NeuroTherapies Summaries Flashcards Preview

Neurology > NeuroTherapies Summaries > Flashcards

Flashcards in NeuroTherapies Summaries Deck (9)
Loading flashcards...
1
Q

Anxiety (OCD, GAD, PTSD etc)

A

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.

2
Q

Schizophrenia

A

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).

3
Q

Bipolar Disorder

A

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.

4
Q

Multiple Sclerosis

A

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

5
Q

Alzheimers

A

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

6
Q

Depression (TSM)

A

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.

  1. 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)
  2. 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
  3. 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.
  4. Novels
    - Mirtazepine (Dual MOA increase seotonin + NA release)
    - Reboxetine (Resistance depression, inhibtis NA reuptake.)
7
Q

Alcohol Detox/Craving

A

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

8
Q

Opiate Addiction

A

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)

9
Q

Psychostimulant Abuse (Cocaine)

A

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.