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3rd Year Drugs > Neurological Drugs > Flashcards

Neurological Drugs Flashcards

1
Q

What is lamotrigine

A

An anti-convulsant

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2
Q

Indications for the use of lamotrigine

A

1) Treats seizures
2) seizures associated with Lennox-Gastaut syndrome
3) Clinical depression - used off label

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3
Q

What is lennox-gastaut syndrome

A

A severe seizure disorder of young people

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4
Q

How does lamotrigine work

A

Sodium channel blocker - inhibits glutamate release hence having an anti-convulsant activity

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5
Q

Adverse effects of lamotrigine

A 
Rashes
Flu-like symtpoms
Visual disturbances
Diszziness
Drowsiness
GI disturbances
Aggression
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6
Q

Warnings of the use of lamotrigine

A

Contraindicated in hepatic and renal impairment!!!

Use in pregnancy only if the risks dont outweigh the benefits

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7
Q

Interactions of Lamotrigine

A

OCP, carbamzazepine, ritonavir, phenytoin and rifampicin –> all decrease its concentration as it induces its glucorindation

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8
Q

Interactino of lamotrigine with valproate

A

Increases its concentration as valproate inhibits its glucorination

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9
Q

What is levitaracetam

A

An anti-convulsant

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10
Q

What do we use levitaracetam for?

A

1) Epilepsy - partial-onset, myoclonic or tonic-clonic seizures

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11
Q

How does levitaracetam work

A

Binds to synaptic vesicle glycopratein, SV2A, inhibts presynaptic calcium channels
This reduces neurotransmitter release –> acts as a neuromodulator
Impedes conduction across synapses

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12
Q

Adverse effects of levitaracetam

A

CNS effects –> most pronounced in the first month (somnolence, fatigue, headaches, dizziness, coordination problems)

Neuropsychiatric symptoms –> agitation, hostility, apathy, depression, suciidal thoughts

SJS and TEN

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13
Q

Warnings of use of levitaracetam

A

Reduce dose in renal impairment

Cautin in pregnanct

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14
Q

Interactions of levitaracetam

A

No significant drug interactions

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15
Q

What is phenytoin

A

An anti-convulsant

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16
Q

Indications of phenytoin

A

1) Status epileptics - if benzodiazepines are ineffective

2) Epilepsy - reduce frequency of generalised or focal seizures

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17
Q

Actiosn of phenytoin

A

Reduces neuronal excitability and electrical conduction among brain cells
Binds to neuronal Na+ channels in their inactive state
Also similar effect in cardaic Purkije fibres –> accoutns for antiarrhytmic and cardiotoxic effects

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18
Q

Adverse effects of Phenytoin

A

1) Appearance change - can corase skin coarsening, acne, hirsutism, gum hypertrophy

2) Neuro effects –> cerebellar toxicity
3) Haematological disorders and osteomalacia –> inducing folic acid and vitamin D metabolism
4) Hypersensitivity
5) CV collapse and respiratory depression - if phenytoin toxicity

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19
Q

Effects of phenytoin overdose

A

CV collapse and respiratory depression

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20
Q

Warning of using pheytoin

A

Metablised by liver at zero order kinetics

Low therapeutic index

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21
Q

Reduce dose of phenytoin in

A

Hepatic impaiment

22
Q

Use of phenytoin in pregnancy causes what

A

Fetal hydantoin Syndrome
Causes craniofacial abnormalities ad a low IQ
Discuss with specialist and take folic acid supplements before conception

23
Q

Interactions of phenytoin

A

Phenytoin inducers P450 enzymes

However it is also metablised by P450 enzymes - hence CP450 inhbiitos increase its effect

24
Q

Name some CP450 inhibitros

A

Amiodarone
DIltiazem
Fluconazole

25
Q

What type of drugs also lower the threshold potential causing the efficacy of phenytoin to reduce

A

SSRIs and tricuclic antidepressants

26
Q

What do we need to ensure we do after giving phenytoin via a cannula

A

Flush the cannula to prevent venous irritation

Give it into a large vein

27
Q

What is carbamazepine

A

An anti-convulsant

28
Q

Indications of carbamazepine

A

1) Epilepsy
2) Trigeminal neuralgia –> First choice to control pain and reduce frequency and severity
3) Bipolar disorder - prophylaxis option

29
Q

Action of carbamazepine

A

Appears to nihibit neuronal sodium channels
Stabilizes resting potentials and reducing neuronal excitability
Stops spread of seizure activity
Stabilises mood in bipolar –> reduces electrical kindling in the temporal lobe and limbic system

30
Q

Adverse effects of carbamazepine

A

1) GI Upset
2) Neuro effects - dizziness and ataxis
3) Hypersensitivity - mac pac rash affects 10% of peoples
4) Antiepileptic hypersensitivity syndrome

31
Q

What is anti-epileptic hypersensitivity syndrome

A

Usually starts within 2 months of treatment
Severe skin reactions
Fever
Lymphadenopathy
Systemic involvement (haematological, hepatic and renal)

32
Q

Warnings of carbamazepine

A

1) In utero causes foetal abnormalities

2) Prior anti-epileptic hypersensitivity syndrome is a contraindication

33
Q

Caution of using carbamazeinpine in

A

Hepatic
Renal
Cardiac disesae

Increased risk of toxicity

34
Q

Interactions of carbamazepine

A

Carbamazepine is metabolised by CPP450 enzymes
It is also an inducer of CP450 enzymes itself

Also beware of other drugs that lower the threshold potential as these decrease its efficacy e.g. SSRIs, tricyclicl anti-depressants and antipsychotics and tramadol

35
Q

What is valproate

A

An anti-convulsant

36
Q

Indications of valproate

A

1) Epilepsy - 1st choice

2) Bipolar - acute treatment of manic episodes and prophylaxis against recurrence

37
Q

Action of valproate

A

Weak inhibitor of neuronal sodium channels

Also increases GABA in the brain content

38
Q

Adverse effects of valproate

A

GI Upset
Neuro and psychiatric effects: tremor, ataxia, behavioural distrubances
Thrombocytopenia and transient increase in liver enzymes
Hypersensitvity reactions
Rare life threatening idiosyncratic reactions

39
Q

Who shoudl you avoid valpraote in

A

Child-bearing age, around time of conceptino and the first trimester

40
Q

Who should we avoid valproate in

A

Pregnancy
Hepatic impairment
Dose reduction if renal impairment

41
Q

Interactions of valproate

A

Itself inhibits CP450 enzymes
Valproate itself is metablised by the CP450 enzymes

Also be aware of drugs that lower the threshold potential as these reduce its efficacy

42
Q

What should we warn patients about when they start taking valproate

A

Tummy upset

Urgent medical advice if they have lethargy, loss of apetite, vomiting and abdo pain

43
Q

Indications of L-Dopa

A

1) Parkinsons disease - in earlier generally use dopamine agonists but L-DOPA is integral in later treatment
2) Treatment of secondary parkinsons

44
Q

Action of L-Dopa

A

Levodopa - a precursor of dopamine that enters the brain via a transporter

45
Q

What are ropinorole and pramipexol

A

Dopamine agonists - these are relatively selective

46
Q

Pathogenesis behind parkinsons

A

Deficiency of dopamine in nigro-striatial pathway - therefore via direct and indirect pathways the basal ganglia exert greater inhibitory effects on the thalamus –> this reduces excitatory input to the motor cortex hence causing symtpoms e.g. bradykinesia

47
Q

What is simenet and madopar

A

These are L-Dopa

48
Q

Adverse effects of L-Dopa

A

Nausea, drowsiness, confusion, hallucinations, hypotension
Wearing off effect –> symptoms worsen at end of dosage interval
On-Off effects

49
Q

Cautions of L-Dopa

A

Cauting in elderly.existing cogntiive/psychiatric disease duet o risk of confusion/hallucinatinos
Caution in cardiovascular disease –> risk of hypotension

50
Q

What do we always need to prescirbe l-dopa with

A

a peripheral dopa-decarboxylase inhibitor e.g. carbidopa –> to reduce its conversion to dopamine outside the brain

51
Q

What should you not comibne L-DOPA with

A

Antipsychotics –> particularly first generation and metacloparamide due to contraidctory effects on receptors

3rd Year Drugs (10 decks)

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