Brain And Nerves Flashcards
What is the indications for lithium?
Treatment and prophylaxis of mania, bipolar disorder and recurrent depression
What are the symptoms of lithium toxicity?
Mnemonic: The Chill Rock BAND
- Tremor
- Convulsions
- Renal Impairment
- Blurred Vision
- Ataxia (shaky movements)
- Nystagmus (rapid involuntary movement of the eyes)
- Dysarthria (speech disorder)
What do you have to monitor for lithium and how frequently?
Measure lithium serum concentration, every three months
Measure renal and thyroid function every 6 to 12 months and maintain sodium levels
What is the main counselling point when discussing lithium?
Maintain adequate fluid intake and avoid dietary changes which may reduce or increase sodium intake
What are the main interactions with lithium?
Mnemonic: DAAN
Diuretics – excretion of lithium reduced by loop and thiazide – sodium depletion
Amiodarone – risk of ventricular arrhythmias
ACE inhibitors – excretion of lithium, reduced by ACE inhibitors – risk of lithium toxicity
NSAIDs – excretion of lithium probably reduced by NSAIDs - risk of lithium toxicity
What type of seizures does Phenytoin treat?
All seizures apart from absence seizures (phenytoin also helps treat neuropathic pain)
Describe the relationship between dose and plasma concentration of phenytoin?
How may this impact treatment?
The relationship between Dostum plasma concentration is nonlinear. Small dose changes may produce large plasma concentrations and hence toxic effects. Therefore monitoring is required.
What monitoring is required for phenytoin?
Mnemonic: FLP
Full blood count,
Liver function tests and
Plasma concentration - in dose changes and suspicion of toxicity
What are the main side-effects of Phenytoin?
Think ‘Phenytoin affects the head’ and go from there.
Head, Mouth, Skin, Stomach.
Tapping each area helps.
Head - hirsutism (course, pigmented hair on the face)
Mouth - Nausea and vomiting, Gingival hypertrophy
Skin - Rash, Acne, Skin/Blood disorders
Stomach - Constipation, Course faeces
What is the main counselling points for phenytoin?
Look out for signs of blood or skin disorders (fever, sore throat, rash, mouth, ulcers, bruising, bleeding, leukopenia) and take with or after food
What are the main interactions with phenytoin?
NSAIDs– effects of phenytoin enhanced by NSAIDs
Amiodarone – inhibits the metabolism of phenytoin
Warfarin –phenytoin accelerates metabolism of warfarin
Cimetidine – cimetidine inhibits the metabolism of phenytoin
Fluoxetine – plasma concentration of Phenytoin increased by fluoxetine
St John’s wort - St John’s wort (an enzyme inducer) reduces plasma concentration of phenytoin
What are the main extra-pyramidal side effects?
Move: Face, Jaw, hands, body
Parkinsonian: tremor, jerky movement from side to side, common in the elderly
Dystonia: abnormal facial movements, more common in children
Akathisia: restlessness after large doses
Tardive Dyskinesia: involuntary jaw or facial movements which develops on long term or high dose therapy
With the exception of aripiprazole, what does dopamine inhibit and what are the symptoms of this?
Prolactin release, therefore many antipsychotics increase prolactin levels.
Symptoms: sexual dysfunction, reduced bone mineral density, breast enlargement, galactorrhoea (milk production from women)
What are the cardiovascular side effects of antipsychotics?
Tachycardia
Hypotension
QT Prolongation with Pimozide and Haloperidol
Which antipsychotics cause hyperglycaemia and diabetes?
Clozapine
Olanzapine
Quetiapine
Risperidone
Which antipsychotics are most likely to case weight gain?
Olanzapine
Clozapine
What are the symptoms of neuroleptic malignant syndrome? What action should you take if a patient presents with these symptoms?
Hyperthermia
Muscle rigidity
Sweating
Urinary incontinence
Discontinue
Name the first generation antipsychotics.
Group 1 Phenothiazine - pronounced sedation and moderate antimuscarinic and extra-pyramidal SEs
- Chlorpromazine
- Levomepromazine
- Promazine
Group 2 Phenothiazine - fewer antimuscarinic and extrapyramidal SEs
- Pipotiazine
- Pericyazine
Group 3 Piperazine Phenothiazines - fewer sedation and antimuscarinic SEs/more pronounced and commonly cause extra-pyramidal SEs
- Prochlorperazine
- Fluphenazine
- Perphenazine
- Trifluoperazine
Butyrophenones - fewer sedation and antimuscarinic SEs but more pronounced extra-pyramidal SEs.
- Benperidol
- Haloperidol - commonly causes sexual dysfunction
Thioxanthenes - moderate antimuscarinic and extra-pyramidal SEs
- Flupentixol
- Zuclopentixol
-Pimozide - requires ECG monitoring
Name the second generation antipsychotics.
Amisulpiride
Aripiprazole
Clozapine
Lurasidone
Olanzapine
Paliperidone
Quetiapine
Risperidone
What side effects should you expect to see in the first few weeks on an Antidepressant?
Agitation
Anxiety
Suicidal ideation
What are the main interactions of SSRIs?
Antiepileptics - reduces anticonvulsant effect
Warfarin - enhances anticoagulant effect
NSAIDs - increased risk of bleeding
Tramadol - risk of CNS toxicity
What are the main interaction of Tricyclic antidepressants?
Antiepileptics - reduce anticonvulsant effects
Tramadol - risk of CNS toxicity
Which SSRI is shown as safe in myocardial infarction?
Sertraline
Which group of antidepressants has antimuscarinic activity and what are the cautions?
Tricyclic antidepressants
Caution in prostate hypertrophy, constipation, raised intraocular pressure and urinary retention
Which drugs have the highest risk for antidepressant withdrawal?
Paroxetine
Venlafaxine
Which tricyclics are the highest and lowest risk for overdose?
Highest - dosulepin and amitriptyline
Lowest - Lofepramine
What are the category 1 Antiepileptics? (4)
Phenytoin
Carbamazepine
Phenobarbital
Primodone
What are the category 2 Antiepileptics? (6)
Valproate
Oxcarbazepine
Lamotrigine
Perampanel
Clobazam
Clonazepam
Topiramate
Zonisamide
What are the category 3 Antiepileptics? (8)
Levetiracetam
Lacosamide
Tiagabine
Gabapentin
Pregabalin
Brivaracetam
Ethosuximide
Vigabatrin
How do you withdraw multiple Antiepileptics?
One at a time
What drugs have anticholinergic properties?
Mnemonic: HADES and Persephone get A BUS.
HADES + P - have anti (think evil gods so people will be Anti- HADES+P)
Antihistamines
Antiarrhythmics
Antidiarrhoeals/Antidepressants
Antiemetics
Antispasmodics
Antiparkinsons/Antipsychotics
A BUS - non-anti
Atropine
Bronchodilators
Urinary drugs
Skeletal Muscle Relaxants
