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NUR3120 PPNP3 Pharmaco - Coggle Diagram
NUR3120 PPNP3 Pharmaco
Antiepileptics
Phenytoin
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Relative narrow therapeutic range + non-linear relationship between dose and plasma (differ in person to person)
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Carbamezapine
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Hepatic enzyme (CYP450) inducer, shortens half life of other drugs
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Sodium valproate
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Valproate bound to plasma proteins, displaces other antiepileptics, must adjust dose for other antiepileptics
MoA: reduce Na and Ca conductance by blockading voltage depdendent Na and Ca channels + inhibits GABA transaminase
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Benzodiazepines
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Examples: Clonazepam, Lorazepam, Diazepam
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MoA: enhance effect of inhibitory GABA neurotransmitters by Allowing more Cl- ions to enter cell, reducing membrane potential, leaving cell in hyperpolarized state, very difficult to discharge => neurons not firing
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Side effects (general)
Dose related
Drowsiness
Confusion
Nystagmus (Nystagmus is a vision condition in which the eyes make repetitive, uncontrolled movements)
Ataxia (Ataxia is a term for a group of disorders that affect co-ordination, balance and speech)
Slurred speech
Nausea
Unusual behaviour
Mental changes
Coma
Non-dose related
Hirutism (excessive hair growth)
Gingival hyperplasia (overgrowth of gums)
Osteomalacia (softening of bone tissue)
Steven-Johnson's syndrome (Very bad eczema, potentially fatal)
Which drug to use first?
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Seizure type, epilepsy symptoms, other medications, co-morbidities, lifestyle and preference play a part
- Assess compliance
- Assess symptoms due to drug toxicity
- Titration of phenytoin dose (careful titration due to low narrow range)
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PD Medication
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Levodopa
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Side effects
(short term) nausea, vomiting, postural hypotension
(long term) motor fluctuations and dyskinesia (movement that people with Parkinson's cannot control)
Post-synaptic plastitiy that is disruptive (not pulse release, just a lot of dopamine)
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"2-in-1" preparation with peripheral decarboxylase inhibitors to prevent side effects due to excess dopamine in peripheral nervous sytem
Levodopa bad at going through blood brain barrier. With peripheral decarboxylase, less of it will be converted in PNS and more can travel through blood brain barrier
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Selegiline (Jumex)
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Efficacious as symptomatic monotherapy, may be used in early stages of PD
Anticholinergics
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Side effects
(especially in elderly) dry mouth, sedation, constipation, urinary retention, delirium, confusion, hallucinations
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may be used as asymptomatic monotherapy or as adjunct to levoddopa t o treat tremors and stiffness in PD
Dopamine agonists
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Side effects
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(ropinirole, pramipexole) somnolence
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Efficacious as symptomatic monotherapy or adjunct to levodopa
In younger Parkinson's disease patients, therapy should commence first with dopamine agonists rather than levodopa
Which medication to use?
Consider points
- Age
- stage of disease
- level of activity
- associated psychological factors
- associated medical conditions
- patient factors
Early symptomatic disease without complications
--> coping well? No need medication
Physio + exercise regime
Healthy, balanced diet
Knowledge on disease
Social support
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