CPTP 4.9-11 Flashcards
E.g. of a MAO-B inhibitor
selegiline
what is amantadine and what does it do
antiviral. stimulates release of dopamine. tx dyskinesias
difference between MAO-B inhibitors and COMT inhibitors
MAO-B inhibitors inhibit the enzyme that degrades dopamine in the neuron. COMT inhibits degredation in the synaptic cleft
e.g. of a COMT inhibitor
entacapone, tolcapone
what is a COMT inhibitor often given with (brand names)
entacapone given with sinemet (carbidopa and ldopa) to form stalevo
e.g. of dopamine agonists
rotigotine, apomorphine
Why are anticholinergics sometimes useful in PD?
In PD there is reduced dopamine and increased ACh.
When are Anticholinergics used
rarely. not in elderly ude to side effects. can use very early on in PD
anticholinergic SEs
dry mouth, constipation, dizziness, blurred vision, urine retention)
L-dopa SEs
nausea and vomiting, postural hypotension, visual hallucinations, insomnia
management of motor complications in PD tx
fractionate ldopa dose, adjuvant tx (DA, COMT-i, MAOI), duodenal ldopa, apomophine infusion, DBS
administration of DA
rotigotine patch. apomorphine SC.
DA side effects
impulse control disordesr, N/V, postural hypotension, somnolence, hallucinations
when is entacapone given
with each lpoa dose
PD tx in newly diagnosed young person
MAO-B inhibitor, dopamine agonist initially. then progress to ldopa and COMT inh
PD tx in newly diagnosed biologically frail person
ldopa. then progress to comt inh and mao-b inh
how are dyskinesias treated
amantadine, reducing ldopa dose
what is sodium valproate first line for
generalised tonic clonic, absence and myoclonic seizures
better tx of absence seizures in children
ethosuximide
tx of generalised seizures in pregnancy
lamotrigine
types of partial seizures
simple partial, complex partial, secondary generalised
1st line tx of partial seizures
carbamazepine
Adverse effects of AEDs
acute skin rash - SJS. toxicity - ataxia, blurred vision. teratogenicity. gum hypertrophy. drug interactions
drug interactions ass with AEDs
AEDs are hepatic enzyme INDUCERS
what can carbamazepine cause
SIADH, neutropenia
SIADH secondary to AED?
carbamazepine
ARDs and OCP
carbamazepine and phenytoin interfere with OCP, need COCP with >50ng oestrogen.
can you use POP, progesterone patch, implant with AEDs?
no, but can have depo provera and mirena
which AED is monitoring very useful for
Phenytoin
tx of status
secure airway, o2, IV access, bloods, glucose, thiamine IV lorazepam (or PR diazepam or buccal midazolam), repeat after 10m if necessary. then phenytoin sodium
risk factors for SUDEP
uncontrolled epilepsy, young, GTCS, learning disabilities, poor compliance
features of delirium tremens
hallucinations, confusion, delusions, agitation GTC seizures
when do DT sx occur
after 8h alcohol withdrawal peak day 2 resolve day 5 with appropriate tx
DT mx
sedation - benzos (chlordiazepoxide), based on CIWA score. screen and tx for Wernicke’s, thiamine
phenytoin levels and cirrhosis
In patients with low albumin e.g. cirrhosis, free phenytoin may be normal despite low total phenytoin. Free phenytoin proportion still normal, steady state concentration lower due to low albumin. Just because total level low doesn’t mean dose needs to be increased, free level is normal.
in status when is medical intervention advised
> 5m
when give phenytoin sodium in status what must you also do
ecg - bradycardia
which AEDs will affect INR if taken with warfarin
carbamazepine and phenytoin (induce warfarin metabolism as hepatic enzyme inducers)
high GGT and carbamazepine explanation
hepatic enzyme inducer
patient with epilepsy admitted complaining of double vision and is found to be unsteady, differential?
AED toxicity
drug induced PD
dopamine antagonists (neuroleptics, antiemetics)
prevention of dyskinesias
ldopa sparing strategy - delaying use of ldopa in young
