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MLA - Pharmacology Revision > Neurology Drugs > Flashcards

Neurology Drugs Flashcards

1
Q

What is Levetricatem also known as?

A

Keppra

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2
Q

How does Leventricatem / Keppra work?

What is its half life?

What are its side effects?

A

Works by SV2A protein binding

HL = 7hr

AE = Neuropsychiatric

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3
Q

How does Valproate work?

What is its half life?

What are its side effects?

A

Na channel inhibition, GABA enhancement

HL = 12-15h

AE - Alopecia, tremor, thrombocytopenia, pancreatitis, fetal abnormalities

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4
Q

How does diazepam work?

What is its half life?

AEs?

A

Allosteric binding to GABA-A Receptor - increasing frequency in which Cl- channels open

HL = 30-40 hours

AE = respiratory depression, respiratory arrest, drowsiness, confusion, headache, syncope, nausea and vomiting, diarrhoea, and tremors.

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5
Q

How does carbamazepine work?

What is its half life?

What are its AEs?

A

Inhibits Na channels

HL= 12-18h

AEs = hyponatremia, leucopenia, aplastic anaemia, can have hypersensitivity

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6
Q

How does Phenytoin work?

What is its half life?

What are its AEs?

A

Inhibits Na channels

HL = 24h

AEs = gum hypertrophy, hirsutism, megaloblastic anaemia, cerebellar ataxia, atrophy and peripheral neuropathy

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7
Q

How many half lives does it take to reach steady state?

A

Approximately 5

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8
Q

What is steady state?

A

Where the rate of absorption = rate of elimination

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9
Q

What is a trough level with medications?

A

It is the lowest blood concentration of the drug - taken just before the next dose is given

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10
Q

Why is phenytoin a complex drug to give?

A

Is 90% protein bound - therefore alterations in proteins impact on the free (active) drug. Means there is a difference between individuals in terms of the level of saturation.

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11
Q

What things affect the available proteins for drug binding in the blood?

A

Liver failure
Kidney failure
Pregnancy

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12
Q

What metabolism considerations are there about Valproate?

A

Highly protein bound = will compete with phenytoin
Metabolised by liver, excreted in urine
Dose-dependant teratogenicity

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13
Q

What metabolism considerations are there about Carbamazepine?

A

Potent inducer of CYP450

Steady state not reached until 20 days due to auto induction. Is sub thereapeutic for 20 days because it incs liver metabolism = auto-induction.

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14
Q

When is a P considered to have drug-resistant epilepsy?

What are their tx options?

A

Considered drug-resistant if they have failed to respond to 2 different appropriate antiseizure meds

Options = surgery, neurostimulator devices, ketogenic diet

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15
Q

How does LT treatment of a seizure differ depending on if it is provoked or unprovoked?

A

If provoked - provided we correct the provoking factor - the likelihood of having a recurrent seizure in the future is low, so dont have to give Rx for further seizures.

If we dont know why (unprovoked) - is always a risk of harm - therefore will need treatment.

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16
Q

What are common SEs of anti-seizure meds?

A

Sedation
Poor coordination
Imbalance
Fatigue
Osteopenia (long-term)
Suicidal ideation
Respiratory depression

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17
Q

What type of anti-seizure meds are best for focal seizures?

A

Sodium channel blockers

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18
Q

Which are the first generation anti-seizure meds we need to know?

A

Phenytoin

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19
Q

What generation are the following anti-seizure meds?

Clonazepam
Valproate
Carbamazepine
Diazepam

A

Second generation drugs

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20
Q

What generation are the following anti seizure meds?

Pregabalin
Levetiracetam
Gabapentin
Lamotrigine

A

Third generation drugs

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21
Q

Which antiseizure meds work on Na channels?

A

Phenytoin
Carbamazepine
Valproate

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22
Q

Apart from seizures, what is diazepam used for?

A

Anxiety
Alcohol withdrawal
Short term insomnia
Muscle spasms

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23
Q

Which anti seizure meds are also used for mood disorders?

A

Carbamazepine
Sodium valproate

Gabapentin and pregabalin - are used for anxiety disorders

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24
Q

Which anti seizure meds are broad spectrum for seizures?

A

Levetriacetam
Valproate
Lamotrigine

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25
Q

Which antiseizure meds do not have hepatic metabolism?

Where are they instead cleared from?

A

Levetiracetam
Gabapentin
Pregabalin

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26
Q

What are the side effects of pregabalin and gabapentin?

A

Weight gain
Cough
Worsens mycoclonic and absence epilepsy

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27
Q

Which antiseizure meds do have hepatic metabolisation?

A

Carbamazepine
Phenytoin
Diazepam
Sodium Valproate

28
Q

Which antiseizure meds can cause Stevens Johnsons syndrome?

A

Carbamazepine
Phenytoin
Lamotrigine

29
Q

Which antiseizure meds are teratogenic?

A

Sodium valproate
Carbamazepine
Phenytoin
?Pregabalin

30
Q

Which antiseizure medications induce CP450?

A

Carbamazepine
Phenytoin

31
Q

Which antiseizure medications inhibit CP450?

A

Sodium valproate

32
Q

What is the management of acute seizures?

A

(1) Benzos - IV Lorazepam in hospital / Midazolam or diazepam outside hospital

(2). IV antiseizre medication - Levetiracetam, Phenytoin, Valproate

(3). Escalate to ITU if needed

33
Q

How many half lives does it take to reach steady state?

What is steady state?

A

5

When rate of absorption = rate of elimination

34
Q

What is special about Carbamazepine’s steady state?

A

Carbamazepine speeds up its own breakdown (autoinduction) - so getting a trough level doesn’t occur for 20-30 days - may need to up the drug initially and tweak it after the first month.

35
Q

What is the trough level?

A

The level of drug in the blood immediately before the next dose is due.

36
Q

How do Phenytoin and Sodium Valproate interact?

A

Phenytoin is 90% protein bound - but is displaced by valproate. Can mean that this increases the serum levels of phenytoin.

37
Q

What is the IV version of Phenytoin called?

A

Fosphenytoin

38
Q

Which antiseizure meds have interactions with sex hormones?

A

Phenytoin
Valproate
Carbamazepine
Levetiracetam

39
Q

How do antiseizure meds affect birth control?

A

Carbamazepine and phenytoin can inc metabolism of oestrogen birth control

Valproate and Lamotrigine are made less effective by oestrogen birth control

40
Q

What is the MOA of Lamotrigine?

A

Na channel blocker but also affects Ca channels and serotonin receptors

41
Q

When should you not use lamotrigine?

A

If P has cardiac issues
If P is taking oestrogen birth control

42
Q

Which antiseizure meds are safest for pregnancy?

A

Levetiracetam
Lamotrigine

43
Q

What is the first line Rx for Parkinsons?

A

Levodopa

Is a dopamine precursor

44
Q

Which drug for PD is a dopamine precursor + decarboxylase inhibitor?

A

Co-careldopa (Sinemet)

45
Q

Which dopamine agonist is given for Parkinsons disease?

A

Ropinirole

46
Q

What COMT Inhibitor is given for Parkinsons?

A

Entacapone

47
Q

Which MAO-B Inhibitor is given for Parkinsons?

A

Rasagiline

48
Q

What drug under “others” is given for Parkinsons?

A

Amantadine

49
Q

What are possible complications of dopaminergic Rx?

A
50
Q

Which Rx are given as an adjunctive Rx for Parkinsons?

A

Ropinirole
Rasagiline
Entacapone

51
Q

What drugs are given for the following non-motor Sx of Parkinsons?

  • Postural hypotension
  • Excessive daytime sleepiness
  • REM Sleep Disorder
  • Constipation
  • Urinary frequency / incontinence
  • Depression
  • Hallucination or psychotic Sx
  • Dementia
A
52
Q

Which drugs are given for acute vertigo?

A

Anti-histamines (cyclizine)
Neuroepileptics (prochlorperazine)
Anti-emetics (metoclopramide, ondansetron)
Anti migraine drugs

53
Q

How does amitriptyline work?

A

Reduces uptake of 5HT and NOR
Is a tricyclic AD.

54
Q

What are the SEs of amitriptyline?

A

Systemic side effects - anti muscarinic effects - affect bowel, bladder, cognition, secretions and QTc prolongation

55
Q

What are gabapentin and pregabalin used for in MS?

A

Central and neuropathic pain

56
Q

What are the side effects of gabapentin and pregabalin?

A

Weight gain
Fatigue
Sleepiness
Brain fog
? Suicide

57
Q

What are the side effects of Pyridostigmine?

A

Diarrhoea, abdo pain, PSS effets inc bradycardia

58
Q

What daily Rx is given for MG?

A

Pyridostigmine (Acetylcholinestease inhibitor)

59
Q

What Rx is given for acute relapse in MG?

A

Prednisolone

60
Q

What do you need to monitor with predinisolone (or any steroids?)

A

If P has diabetes - monitor sugars as can inc risk of hyperglycaemia

61
Q

MG is one of the few situations where long term steroids may be used. Which is most commonly used?

A

Azathioprine

62
Q

How does Azathioprine work?

A

Inhibits purine synthesis

63
Q

What are the potential SE of Azathioprine?

A

Bone marrow suppression
Hepatotoxicity

64
Q

How does Mycophenolate work?

What are its SEs?

A

T & B cell inhibition.

GI side effects are common. Monitor for skin cancer.

65
Q

How does methotrexate work?

What are its SEs?

A

Inhibits DNA synthesis & T cell mediated inflammation

Can cause interstitial lung disease, bone marrow suppression and hepatotoxicity (but quickest to work)

66
Q

What drugs should be avoided in MG?

A

Anything that causes neuromuscular blockade

  • Cardiac drugs
  • Abx
  • APs
  • β blockers
  • Aminoglycosides

MLA - Pharmacology Revision (17 decks)

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