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TCD Cases > Transient LOC + Clinical Reasoning > Flashcards

Transient LOC + Clinical Reasoning Flashcards

1
Q

What is Graham’s law in relation to pharmacokinetics?

A

Rate of passive diffusion is inversely proportional to the square root of the molecular size

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2
Q

What is Fick’s law in relation to pharmacokinetics?

A

Rate of diffusion across a membrane is proportional to the concentration gradient across that membrane

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3
Q

Name a drug with an active metabolite

A

Morphine

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4
Q

Name 3 types of phase 1 reaction that occurs in the liver

A
  1. Oxidation
  2. Reduction
  3. Hydrolysis
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5
Q

What type of reaction is phase 2 of metabolism in the liver?

A

Conjugation

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6
Q

Name the enzyme responsible for the metabolism of catecholamines

A

Mitochondrial enzyme - Monoamine oxidase

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7
Q

What is the other name for the cytochrome p450 enzymes?

A

Mixed function oxidase system in the endoplasmic reticulum

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8
Q

Suggest 3 drugs that will induce the cytochrome p450 system in the liver

A
  1. Rifampicin
  2. Chronic alcohol abuse
  3. Anticonvulsants e.g. Phenytoin and carbamazepine
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9
Q

Suggest 3 drugs that will cause inhibition of the cytochrome p450 system in the liver

A
  1. Metronidazole
  2. Amiodarone
  3. Cimetidine
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10
Q

What is enterohepatic recycling in regards to pharmakoinetics?

A

Drugs excreted in the bile may be hydrolysed by bacterial enzymes. The products of hydrolysis may then be reabsorbed into the bloodstream and may have an active effect

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11
Q

Name a common medication that is affected by enterohepatic recycling

A

Oral contraceptive pill

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12
Q

When is phenytoin most commonly used as an anti-epileptic agent?

A

Emergency treatment of status epilepticus

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13
Q

Name the most commonly used anti-epileptic agent used throughout the world

A

Phenobarbital

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14
Q

What is the gold standard treatment for localised related seizures?

A

Carbamazepine

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15
Q

What is the gold standard treatment for a primary generalised seizure?

A

Sodium valproate

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16
Q

In which layer of the cereal cortex are pyramidal cells found?

A

Layer 4

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17
Q

What is the most common neurotransmitter in an excitatory neuron?

A

Glutamate

18
Q

What is the most common neurotransmitter in an inhibitory neuron?

A

GABA

19
Q

Which channel type does the drug Retigabine act upon?

A

Potassium channels

20
Q

Describe the the action of Levetiracetam

A

Inhibits the release of neurotransmitter from the vesicle into the synaptic cleft

21
Q

Name 5 anti-epileptic drugs that act on calcium channels

A
  1. Ethosuximide
  2. Pregabalin
  3. Gabapentin
  4. Lamotrigine
  5. Zonisamide
22
Q

Name 3 anti-epileptic drugs that act on sodium channels

A
  1. Phenytoin
  2. Carbamazepine
  3. Lamotrigine
23
Q

Describe the action of topiramate

A

Acts on the post synaptic NMDA receptors to inhibit the uptake of glutamate from the synaptic vesicle

24
Q

Name 4 anti epileptic drugs that act on the postsynaptic GABA receptors

A
  1. Benzodiazepines
  2. Phenobarbitone
  3. Valproate
  4. Topiramate
25
Q

Describe the mechanism of action of Tiagabine

A

GABA reuptake inhibitor

26
Q

Describe the mechanism of action of Vigabatrin

A

GABA transaminase inhibitor

27
Q

Give 3 pharmacokinetics processes involving anti-epileptic drugs that are not linear in nature

A
  1. Elimination of phenytoin
  2. Absorption of Gabapentin
  3. Protein binding of valproate
28
Q

Name 3 anti-epileptics which may cause a rash

A
  1. Lamotigine
  2. Carbamazepine
  3. Phenytoin
29
Q

Name 2 anti-epileptic agents which may cause bone marrow suppression

A
  1. Felbamate

2. Carbamazepine

30
Q

Name 2 anti-epileptic agents which may cause hepatic toxicity

A
  1. Valproate

2. Felbamate

31
Q

Outline 6 common neurotoxic side effects associated with anti-epileptic drugs

A
  1. Dizziness
  2. Diplopia
  3. Ataxia
  4. Incoordination
  5. Drowsiness
  6. Cognitive slowing
32
Q

Name an anti-epileptic which may cause weight gain

A

Valproate

33
Q

Name an anti-epileptic which may cause weight loss

A

Topiramate

34
Q

Which anti-epileptics are associated with a 10% increased risk of mood disorders?

A
  1. Topiramate

2. Levetiracetam

35
Q

Outline 3 potential reproductive consequences of anti-epileptic drugs

A
  1. Polycystic ovarian syndrome (valproate)
  2. Erectile dysfunction
  3. Teratogenesis
36
Q

What is the medication of choice for new onset focal epilepsy?

A

Lamotrigine

37
Q

Name an anti-epileptic that does not interact with the OCP

A

Sodium valproate

38
Q

What is the half life of carbamazepine?

A

35 hours

39
Q

Name an anti-epileptic that is contra-indicated for the treatment of Juvenile myoclonic epilepsy due to the risk of exacerbating seizure activity

A

Carbamazepine

40
Q

If Phenytoin needs to be taken long term, it should be replaced with which alternative drug?

A

Lamotrigine

TCD Cases (25 decks)

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