Neuro Drugs

Question 1

Anti-convulsant names

Answer 1

lamotrigine, perampanel, phenobarbital and phenytoin

Question 2

When are anti-convulsants(lamotrigine, phenytoin) used

Answer 2

Epileptic seizures prevention

Question 3

Anti-convulsants side effects

Answer 3

Induce hepatic enzymes - make COCP, POP, implants etc not effective

Question 4

Cholinesterase inhibitors names

Answer 4

donepezil, rivastigmine (DLB, DPD), galantamine

Question 5

When are Cholinesterase inhibitors used

Answer 5

• Slow cognitive decline for some forms of dementia
• More effect in DLB/DPD than Alzheimers

Question 6

Contraindications to - Cholinesterase inhibitors

Answer 6

May worsen COPD/asthma

Question 7

Cholinesterase inhibitors side effects

Answer 7

• GI (nausea and diarrhoea most common)
• Headache
• Muscle cramps
• Bradycardias

Question 8

Memantine mech of action

Answer 8

NMDA receptor antagonist

Question 9

When to use Memantine

Answer 9

Used in moderate or severe AD or where cholinesterase inhibitors are not tolerated - slow cognitive decline and prevents BPSD

Question 10

Contraindications to memantine

Answer 10

May cause hypertension

Question 11

Memantine side effects

Answer 11

• Hypertension
• Sedation
• Dizziness
• Headache
• Constipation

Question 12

Opioid mech of action

Answer 12

Act on G-protein-coupled opioid receptors, μ is responsible for most of the analgesic action of opioids

Question 13

Opioid contraindications

Answer 13

Caution - opioid dependence/addiction

Question 14

Opioid side effects

Answer 14

• Apnoea
• Orthostatic hypotension
• Nausea, vomiting, constipation, increased intrabillary pressure

Question 15

Name some opioid receptor antagonists

Answer 15

• Naloxone - used to reverse opioid toxicity
• Naltrexone - similar to naloxone
• Alvimopan, methylnaltrexone - do not enter CNS, reduce G.I. effects of surgical and chronic opioid agonist use

Question 16

NSAID mech of action

Answer 16

Inhibiting the synthesis and accumulation of prostaglandins by cyclo-oxygenase (COX) enzymes COX-1 and COX-2

Question 17

Contraindications to NSAIDs

Answer 17

• Contraindicated in active GI bleeding/ulceration, patients with a history of GI bleeding/perforation related to previous NSAID therapy, and in patients with a history of recurrent GI ulceration
• Also avoid long term NSAIDs in patients with ischaemic heart disease

Question 18

NSAIDs side effects

Answer 18

Long term administration of non-selective NSAIDs may produce gastrointestinal damage (PGE2 produced by COX-1 protects against the acid/pepsin environment)

Question 19

When to use Gabapentin and pregabalin

Answer 19

• Antiepileptics but used in the treatment of chronic pain
• Gabapentin is employed in migraine prophylaxis
• Pregabalin is useful in painful diabetic neuropathy

Question 20

Gabapentin and pregabalin mech of action

Answer 20

• Reduce the cell surface expression of a subunit (α2δ) of some voltage-gated Ca2+ channels (high-voltage-activated subgroup) which are upregulated in damaged sensory neurones
• This presumably causes a decrease of neurotransmitters, such as glutamate and substance P, from the central terminals of nociceptive neurones

Question 21

Gabapentin and pregabalin contraindications

Answer 21

Can’t use in preg

Question 22

When to use Carbamazepine

Answer 22

First-line treatment to control pain intensity and frequency of attacks in trigeminal neuralgia

Question 23

Carbamazepine mech of action

Answer 23

Blocks subtypes of voltage-activated Na+ channels that are upregulated in damaged nerve cells

Question 24

Carbamazepine side effects

Answer 24

P450 enzyme inducer
Diplopia
Leucopenia
Hyponatraemia
Headache
Drowsiness
Dizziness
Ataxia
Stevens-Johnson syndrome