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0. Clinical Pharmacology > Neurology/Psychiatry Drugs > Flashcards

Neurology/Psychiatry Drugs Flashcards

1
Q

List the 3 main types of Parkinson’s drugs.

Give an example of each.

A

Dopamine precursors (e.g. levodopa)

Dopamine agonists (e.g. apomorphine)

Catechol-o-methyl transferase (COMT) inhibitors (e.g. entacapone)

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2
Q

List the 5 main anti-epileptics.

A 
Carbamazepine
Sodium valproate
Phenytoin
Lamotrigine
Levetiracetam
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3
Q

Briefly describe the mechanism of action of levodopa. (2)

List 5 common side effects.

A

MECHANISM:

  1. Cross the BBB and is converted to dopamine in the pre-synaptic bulb (via decarboxylation)
  2. This increases neurotransmission in the striatum
SIDE EFFECTS:
Dyskinesia
Compulsive disorders
Hallucinations
Nausea
GI upset
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4
Q

Briefly describe important pharmacokinetics/dynamics of levodopa. (4)

What would you tell the patient when prescribing? (3)

A

IMPORTANT PHARMA INFO:

  • Converted into dopamine in the peripheries, causing GI/motor side effects
  • Prescribed with a dopamine decarboxylase inhibitor or COMT inhibitor
  • Half-life: 50-90 minutes
  • Rapid GI absorption via large neutral amino acid (LNAA) carriers

PATIENT INFO:

  • Dyskinesia is very common
  • Reduced efficacy over time
  • Avoid abrupt withdrawal
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5
Q

List 5 examples of dopamine agonists.

Which one is non-selective?

Which one is selective? (And which is the only dopamine receptor it works on?)

A

Apomorphine (non-selective)
Pramipexole (selective - D3)

Bromocriptine
Pergolide
Rotigotine

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6
Q

Briefly describe the mechanism of action of dopamine agonists. (2)

A
  1. Directly stimulate post-synaptic dopamine receptors
  2. Type of dopamine receptor depends on the specific drug, e.g.
    - Apomorphine: non-selective: D1 and D2 receptors
    - Pramipexole: selective: D3 receptor only
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7
Q

For apomorphine, list:

a) What type of drug is it?
b) Common side effects (3)
c) Important pharmacokinetics/dynamics (4)
d) What would you tell the patient? (2)

A

Non-selective D1 and D2 dopamine agonist

SIDE EFFECTS:
Pain at injection site
Nausea
Vomiting

IMPORTANT PHARMA INFO:

  • Highly emetic
  • Half-life: 40 minutes
  • Administration: injection
  • Reduced efficacy over time

PATIENT INFO:

  • Can only be injected
  • Less effective than L-dopa; treatment may need to be modified later
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8
Q

For pramipexole, list:

a) What kind of drug is it?
b) Common side effects (4)
c) Important pharmacokinetics/dynamics (3)
d) What would you tell the patient? (1)

A

Selective D3 dopamine agonist

SIDE EFFECTS:
Hallucinations
Nausea
Drowsiness
Involuntary movements

IMPORTANT PHARMA INFO:

  • Cimetidine increases toxicity
  • Half-life: 8 hours
  • Reduced efficacy over time

PATIENT INFO:
-Weaker than L-dopa; treatment may need to be modified

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9
Q

Give 1 example of a COMT inhibitor.

Briefly describe its mechanism of action. (2)

In Parkinson’s disease, what would you prescribe in conjunction with this? (2)

A

Entacapone

MECHANISM OF ACTION:
1. Inhibits catechol-o-methyl transferase, which breaks down levodopa in the peripheries

  1. COMT converts L-dopa into 3-OMD, which does not cross the BBB, making l-dopa less effective
    a. COMT inhibitors prevent this, making L-dopa more effective

PRESCRIBED WITH:
Levodopa
Dopamine decarboxylase inhibitor

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10
Q

List 6 common side effects of COMT inhibitors.

Briefly describe the important pharmacokinetics/dynamics. (2)

What would you tell the patient when prescribing COMT inhibitors? (3)

A 
SIDE EFFECTS:
Dyskinesia
Nausea
Abdominal pain
Vomiting
Dry mouth
Dizziness

IMPORTANT PHARMA INFO:

  • Rapid absorption
  • Levodopa dose needs to be reduced (by 10-30%)

PATIENT INFO:

  • Urine may turn brown (normal)
  • Lightheaded/dizziness may occur during normal daily activities
  • Avoid abrupt withdrawal
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11
Q

List 5 examples of SSRIs.

A 
Citalopram
Fluoxetine
Paroxetine
Escitalopram
Sertraline
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12
Q

Describe the mechanism of action of SSRIs. (2)

What are the indications for prescribing SSRIs? (3)

A

MECHANISM OF ACTION:
1. Inhibition of serotonin reuptake at the serotonin reuptake pump of the synaptic cleft (in CNS)

  1. Increases serotonin stimulation of 5-HT1A and terminal autoreceptors

INDICATIONS:
Depression
Bulimia
OCD

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13
Q

List 5 common side effects of SSRIs.

List 2 serious, but rare side effects of SSRIs.

A 
COMMON SIDE EFFECTS:
Dry mouth
Nausea
Insomnia
Anxiety
Decreased libido

RARE SIDE EFFECTS:
Seizures
Dyskinesia

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14
Q

Describe important pharmacokinetics/dynamics of SSRIs. (2)

What would you tell the patient when prescribing SSRIs? (3)

A

IMPORTANT PHARMA INFO:

  • Less binding to histamine/ACh/NA receptors than TCAs, therefore fewer side effects
  • Less dangerous in overdose than TCAs

PATIENT INFO:

  • Toxicity possible with alcohol
  • Symptom improvement may take several weeks
  • Abrupt discontinuation may cause withdrawal
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15
Q

List 3 examples of tricyclic antidepressants.

A

Amitryptyline
Imipramine
Doxepin

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16
Q

Describe the mechanism of action of TCAs. (2)

What are the indications for prescribing TCAs? (3)

A

MECHANISM OF ACTION:
1. Inhibit reuptake of monoamines by binding to the monoamine pump at the pre-synaptic cleft

  1. This causes reduced reuptake of noradrenaline and/or serotonin, improving depression

INDICATIONS:
Depression
Panic disorders
Neuropathic pain

17
Q

List 7 side effects of TCAs.

HINT: there are 3 categories of side effects.

A

ANTI-HISTAMINERGIC SIDE EFFECTS:
Sedation

ANTI-ADRENERGIC SIDE EFFECTS:
Postural hypotension
Tachycardia

ANTI-CHOLINERGIC SIDE EFFECTS:
Urinary retention
Dry mouth
Blurred vision
Diplopia
18
Q

Describe the important pharmacokinetics/dynamics of TCAs. (3)

What would you tell the patient when prescribing TCAs? (2)

A

IMPORTANT PHARMA INFO:

  • Action on other receptors causes many side effects
  • Good oral absorption
  • First pass metabolism via liver

PATIENT INFO:

  • Symptomatic improvement may take several weeks
  • Overdose may cause seizures/arrhythmias
19
Q

List 4 examples of anti-psychotic drugs. Which ones are:

a) First generation anti-psychotics
b) Atypical anti-psychotics

A

FIRST GENERATION:
Haloperidol
Chlorpromazine

ATYPICALS:
Olanzapine
Clozapine

20
Q

Describe the mechanism of action of anti-psychotic drugs. (3)

List 5 indications of anti-psychotic drugs.

A

MECHANISM OF ACTION:

  1. Block dopamine receptors; type depends on specific drug:
    a. First generation: D1 and D2
    b. Atypicals: varying
  2. Dopamine neurotransmission is decreased in mesolimbic and nigrostriatal pathways
    a. Improves psychotic symptoms
  3. Anti-histaminergic and anti-cholinergic effect
    a. Reduce positive symptoms of schizophrenia
    b. Cause sedation and anti-emetic activity
INDICATIONS:
Schizophrenia
Mania
Delusions, hallucinations
Behavioural problems
Anti-emetic (especially haloperidol)
21
Q

List 6 common side effects of anti-psychotic drugs.

HINT: there are 3 categories of side effects.

A

ANTI-HISTAMINERGIC SIDE EFFECTS:
Sedation

ANTI-ADRENERGIC SIDE EFFECTS:
Postural hypotension
Tachycardia

ANTI-CHOLINERGIC SIDE EFFECTS:
Urinary retention
Dry mouth
Blurred vision

22
Q

Describe the important pharmacokinetics/dynamics of anti-psychotics. (1)

What would you tell the patient when prescribing anti-psychotics? (2)

A

IMPORTANT PHARMA INFO:
-Affects several receptor systems in CNS

PATIENT INFO:

  • Symptoms don’t always disappear while on meds
  • Dosage may need to be increased if no improvement is seen
23
Q

List 3 common examples of benzodiazepines.

A

Diazepam
Lorazepam
Midazolam

24
Q

Describe the mechanism of action of benzodiazepines. (2)

What are some common indications for prescribing benzodiazepines? (4)

A

MECHANISM OF ACTION:
1. Increases GABA affinity for the GABA receptor

  1. Increased GABA binding to the receptor increases chloride influx through chloride channels
    a. This causes hyperpolarisation, causing reduced activity in limbic/thalamic/hypothalamic areas
INDICATIONS:
Anxiety
Epilepsy
Muscle spasm
Alcohol withdrawal
25
Q

Describe the important pharmacokinetics/dynamics for different benzodiazepines. Consider:

a) Diazepam (3)
b) Lorazepam (2)
c) Midazolam (2)

A

DIAZEPAM:

  • Long-acting
  • Accumulates if given long term/in liver failure
  • Admin: oral, rectal, parenteral

LORAZEPAM:

  • Less accumulation
  • Admin: oral, parenteral

MODAZOLAM:

  • Short-acting
  • Admin: parenteral
26
Q

What would you tell the patient when prescribing benzodiazepines? (2)

A

PATIENT INFO:
Monitor breathing - report severe breathlessness or palpitations

Risk of addiction - only prescribed short term

0. Clinical Pharmacology (14 decks)

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