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AAClinical school conditions > Neurophysiology pharmacology > Flashcards

Neurophysiology pharmacology Flashcards

1
Q

3 causes of status epilepticus

A

Compromised airway
Metabolic disturbance
Neuronal excitotoxicity/hypoxia.

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2
Q

How do you treat status epilepticus?

A

1) Minimise hypoxia by using high flow O2 and securing airway.
2) Terminate event by using a fast acting CNS depressant. If no response
3) Load with IV anti-epileptic e.g phenytoin, levetiracetam or sodium valproate.

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3
Q

What are the fast acting CNS depressants and when do you use them?

A

Lorazepam
Diazepam (if lorazepam unavailable)
Buccal midazolam (if others unavailable or no IV access
Rectal diazepam (last line)

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4
Q

When would you use buccal midazolam?

A

To terminate status epilepticus when there is no IV access.

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5
Q

How would you investigate someone with status epilepticus?

A 
Imaging for structural disturbance
Electrolytes for imbalance
FBC
ABG for metabolic disturbance
CXR for aspiration
Toxicology if cause unknown.
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6
Q

If alcohol withdrawal is suspected in someone with status epilepticus, how do you treat?

A
  • 50 ml of 50 % glucose IV and

* One pair of pabrinex ampoules IV

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7
Q

What monotherapy would you start in someone with a primary generalised tonic clonic seizure?

A

Sodium valproate
Carbamazepine
or
Phenytoin

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8
Q

What monotherapy long term treatments would you use in an epileptic with a partial secondary generalised seizure?

A

Sodium valproate
Carbamazepine
or
Phenytoin

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9
Q

What monotherapy treatment would you use in someone with an absence seizure?

A

Sodium valproate

Ethosuxemide

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10
Q

What monotherapy would you use in an atypical absence seizure which is myoclonic and atonic.

A

Sodium valproate or levetiracetam.

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11
Q

What are the types of drug treatment for severe or recurrent depression?

A

Prevent monoamine reuptake or breakdown.

Enhance monoamine related neurotransmission.

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12
Q

Which drugs prevent monoamine reuptake and what are they used for?

A

TCAs, SSRIs, venlafaxine

Used for depression

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13
Q

Which drugs prevent monoamine breakdown and what are they used for?

A

MAOIs

Used in depression

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14
Q

Which drug enhances monoamine related neurotransmission?

A

Mirtazapine (used in depression)

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15
Q

What do SSRIs do?

A

Block pre-synaptic reuptake of 5-HT via SERT. So increase 5HT activity.

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16
Q

What do TCAs do?

A

Block pre-synaptic uptake of NA and 5-HT via SERT and NAT.

17
Q

What does mirtazapine do?

A

Blocks autoreceptors so prevents negative feedback, so NA and 5-HT release is maintained.

18
Q

What does venlafaxine do?

A

Block pre-synaptic reuptake of NA nad 5-HT via SERT and NAT. Possibly affects DA reuptake.

19
Q

What do MAOIs do?

A

Inhibit enzymatic breakdown of monoamines.

20
Q

When should a TCA dose be given?

A

At night - it has marked sedative properties.

21
Q

What should you be careful of in TCA use?

A

Overdose - can be cardiotoxic.

Marked anti-cholinergic effect.

22
Q

How do anti-psychotics work?

A

By antagonising or modulating CNS dopamine signalling.

23
Q

What should you be worried about with rapid tranquillisation of a patient with acute psychosis (which may be necessary)

A 
Airway obstruction
Resp depression
Hypotension
Coma 
Seizure 
NEUROLEPTIC MALIGNANT SYNDROME.
24
Q

Observed symptoms of Parkinson’s disease

A

Bradykinesia
Tremor
Rigidity

25
Q

Therapeutic targets in Parkinson’s disease

A

Replace, stimulate release of or mimic DA at synapses.
Inhibit DA metabolism via MAO-B
Inhibit DA metabolism via COMT
Reduce influence of ACh

26
Q

Dopamine receptor agonists used in Parkinson’s disease.

A

Rotigotine
Ropinirole
Pramipaxole
Apomorphine

27
Q

Dopamine stimulating drug.

A

Amantadine

28
Q

Drug increasing DA synthesis

A

L-DOPA

29
Q

What are a few MAO-B inhibitors?

A

Selegilin
Rasageline
Used in Parkinsons

30
Q

What is entacapone?

A

A COMT inhibitor used to potentiate effects of L-DOPA.

31
Q

What drug classes are most commonly involved in interactions?

A

Transplant anti-rejection drugs
Antibiotics
Anti-epileptic drugs
TDM drugs

32
Q

Which transplant anti-rejection drugs are commonly involved in interactions?

A

Ciclosporin
Tacrolimus
Sirolimus

33
Q

Which TDM drugs are commonly involved in interactions?

A

Phenytoin, digoxin, lithium,

aminophylline, theophylline.

34
Q

Which anti-epileptics are commonly involved in interactions?

A

Carbamazepine

35
Q

Which antibiotics are commonly involved in drug interactions?

A

Macrolides

36
Q

Which two drugs are very commonly involved in dangerous interactions?

A

Warfarin and Methotrexate.

AAClinical school conditions (32 decks)

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