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drugs y3 > Neurological > Flashcards

Neurological Flashcards

1
Q

Example of dopaminergic drugs

A

levodopa, co-carledopa

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2
Q

how does levodopa work

A

it is a precursor of dopamine that can enter the brain via a membrane transporter (dopamine cannot enter the brain as it cannot cross the blood-brain barrier) - increasing dopaminergic stimulation to the striatum

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3
Q

how is levodopa given

A

with a de-carboxylase inhibitor to form co-carledopa as this decreases peripheral conversion hence decreasing side effects

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4
Q

when is levodopa used

A

Parkinson’s disease and Parkinsonism

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5
Q

contraindications of levodopa

A

caution in elderly, CVS disease and other psych disorders

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6
Q

side effects of levodopa

A

nausea, vomiting, drowsiness, confusion, hallucinations, hypotension, has a wearing off effect, too much causes dyskinesia

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7
Q

possible interactions of levodopa

A

metoclopramide (opposing effects on dopamine receptors), anti-psychotic drugs

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8
Q

what is phenytoin

A

anti-convulsant

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9
Q

how does phenytoin work?

A

decreases neuronal excitability and conductivity, thus decreasing spread of seizure activity
- thought to do this by binding to sodium ion channels thus preventing sodium influx and hence preventing action potentials

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10
Q

when is phenytoin used

A
  • seizures and static epileptics (second line)

- generalised and focal seizures in epilepsy

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11
Q

contraindications in phenytoin

A
  • careful in pregnancy

- reduce dose in hepatic impairment

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12
Q

side effects of phenytoin

A

acne, hirsutism, gum hypertrophy, haematological disorders, osteomalacia, euro effects (nystagmus, ataxia, dis-coordination)

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13
Q

possible interactions with phenytoin

A

decreases the efficacy of drugs metabolised by P450 inhibitors such as oestrogen, progesterone and warfarin

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14
Q

how does carbamazepine work

A
  • inhibits neuronal Na channels, decreasing excitability and hence inhibits spread of seizure activity
  • blocks synaptic transmission in the trigeminal nucleus, thus controlling neuralgic pain
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15
Q

when is carbamazepine used

A
  • epilepsy (1st line in clonic-tonic and focal seizures)

- trigeminal neuralgia

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16
Q

contraindications for carbamazepine

A

cautious in pregnancy (neural tube defects), renal, hepatic and CVS disorders, not to be used if anti-epileptic sensitivity syndrome

17
Q

side effects of carbamazepine

A

GI disturbance, oedema, dizziness and ataxia, hypernatraemia, anti-epileptic sensitivity syndrome

18
Q

possible interactions of carbamazepine

A
  • cytochrome P450 inhibitors
  • decreases efficacy of drugs metabolised by cytochrome P450 enzymes (warfarin, progesterone, oestrogen)
  • other anti-epileptic drugs
19
Q

how does sodium valproate work

A
  • inhibits neuronal Na channels, decreasing excitability and hence inhibits spread of seizure activity
  • increases GABA in the brain, regulating neuronal excitability
20
Q

when is sodium valproate used

A
  • epilepsy (1st line in most types of seizure)
  • established convulsive status epilepticus
  • bipolar disorder
21
Q

contraindications of sodium valproate

A
  • conception / child bearing age
  • 1st trimester of pregnancy
  • hepatic and renal impairment
22
Q

side effects of sodium valproate

A

GI disturbance, neuro and psych effects such as ataxia, tremor, behavioural disturbance, thrombocytopenia, hair loss

23
Q

possible interactions of sodium valproate

A
  • cytochrome P450 inhibitors

- decreases efficacy of drugs metabolised by cytochrome P450 enzymes (warfarin, progesterone, oestrogen)

24
Q

how does lamotrigine work

A

blocks Na channels, decreasing convulsive activity and stabilising neuronal activity
- also blocks some Ca channels

25
Q

when is lamotrigine used

A
  • epilepsy

- bipolar depressive episodes

26
Q

when is lamotrigine contraindicated

A

dose monitored in pregnancy and hepatic impairment

27
Q

side effects of lamotrigine

A

drowsiness, headaches, blurred vision, irritability, dizziness, GI disturbance, skin rash

28
Q

possible interactions of lamotrigine

A

lamotrigine is metabolised by glucuronidation

  • drugs which induce this include oestrogen, phenytoin and carbamazepine and these decrease lamotrigine in the brain
  • drugs which inhibit this include valproate and this increases lamotrigine concentration
29
Q

how does levetiracetam work?

A

attaches to synaptic vesicle glycoprotein 2A, modulating neuronal excitability and decreased seizure risk

30
Q

when is levetiracetam used?

A
  • epilepsy (2nd or 3rd line)

- convulsive status epilepticus 2nd line (if benzodiazepines fail to work)

31
Q

contraindications of levetiracetam

A

decrease dose in renal impairment

32
Q

side effects of levetiracetam

A

mild - dizziness, headaches, drowsiness, weakness

33
Q

possible interactions of levetiracetam

drugs y3 (10 decks)

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