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COMPETENCY > NEURO > Flashcards

NEURO Flashcards

migraine, psychiatry, parkinson's, dementia, epilepsy

1
Q

how often can you use analgesics, opioids, ergotamines or triptans in a month

A

2 to 3 days per week, or 10 days per month

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2
Q

food triggers of migraine

A

alcohol
caffeine
chocolate
fermented and pickled foods
MSG
diet sodas
tyramine (eg cheese, meat)

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3
Q

how do ergot alkaloids work for moderate to severe migraine attacks

A

5HT3 receptor agonist
constrict intracranial blood vessels
inhibit neurogenic inflammation

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4
Q

list 3 side effects of ergotamines

A
  1. nausea, vomiting, diarrhoea
  2. chest tightness, weakness
  3. ergotism (peripheral ischemia) - MI
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5
Q

can you use ergotamines and triptans together

A

do not use within 24h of each other

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6
Q

contraindications to ergot derivatives (list 4)

A
  1. renal, hepatic failure
  2. vascular disease
  3. uncontrolled hypertension
  4. pregnancy and lactation
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7
Q

list 4 nsaids that are effective in migraines

A

aspirin
diclofenac
ibuprofen
naproxen sodium

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8
Q

first line for migraine

A

triptans

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9
Q

how do triptans work

A

selective agonist of 5ht1b and h5t1d receptor

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10
Q

as selective agonists of 5ht, how do triptans cause relieve of migraines (3 ways)

A
  1. constrict dilated intracranial arteries
  2. inhibit vasoactive peptide release
  3. inhibit of transmission of neurons ascending to the thalamus
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11
Q

why are second generation triptans better than first generation (sumatriptan)? list two reasons

A
  1. higher oral bioavailability
  2. longer half-lives
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12
Q

list 5 side effects of triptans

A
  1. tingling sensation
  2. dizziness
  3. flushing
  4. warm sensation
  5. somnolence
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13
Q

bb to reduce frequency of migraine attacks (list 3)

A

propranolol, timolol metoprolol

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14
Q

how long should you continue prophylaxis for after migraine severity has diminished

A

at least 6-12 months, then gradual tapering

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15
Q

who should avoid use of topiramate (list 2)

A
  1. history of kidney stones
  2. cognitive impairment
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16
Q

side effects of topiramate (list 5)

A
  1. tingling sensation
  2. weight loss
  3. cognitive reduction
  4. taste issues
  5. nausea
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17
Q

how does topiramate work

A

activates GABA-A, enhances influx of chloride ions

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18
Q

cafergot metabolised by

A

cyp3a

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19
Q

who is erenumab indicated for

A

prophylaxis of migraine in patients with at least 4 migraine days a month

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20
Q

2 side effects of erenumab

A

constipation, pruritis

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21
Q

what is classified as a remote symptomatic seizure

A

when it occurs more than 1w from the disorder causing the predisposition

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22
Q

what is epilepsy

A

at least 2 unprovoked seizures occuring more than 24 hours apart

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23
Q

what are non-epileptic seizures

A

no abnormal neuronal discharge

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24
Q

target for phenytoin in epilepsy

A

10-20 mg/l

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25
Q

target for valproate in epilepsy

A

50-100 mg/L

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26
Q

target for cbz in epilepsy

A

4-12

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27
Q

how is lamotrigine affected by oral contraceptives

A

can by lowered by OC, causing breakthrough seizures

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28
Q

how do phenytoin/cbz affect OC

A

lower OC concentration

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29
Q

when to consider discontinuing ASM

A

minimally 2 year seizure free

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30
Q

list two options for seizure in pregnancy

A

lamotrigine, levetiracetam

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31
Q

list three options for first line therapy during status epilepticus

A
  1. IM Midazolam
  2. IV/ Intranasal Lorazepam
  3. IV/Rectal Diazepam
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32
Q

should first line therapy for SE fail, what other options are there? max doses?

A
  1. IV Fosphenytoin 1500mg
  2. IV Valp 3000mg
  3. IV Levetiracetam 4500mg
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33
Q

list 5 side effects that are dose related in ASMs

A

Somnolence
dizziness, drowsiness,
visual disturbances, nystagmus,
ataxia

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34
Q

4 side effects of phenytoin

A
  1. gingival hyperplasia (overgrowth of gums)
  2. hirsutism
  3. peripheral neuropathy
  4. osteomalacia (softening of bones)
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35
Q

carbamazepine allele

A

hlab 1502

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36
Q

what channel does valproate block that cbz does not

A

ca2+

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37
Q

list 4 side effects of valproate

A
  1. NVD
  2. painful/irregular periods
  3. alopecia
  4. weight gain
38
Q

valproate inhibitor of?

A

cyp2c9

39
Q

levetiracetam binds to?

A

protein 2A

40
Q

common side effects of levetiracetam

A

vertigo, cough, headache, depression, suicide

41
Q

main adverse effect of leve to look out for

A

agranulocytosis

42
Q

what does lamotrigine induce and inhibit

A

induces cyp3a4, inhibits cyp2c19

43
Q

which ASM causes weight gain

A

valproate

44
Q

maximum dose of sumatriptan to take in 24 hours

A

200mg, every 2hours

45
Q

what to avoid cbz with and why

A

macrolides due to cyp3a4 inhibition

cbz causes autoinduction of its own metabolism 3-5d after initiation

46
Q

list 2 signature findings in alzheimer’s

A
  1. formation of senile plaques
  2. formation of neurofibrillary tangles
47
Q

what is mild in AD (MMSE)

A

26-21

48
Q

what is moderate in AD (MMSE)

A

20-10

49
Q

what is severe in AD (MMSE)

A

<10

50
Q

list three cholinesterase inhibitors

A

donepezil, rivastigamine, galantamine

51
Q

how do cholinesterase inhibitors work

A

promotes increase of acetylcholine for neurotransmission

52
Q

how does memantine work

A

NMDA receptor antagonist, blocks glutamate transmission.

53
Q

what stage of AD is memantine indicated for

A

moderate to severe AD

54
Q

what stage of AD are rivastigamine and galantamine indicated for

A

mild to moderate

55
Q

what is rivastigamine’s excretion by

A

kidney

56
Q

what is galantamine’s metabolism by

A

hepatic

57
Q

list 3 classes of adverse effects of cholinesterase inhibitors

A
  1. GI
    - cholinergic hyperactivation (think: water)
    - diarrhoea
    - muscle cramps
    - increased gastric juice secretion
    - dyspepsia
  2. CNS
    - vivid dreams
    - insomnia
  3. CVS
    - MI
    - Bradycardia
    - Low BP
  4. GI bleed
58
Q

what to look out for when using galantamine

A

signs of rash, can be SJS/TENS

59
Q

side effect of rivastigmine

A

allergic dermatitis

60
Q

list 2 classes of side effects for memantine

A
  1. CNS
    - headache, confusion
    - hallucinations
  2. GI - constipation (can antagonise the diarrhoea caused by donepezil)
61
Q

preferred antidepressants in AD

A

SSRI - sertraline, citalopram.

avoid TCAs

62
Q

list 4 atypical antipsychs effective for BPSD

A

aripiprazole, risperidone, olanzapine, quetiapine

63
Q

which cholinesterase inhibitor has use for parkinson’s dementia?

A

rivastigmine

64
Q

do cholinesterase inhibitors cause weight changes

A

weight loss

65
Q

do you take cholinesterase inhibitors with meals

A

donepezil: with or without
riva/galant: with meals

66
Q

which ASM can cause dose related SIADH

A

carbemazepine

67
Q

what is the black box warning for valproate

A

pancreatitis

68
Q

what does TRA stand for in PD

A

tremor
rigidity
akinesia/bradykinesia

69
Q

list three classes of medication causing parkinsonism

A
  1. antipsychotics
  2. methyldopa
  3. antiemetic, gastric motility agents - prochloperazine, metocloperamide
70
Q

list three side effects of amantadine in PD

A
  1. confusion / hallucinations
  2. livedo reticularis
  3. ortho hypo
71
Q

what is amantadine used for

A

levodopa induced dyskinesia

72
Q

what is levodopa

A

precursor or dopamine

73
Q

what is the purpose of carbidopa/benserazide

A

decarboxylase inhibitor, increases CNS penetration of levodopa

74
Q

what food should u avoid with levodopa

A

high protein meals

75
Q

4 types of side effects of levodopa

A
  1. dyskinesia
  2. nausea / vomiting
  3. ortho hypo (check BP)
  4. hallucinations
76
Q

when is levodopa preferred over dopamine agonist

A

bradykinesia, rigidity.

when to use DA: speech, gait disturbances

77
Q

what is the preferred NV agent in PD

A

domperidone / ondansetron

78
Q

what happens to the urine when using levodopa

A

turn red

79
Q

when should amantadine taken

A

with levodopa

80
Q

how do meals and antacids affect levodopa

A

meals: delay gastric emptying
antacids: promote gastric emptying

81
Q

what classes of meds can help with wearing off effect of levodopa

A

cmt (entacapone)
maob (rasagiline)
dopamine agonist

82
Q

what class of meds can help with freezing episodes in PD

A

maob, entacapone

83
Q

possible side effects of selegiline that are not in rasagiline

A
  1. worsen pre-existing dyskinesia / psychiatric symptoms
84
Q

when should you take rasagiline

A

in the day, as it can cause insomnia (amphetamine metabolite)

85
Q

how do maob inhibitors help

A

motor function

86
Q

what is the ergot derivative of DA, and why is it not preferred compared to non ergot derivatives

A

bromocriptine

pulmonary fibrosis

87
Q

what is apomorphine used for

A

rescue therapy, triggers on response within 20 mins

88
Q

which types of PD medication are anticholinergics

A

benzhexol (for tremors)
amantadine

89
Q

preferred agent for ortho hypo in PD

A

fludrocortisone

midodrine also can

90
Q
A

COMPETENCY (19 decks)

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