryptine
Non-ergot;
-Ropinirole
-Pramipexole
45
Q

Give some dopamine receptor agonist advantages

A

Direct acting
Fewer dyskinesias and motor complications
Possible neuroprotection

46
Q

Give some disadvantages of dopamine receptor agonists

A

Less efficacious than L-DOPA
Impulse control disorders
More psychiatric ADRs (these are dose-limiting)
Expensive

47
Q

What are impulse control disorders?

A 
Also called dopamine dysregulation syndrome
Pathological gambling
Hypersexuality
Compulsive shopping
Desire to increase dosage
48
Q

Give some dopamine receptor agonist ADRs

A 
Sedation
Hallucinations
Confusion
Nausea
Hypotension
49
Q

What is the action and mechanism of Catechol-O-methyl Transferase (COMT) Inhibitors in PD treatment?

A

Reduces the peripheral breakdown of L-DOPA to 3-O-methyldopa and so enhances the actions of L-DOPA within the CNS

50
Q

What is the action of MAO B Inhibitors in PD?

A

MAO B metabolises dopamine

Inhibition potentiates it

51
Q

What is the role of anticholinergics in the treatment of PD?

A

Minor
Treats tremor
No effect on bradykinesia
Significant side effects

52
Q

What is the role of Amantidine in the treatment of PD?

A

Poorly effective
Uncertain mechanism
Few side effects

53
Q

What are the main symptoms of myasthenia gravis?

A 
Fluctuation
Fatiguable
Weakness
Commonly;
-Extraoccular muscles
-Bulbar involvement
-Limb weakness
-Respiratory muscle involvement
54
Q

Give examples of drugs which can exacerbate myasthenia gravis

A

Aminoglycosides
Beta blockers
ACEi
Basically anything affecting neuromuscular transmission

55
Q

What are the complications of myasthenia gravis?

A 
Acute exacerbation (myasthenic crisis)
Overtreatment (cholinergic crisis)

ESA 5 (17 decks)

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