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Neuro > Vision, Special Sense And Pharmacology > Flashcards

Vision, Special Sense And Pharmacology Flashcards

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1
Q

Why do some drugs reversibly change between ionised and non-ionised?

A

To allow them to cross lipid membranes (ionised cannot pass lipid membrane)

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2
Q

Give 5 main ideal properties of local anaesthetics

A

Reversible, non-irritant to surrounding tissues, rapid onset, readily metabolised, slowly removed from site of action

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3
Q

What is analgesia

A

Loss of response to pain

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4
Q

Why is IV route used for general anaesthetics?

A

Inhaled route would be too slow and have a short half life

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5
Q

Give two IV general anaesthetic drugs

A

Thiopentone and Propofol

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6
Q

Give 2 inhaled general anaesthetic drugs?

A

Isoflurane and Nitrous Oxide

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7
Q

Why can Nitrous oxide not be used on its own as a general anaesthetic?

A

95% conc for induction which would cause asphyxia

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8
Q

Where do the optic nerves cross?

A

Optic chiasm

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9
Q

Where do the optic fibres first synapse?

A

Lateral geniculate

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10
Q

Where do the majority of fibres pass through when they leave the lateral geniculate?

A

Optic radiation

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11
Q

Why do some fibres from the lateral geniculate not pass through the optic radiation?

A

The pass to other centres which help aid eye movement

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12
Q

What happens to fibres at the optic chiasm?

A

The medial optic fibres cross over while the lateral fibres stay ipsilateral so the right LGN only receives light from the right and vice versa

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13
Q

What information do fibres in the lower half of the optic radiation carry?

A

Top of the visual field

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14
Q

Where do fibres in the lower half of the optic radiation pass over?

A

Temporal horn of the lateral ventricle to form meyers loop

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15
Q

What is akinetopsia?

A

Loss of perception of movement?

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16
Q

What may lesions of the parietal pathway cause?

A

Akinetopsia

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17
Q

What do circular eye muscles do and what innervates them?

A

Constrict the pupil, innervated by pns

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18
Q

What do radial eye muscles do and what innervates them?

A

Dilate the pupil, innervated by sns

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19
Q

What effect would activation of Muscarinic receptors have on the eye?

A

Contract via PNS

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20
Q

Give an example of a drug that would constrict the pupil AND accommodate the lens for near vision along with one to reverse this

A

Pilocarpine, reversed by tropicamide

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21
Q

Give a drug that would dilate the pupil with no effect on the lens

A

Phenylephrine (adrenergic receptors)

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22
Q

What is tonometry?

A

Measuring eye pressure

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23
Q

What is gonioscopy?

A

Measuring the angle between cornea and ciliary body

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24
Q

What causes blindness in glaucoma?

A

Optic nerve damage

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25
What drug can be used to decrease aqueous humour formation?
Apraclonidine
26
Give a sodium channel blocker used in epilepsy
Carbamazepine
27
How do barbiturates help in epilepsy? Give an example of one
Increase duration of GABAa channel opening, phenobarbitone
28
Give 3 examples of prophylactic migraine treatment
B-blockers, Antiepileptics, TCAs
29
What drugs can be used for acute migraine treatment?
Triptans, NSAIDs, antiemetics
30
How does sumatriptan work?
Acts of 5HT1b/d to inhibit trigeminal nerve transmission and constrict smooth muscle around the cranial and basilar arteries
31
What is rumination
Repetitive regurgitation of recently ingested food to the mouths followed by re swallowing or expulsion
32
How do dopamine antagonists work to reduce vomiting?
Act on the CTZ to reduce the efffect of dopamine
33
how do anaesthetics act on the brain?
They have a descending action on brain centers, the higher brain centers- reasoning, inhibition, sensory and motor skills, consciousness and memory are inhibited
34
characteristics of propofol
high lipid solubility, very good distribution, high potency, rapid action due to high perfusion rate of the brain,
35
What is entonox?
Entonox is a 50:50 mixture of oxygen and nitrous oxide. It is most commonly used for dental procedures, dressing changes, and obstetric anesthesia.
36
pre medication before surgery
antimuscarinic/antihistamine- reduce gut secretions and motility opioid analgesics- reduces intra and post op pain sedative e.g temazepam - relaxes patient, anterograde amnesia antiemetics
37
what is the anaesthesia triad?
anaesthetics, NMJ blockers (and anticholinesterase) , analgesics
38
how do local anesthetics work?
They prevent sodium channels from opening, thus blocking action potentials. They cause a reversible block along conduction fibres
39
how is procaine used as a local anesthetic?
first true local anesthetic, no vasoconstriction, poorly absorbed from mucus membranes- not now used
40
analgesic opioid examples and their roles
fentanyl- very potent, for chronic breakthrough pain morphine- standard opioid, usually given IV codeine - less potent , better oral absorption pethidine- rapid acting,often used in obsteterics tramadol- moderate potency opioid,
41
how do opioids cause respiratory depression
acts in medulla to decrease rate and depth of breathing, especially seen in more lipid soluble opioids
42
how do opioids cause nausea and vomiting?
They stimulate the chemoreceptor trigger zone, usually tolerance develops
43
how do opioids cause cough suppression?
they have antitussive action, inhibit cough centre in the medulla
44
drugs used for treatment of migraines
non specific- NSAIDs, antiemetics specific- triptans simple analgesic in combination with 5 HT-1 and antiemetics
45
how do triptans help migraines?
triptans act on 5 HT1 B and D receptors, inhibits trigeminal nerve transmission , constricts vascular smooth muscle around cranial and basilar arteries
46
antiemetics for acute migraines
dopamine antagonists-metoclopramide antihistamines
47
drugs to treat sickness in pregnancy and why we treat
severe vomiting- antihistamines- promethazine 2nd line- dopamine antagonist usually self limiting but treat if persistent as can lead to vitamin deficiency and slowed fetal development
48
what happens in lens accommodation?
focusing on near objects --> ciliary muscles tighten, lens flattened focusing on distance --> ciliary body relaxes, lens stretched
49
why does accommodation get worse with age?
elasticity of lens are damaged by UV oxidation due to sunlight exposure, decreases near point acuity
50
Describe open angle glaucoma.
most common type of glaucoma, makes up 90% of cases, the trabecular meshwork becomes blocked by matrix debris, reducing outflow
51
describe closed angle glaucoma
In closed angle glaucoma, the ciliary body is pushed forward to act as a physical block of the drainage of aqueous fluid that increases intraocular pressure, which impinges on the optic nerve causing damage more common in long sighted people
52
non drug method to treat glaucoma
laser ablation of trabecular meshwork, increases the drainage of aqueous fluid by punching holes into the matrix
53
sodium channel blocker drugs in epilepsy
carbamazepine phenytoin lamotrigine lacosamide valproate
54
What is carbamazepine? plus side effects
most widely used epilepsy drug, S/E- some sedation, dizziness, liver affects- CYP450- lots of potential drug interactions,
55
What is phenytoin? plus side effects
anticonvulsant drug used in ER, adminstered as an IV narrow therapeutic range, CYP450- many drug interactions S/E- ataxia, sedation, double vision, hypersensitivity rash teratogenic -birth defects- should not be given to women of child bearing age
56
What is Lamotrigine?
sodium channel blocker used in epilepsy but also has affects on calcium channels no affect on CYP450- less drug interactions side effects are rare
57
use of barbiturates
good at treating status epilepticus phenobarbitone increases duration of GABA channel opening other barbiturates (thiopentone, propofol)- used to treat status epilepticus S/E- marked sedation, CYP450- lots of drug interactions
58
Mechanism of Levetiracetam
binds SV2A, a synaptic vesicle glycoprotein, reducing transmitter release also inhibits presynaptic Ca2+ channels add on therapy for tonic clonic seizures
59
What are the typical antipsychotics?
dopamine receptor antagonists D2- most effective also D1, 3 and 4
60
What are the atypical antipsychotics?
they block 5-HTA, glutamate receptors, reduce negative features
61
Mechanism of antipsychotics?
blockade of D2 receptors in the mesolimbic and mesocortical pathways improve positive features atypical- block 5-HT2 in mesolimbic system - reduce negative features
62
main classes of antipsychotics
phenothiazines non-phenothiazines atypical drugs
63
Give an example of a phenothiazine
Fluphenazine
64
Give an example of a non phenothiazine
Haloperidol
65
Give an example of an atypical antipsychotic
Clozapine
66
What is L-DOPA?
dopamine precursor that is converted to dopamine by DOPA decarboxylase
67
what is MAO?
monoamine oxidase- two types A- mainly NA and 5-HT2 breakdown B- mainly dopamine breakdown
68
What are MAOB inhibitors?
Selegiline Rasagiline they prolong dopamine survival within NS
69
describe SSRIs
selective serotonin reuptake inhibitors, e.g sertaline, citalopram, fluoxetine side effects- sexual dysfunction relatively safe in overdose
70
describe SNRIs
serotonin noradrenaline reuptake inhibitors e.g. duloxetine, venlafaxine marginally more effective than SSRIs but more side effects
71
describe TCAs
tricyclic acid antidepressant drugs e.g. amitriptyline also block post synaptic receptors like muscarinic troublesome side effects and unsafe in overdose
72
use of lithium
acute treatment of manic and hypomanic episodes prophylaxis of bipolar disorder improves antidepressants and antipsychotics reduces impulsivity, aggression and suicidal tendencies in all mental health patients
73
adverse effects of lithium
thirst, polyuria, fine tremor, weight gain worsening of dermatology symptoms hypothyroidism renal problems
74
drugs used in insomnia
benzodiazepine hypnotics, cyclopyrrolones, melatonin receptor agonists, antihistamines, antidepressants
75
drugs used in anxiety disorders
SSRIs, SNRIs, benzodiazepine anxiolytics, TCAs, MAOIs, antipsychotics, beta blockers,
76
role of barbiturates
use in severe intractable insomnia in those already using barbiturates
77
How do barbiturates work?
increase duration of Cl- channel opening, prolonged hyperpolarization
78
adverse effects of benzodiazapines
dangerous when combined with alcohol or barbiturates memory disturbance impaired driving ability potentially disinhibiting tolerance to hypnotic effect discontinuation symptoms recommended for short term only due to risk of dependence

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