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Eye Disease > Systemic Drugs - CNS > Flashcards

Systemic Drugs - CNS Flashcards

1
Q

what % of the population take CNS drugs

A

25

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2
Q

How many people have mental health problems?

A

1/3 of the population : depression has the highest prevalence (like me studying)

1/250 also have psychotic illness this includes Bipolar affective disorder and schizophrenia

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3
Q

How does the GP diagnose depression?

A
  1. subthreshold depression : less then 5 symptoms (normal mood changes)
  2. Mild : just north of 5 symptoms and minor functional impairment
  3. moderate depression (area between mild and severe)
  4. severe : have most of the symptoms, including with and without psychotic symptoms, interfere with functioning
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4
Q

what is watchful waiting?

A

the px does not want intervention / mild depression we dont give intervention we just keep an eye.

Exercise and light therapy will help a px with mild dep

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5
Q

What are two low-intensity psychological therapy interventions?

A

CBT (cognitive behaviour therapy) - group intervention
CCBT (computerised cognitive behavioural therapy) - group online

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6
Q

We give CBT/CCBT to mild depressed px, what do we give to moderate/severe depressed px? (OR someone who has been subthreshold depressed for a long time)

A

DRUGS

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7
Q

How do we prescribe drugs for severe/ moderate , prolonged subthreshold px?

A
  1. Look at past experience - if they have any
  2. px choice
  3. Look for any side effects (BNF) or chance of them using the drug to hit the hay permanently (suicide)
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8
Q

What is the therapeutic aim of these drugs?

A

maintain the levels of monoamine neurotransmitters in the brain ;
- serotonin (5-HT) (SSRI / TCA)
-noradrenaline (TCA)
- dopamine

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9
Q

How do Selective serotonin reuptake inhibitors work?

A
  1. The will bind to 5-HT transporter protein
  2. This prevents them going back to the presynaptic neuron for retake up
  3. Maintains 5-HT level in the synaptic cleft so increases likelihood of binding to the target
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10
Q

What are four examples of SSRI?

A

Citalopram (cipramil)
Escitalopram (cipralex)
Fluoxetine (Prozac)
Paroxetine (seroxat)

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11
Q

How does TCA work?

A

Same as SSRI but also works on noradrenaline toooo.
There is accumulation of 5-HT and noradrenaline too
They are not first line though, we start with SSRI

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12
Q

What is an advantage to TCA?

A

long half life = helps px sleep too

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13
Q

Which one do we pick TCA vs SSRI?

A

Look at adverse effects on the profile of the drug… see if the px is suitable

SSRI is safer as overdose wont be as harmful

SSRI is first time

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14
Q

What are four examples of TCA?

A

Amitriptyline, clomipramine , imipramine, lofepramine

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15
Q

what’s Venlafaxine and Duloxetine?

A

Next gen drugs, work similar to TCA but different chem structure

SO these or TCA?? Look at the price and side effects

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16
Q

what is monoamine oxidase A?

A

Enzyme which breaks down amines ; 5-HT and noradrenaline

It converts them into their carboxylic acid.

Look at the diagram on the slide:
- In the presynaptic neuron you can see the inhibitor preventing the break down of the monoamines… this means there is more monoamines neurotransmitter available

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17
Q

why is there limitations on Monoamine oxidase inhibitors?

A

Dietary restrictions : Amino acid Tyramine, found high conc in cheese.

18
Q

Examples of MAOI

A
  • Phenelzine
    • Isocarboxazid
      • Moclobemide
19
Q

What are hypnotics?

A

They are drugs which help with insomnia (sleep is 4 the weak though)- SHORT TERM MANAGEMENT (due to its addictiveness)

20
Q

Two examples of hypnotics: benzodiazepines and Non-benzothiazines, name some examples of each type.

A

Benzodiazepines: short half life
- Nitrazepam
- Flurazepam

Non- benzodiazepine:
Zopiclone

21
Q

what is anxiolytics?

A

short term relief of anxiety that is causing px distress. short term = 2-4 weeks

22
Q

What are three Examples of anxiolytics?

A

Benzodiazepines: longer half-life and muscle relaxers
- Lorazepam
- Diazepam
- Oxazepam

23
Q

why do we use hypnotics and antiolytics short term?

A

they are addictive as fuck and we do not want the px to become reliant on them, it will just mask the problem and not solve it.

24
Q

So what is a benzodiazepine (We have these types of drugs available for hypnotics and anxiolytics)?

A
  1. they enhance the binding site of GABAa (receptor for GABA)
  2. Enhance effectiveness therefore MORE inhibitory

** GABA is a inhibitory ball

25
Q

What are the two classifications of antipsychotics/ neuroleptics/tranquiller?

A

Typical and Atypical

26
Q

what does the Typical (conventional) antipsychotic drug work on?

A

Dopamine receptors. But why isn’t dopamine good ?? Yes, but an unnaturally elevated amount of dopamine s linked to psychosis.

SO this is how it works:
- The Typical drug will block the D2 receptor on the post synaptic membrane

what other effects can typical antipyschotic drugs have?
- cholingeric, histaminergic, stasdklvjnaslkjdvnfaskjdn

27
Q

What are the side effects of typical antipsychotics?

A

sedations, Extrapyramidial effects (like Parkinson’s) and anticholinergic effects (dry mouth ect)

28
Q

Name three Typical antipsychotic drugs

A

1) Phenothiazines: chlorpromazine
2) Thioxanthene’s: flupentixol
3) Butyrophenones : Haloperidol

29
Q

What do Atypical drugs do and what do they act on?

A

Same shit as typical but they also act on other receptors (typical = only dopamine and the D2 receptor)

they are less likely to cause side effects compared to typical

30
Q

What five examples of Atypical drugs?

A

Amisulpride(solian)
Clozapine(Clozaril)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Risperidone(Risperdal)

31
Q

What is bipolar affective disorder

A

Dramatic mood swings. We can use DRUGS to control acute attacks and also prevent their recurrence

32
Q

Name the drugs we use for Bipolar affective disorder : for acute attacks and for prophylaxis

A

Acute attacks:
- Benzodiazepines
- Antipsychotics

Prophylaxis:
Lithium (Priadel)

33
Q

Antiepileptic drugs - this is a big que card, just learn everything on this.

A

Epilepsy can be spontaneous or following a brain trauma , stroke.

* Carbamazepine 
* Lamotrigine 
* Sodium valproate

Ocular adverse side effects, but not prescribed commonly
* Vigabatrin
- Topiramate

34
Q

Which group makes the guidelines for recommendations for the treatment and management of depressions?

A

NICE guidelines

35
Q

Which types of drugs are recommended as first line treatment for depression?

A

SSRIs (Selective serotonin reuptake inhibitors) - they are as effective as tricyclic anti-depressants but safer in overdose

36
Q

Which is safer in overdose- TCAs or SSRIs?

A

SSRIs

37
Q

What are four examples of monoamine neurotransmitters?

A
  • Serotonin
  • Noradrenaline
  • Dopamine
  • Adrenaline
38
Q

What is depression associated with?

A

Reduced levels of monoamine neurotransmitters in the brain (serotonin, noradrenaline and dopamine)

39
Q

What is the main objective of antiepiletics?

A

Object of treatment is to prevent epileptiform event (seizures) by preventing the depolarisation of neurones (inhibition of excitatory neurones, direct membrane stabilisation, stimulation of inhibitory neurones)

40
Q

What is an epileptiform event?

A

A seizure- excessive depolarisation of cerebral neurones which can be localised or spread

41
Q
A

Eye Disease (48 decks)

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