Nervous System Pharmacology 💊

Question 1

What type of pain is transmitted via myelinated Ad fibres?

Answer 1

Sharp, well-localised pain

Question 2

What type of pain is transmitted via non-myelinated C fibres?

Answer 2

Dull, diffuse, burning pain

Question 3

What are the actions of stimulating opioid receptors?

Answer 3

Hyperpolarisation by potassium efflux, inhibit transmitter release, inhibit adenylyl cyclise so reduce cAMP production

Question 4

What are some side effects of morphine?

Answer 4

Respiratory depression, nausea and vomiting, constipation

Question 5

What structure in the nervous system help modulate pain peripherally and centrally?

Answer 5

Peripherally- substantia gelatinosa

Centrally- peri aqueductal grey

Question 6

What are some endogenous opioids?

Answer 6

Enkephalins, endorphins, dynorphins

Question 7

What type of receptors are opioid receptors?

Answer 7

G-protein coupled receptors

Question 8

What are two common mechanisms of opioid tolerance?

Answer 8

1- phosphorylation and uncoupling, 2- cAMP production

Question 9

What is morphine’s bioavailability like orally?

Answer 9

Poor

Question 10

Can morphine easily cross the blood-brain barrier?

Answer 10

No it struggles to cross BBB

Question 11

What are the metabolites of morphine formed from glucoronidation in the liver, which exerts therapeutic effect?

Answer 11

M6G- exerts therapeutic effect

M3G

Question 12

How is morphine excreted?

Answer 12

Renally

Question 13

How does fentanyl’s bioavailability compare to morphine’s?

Answer 13

Fentanyls is much higher

Question 14

Can fentanyl cross the blood-brain barrier?

Answer 14

Yes- high level of CNS crossing

Question 15

How is fentanyl metabolised and excreted?

Answer 15

Hepatic metabolism via CYP3A4

Excreted renally

Question 16

How does codeine get broken down?

Answer 16

Codeine gets broken down into morphine via CYP2D6 enzyme

Question 17

Why would you not give codeine to children under 12?

Answer 17

Risk of respiratory distress which is worse in children

Question 18

How is buprenorphine metabolised and excreted?

Answer 18

Hepatic metabolism via CYP3A4

Biliary excretion

Question 19

How does buprenorphine’s affinity for opioid receptors compare to that of morphine’s?

Answer 19

Buprenorphine has much higher affinity

Question 20

What are some side effects of buprenorphine?

Answer 20

Respiratory depression, low BP, dizziness, nausea

Question 21

What is an example of a mixed agonist-antagonist (partial agonist) of opioid receptor?

Answer 21

Buprenorphine

Question 22

What is an example of an opioid receptor antagonist?

Answer 22

Naloxone

Question 23

What is naloxone’s bioavailability like orally?

Answer 23

Very low

Question 24

What is the duration of action of naloxone?

Answer 24

30-60mins

Question 25

Starting from highest to lowest affinity for opioid receptors list morphine, buprenorphine and naloxone

Answer 25

Buprenorphine > naloxone > morphine

Question 26

What are some contraindications of opioid treatment?

Answer 26

Hepatic failure, acute respiratory distress, comatose, head injuries, raised ICP

Question 27

What examples of anxiolytics?

Answer 27

Diazepam, lorazepam, midazolam

Question 28

What is the action of anxiolytics?

Answer 28

They increase GABA activity which is an inhibitory neurotransmitter

Question 29

What drug classes are in the category of anti-emetics?

Answer 29

H1 antagonists, D2 antagonists, 5HT3 antagonists, muscarinic antagonists and neurokinin-1 antagonists

Question 30

What is an example of a h1 antagonist anti-emetic?

Answer 30

Cyclizine

Question 31

What are examples of d2 antagonist anti-emetic drugs?

Answer 31

Domperidone, metoclopramide

Question 32

What is an example of a 5HT3 antagonist anti-emetic drug?

Answer 32

Ondansetron

Question 33

What i an example of a muscarinic antagonist anti-emetic drug?

Answer 33

Hyoscine hydrobromide

Question 34

What is an example of a neurokinin-1 antagonist anti-emetic drug?

Answer 34

Aprepitant

Question 35

Which anti-emetic is first line for motion sickness?

Answer 35

Hyoscine hydrobromide

Question 36

What anti-emetics are given in chemotherapy with high chance of emesis?

Answer 36

Ondansetron and aprepitant and metoclopramide for rescue

Question 37

What are some side effects of metoclopramide?

Answer 37

Extra-pyramidal effects (dystonia, Parkinsonism) and galactorrhoea

Question 38

What are some side effects of domperidone?

Answer 38

Galactorrhoea, sudden cardiac death

Question 39

What are some examples of anti-psychotics?

Answer 39

Chlorpromazine, haloperidol

Question 40

What is the primary action of anti-psychotics? What other agents can they act as?

Answer 40

Post synaptic D2 receptor antagonism, have anti-emetic effects

Question 41

What is the purpose of high dose aspirin?

Answer 41

Analgesia

Question 42

How does aspirin exert an analgesic effect?

Answer 42

Inhibits prostaglandin production

Question 43

What are examples of opioid receptor agonists?

Answer 43

Buprenorphine, fentanyl, morphine, codeine, methadone, tramadol

Question 44

What is given to a patient suffering paracetamol overdose?

Answer 44

Acetylcysteine

Question 45

What drug is given in opioid overdoses because its an opioid receptor antagonist?

Answer 45

Naloxone

Question 46

What are some anti-epileptic drugs which work by blocking sodium channels?

Answer 46

Carbamazepine, lamotrigine, phenytoin

Question 47

What are side effects of carbamazepine?

Answer 47

Suicidal thoughts, joint pain and bone marrow failure

Question 48

Why should you be careful adjusting doses of phenytoin?

Answer 48

Has zero order kinetics

Question 49

What are side effects of phenytoin?

Answer 49

Bone marrow suppression, hypotension, arrhythmias

Question 50

Which anti-epileptic is first line for generalised epilepsies?

Answer 50

Sodium valproate

Question 51

What are the side effects of sodium valproate?

Answer 51

Liver failure, pancreatitis, lethargy

Question 52

Which anti-epileptic is safe in pregnancy?

Answer 52

Levetiracetam

Question 53

Is sodium valproate a CYP inducer or inhibitor?

Answer 53

Inhibitor

Question 54

Are phenytoin, barbiturates and carbamazepine CYP inducers or inhibitors?

Answer 54

Inducers

Question 55

How long will someone with epilepsy need to be seizure free for before they can reapply for their driving license?

Answer 55

1 year

Question 56

Why is levodopa always given in combination with DOPA decarboxylase inhibitor?

Answer 56

Prevents conversion to dopamine in peripheral tissues: therefore less side effects and more L-dopa reaching the brain

Question 57

What are some dopamine receptor agonists used in the treatment of Parkinson’s disease?

Answer 57

Rotigotine, ropinirole, apomorphine, amantadine

Question 58

What drug class are rasagiline and selegiline which are used to treat Parkinson’s disease?

Answer 58

Monoamine oxidase type B inhibitors

Question 59

What is an example of a COMT inhibitor?

Answer 59

Entacapone

Question 60

What are some side-effects of dopamine receptor agonists?

Answer 60

Impulse control disorders, sedation, hallucination, confusion, nausea, hypotension