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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
target for valproate in epilepsy
50-100 mg/L
26
target for cbz in epilepsy
4-12
27
how is lamotrigine affected by oral contraceptives
can by lowered by OC, causing breakthrough seizures
28
how do phenytoin/cbz affect OC
lower OC concentration
29
when to consider discontinuing ASM
minimally 2 year seizure free
30
list two options for seizure in pregnancy
lamotrigine, levetiracetam
31
list three options for first line therapy during status epilepticus
1. IM Midazolam 2. IV/ Intranasal Lorazepam 3. IV/Rectal Diazepam
32
should first line therapy for SE fail, what other options are there? max doses?
1. IV Fosphenytoin 1500mg 2. IV Valp 3000mg 3. IV Levetiracetam 4500mg
33
list 5 side effects that are dose related in ASMs
Somnolence dizziness, drowsiness, visual disturbances, nystagmus, ataxia
34
4 side effects of phenytoin
1. gingival hyperplasia (overgrowth of gums) 2. hirsutism 3. peripheral neuropathy 4. osteomalacia (softening of bones)
35
carbamazepine allele
hlab 1502
36
what channel does valproate block that cbz does not
ca2+
37
list 4 side effects of valproate
1. NVD 2. painful/irregular periods 3. alopecia 4. weight gain
38
valproate inhibitor of?
cyp2c9
39
levetiracetam binds to?
protein 2A
40
common side effects of levetiracetam
vertigo, cough, headache, depression, suicide
41
main adverse effect of leve to look out for
agranulocytosis
42
what does lamotrigine induce and inhibit
induces cyp3a4, inhibits cyp2c19
43
which ASM causes weight gain
valproate
44
maximum dose of sumatriptan to take in 24 hours
200mg, every 2hours
45
what to avoid cbz with and why
macrolides due to cyp3a4 inhibition cbz causes autoinduction of its own metabolism 3-5d after initiation
46
list 2 signature findings in alzheimer's
1. formation of senile plaques 2. formation of neurofibrillary tangles
47
what is mild in AD (MMSE)
26-21
48
what is moderate in AD (MMSE)
20-10
49
what is severe in AD (MMSE)
<10
50
list three cholinesterase inhibitors
donepezil, rivastigamine, galantamine
51
how do cholinesterase inhibitors work
promotes increase of acetylcholine for neurotransmission
52
how does memantine work
NMDA receptor antagonist, blocks glutamate transmission.
53
what stage of AD is memantine indicated for
moderate to severe AD
54
what stage of AD are rivastigamine and galantamine indicated for
mild to moderate
55
what is rivastigamine's excretion by
kidney
56
what is galantamine's metabolism by
hepatic
57
list 3 classes of adverse effects of cholinesterase inhibitors
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
what to look out for when using galantamine
signs of rash, can be SJS/TENS
59
side effect of rivastigmine
allergic dermatitis
60
list 2 classes of side effects for memantine
1. CNS - headache, confusion - hallucinations 2. GI - constipation (can antagonise the diarrhoea caused by donepezil)
61
preferred antidepressants in AD
SSRI - sertraline, citalopram. avoid TCAs
62
list 4 atypical antipsychs effective for BPSD
aripiprazole, risperidone, olanzapine, quetiapine
63
which cholinesterase inhibitor has use for parkinson's dementia?
rivastigmine
64
do cholinesterase inhibitors cause weight changes
weight loss
65
do you take cholinesterase inhibitors with meals
donepezil: with or without riva/galant: with meals
66
which ASM can cause dose related SIADH
carbemazepine
67
what is the black box warning for valproate
pancreatitis
68
what does TRA stand for in PD
tremor rigidity akinesia/bradykinesia
69
list three classes of medication causing parkinsonism
1. antipsychotics 2. methyldopa 3. antiemetic, gastric motility agents - prochloperazine, metocloperamide
70
list three side effects of amantadine in PD
1. confusion / hallucinations 2. livedo reticularis 3. ortho hypo
71
what is amantadine used for
levodopa induced dyskinesia
72
what is levodopa
precursor or dopamine
73
what is the purpose of carbidopa/benserazide
decarboxylase inhibitor, increases CNS penetration of levodopa
74
what food should u avoid with levodopa
high protein meals
75
4 types of side effects of levodopa
1. dyskinesia 2. nausea / vomiting 3. ortho hypo (check BP) 4. hallucinations
76
when is levodopa preferred over dopamine agonist
bradykinesia, rigidity. when to use DA: speech, gait disturbances
77
what is the preferred NV agent in PD
domperidone / ondansetron
78
what happens to the urine when using levodopa
turn red
79
when should amantadine taken
with levodopa
80
how do meals and antacids affect levodopa
meals: delay gastric emptying antacids: promote gastric emptying
81
what classes of meds can help with wearing off effect of levodopa
cmt (entacapone) maob (rasagiline) dopamine agonist
82
what class of meds can help with freezing episodes in PD
maob, entacapone
83
possible side effects of selegiline that are not in rasagiline
1. worsen pre-existing dyskinesia / psychiatric symptoms
84
when should you take rasagiline
in the day, as it can cause insomnia (amphetamine metabolite)
85
how do maob inhibitors help
motor function
86
what is the ergot derivative of DA, and why is it not preferred compared to non ergot derivatives
bromocriptine pulmonary fibrosis
87
what is apomorphine used for
rescue therapy, triggers on response within 20 mins
88
which types of PD medication are anticholinergics
benzhexol (for tremors) amantadine
89
preferred agent for ortho hypo in PD
fludrocortisone midodrine also can
90

COMPETENCY (22 decks)

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