Pharm7e-Ch07-Presentation

[Audio] Welcome to the Pharmacology for Technicians Seventh Edition Watch and Learn Lessons!.

[Audio] Chapter 7, The Nervous System and Drug Therapy..

[Audio] In the anatomy and physiology section of this chapter, you will learn about the divisions of the nervous system and their functions. You will get an overview of the classes of drug therapy that are used to treat conditions affecting the nervous system. In the section called seizure disorders and drug therapy, you will learn about the physiologic processes that occur in epilepsy. In addition, you will develop an understanding of how seizures are classified and the goals of antiseizure therapy. You will also learn about the specific drugs used in the treatment of different classes of seizures..

[Audio] In the section of this chapter called Parkinson's disease and drug treatments, you will learn about the pathophysiology and manifestations of Parkinson's disease. You will also learn about the drug treatments for Parkinson's disease. In the multiple sclerosis and drug treatments section, you will learn about drugs used for multiple sclerosis. In the section on Alzheimer's disease and drug treatments, you will learn about drugs used to manage Alzheimer's disease. In the section on attention deficit hyperactivity disorder and drug treatments, you will discover drugs that are used to treat attention deficit hyperactivity disorders..

[Audio] Chapter 7, Section 1, Anatomy and Physiology of the Nervous System..

[Audio] The nervous system has two anatomical divisions, the central nervous system, and the peripheral nervous system. The CNS consists of the brain and spinal cord. These organs process incoming information and determine responses. The PNS consists of nerves and sensory receptors. These nerves and sensory receptors are located outside of the CNS. The PNS carries nerve signals between the body and the CNS..

[Audio] The peripheral nervous system can be further divided into the sensory and motor divisions. The sensory division carries information to the CNS from sensory receptors that detect heat, cold, pain, and the presence of chemicals. This division is called the afferent system. The afferent system is further divided into the somatic sensory and visceral sensory systems. The somatic sensory system includes nerves that sense touch, pressure, temperature, and painful stimuli on the muscles and joints. The visceral sensory system includes nerves that sense pain in the internal organs. The motor division carries information from the CNS to parts of the body, such as muscles and glands. This division is called the efferent system. The motor division can be further subdivided into the autonomic nervous system and the somatic nervous system. The autonomic nervous system regulates motor activity that is involuntary. This would include the heart, lungs, stomach, and intestines. The somatic nervous system regulates motor activity that is voluntary, like the skeletal muscles..

[Audio] The autonomic nervous system can be further subdivided into the sympathetic nervous system and the parasympathetic nervous system. They each control specific autonomic functions. The sympathetic nervous system controls the fight-or-flight functions. The parasympathetic nervous system controls rest, digestion, and homeostasis..

[Audio] The nervous system is responsible for transmitting information over a vast network of neurons. A neuron transmits information through electrical and chemical signals. Neurons are connected by a synapse. The nerve impulse reaches the synaptic vesicle and releases neurotransmitters. Neurotransmitters are chemical messengers that carry the signal across the synapse to the next neuron. These chemical signals are then received by receptors on the cell body or by dendrites. A dendrite is a branchlike extension from a neuron's cell body. The receptors or dendrites convert the chemical signals into electrical signals, also called impulses. The impulse travels down the neuron's axon away from the cell body until it ends at the axon terminal. The neuron's axon terminal bulbs contain neurotransmitters that can then be released onto subsequent cells to stimulate or inhibit the activity of that cell or target tissue..

[Audio] Neurotransmitters are released at each neuron junction. Some of these are excitatory and some are inhibitory. This table provides a comprehensive look at neurotransmitters, their anatomical division, and their functions. Acetylcholine stimulates skeletal muscle. Gamma-aminobutyric acid works as an inhibitory neurotransmitter and can impact muscle tone. Dopamine is an inhibitory neurotransmitter. Glutamate is a stimulatory neurotransmitter..

[Audio] The effect of a neurotransmitter on a cell can depend on the type of receptor it binds itself to. In the nervous system, adrenergic receptors are sensitive to both epinephrine and norepinephrine. The three types of adrenergic receptors are alpha, beta-1, and beta-2. The binding of epinephrine and norepinephrine to these receptors facilitates the following responses. An alpha receptor causes blood vessels to constrict, which raises blood pressure and provides decongestion. A beta-1 receptor increases the heart rate and contractile force of the heart. Beta-2 receptor influences dilation of both bronchial tubes and blood vessels..

[Audio] Chapter 7, Section 2, Seizure Disorders and Drug Treatments..

[Audio] A seizure is a change in behavior or function that is caused by abnormal electrical discharges in the cerebral cortex. Seizures result in the sudden, excessive firing of a small number of neurons with spread to adjacent neurons. This often occurs without any outside trigger. These firings can result in a convulsion, an involuntary contraction or series of contractions of voluntary muscles. Epilepsy is a neurologic disorder characterized by paroxysmal seizures. Paroxysmal means that the seizures are sudden and recurring. All epilepsy patients have seizures, but not all patients with seizures have epilepsy..

[Audio] Healthy individuals have a balance between neuronal excitation and inhibition. Individuals diagnosed with epilepsy have an imbalance. When excitation is excessive relative to inhibition, neurons can fire uncontrollably, which can lead to a seizure. Glutamate is an excitatory neurotransmitter while gamma-aminobutyric acid is an inhibitory neurotransmitter. These two neurotransmitters play the greatest role in seizures. Neurotransmitter levels are determined by the levels of the enzymes that produce them. Upsetting these enzymes disrupts the balance between excitation and inhibition. The majority of seizures are caused by illegal or recreational drug use, alcohol withdrawal, or extreme intoxication, epilepsy, high fever, hypoglycemia and hyperglycemia, meningitis infection, tumor in the brain, and head trauma or injury..

[Audio] The two major types of seizures are focal and generalized. Each type is further subdivided according to its manifestations. Focal seizures are localized in a specific hemisphere of the brain. It is important to take note of the confined area in the illustration of the brain and on the corresponding electroencephalogram. When a patient has a simple focal seizure, twitching and sensory hallucinations occur but there is no loss of consciousness. With a complex focal seizure, the patient experiences a blank stare, post-seizure amnesia, and impaired consciousness..

[Audio] Generalized seizures involve simultaneous malfunction in both hemispheres of the brain. Take note of the widespread area in the illustration of the brain and on the corresponding electroencephalogram. When a patient has a tonic-clonic seizure, muscle rigidity followed by muscle jerks occur. These may be accompanied by shallow breathing, loss of bladder control, and excess salivation. Status epilepticus is the occurrence of continuous tonic-clonic convulsions, with or without loss of consciousness. Status epilepticus is characterized by high fever and lack of oxygen..

[Audio] Absence, myoclonic, and atonic are additional types of generalized seizures that affect both hemispheres of the brain. An absence seizure includes some or all of the following signs: blank stare, rotating eyes, momentary break in consciousness, uncontrolled facial movements, chewing, rapid eye blinking, twitching or jerking of an arm or leg but no generalized convulsions. Often, the patient has a premonition of the attack through unusual sensations of light, sound, and taste. This is called an aura. In a myoclonic seizure, the patient experiences sudden, massive, brief muscle jerks, or smaller, quick jerks of the arms, hands, legs or feet. There is no loss of consciousness with this type of seizure. In an atonic seizure, there is sudden loss of muscle tone and consciousness..

[Audio] Drug therapy with anticonvulsant drugs has two goals. The first goal is to control seizures or reduce their frequency, so that the patient can live a mostly normal life. The second goal is to prevent emotional and behavioral changes that may result from the seizures. A few guiding principles in the use and dispensing of anticonvulsant drugs are to initiate monotherapy at a low dose, increase the dose gradually, monitor plasma concentrations, progress to combination therapy if needed, periodically evaluate the continued need for therapy, monitor for drug interactions, watch for "dispense as written" on prescriptions, and dispense with medication guide..

[Audio] The sodium channel blockers make neurons less likely to fire by blocking sodium channels. They are used to treat various types of seizures and are available in various dosage forms depending on the medication. The side effects for each anticonvulsant can be numerous. They generally involve central nervous system effects such as dizziness and drowsiness, along with some GI effects. Carbamazepine's side effects include rash, dizziness, drowsiness, nausea, and unsteadiness. Carbamazepine has two boxed warnings. One warning is for potentially fatal dermatologic reactions. The other boxed warning is for aplastic anemia and agranulocytosis. Blood monitoring is necessary with this drug. The main side effects of eslicarbazepine include dizziness, drowsiness, headache, nausea, and vomiting. Oxcarbazepine's main side effects are abdominal pain, headache, trouble walking, abnormal vision, and difficulty moving..

[Audio] Lacosamide, another sodium channel blocker, may cause dizziness, fatigue, headache, nausea, and tremors. Lacosamide is also associated with serious cardiac side effects. Cardiac function should be monitored with this agent. Reflunimide is likely to cause dizziness, drowsiness, headache, nausea, vomiting, and aggressive behavior. When using this agent, patients should report rash or fever to the prescriber..

[Audio] Phenytoin is a sodium channel blocker used to treat several types of seizures. Phenytoin is also used in the prevention of seizures after head trauma or neurosurgery. It has numerous side effects, including decreased coordination, decreased movement, mental confusion, slurred speech, dizziness, and gingival hyperplasia. Phenytoin is considered a high alert drug due to safety concerns with its use. The IV product can cause phlebitis, which is an inflammation of the vein. Additionally, there is an infusion rate limit on the product due to the potential for hypotension if given at faster rates. Phenytoin should also be avoided in certain cardiac conditions and if a rash develops during treatment. Fosphenytoin is an injectable product converted to phenytoin after administration. Fosphenytoin is better tolerated and can be run at a faster rate than phenytoin. Its main use is in the treatment of status epilepticus. The main side effects of fosphenytoin are dizziness, itching, numbness, headache, and tiredness. Although it can be given at a faster rate than phenytoin, this product also has a rate limit. Similar to phenytoin, heart conditions and development of a rash should be monitored. Vigabatrin is only used as adjunct therapy in the treatment of seizures. Vigabatrin's main side effects include fatigue, headache, confusion, poor coordination, and decreased memory. Frequent eye examinations are required with this product..

[Audio] The calcium channel blockers are anticonvulsants that stabilize neurons by blocking calcium channels. Calcium is a positively charged ion, which excites neuronal cells and makes them more likely to fire. This medication class is used for a variety of seizure types and are only available as oral products. Ethosuximide has several mild side effects including headache, drowsiness, dizziness, nausea, and vomiting. Patients taking this medication should have their CBC monitored periodically. Zonisamide has a similar side effect profile to ethosuximide. Important cautions with this medication are that it should be taken with 6 to 8 ounces of water. Patients should also be monitored for suicidal ideation, glaucoma, metabolic acidosis, elevated ammonia, and psychiatric symptoms. Divalproex sodium's side effects are similar to the other calcium channel blockers. It has several boxed warnings. One warning is for liver failure, which usually occurs within the first six months of therapy. Liver function tests should be performed. Other boxed warnings are for pancreatitis and for the risk of fetal malformations when used during pregnancy. Divalproex sodium should not be taken with aspirin or carbonated beverages..

[Audio] Gamma-aminobutyric acid enhancers inhibit neuron firing by increasing GABA. Increasing GABA provides an anticonvulsant effect. GABA enhancers are used in various types of seizures and are available in various dosage forms depending on the medication. The main side effects of gabapentin are dizziness, drowsiness, fatigue, nausea, and vomiting. Pregabalin's side effects include dizziness, drowsiness, dry mouth, blurred vision, and fluid retention. Because it can cause euphoria and withdrawal, it is classified as a Schedule 5 controlled substance. Phenobarbital has several side effects including fatigue, drowsiness, hepatotoxicity, aggression or mood changes, and hypotension. Because of its abuse potential, it is classified as a Schedule 4 controlled substance. CNS depressants should be avoided when using phenobarbital. It should not be stopped abruptly..

[Audio] Primidone is converted to phenobarbital. Its side effects include difficulty moving, dizziness, nausea, vomiting, and loss of appetite. An annual CBC is recommended while on this drug. Tiagabine's side effects include dizziness, drowsiness, nausea, nervousness, and tremors. There is an increased risk of seizures when tiagabine is used to treat conditions other than epilepsy. It has a boxed warning for this reason..

[Audio] Glutamate inhibitors decrease neuron firing by blocking glutamate. Remember that glutamate is an excitatory neurotransmitter. Decreasing it provides an anticonvulsant effect. These medications are used in various types of seizures and are available in various dosage forms depending on the medication. Lamotrigine's side effects include rash, decreased coordination or movement, dizziness, headache, and insomnia. Lamotrigine has a boxed warning for the risk of a fatal rash. The side effects of perampanel include dizziness, vertigo, hostility, and aggressive behavior. Perampanel should be used with caution in psychiatric disorders, especially depression..

[Audio] Topiramate is a glutamate inhibitor whose side effects include dizziness, numbness, memory problems, depression, and kidney stones. Topiramate should always be taken with plenty of water. Felbamate's side effect profile includes insomnia, loss of appetite, weight loss, nausea, and vomiting. Felbamate carries black box warnings for aplastic anemia and liver failure..

[Audio] Synaptic vesicle protein binder anticonvulsants include brivaracetam and levetiracetam. It is unclear how they work. Brivaracetam and levetiracetam are both used in focal seizures, and available as oral and injectable forms. The side effects of brivaracetam include drowsiness, fatigue, abnormal gait, and vertigo. Brivaracetam can cause decreased white blood cell count and DRESS, so it must be monitored with blood testing. Levetiracetam's side effects include dizziness, drowsiness, lack of energy, depression, and behavioral changes. Patients taking levetiracetam should be monitored for changes in behavior, suicidal thoughts, and depression..

[Audio] Chapter 7, Section 3, Parkinson's Disease and Drug Treatments..

[Audio] Parkinson's disease is characterized by muscular difficulties and postural abnormalities. The three characteristic signs of PD are tremors while resting, rigidity, and akinesia, which is the absence of movement. These signs may manifest as poor posture control, shuffling gait, and loss of overall muscle control. PD occurs because of pathologic alterations in the extrapyramidal system of the CNS, which controls movement. Normal movement requires that two neurotransmitters, dopamine, an inhibitor, and acetylcholine, an excitatory neurotransmitter, be in balance..

[Audio] In a healthy person, dopaminergic neurons in the substantia nigra, a structure in the midbrain, release enough dopamine to control the stimulating effect of acetylcholine on muscle movements. In PD, however, there is progressive destruction of dopaminergic neurons in key areas of the brain. As a result, an insufficient amount of dopamine is produced to counterbalance acetylcholine production. This dopamine deficiency results in a predominance of cholinergic neuronal activity, which produces excessive motor nerve stimulation..

[Audio] Currently, there is no cure for PD. The goals of treatment are to minimize disability and help patients maintain the highest possible quality of life. Drug therapy is aimed only at symptomatic relief. It cannot alter the underlying disease process. The combination product of levodopa and carbidopa is the most commonly used drug therapy for PD. Levodopa is metabolized in the brain into dopamine. Carbidopa inhibits the conversion of levodopa to dopamine in peripheral tissues. By doing so, carbidopa prevents the loss of levodopa from the CNS. This combination product is available in oral dosage forms. Its main side effects are the on-off phenomenon, dizziness, headache, nausea, constipation, and low blood pressure. The on-off phenomenon is the fluctuation between hyperkinetic and hypokinetic states, which can occur throughout the day. It can look like excessive movement alternating with freezing episodes. Apomorphine is a dopamine agonist, which is self-injected. It is given to treat the off times. It boosts the effects of levodopa until the next dose. It is not given regularly; instead, it is saved for when levodopa wears off more quickly than anticipated. Despite its name, it is not an opioid drug..

[Audio] The dopamine agonists work by stimulating dopamine receptors. Remember that the neurotransmitters of dopamine and acetylcholine need to be in balance, and that in PD there is insufficient dopamine. Bromocriptine is used as an adjunct to levodopa-carbidopa and is taken as a tablet. Bromocriptine's side effects include drowsiness, nausea, and hypotension. Pramipexole is used early in PD either as monotherapy or as an adjunct. It is available as a tablet and is known for causing fewer side effects than other antiparkinsonian drugs. Ropinirole is taken in tablet form and its side effects include hypotension and dizziness. Rotigotine provides the benefit of being available as a transdermal patch. This is helpful so that patients do not have to take multiple doses a day. Rotigotine's side effects include stomach upset, drowsiness, headache, and local irritation..

[Audio] Anticholinergic agents are used early in PD to treat mild symptoms, primarily tremors. They are used later in the disease as adjunct therapy. Anticholinergic agents work by reducing the activity of acetylcholine in the brain. Remember that the neurotransmitters dopamine and acetylcholine need to be in balance, and that in PD there is excess acetylcholine activity. Benztropine is taken as a tablet and its main side effect is constipation. Trihexyphenidyl targets tremors associated with PD and is taken orally..

[Audio] COMT inhibitors work to boost the effects of levodopa and dopamine by blocking an enzyme that metabolizes dopamine. In order to work, these medications must be combined with levodopa. Tolcapone is a COMT that has been associated with fatal liver injuries. Because of this, tolcapone carries a boxed warning recommending that its use be limited to people who do not respond to or are not appropriate candidates for other available treatments. The drug should be discontinued if the patient does not demonstrate any improvement within three weeks. Entacapone is used in patients experiencing a deteriorating response to levodopa. Its main side effect is urine discoloration..

[Audio] Monoamine oxidase inhibitors are mild dopamine-boosting drugs. They are used in early PD or as adjunct therapy in advanced PD. These drugs work by blocking monoamine oxidase, an enzyme that breaks down dopamine. Patients taking medications in this class should avoid eating foods containing tyramine. MAOIs block the metabolism of tyramine, and if tyramine concentrations are too high, blood pressure can increase dangerously. A few of these foods include aged cheese, beef, and red wine. Additional foods are listed in your text. Rasagiline is often used for mild PD symptoms. Rasagiline is available as a tablet, and its main side effects are nausea and abdominal pain. Selegiline is used as adjunct therapy when levodopa begins wearing off. Selegiline is also available in tablet form and has the same side effects are rasagiline. Safinamide is also used as adjunct therapy when levodopa begins wearing off. Safinamide comes in oral dosage forms as well as a transdermal patch. Its side effects include difficulty moving, nausea, and insomnia..

[Audio] Chapter 7, Section 4, Multiple Sclerosis and Drug Treatments..

[Audio] Multiple sclerosis, abbreviated as MS, is an autoimmune disease in which the myelin sheaths around the nerves degenerate. This degeneration causes patients to lose muscle control. MS can affect eyesight. It can result in severe trembling in later stages. There is no cure for MS, but medications are used to slow its progression..

[Audio] Interferons are used for a variety of conditions affecting the immune system, including MS. Beta interferons closely resemble interferons produced by the body. They are used for their ability to prevent CNS inflammation and demyelination. They are given by injection. Interferon beta 1a reduces the frequency of MS attacks and delays disability in patients with relapsing MS. Its side effects include flu-like symptoms and injection site reactions. There is a risk of anaphylaxis which can occur either immediately after initiation or after prolonged use. There is also a risk of asymptomatic liver dysfunction, leukemia, and anemia with its use. Interferon beta-1b reduces MRI lesions, decreases relapses, and lessens the severity of relapses in MS. Its side effects and cautions are the same as those of the beta-1a product..

[Audio] There are several disease-modifying therapies for MS in addition to the interferon betas. Cladribine is available as a tablet and an injection. Its side effects include fatigue, headache, fever, rash, and nausea. Additional side effects are provided in your textbook. Cladribine has a boxed warning about its increased risk of cancer and birth defects. Cladribine is also associated with an increased risk of infections. Dimethyl fumarate is available as a capsule. Its side effects include flushing, abdominal pain, and diarrhea. Dimethyl fumarate may also decrease lymphocyte counts. Diroximel fumarate is available as a capsule. Its side effects are similar to those of dimethyl fumarate. Patients taking diroximel fumarate are monitored closely due to increased risk of infection. Similar to dimethyl fumarate, there is concern for reduced lymphocytes in the blood..

[Audio] Fingolimod is available as a capsule. Its side effects include cardiac effects, increased liver enzymes, infections, and diarrhea. Fingolimod is associated with the risk of varicella-zoster virus and tumor development. Patients should be tested for immunity to chicken pox and varicella zoster prior to starting this drug. These immunizations should not be administered until at least one month after the patient has completed treatment with it. Glatiramer acetate is an injectable medication. Side effects associated with this drug include injection site reactions, chest pain, flushing, and dyspnea. Mitoxantrone is given by intravenous infusion. Its main side effects are nausea, alopecia, and menstrual disorders. Cautions with the use of mitoxantrone include bone marrow suppression, myocardial toxicity, and the risk of severe tissue damage with extravasation..

[Audio] Natalizumab is an intravenous infusion with the potential side effects of headache, fatigue, and arthralgia. This medication carries a boxed warning for the development of progressive multifocal leukoencephalopathy. PML is a potentially fatal disease affecting the brain's white matter. For this reason, it is part of a Risk Evaluation and Mitigation Strategy program. Siponimod is available as an oral tablet. Some of its side effects include hypertension, headache, falls, liver dysfunction, and swelling. Additional side effects are provided in your textbook. Siponimod is associated with risk of PML like natalizumab. Teriflunomide is an oral drug, which is its main advantage. Its side effects include diarrhea, nausea, and hair thinning. Teriflunomide use is associated with a risk of liver toxicity and is not recommended during pregnancy..

[Audio] Chapter 7, Section 5, Alzheimer's Disease and Drug Treatments..

[Audio] Alzheimer's disease is a degenerative brain disorder, which leads to progressive dementia and changes in personality and behavior. In the early stages, patients complain of memory deficit, forgetfulness, and misplacement of ordinary items. As the disease progresses, complex tasks such as managing personal finances become impossible, and concentration becomes poor. In the final stages, the disease progresses to incapacitation, disorientation, and failure to thrive. Two neurochemical mechanisms for Alzheimer's disease have been identified. One is that there is not enough acetylcholine produced to transmit reliable signals. The other is that some of the receptors for glutamate are hyperactive. This causes the neuron to fire even when there is no glutamate present. Drug therapy slows Alzheimer's disease but does not cure or reverse it..

[Audio] Donepezil, galantamine, and rivastigmine are acetylcholinesterase inhibitors. They are used to treat mild symptoms early in disease progression. They will not work once severe memory and functional loss have occurred. These agents work by inhibiting enzymes that break down acetylcholine. They are available in a variety of oral dosage forms. In addition, rivastigmine is available as a patch. Side effects common to this drug class include nausea, vomiting, agitation, rash, loss of appetite, weight loss, and confusion. Donepezil should not be used in cardiac disease, liver problems, or PD..

[Audio] Memantine is an NMDA antagonist that works by blocking NMDA receptors, a type of glutamate receptor. These receptors are excessively excitable in Alzheimer's disease and can cause neurons to fire even without glutamate being present. Memantine is available in a variety of oral dosage forms. Its side effects include dizziness, headache, drowsiness, constipation, and vomiting. Memantine should be used with caution in seizure disorders, heart disease, kidney disease, or liver disease..

[Audio] Chapter 7, Section 6, Attention Deficit Hyperactivity Disorder and Drug Treatments..

[Audio] Attention deficit hyperactivity disorder, ADHD, is a condition characterized by inattention, impulsivity, and hyperactivity. In order to be diagnosed with ADHD, an individual must exhibit a certain number of symptoms within these categories in at least two settings for at least six months. Many people think environment and stressors cause an individual to have ADHD. However, research has shown that these factors merely exacerbate the condition rather than cause it. Over the course of ADHD, there is a decline in hyperactivity with age, but the potential for persistence of inattention and impulsivity continue into adulthood. Coexisting conditions include learning disabilities, depression, and anxiety..

[Audio] Common therapy for children and adults with ADHD includes the use of CNS stimulants. A CNS stimulant is a drug that affects the levels of certain chemicals in the brain, temporarily boosting mental and physical processes. CNS stimulants include methylphenidate, dexmethylphenidate, amphetamine, dextroamphetamine / amphetamine, and lisdexamfetamine. They are available in a variety of oral dosage forms. Their side effects as a class include headache, loss of appetite, and insomnia. The CNS stimulants all carry a boxed warning for dependence, and are Schedule II controlled substances. There is a risk of rare, but serious, cardiac abnormalities with these medications. When using methylphenidate, the complete blood count should be monitored..

[Audio] Nonstimulant drugs are also used to treat ADHD. These include atomoxetine, bupropion, desipramine, nortriptyline, venlafaxine, clonidine, and guanfacine. The most common of these is atomoxetine. It works by selectively inhibiting reuptake of norepinephrine, which controls impulsivity and activity. Atomoxetine is available as a capsule, and its most common side effects are nausea, heartburn, fatigue, and decreased appetite. Important considerations with atomoxetine are the risk for causing severe liver injury, as well as an increased risk of suicide..

[Audio] Chapter 7, Section 7, Other Central Nervous System Disorders and Drug Treatments..