Neurology

Question 1

Levodopa
- class + mech action
- SE

Answer 1

• class: dopamine precursor. taken with carbidopa (peripheral decarboxylase inhibitor)
• SE: dyskinesia (dystonia, chorea, athetosis), dry mouth, anorexia, palpits, post hypotension, psychosis, end of dose wearing off), suddenly stopping neuroleptic malig syndrome, effectiveness wears off within 2 years

Question 2

Dopamine agonists:
- examples
- SE

Answer 2

• examples: ropinirole, rotigotine
• indications: parkinsons, prolactinomas, galactorrhea, breast disease cyclical, agromegaly
• SE pul/cardiac fibrosis (so echo + cxr + creatinine + esr before), impulse control disorders, daytime sleepiness), n+v, post hypot

Question 3

Entacapone:
- class

Answer 3

entacapone (comt inhibitor) always taken with levodopa as they prolong its action

Question 4

Rasagiline/ selegiline:
- class + mech
- SE

Answer 4

• class: monoamine oxidase inhib inhibits breakdown dopamine
• SE: abdo pain, conjunct, headache)

Question 5

Sodium valporate:
- mechanism
- SE
- monitoring

Answer 5

• mech: inc gaba activity
• SE: inc appetite/weight gain, teratogenic (spina bifida), alopecia, pancreatitis, p450 inhib, ataxia, tremor, hepatitis, thrombocytopenia, hyponat
• monitoring: bmi, fbc, lfts

Question 6

Ethosuximide:
- mech
- SE

Answer 6

• mech: ccb in absence seizures
• SE: night tremors, dizzy, nausea, anorexia, lethargy

Question 7

Carbamazepine:
- class + mech
- SE

Answer 7

• class: na ch inhibitor preventing hyperexcitable cells ap (the greater the firing the greater the blockade)
• indic: epilepsy, trigem neuralgia, bipolar
• SE: p450 inducer, dizzy, ataxia, drowsy, agranulocytosis, siadh, diplopia, sjs

Question 8

Lamotrigine:
- mech
- SE

Answer 8

• mech: na ch inhibitor
• SE: SJS, nausea, dizzy, ataxia

Question 9

Phenytoin:
- mech
- SE
- contraind
- monitoring

Answer 9

• mech: na ch blocker
• se:
  acute: dizzy, diplopia, nystagmus, slurred speech, ataxia, confusion, seizures, TEN
  chronic: gingival hyperplasia, hirsutism, coarsening of facial features, drowsy, megaloblastic anaemia (needs folate), peripheral neuropathy, osteomalacia, drug induced lupus
• contraind: preg (cleft lip + palate + CHD)
• monitoring: trough levels before dose only if adjusting dose/toxicity/non adherence

Question 10

Triptans:
- definition
- se
- contraind

Answer 10

Triptans:
- definition: 5HT1 agonists. Take asap after onset (rather than aura onset). Oral, nasal, sc. If nasal doesn’t respond to 1st dose can use 2nd dose after 2 hours
- se: tingling, head, throat/chest tightness, heaviness. nasal: epistaxis, nasal irritation, altered taste, throat irritation
- contraind: signif risk f for isch HD