Neurological

Question 1

Which pharmacological intervention is used to intervene in an ischaemic stroke?

Answer 1

Thrombolytic therapy aka clotbusters

Question 2

What does alteplase do?

Answer 2

Acts on fibrin in thrombus, reperfuses occluded vessels in approximately 90 minutes in most patients

Question 3

Alteplase indication

Answer 3

Acute myocardial infarction and acute ischemic stroke withing 4.5 hours of onset of symptoms

Question 4

What causes Parkinson’s Disease?

Answer 4

Destruction of the dopaminergic neuronal cells in the basal ganglia of the CNS

Question 5

What are extrapyramidal effects?

Answer 5

Involuntary movements that you cannot control

Question 6

When dopamine levels drop which neurotransmitters increase?

Answer 6

Acetylcholine

Question 7

What are the three classes of drugs used to treat PD?

Answer 7

Medications that raise brain dopamine levels or stimulate dopamine receptors
Medications with central anticholinergic activity
Other medications as adjuncts for symptomatic relief (anti-inflammatory, decongestants, laxatives, antipsychotics)

Question 8

What medication is the precursor to dopamine which is the first line treatment for PD?

Answer 8

Levodopa

Question 9

What medication makes sure that levodopa isn’t converted to dopamine in the periphery?

Answer 9

Carbidopa

Question 10

Which two enzymes convert dopamine?

Answer 10

MAO-B and COMT

Question 11

How does Selegiline work?

Answer 11

It inhibits the conversion of dopamine by MAO-B leaving more available for the receptors

Question 12

How does entacapone work?

Answer 12

It inhibits the conversion of dopamine by COMT leaving more available for the receptors

Question 13

What the side effects of Selegiline?

Answer 13

Nausea, vomiting, dizziness. Inform patients to use caution if using heavy machinery

Question 14

How do apomorphine and rotigotine work?

Answer 14

They mimic the actions of dopamine as well as stimulate dopamine receptors

Question 15

When the dopaminergic system deteriorates, which system predominates and causes PD symptoms?

Answer 15

Cholinergic

Question 16

Which drugs treat PD symptoms of muscle rigidity and tremor directly?

Answer 16

Anticholiergics

Question 17

How does Benztropine work?

Answer 17

It’s an anticholinergic that blocks central cholinergic pathways and restores balance between dopamine and acetylcholine

Question 18

What’s the other name for antiepileptics?

Answer 18

Anticonvulsants

Question 19

How do antiepileptics work?

Answer 19

By inhibiting ionic channels (sodium, calcium) involved in the excitation of the neuron by either enhancing GABA mediated inhibition or by blocking excitatory transmissions

Question 20

What are the common side effects of antiepileptics?

Answer 20

Excessive sedation, ataxia (abnormal, uncoordinated movements), confusion

Question 21

What does GABA do?

Answer 21

It’s a neurotransmitter that decreases excitability in the brain

Question 22

How do benzos treat epilepsy?

Answer 22

They act at the same site as GABA and facilitates its binding, causing decreased brain activity

Question 23

What are the four ascending stages of analgesia?

Answer 23

Analgesia, Delirium, Surgical, Medullary paralysis

Question 24

What’s the mechanism of action of General anaesthesia?

Answer 24

They act on the ion channels in the nerve membrane in the central nervous system. They act on GABA receptors which when open, causes a chloride influx into the nerve cell

Question 25

What is Propofol?

Answer 25

Intravenous anaesthetic with a short half life. Patient resumes consciousness within 10 minutes

Question 26

How does Ketamine work?

Answer 26

It antagonises NMDA receptors which causes dissociative anaesthesia where not all parts of the brain are depressed and muscle tone and respiration remain normal

Question 27

How does local anaesthetic work?

Answer 27

Inhibits movement of sodium through the channels in the plasma membranes of a neuron, hence inhibiting the transmission of a nerve impulse