Disorders Flashcards
Types of hypnotics
Benzodiazepines - pams and chlordiazepoxide
Barbituates - pentobarbital, thiopental
Zopiclone (non-BDZ)
Ethanol
Anaesthetics - propofol, etomidate
Benzodiazepines
Increase the effect of GABA on GABAa receptors (PAM)
increase inhibition and decrease anxiety
can be hypnotic (triazolam) = memory impairment
Gamma2 subunit on GABAa important for full response
GABA inhibition
NAM - FG-7142
antagonist - flumazenil
anxiogenic
GAD
general anxiety disorder
Treat with SSRI, cognitive therapy
seconds line - pregabalin or buspirone
Quetiapine - atypical antipsychotic (5HT2a and D2)
Insomnia
Cognitive-behaviour therapy
Benzos, antidepressants, melatonin, orexin antagonist, gabapentin
Benzodiazepines adverse effects
High therapeutic index
Drowsiness, decreased alertness, ataxia, tolerance (less binding sites), dependance (mostly to sedative and ataxic effects), withdrawal
Seizures
Epileptic - epilepsy, acute symptomatic, febrile
Non-epileptic - vasovagal faint, day dreaming, tics, parasomnia
Epilepsy
Recurring seizures (2 more than 24 hours apart and ongoing)
Types of seizures
Focal - one place, discrete (may be aware)
Generalised - widespread, bilateral, tonic-clinic, absence
Tonic-clonic
abrupt onset of bilateral tonic (increased muscle tone), jerking (clonic), unaware with no warning event, confused and drowsy
Absence seizure
Abrupt and less than 10 seconds
Normal after seizure
Eyelid flutter/blinking
Focal seizures
Limited network in one hemisphere, distribution varies, may mirror focus
Aware, impaired, focal to bilateral tonic clonic
Causes of seizures
Increase synaptic excitation, decrease inhibition, increase intrinsic excitability
Anti-epileptic drugs
Focal and generalised = valproate, carbamazepine, phenytoin
Absence = valproate, ethosuximide
Gabapentin
Status epileplicus drugs
Midazolam, phenytoin, phenobarbital
Epilepsy drug MoAs
Carbamazepine, valproate, phenytoin = increase inactive Na2+ channels
Ethosuximide, valproate = inhibit T-type Ca2+ channels
Vigabatrin = inhibits GABA transaminase
Tiagabine = inhibits GABA reuptake
Benzos = PAMs
Other uses of anti-epileptic drugs
BPD, migraine, anxiety, neuropathic pain, tinnitus
Anti-epileptic side effects
Carbamazepine - nausea, dizziness, drowsiness, agranulocytosis, blurred vision
Lamotrigine - rash, blurred vision , dizziness, drowsiness
Valproate - weight gain, bleeding, hair loss, autism in pregnancy
Levetiracetam - lethargy, fatigue
Phenytoin - narrow therapeutic index, vertigo, headache, confusion, hyperplasia of gums, hepatitis, etc
Depression
Noradrenaline and serotonin
Depressed mood, fatigue, weight change, insomnia, cognitive impairment, feelings of worthlessness, suicidal ideal action, anhedonia
Bipolar depression
Depressed and manic (gambling, speeding, risks)
BPD drugs
Lithium, carbamazepine, valproate (D2 antagonist), gabapentin
Electroconvulsive therapy
Monoamine hypothesis
Deficiency of NA and 5HT
May be more one than another
Evidence = muted response to DL-fenfluramine (interference with release), PET scan shows less serotonin
Stress -> gene transcription -> change neurogenesis in brain
No good evidence
Anti-depressants
SSRIs - selective serotonin reuptake inhibitors
SNRIs - selective noradrenaline reuptake inhibitors
MAOIs - monoamine oxidase inhibitors
TCAs - tricyclic antidepressants
Mianserin, trazodome, mirtazapine
TCAs
Imipramine, amitriptyline
Block 5-HT and NA reuptake (and ACh, alpha NA, histamines) = non selective
Take 2-3 weeks to work
Cardiotoxicity, dry mouth, blurred vision, constipation, tachycardia
