NeuroTherapies Summaries Flashcards
Anxiety (OCD, GAD, PTSD etc)
Is a NEUROSIS
1st Line = SSRI/SNRI, 12wks, response then 6months.
Cognitive Behavioral Therapy
Consider Benzo’s for short-term effect (withdrawl etc)
Higher dose SSRI’s associated with greater effect.
Schizophrenia
PSYCHOSIS
Combinations NOT recommend
Positive+Neg+Cog Symptoms. AP’s mainly Postive Sympoms.
1st Line = Atypical Agents. Risperidone 4mg/day (D2 agonist) , Quentiapine, Ondazapine 5mg/day.
For negative symptoms of Sch = Clozapine (D4) but monitoring S/E of granulocytosis.
Compliance consider Ester Deposit (IM).
Therapy in 3 Stages. Acute (psych episode to remission/improve 4-6wk), Stabalisation 6wk-6mts, prophylax with Anti-Psychs) and Maintenance (1-2years, only prophylatic in >1ep in 5 years).
Bipolar Disorder
Episodes of Mania+Depression. With intervenings.
Cog+Behavioral Symptoms
Some evidence of genetic links.
Lithium = Mood Stabaliser.
Effective Acute+Preventative. Forumulations NB.
MOA: Reduces free inositol.
2-3wks b4 effect.
S/E’s @ T/Index (0.4-1mmol/L): Fine Tremor, metallic taste Polyuria/dypsia, constipation + more
S/E @ High Conc: 1.5mmol/L = GI upset, Neuro: vision, weak, drowsy) 2mmol/L = Frank toxicity: hypereflexivity, hyperextension of limbs, convulsions, hypothermia, psychoses, coma, death.
Multiple Sclerosis
Dx
- Clinical = >2 Attacks (separated in time and space)
- MRI = White Spots, Atrophy, sometimes hydroceph.
- LP = Oligocytes
- Eye Test = Evoked Potentials give Delayed VER
Acute Attacks. = Steroids or IV IgG
Ongoing MDTeam
Drugs (RRMS)
First Line: Interferon Beta (Avonex), Glatermimer Acetate = -30% relapses
also B12/fumerate = 1st line oral
Mitoxantrone – 60% but CardiTox, Leukemia(Also Alemtuzumab (50-60% reduction)
Tysabri (Natalizumab, Wcsupp, S/E’s, us if RapidProg, Refractive or >1 relapse a year) = 60%
Don’t give in immunocomp, PP/SP MS or
Alzheimers
Features: Loss of gray matter, amyloid plaque, Tau Tangles.
Screening not useful: NHS decided not to in April 15.
Treatment very limited.
Cholinesterase Inhibitors.
- Improvement in up to 40%
- Donepezil (reversable: high CNS specificity, the only LIVER Metab, well tolerated)
- Rivastigmine (slowly/irreversible, bChE selective, slows cog decline, N+V, Depression, confus, agitates)
- Galantamine (reversible: Dual MOA: Ach hydrolysis inhib and modulation of pre-synapse nicotinic receptors = symptomatic relief)
W/wo Memantine (use late stage) (NMDA antagonist, opposes glutamate excitotoxiciity, se’s = Dysphonia, headache dizziness.)
Reassess @ 3-4months
Depression (TSM)
Low Mood + Four Symptoms >2 Weeks (Inconsistant w/prior personality)
Step Wise:
Step 1: (Assess, support, psychoEd, monitor+refer of persists)
Step 2:( Low intensity psych interventions inc meds)
Step 3: (High Intensity, combination treatment,)
Step 4: (Threat to life, self-neglect: Inpatient care, crisis services)
6D’s (Drug Induced? Drug, Dose, (No) Delay Duration, Discontinue)
Little evidence that any drug better than others merely diff in S’E profiles.
3 Classes (TSM): Tricyclics, SSRI’s, Monoamine Oxidase.
- TCAs (-pramines): Prevent PreSyn reuptake of amines Noradrenaline and Serotonin
Trimipramine, clomipramine (5HTsel), desipramine (Nasel).
Poorly Selective except Clo/Des)
Dangerous in OD (CNS seizures, Arrhythmias, hypotension, Interfere with ANS) - SSRI: Block reuptake of serotonin
Venlafaxine (5HT+NA), Desvenlafaxine (in Refrac), Duloxetine (don’t use in liver).
Better S/E profile, as no anti-histamine component.
CAN INCREASE BP+Neuropathic pain - MAOIs: Reduce activity of Maoxidase in breaking down presynaptic amines.
Phenelzine, Tranylcypromine and isocarboxazid. NOT COMMONLY USED.
- Dietary and drug interactions
- Cheese and Wine Effect (Taurine = cardiac effects = Tachy.
- Interact with TCA’s, Opioids, decongestants. - Novels
- Mirtazepine (Dual MOA increase seotonin + NA release)
- Reboxetine (Resistance depression, inhibtis NA reuptake.)
Alcohol Detox/Craving
Withdrawl
Benzodiazepines – Long Term (Chlordiazepoxide) or Short Acting as required (Oxazepam)
Antipsychotics (if psychosis emerges – e.g. Haloperidol)
Anticonvulsants (Profylaxis- Valproate since not addictive)
Cravings (Difficult) – Careful in IVDU’s
Naltrexone (Opioid Blocker)
Nalmefene (Opioid Blocker)
Abstinence
Acamprosate
Disulfiram
Opiate Addiction
Heroin (prodrug of ->)and Morphine most important.
Tolerance, Phys+Psych Dependence
Severe withdrawal
Agonism at MU receptor inhibits GABA release
Inhibition on Dopaminergic neurons reduced = euphori.
Detox Variations
Ultra-Rapid: 1-3days (Naltrexone+benzo+clonidine) (NBC)
Rapid 3-10days (Naltrexone + Buprenorphine/Naloxone (NN))
Short-Term 30days (Methadone)
Long-Term 180days (Methadone)
Methadone
- Oral with long T/12
Buprenorphinr
- Mildly euphoric, (good compliance)
Psychostimulant Abuse (Cocaine)
Cocaine
DA+NA reuptake = opioid system activation.
Psych Dependence Only
OD = Tremors, Convulsions, resp+vasomotor dep,
Chronic Use: Paranoia, cog imp, necrosis of septum, cortical BF reduced.
Tx
OD – Seizure=Diazepam, Cardio=BBlockers
Withdrawal = Lots but none great. SSRI’s, TCA’s if ev depressed. Baclofen=some efficacy.
Nicotine
Replacement Therapy
Varenicline (Partial Nicotine receptor agonist). Blocks Reward.
Bupropion (inhib uptake of D&NA)
Possibly vaccine on horizon. NicVax 1st trials encouraging.
