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2060 Pharmacology > Module 14B CNS > Flashcards

Module 14B CNS Flashcards

1
Q

Epilepsy

A
  • Neurological disorder
  • Brief disturbances in brain electrical activity
  • Sudden brief seizure
  • Varying intensities
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2
Q

Seizure

A
  • Alteration of behaviour
  • Caused by CNS dysfunction
  • Sudden & transient
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3
Q

Epileptic Seizure

A
  • Caused by primary CNS dysfunction
  • Excess depolarization
  • Hypersynchronization of neurons
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4
Q

Non-Epileptic Seizure

A
  • Seizure like episode
  • Not caused by abnormal electrical brain activity
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5
Q

Status Epilepticus

A
  • Unremitting epileptic seizure
  • Duration longer than 30 mins
  • Frequent seizures without recovery/awareness
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6
Q

Focal/Partial Seizures

A
  • Occur in 1 area of brain
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7
Q

Simple Partial Seizure

A
  • No loss of consciousness
  • Symptoms dependent on area of seizure activity
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8
Q

Complex Partial Seizure

A
  • Involves loss of consciousness
  • Awake but not aware of surroundings
  • Symptoms dependent on area of seizure activity
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9
Q

Generalized Seizure

A
  • Bilateral diffuse onset, arise from all brain areas
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10
Q

Types of Generalized Seizures

A
  • Absence
  • Tonic/clonic
  • Myoclonic
  • Tonic
  • Atonic
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11
Q

Absence Seizures

A
  • Loss of consciousness
  • Behavioural arrest/staring
  • Brief, occur in clusters (multiple per day)
  • No association with automatisms
  • Common in childhood
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12
Q

Tonic/Clonic Seizures

A
  • Abrupt loss of consciousness
  • Tonic period of 1 min (rigid muscles)
  • Clonic period of 2-3 mins (involuntary muscle contraction)
  • Incontinent state/tongue biting
  • Drowsy/confused/headache post seizure
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13
Q

Myoclonic Seizures

A
  • Sudden, brief muscle contraction (any muscle group)
  • No loss of consciousness
  • Associated with later development of tonic/clonic seizure
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14
Q

Tonic Seizures

A
  • Sudden muscle rigidity
  • Consciousness impairment
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15
Q

Atonic Seizures

A
  • Sudden loss of muscle tone
  • Duration 15 secs
  • Drop to ground (fall injury risk)
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16
Q

Secondary Generalized Seizures

A
  • Begins in 1 are of brain and spreads
  • Focal phase (primary) referred to as ‘aura’
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17
Q

Frontal Lobe

A
  • Simple repetitive motor movements (primary motor cortex)
  • Tonic posturing (supplemental motor structures)
  • Behavioural automatisms with bilateral movement
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18
Q

Parietal Lobe

A
  • Localized paresthesia (somatosensory cortex)
  • Complex/widespread paresthesia (somatosensory association cortex)
  • Multisensory hallucinations (high order sensory association areas)
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19
Q

Occipital Lobe

A
  • Visual hallucinations
  • Temporary blindness
  • Reflex nystagmus (involuntary eye movement)
  • Simple seizures mistaken for migraines (similar symptoms)
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20
Q

Temporal Lobe

A
  • Emotions & psychic symptoms
  • Auditory, olfactory, gustatory hallucinations
  • Visual distortions
  • Paresthesia (numbness)
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21
Q

Epileptogenesis Classes

A
  • Symptomatic (identified physical cause)
  • Idiopathic (no identified cause)
  • Cryptogenic (underlying cause likely but not identified)
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22
Q

Seizure Threshold

A
  • Balance between excitable/inhibitory forces in brain
  • Susceptibility to having a seizure
  • Threshold must be reached & AP fired to generate seizure
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23
Q

Affecting Factors of Seizure Threshold

A
  • Stroke
  • Head injury
  • Drug/alcohol withdrawal
  • Infection
  • Tumour
  • Severe fever
  • Visual stimuli
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24
Q

Actions of AntiEpileptic Drugs (AED)

A
  • Blocking sodium channels
  • Blocking voltage-dependent calcium channels
  • Glutamate antagonists
  • Potentiating actions of GABA
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25
Q

Sodium Channel Blocking

A
  • Prolong inactivation state of Na+ channel
  • Neurons fire at low frequency
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26
Q

Phenytoin

A
  • Most common AED
  • Blocks sodium channels
  • Treatment for all seizure types (excludes absence)
  • Non-linear kinetics (limited liver metabolism)
  • Narrow therapeutic range (monitoring)
  • Teratogenic
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27
Q

Adverse Effects of Phenytoin

A
  • Sedation
  • Gingival hyperplasia
  • Skin rash
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28
Q

Blocking Voltage-Dependent Calcium Channels

A
  • Inhibition of Ca++ channels
  • Suppress neurotransmitter release
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29
Q

Glutamate Antagonists

A
  • Decreases CNS excitation
  • Treatment target AED’s
  • Binds to NMDA/AMPA receptor acts as block
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30
Q

GABA Receptor

A
  • Inhibitory CNS neurotransmitter
  • Binding to receptor causes Cl- ions into cell
  • More difficult to reach threshold
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31
Q

Potentiating Actions of GABA

A
  • Increase inhibitory stimuli
  • Suppress seizure activity
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32
Q

Types of GABA Potentiating Actions

A
  • Enhancing GABA binding to receptor
  • Stimulating GABA release
  • Inhibiting GABA reuptake
  • Inhibiting GABA metabolism
33
Q

AntiEpileptic Drugs

A
  • Classified as traditional or newer
  • Effects similar between classes
  • Newer have decrease side effects
  • Decrerased induction of hepatic metabolizing enzymes
34
Q

Depression Diagnosis

A
  • 5+ of following symptoms present
  • Depressed mood most of day, everyday
  • Loss of interest/pleasure
  • Weight gain/loss
  • Insomnia/hypersomnia
  • Psychomotor agitation/retardation
  • Fatigue/energy loss
  • Worthlessness
  • Excessive guilt
  • Death/suicidal thoughts
  • Decreased ability to think, concentrate
35
Q

Exogenous Depression

A
  • Prolonged grieving & excessive guilt (pathological)
  • Prolonged depression following failure/rejection (adjustment)
36
Q

Endogenous Depression

A
  • Major depression
  • Severe depression
  • Atypical depression
  • Dysthymia
  • Seasonal affective disorder (SAD)
  • Postpartum depression
  • Bipolar
37
Q

Major Depression

A
  • Loss of interest
  • Lack of response to positive stimuli
  • Insomnia
  • Weight loss
  • Worse in AM
38
Q

Severe Depression

A
  • Similar to major
  • In addition, suicidal ideation & psychoses
39
Q

Atypical Depression

A
  • Similar to major
  • Hypersomnia & hyperphagia
  • Obesity
40
Q

Dysthymia

A
  • Mood regularly low (less severe than major)
  • Noticeable to those close to patient
  • Response psychotherapy over drugs
41
Q

Seasonal Affective Disorder (SAD)

A
  • Mild or moderate depression symptoms
  • Associated with lack of sunlight (winter months)
42
Q

Postpartum Depression

A
  • Moderate to severe depression after giving birth
  • 3 months-1 year after birth
43
Q

Bipolar Disorder

A
  • Alternating periods of elevated/irritable mood
  • Periods of depression
44
Q

Monoaime Hypothesis

A
  • Altered monoxime release
  • Receptor sensitivity
  • Post-synaptic function
  • Lead to depression symptoms
45
Q

Antidepressants

A
  • Increase synaptic levels of monoamine neurotransmitters
  • Inhibiting monoamine reuptake or metabolism
46
Q

Antidepressant Classes

A
  • Tricyclic antidepressants
  • Selective serotonin reuptake inhibitors (SSRI)
  • Selective serotonin/norepinephrine reuptake inhibitors (SNRI)
    Monoamine oxidase inhibitors (MAOI)
47
Q

Tricyclic Antidepressants

A
  • Inhibit reuptake of serotonin & norepinephrine
  • Effective treatment of major depression
  • Chemical structure has three rings
48
Q

Adverse Effects of Tricyclic Antidepressants

A
  • Anticholinergic effects
  • Sedation
  • Orthostatic hypotension
  • Decreased seizure threshold
  • Cardiac toxicity
  • Weight gain
  • Sexual dysfunction
49
Q

Selective Serotonin Reuptake Inhibitors (SSRI)

A
  • Similar efficacy to TCAs
  • Block only serotonin reuptake
  • Less side effects than TCAs
  • Common major depression treatment
50
Q

Adverse Effects of SSRIs

A
  • Weight gain
  • Sexual dysfunction
  • Insomnia
  • Serotonin syndrome (agitation, confusion, anxiety, hallucinations)
51
Q

Selective Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)

A
  • Block reuptake of serotonin & norepinephrine
  • Effective treatment of major depression
  • Faster onset of action
  • Mechanism of action similar to TCA’s
52
Q

Adverse Effects of SNRIs

A
  • Nausea
  • Diastolic hypertension
  • Sexual dysfunction
53
Q

Monoamine Oxidase Inhibitors (MAOI)

A
  • Inactivates monoamine neurotransmitters A&B
  • MAO-A metabolizes serotonin & norepinephrine
  • MOA-B metabolizes dopamine
  • Treatment of atypical & dysthymia
    Inhibiting monoamine metabolism is pre-synaptic neuron
54
Q

Adverse Effects of MAOIs

A
  • CNS excitation
  • Orthostatic hypotension
  • Hypertensive crisis (combined with tyramine foods)
55
Q

Manic Phase Symptoms

A
  • Irritation
  • Inflated self-esteem
  • Little need for sleep
  • Poor control of temper
  • Reckless behaviour
  • Easily distracted
56
Q

Bipolar Drug Treatment

A
  • Mood stabilizers
  • Antipsychotics
  • Antidepressants
57
Q

Mood Stabilizers

A
  • Relieve symptoms during manic/depressive episodes
  • Prevent recurrence of episodes
  • Doesn’t worsen or alter rate of episodes
    Lithium & valproic acid
58
Q

Lithium Usage

A
  • Alters uptake/release of glutamate
  • Blocks serotonin binding
  • Narrow therapeutic range
  • Plasma conc altered by Na+
  • Na+ loss increase lithium conc
59
Q

Antipsychotics

A
  • Control symptoms during manic episodes
  • Stabilize mood (long term)
  • Lower risk of extrapyramidal symptoms
60
Q

Antidepressants

A

Antidepressants
- Treatment of depressive episode
- Combined with mood stabilizer

61
Q

Anxiety

A
  • Normal physiological response to stress
  • Symptoms create functional impairment on daily living
  • Linked closely with depression
62
Q

Anxiety Types

A
  • General anxiety disorder
  • Panic disorder
  • Agoraphobia
  • Obsessive-compulsive disorder (OCD)
  • Social anxiety disorder
  • Post-traumatic stress disorder (PTSD)
  • Simple phobia
63
Q

General Anxiety Disorder

A
  • Overwhelmed with uncontrollable worrying
  • Unrealistic/excessive worry
  • Last 6+ months
64
Q

Panic Disorder

A
  • Sense of impending doom unrelated to stressors
  • Panic attacks (SOB, chest pain, dizziness)
  • Confused with heart attack
65
Q

Agoraphobia

A
  • Feeling judged
  • Situational escaping feels difficult/embarrassing
66
Q

Obsessive Compulsive Disorder (OCD)

A
  • Obsession/compulsion
  • Interfere with daily life
67
Q

PTSD

A
  • Anxiety occurring after traumatic event
  • Re-experiencing event
  • Insomnia
68
Q

Simple Phobia

A
  • Related to specific fear
69
Q

Anxiety Drug Treatment

A
  • Benzodiazepines (BDZ)
  • Buspirone
  • Antidepressants
70
Q

Benzodiazepines (BDZ)

A
  • First line therapy for anxiety
  • Potentiating actions of GABA & GABA receptor
  • Increased binding of GABA to receptor
  • Cl- moves into cell
  • CNS depression
71
Q

Benzodiazepine Uses

A
  • Anxiety (generalized & social)
  • Seizures
  • Insomnia (higher dose)
  • Alcohol withdrawal
  • Muscle spasm
72
Q

Adverse Effects of Benzodiazepines

A
  • CNS depression (drowsiness, concentration difficulty)
  • Anterograde amnesia (impaired memory following dosing)
  • Respiratory depression (combined with alcohol)
  • Teratogenic
  • Tolerance
  • Withdrawal
73
Q

Buspirone

A
  • Modulation of serotonergic/dopaminergic neurotransmission
  • Treatment of generalized anxiety
  • No signs of tolerance/physical dependence
  • Anxiolytic effects develop slowly
  • Well tolerated
74
Q

Generalized Anxiety Treatment

A
  • SSRI & SNRI
  • Buspirone
  • Slow to generate effect
75
Q

Panic/Agoraphobia Treatment

A
  • SSRI, TCA, MAO inhibitor
  • 6-12 weeks to take effect
  • SSRIs tolerated best
76
Q

OCD Treatment

A
  • SSRIs
  • Behavioral therapy
77
Q

Social Anxiety Treatment

A
  • SSRIs long term
  • BDZs immediate relief
78
Q

PTSD Treatment

A
  • No evidence of effective drug treatment
  • Therapy

2060 Pharmacology (18 decks)

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