Neurological

Question 1

what type of drug are Madopar/Sinemet?

Answer 1

Levodopa

Question 2

how does levodopa work?

Answer 2

Pre-cursor to dopamine and acts by replenishing depleted striatal dopamine (given with extracerebral dopa-decarboxylase inhibitor to reduce peripheral conversion of levodopa to dopamine to reduce side effects)

Question 3

what are the indications to take levodopa?

Answer 3

parkinsons disease

Question 4

what are the contraindications to taking levodopa?

Answer 4

Caution with severe cardio or respiratory disease, psychiatric illness, endocrine disorders and history of convulsions or peptic ulcer

Question 5

what are the side effects of levodopa?

Answer 5

Nausea, vomiting, taste disturbances, dry mouth, anorexia, arrhythmias, palpitations, postural hypotension, syncope, drowsiness, fatigue, dementia, psychosis, confusion, euphoria, abnormal dreams, insomnia, depression, anxiety, dizziness

Question 6

what are the interactions of levodopa?

Answer 6

Anaesthetics (increased risk of arrhythmias); MAOIs (risk of hypertensive crisis, avoid for at least 2 weeks after stopping MAOI)

Question 7

what class of drug is phenytoin?

Answer 7

anticonvulsant

Question 8

how does phenytoin work?

Answer 8

Reduction of sensitivity of muscle spindles to stretch causing muscle relaxation

Question 9

what are the indications to take phenytoin?

Answer 9

Tonic-clonic seizures, focal seizures, prevention and treatment of seizures during or following neurosurgery or severe head injury, status epilepticus, trigeminal neuralgia if carbamazepine inappropriate

Question 10

what are the contraindications to taking phenytoin?

Answer 10

Sinus bradycardia, heart block, stroke’s-adams syndrome, acute porphyria

Question 11

what are the side effects of phenytoin?

Answer 11

Nausea, vomiting, constipation, drowsiness, insomnia, transient nervousness, tremor, paraesthesia, dizziness, headache, anorexia, gingival hypertrophy and tenderness, rash, acne, hirsutism, coarsening of facial appearance

Question 12

what are the interactions with phenytoin?

Answer 12

is a P450 inducer - therefore reduces efficacy of other drugs metabolised by P450 e.g. warfarin, and
oestrogens

same vice versa

other anti-epileptics - alter metabolism and cause complex interactions

Question 13

how does carbamazepine work?

Answer 13

Inhibits neuronal sodium channels, stabalising resting membrane potentials and reducing neuronal excitability - may inhibit spread of seizure activity in epilepsy, block synaptic transmission of pain

Question 14

what are the indications to take carbamazepine?

Answer 14

epilepsy (focal seizures with and
without secondary generalisation and for primary generalised seizures.)

trigeminal neuralgia

bipolar disorder

Question 15

what are the contraindications to taking carbamazepine?

Answer 15

pregnancy - neural tube defects
hepatic, renal or cardiac disease, due to increased risk of toxicity
history of bone-marrow depressions, acute porphyria

Question 16

what are the side effects of carbamazepine?

Answer 16

Headache, ataxia, drowsiness, nausea, vomiting, blurred vision, dizziness, unsteadiness, allergic skin reactions (all dose related), may exacerbate tonic, atonic, myoclonic and absence seizures (avoid if present

Question 17

what are the interactions with carbamazepine?

Answer 17

P450 inducer - reduces efficacy of drugs that are metabolised by P450
enzymes (e.g. warfarin, oestrogens)
other antiepileptic drugs as most alter drug metabolism.
The efficacy of antiepileptic drugs is reduced by
drugs that lower the seizure threshold (e.g. SSRIs,

Question 18

how does sodium valproate work?

Answer 18

Inhibitor of neuronal sodium channels, stabilising resting membrane potentials and reducing neuronal excitiabilty. Also increases GABA in brain (principle inhibitory transmitter)

Question 19

what are the indications to take sodium valproate?

Answer 19

epilepsy (control of generalised or
absence seizures and as a treatment option for focal seizures.)
bipolar

Question 20

what are the contraindications to taking sodium valproate?

Answer 20

Personal/family history of severe hepatic dysfunction, porphyria, known/suspected mitochondrial disorders

Question 21

what are the side effects of sodium valproate?

Answer 21

GI upset, weight gain, tremor, extrapyramidal disorders, stupor, somnolence, convulsion, memory impairment, headache, nystagmus, confusion, aggression, hyponatraemia, thrombocytopenia, anaemia, haemorrhage, menstrual disturbance, transient hair loss, deafness

Question 22

what are the interactions with sodium valproate?

Answer 22

Inhibits P450 so increases conc and toxicity of drugs metabolised by P450 (warfarin and other antiepileptics, lamotrigine, sodium oxybate), plasma conc of valproate reduced by P450 inducers (carbamazepine, phenytoin), adverse effects increased by P450 inhibitors (macrolides, protease inhibitors), aspirin, SSRIs, tricyclic antidepressants, antipsychotics, tramadol

Question 23

how does lamotrigine work?

Answer 23

Inhibition of sodium channels, stabilising neuronal membranes

Question 24

what are the indications to take lamotrigine?

Answer 24

focal seizures and generalised seizures including tonic-clonic seizures, seizures assocites with Lennox-Gastaut syndrome, monotherapy of typical absence seizures in children, prevention of depressive episodes with bipolar disorder

Question 25

what are the side effects of lamotrigine?

Answer 25

Nausea, vomiting, diarrhoea, dry mouth, aggression, agitation, headache, drowsiness, dizziness, tremor, insomnia, ataxia, back pain arthralgia, nystagmus, diplopia, blurred vision, rash

Question 26

what are the interactions with lamotrigine?

Answer 26

Oestrgen, rifampicin (reduce plasma conc of lamotrigine); sodium valproate (increase plasma conc of lamotrigine) tricyclic and SSRI antidepressants, antipsychotics (anticonvulsant effect antagonised by these) orlistat (increased risk of convulsions)

Question 27

what class of drug is Levetiracetam (keppra)?

Answer 27

anticonvulsant

Question 28

how does keppra work?

Answer 28

Selectively prevents hypersynchronisation of epileptiform burst firing and propagation of seizure activity.

Question 29

what are the indications to take keppra?

Answer 29

therapy treatment of focal seizures with/without secondary generalisation and for adjunctive therapy of myoclonic seizures in patients with juvenile myoclonic epilepsy and primary generalised tonic-clonic seizures, can also be prescribed under specialist supervision for absence seizures

Question 30

what are the contraindications to taking keppra?

Answer 30

Depression, kidney disease, hallucination, decreased count of any blood cell type, having thoughts of suicide

Question 31

what are the side effects of keppra?

Answer 31

Anorexia, abdo pain, nausea, vomiting, dyspepsia, diarrhoea, cough, nasopharyngitis, vertigo, drowsiness, ataxia, convulsions, dizziness, headache, tremor, malaise, aggression, depression, insomnia, anxiety, irritability, rash

Question 32

what are the interactions with keppra?

Answer 32

Methotrexate (plasma conc increased by levetir); SSRI and tricyclic antidepressants, antipsychotics, mefloquine (anticonvulsant effect antagonised), orlistat (increased risk of convulsions)