Neurology

Question 1

Dopaminergics

Name

Answer 1

Levodopa (co-careldopa), pramipexol

Question 2

Dopaminergics

Mechanism of Action

Answer 2

Levodopa crosses BBB, increasing D in nigrostriatial PW which link substantia nigra to corpus striatum to increased BG inhibition of thalamus to reverse cortical bradykinesia/rigidity

Question 3

Dopaminergics

Indications

Answer 3

Early parkinson’s, 2^ parkinsonism

Question 4

Dopaminergics

Contraindications

Answer 4

Pre-existing cognitive/psych conditions, CVD

Question 5

Dopaminergics

Side effects

Answer 5

Nausea, sedation, hallucination, hypotension, on-off-effect, wearing off effect, dry mouth, anorexia

Question 6

Dopaminergics

Interactions

Answer 6

Needed with carbidopa - prevent extra-cranial conversion via dopa-decarboxylase
Avoid antipsychotics and metoclopramide - both oppose effect

Question 7

Anticonvulsants

Name

Answer 7

Phenytoin, carbamazepine, sodium valrpoate, lamotrigine, levitaracetam

Question 8

Phenytoin

MoA

Answer 8

Reduces neuroexcitability, inhbits spread of seizure activity via Na channel inhibition (causes side effects in heart)

Question 9

Phenytoin

Indications

Answer 9

Status epilepticus (after benzo), increase seizure threshold

Question 10

Phenytoin

Contraindications

Answer 10

Zero order liver kinetics, low TPI, in-utero abnx req high dose folic acid

Question 11

Phenytoin

Side effects

Answer 11

Sedation, cognition change, thick skin, acne, hirsutism, thick gums, haem disorders, osteomalacia, CV collapse, respiratory depression

Question 12

Phenytoin

Interactions

Answer 12

CYP450 inducer
Reduces: warfarin, oestrogens), also metabolised by CYP450 so inhibitors increase effect (amiodarone, diltiazem, fluconazole)

Question 13

Carbamazepine

MoA

Answer 13

Inhibits Na channels to reduce neuroexcitability, increases refractory period

Question 14

Carbamazepine

Indications

Answer 14

Epilepsy, bipolar, trigeminal neuralgia

Question 15

Carbamazepine

Contraindications

Answer 15

In utero NTDs/cardio/urinary abnx, if pt has had anti-epileptic hypersensitivity syndrome (SJS, TEN)

Question 16

Carbamazepine

Side effects

Answer 16

GI, neuro (dizzy, ataxia, sedation, diplopia), fever, lymphadenopathy, oedema, hyponatraemia (ADH-like), leucopenia/agranulocytosis

Question 17

Carbamazepine

Interactions

Answer 17

CYP450 inducer also metabolised by CYP450

Question 18

Sodium Valproate

MoA

Answer 18

Weakly inhibits Na, stabilises resting membrane potentials, increases GABA

Question 19

Sodium Valproate

Indications

Answer 19

Epilepsy, bipolar

Question 20

Sodium valproate

Contraindications

Answer 20

Child-bearing women, conception/T1, foetal abnx in utero

Question 21

Sodium valproate

Side effects

Answer 21

Gi, neuropsych (tremor, ataxia, behaviour change), low platelets, hairloss/curlier,

Question 22

Sodium valproate

Interactions

Answer 22

Inhibits CYP450, metabolised by CYP450

Question 23

Lamotrigine

Summary

Answer 23

MoA - affect many neuronal channels
I - Tonic-clonic dirst line, given with other anti-seizure drugs
C/I - pancytopenia, meningitis
S/E - dizzy, somnolence, headache, N&V rash
Int - CYP breakdown, inducers decrease conc

Question 24

Levitaracetam

Summary

Answer 24

MoA - slows abnormal impulses
I - epilepsy
C/I - hypersensitivity
S/E - cough, loss of appetite, GI, tired, vomiting
Int - paracetamol (acetaminophens)