Neurology drugs Flashcards
What are examples of dopaminergic drugs?
Levodopa
Dopamine agonists (i.e. rotigotine)
MAO-B inhibitors (i.e. selegiline)
Main use for dopaminergic drugs?
Treatment of Parkinson’s disease - alleviates motor symptoms
Mechanism of action for dopaminergic drugs?
All dopaminergic drugs aim to increase dopamine concentration in the brain
Contraindications and cautions of dopaminergic drugs?
Dopamine agonists should be avoided in patients with a history of addiction, obsessive compulsive disorder and impulsive personality
What are the adverse effects of dopaminergic drugs?
- Postural hypotension- can lead to falls
- Impulse control disorders, including pathological gambling, hypersexuality, bing eating, compulsive spending (all occur much more often with dopamine agonists).
- Dopamine agonists are more commonly associated with hallucinations and should NOT be prescribed in the elderly.
There is no long term complications of levodopa use. true/false?
False
Levodopa provides the greatest symptomatic benefit. Long-term use is associated with motor complications (dyskinesia and motor fluctuations).
Should dopamine agonists (i.e. rotigotine) be prescribed in the elderly?
No
Since most commonly associated with hallucinations and should therefore not be prescribed in the elderly especially in those with cognitive impairments.
Long-term complications of dopaminergic drugs?
- Motor fluctuations
- Non-motor fluctuations
- Dyskinesia - involuntary choreiform or dystonic movements.
- Drug-induced psychosis
Route of administration for dopaminergic drugs?
PO (orally)
Examples of anti-convulsant drugs?
Lamotrigine, perampanel, phenytoin
Main indication of anti-convulsant drugs?
Prevent occurrence of epileptic seizures
Adverse effects of anti-convulsant drugs?
Some anti-convulsants induce hepatic enzymes
Can alter efficacy of COCP (combined oral contraceptive pill)
Examples of cholinesterase inhibitors and when are they used?
Alzheimer’s disease - donepezil, rivastigmine and galantamine.
Dementia with Lewy bodies (DLB) and Dementia with Parkinson’s disease (DPD) - rivastigmine
Main indication for cholinesterase inhibitors?
- Slow cognitive decline for some forms of dementia.
- More of an effect in DLB/DPD than Alzheimer’s.
Mechanism of action for cholinesterase inhibitors?
Inhibit cholinesterase receptors.
Contraindications for cholinesterase inhibitors?
May worsen COPD/asthma
Adverse effects of cholinesterase inhibitors?
- GI (nausea and diarrhoea most common)
- Headache
- Muscle cramps
- Bradycardias
Administration route of cholinesterase inhibitors?
PO (orally)
Main indication of memantine?
Used in moderate or severe Alzheimer’s disease or where cholinesterase inhibitors are NOT tolerated.
Slows cognitive decline and prevents BPSD (behavioural and psychological symptoms of dementia).
Mechanism of action for memantine?
NMDA receptor antagonist
Contraindications and cautions for memantine?
May cause hypertension - check BP before starting
Adverse effects of memantine?
- Hypertension
- Sedation
- Dizziness
- Headache
- Constipation
Administration route of memantine?
PO (orally)
Main indications of carbamazepine?
First line treatment to control pain intensity and attack frequency in trigeminal neuralgia.
Mechanism of action of carbamazepine?
Blocks subtypes of voltage-activated Na+ channels that are up-regulated in damaged nerve cells.
Main indications for gabapentin and pregabalin?
- Antiepileptics but are used in the treatment of chronic pain.
- Gabapentin is employed in migraine prophylaxis.
- Pregabalin is useful in painful diabetic neuropathy.
Contraindications and cautions for gabapentin and pregabalin?
Contraindicated in pregnancy
Route of administration for gabapentin and pregabalin?
Po (orally)
Rhyme used for patient with anticholinergic toxicity?
What would you suspect in a patient who blind as a bat, mad as a hatter, red as a beet, hot as a hare, dry as a bone, the bowel and bladder lose their tone, and the heart runs alone?
Blurred vision
Hallucinations
Increased heart rate
Decreased sweating
What is first line treatment for controlling pain intensity and attack frequency in trigeminal neuralgia?
Carbamazepine
