Central Nervous System Flashcards
1
Q
Migraine symptoms
A
unilateral, pulsating, maybe NV, photophobia, phonophobia, aura (comes before headache)
2
Q
Aura symptoms
A
- visual (zigzag, flickering, lights, spots, lines)
- sensory (pins&needles)
- dysphagia
3
Q
Lifestyle advice for migraines
A
- maintain hydration
- sleep & exercise
- avoid chocolate and wine
- relax after stress
- headache diary for triggers
4
Q
Migraine acute treatment
A
- aspirin, ibuprofen, 5HT1-receptor agonist (triptans, sumatriptan favourable)
- take as soon as you know migraine is developing
- with aura = triptan at start of headache
- repeat triptan after 2 hours (4 hours if naratriptan) if response to 1st dose
- triptans constrict vessels so avoid in CVD
- soluble paracetamol = faster acting, use if can’t use others
- antiemetics = metoclopramide or prochlorperazine
5
Q
Migraine prophylaxis
A
- propranolol –> metoprolol or nadalol
- amitriptyline effective but sedating
- valproate, pizotifen, botox - specialist use
6
Q
What is a cluster headache
A
intense unilateral pain in/around one eye
7
Q
Acute treatment of cluster headache
A
- subcutaneous sumatriptan
- nasal suma/zolmi-triptan if unavailable
8
Q
Prophylactic treatment of cluster headache
A
verapamil, lithium, prednisolone, ergotamine tartare (rare)
9
Q
What is trigeminal neuralgia
A
- severe facial pain
- like electric shock in jaw, teeth or gums
10
Q
Trigeminal neuralgia treatment
A
- carbamazepine
- send to A&E
11
Q
What is a tension headache
A
bilateral throbbing pain like tight band around head
12
Q
Tension headache treatment
A
paracetamol/ibuprofen
13
Q
What is a subarachnoid hemorrhage
A
- sudden sharp pain at back of neck
- send to A&E
14
Q
Parkinsons general treatment mechanism
A
increase dopamine to alleviate symptoms
15
Q
Parkinsons motor effects treatment
A
levodopa + carbidopa/benserazide
16
Q
Parkinsons - treatment for motor effects that don’t affect QoL
A
- levodopa + carbidopa/benserazide
- non-ergot derived dopamine receptor agonist (pramiprexole, ropinorole, rotigotine)
- MAOB inhibitors (rasagiline, selegline)
17
Q
Parkinsons - treatment for dyskinesia/motor fluctuations
A
- non-ergot derived dopamine receptor agonist is (pramiprexole, ropinorole, rotigotine) OR MAOBi (rasagiline, selegiline)
- COMT inhibitor (entecapone, talcapone)
- ergot-derived dopamine receptor agonist (cabergoline, bromocriptine)
18
Q
What is the MoA of carbidopa/benserazide
A
stops breakdown of levodopa
- administered together to reduce side effects of levodopa
19
Q
Side effects of levodopa and carbidopa/benserazide
A
- impulse disorders - gambling, eating, sex
- sudden onset sleep - modafinil
- red urine
20
Q
Non - ergot derived dopamine receptor agonists side effects
A
- pramiprexole, ropinorole, rotigotine
- impulse disorders - gambling, eating, sex
- sudden onset sleep - modafinil
- hypotension - midodrine
21
Q
MAOB inhibitors side effects
A
- rasagiline, selegiline
- hypertensive crisis with phenylephedrine/pseudoephedrine, tyramine (cheese, salami, tofu, marmite, yeast)
22
Q
COMT inhibitors side effects
A
- increase sympathetic side effects = increase in CVD
- tachycardia, fast breathing
- entecapone = red/brown urine
- talcapone = hepatotoxic
23
Q
Ergot - derived dopamine receptor agonists side effects
A
- bromocriptine, cabergoline
- pulmonary reaction - SOB, chest pain, cough
- pericardial reaction - chest pain
24
Q
Parkinsons medication key points
A
- don’t withdraw abruptly
- ‘off periods’ (meds wearing off) = MR preps
- nocturnal akinesia = 1. levodopa OR oral dopamine receptor agonists
2. rotigotine
25
Name the 4 types of dementia
1. alzheimers
2. vascular
3. lewy body
4. frontotemporal
26
Dementia general treatment
increase acetylcholine to alleviate symptoms
27
Mild to moderate dementia treatment
- acetylcholine esterase inhibitors - act on parasympathetic pathway
- Donepezil - ON, neuroleptic malignant syndrome
- Rivastigmine - GI effects (reduced in transdermal)
- galantamine - steven johnson syndrome
28
Moderate to severe dementia treatment
- memantine - NMDA receptor antagonists
29
Aggravation with dementia treatment
benzodiazepines or antipsychotics
30
Side effects of increased acetylcholine with acetylcholine esterase inhibitors
- parasympathetic side effects (rest & digest)
- DUMBBELS
- Diarrhoea
- Urinary incontinence
- Muscle weakness
- Bradycardia
- Bronchospasms
- Emesis
- Lacrimation
- Salivation
- stop tx, tx dehydration, amend dose if required and restart
31
Focal seizures treatment
1. lamotrigine or levetiracetam
2. carbamazepine, oxcarbazepine, zonisamide
32
Absence seizure alone treatment
1. ethosuximide
2. valproate (avoid in child bearing PPP)
33
Absence seizure + other seizure OR tonic-clonic treatment
1. valproate
2. Lamotrigine --> levetiracetam
34
Myoclonic seizure treatment
1. valproate
2. levetiracetam
35
All other seizures treatment
1. valproate
2. lamotrigine
36
Status epilepticus treatment
- seizures lasting linger than 5 minutes
1. IV lorazepam
1. buccal midazolam or rectal diazepam - community
2. 2nd dose after 5-10 mins
3. levetiracetam, phenytoin OR valproate
4. levetiracetam, phenytoin OR valproate - diff to 3.
5. phenobarbital OR general anaesthesia
37
Category 1 epilepsy meds (brand specific)
- carbamazepine
- phenytoin
- primidone
- phenobarbital
38
Category 2 epilepsy meds (brand specific recommended)
- lamotrigine
- valproate
- clobazam
- topiramate
- clonazepam
- oxcarbazepine
39
Category 3 epilepsy meds (no specific requirements)
- levetiracetam
- gabapentin
- pregabalin
- ethosuximide
40
Driving rules with epilepsy
- epileptic fit whilst driving = stop and tell DVLA
- 1st unprovoked/single isolated = banned for 6 months
- established epilepsy - 1 year fit free before driving again
- no driving for 6 months after last dose/change
- seizure due to change in meds = 1 year ban - reinstated after 6 months if meds resumed and no seizure
41
Pregnancy information with epilepsy
- folic acid = to reduce risk of NTD in 1s trimester
- vit K injection at birth = to reduce risk of neonatal haemorrhage
- most risk = valproate (PPP)
- topiramate = cleft palate
42
Breast feeding with epilepsy
- encouraged to breast feed
- if combo therapy/risk factors e.g. premature = specialist advice
- high presence in milk = primidone, ethosuximide, lamotrigine, zonisamide (PELZ)
- risk of drowsiness = primidone, phenobarbital, benzodiazepines
- withdrawal effects if mother suddenly stops breastfeeding = phenobarbital, primidone, benzodiazepines, lamotrigine
43
Epilepsy medications interactions
- hepatotoxicity - carbamazepine/phenytoin/valproate + amiodarone, itraconazole, macrolides, alcohol
- CYP inducers = carbamazepine, phenytoin, phenobarbital
- CYP inhibitors = valproate
- lowers seizure threshold = tramadol, theophylline, quinolones
- carbamazepine = hyponatraemia - SSRIs, diuretics
- phenytoin - antifolates = (MTX, trimethoprim) = blood dyscrasias
44
Carbamazepine, phenytoin and valproate side effects
- depression + suicide
- hepatotoxicity
- hypersensitivity
- blood dyscrasia
- vit D deficiency (bone pain)
45
Carbamazepine side effects
- hyponatraemia
- oedema
46
Phenytoin side effects
- coarsening appearance
- facial hair
47
Valproate side effects
- pancreatitis
- teratogenic (ensure PPP)
48
Which anti-epileptics may cause hypersensitivity reactions
- carbamazepine
- phenobarbital
- phenytoin
- primidone
- lamotrigine
49
Which anti-epileptics cause skin rash
- lamotrigine (steven johnson syndrome)
50
Which anti-epileptics cause blood dyscrasias
- carbamazepine
- valproate
- ethosuxamide
- topiramate
- phenytoin
- lamotrigine
- zonisamide
- C.VET.PLZ
51
Which anti-epileptics cause eye disorders
- vigabatrin (reduced visual field)
- topiramate (secondary glaucoma)
52
Which anti-epileptics cause encephalopathy
- vigabatrin
53
Which anti-epileptics cause respiratory depression
- gabapentin
- pregabalin
54
What is bipolar disorder
- fluctuation between manic and depression
55
Bipolar acute treatment
1. benzodiazepines
2. antipsychotics ( quetiapine, olanzapine, risperidone)(2nd gen)
3. lithium or valproate
56
Bipolar prophylaxis treatment
carbamazepine, valproate or lithium
57
Lithium therapeutic range
- maintenance: 0.4 - 1 mmol/L
- acute: 0.8 - 1 mmol/L
- levels 12 hours after dose, weekly until stable, then 3 monthly for 1 year, then 6 monthly
58
Lithium toxicity symptoms
- Renal impairment
- EPS - tremors
- Visual disturbances - blurred vision
- Nervous system disorder - confusion and restlessness
- GI disorders - DV
- REVNG
59
Lithium side effects
- thyroid disorder
- nephrotoxicity
- rhabdomyolysis
- QT prolongation
- benign intercranial hypertension - vertigo, headache
- 1st trimester = teratogenic
60
Lithium interactions
- diuretics, SSRIs = hyponatraemia
- salt imbalance
- SSRIs, tramadol = serotonin syndrome
- antipsychotics, some anti-emetics = EPS
- macrolides, RLCCBs = QT prolongation
- really cleared drugs, NSAIDs = increased risk of toxicity
- reduced seizure threshold
- hypokalaemia
61
carbamazepine therapeutic range
4 - 12 mg/L
62
carbamazepine toxicity symptoms
- Hyponatraemia
- Ataxia
- Nystagmus
- Drowsiness
- Blurred vision
- Arrhythmias
- GI disturbances
- HANDBAG
63
Phenytoin therapeutic range
10 - 20 mg/L
64
Phenytoin toxicity symptoms
- Slurred speech
- Nystagmus
- Ataxia
- Confusion
- Hyperglycaemia
- Double vision
- SNACHD
65
1st generation antipsychotics
- Thioxanthenes
- Butyrophenones
- Group 1, 2, 3 phenothiazines
- Others = primazide, sulpride
66
Thioxanthenes information
- flupentixol, zuclopenthixol
- moderate sedation
- antimuscarinic effects
- EPS
67
Butyrophenones information
- benperidol, haloperidol
- moderate sedation
- high EPS
68
Group 1 phenothiazines information
- chlorpromazine, levomepromazine, promazine
- most sedation
- moderate antimuscarinic
- EPS
69
Group 2 phenothiazines information
- pericyazine
- moderate sedation
- least EPS
70
Group 3 phenothiazines information
- fluphenazine, prochlorperazine, trifluoperazine
- moderate sedation
- high EPS
71
Primazide and sulpride information
- reduced sedation
- antimuscarinic effects
- EPS
72
Name second generation antipsychotics
- amisulpride
- aripiprazole - least side effects
- clozapine
- olanzapine
- quetiapine
- risperidone
73
Schizophrenia positive symptoms
- delusions
- hallucinations
- disorganisation
74
Schizophrenia negative symptoms
- social withdrawal
- neglect
- poor hygiene
- depression
75
Antipsychotics side effects
- EPS - most in group 3 phenothiazines and butyrophenones, less in 2nd gen
- EPS - avoid in PD
- hyperprolactinaemia - least in aripiprazole
- sexual dysfunction - all antipsychotics
- neuroleptic malignant syndrome - stop tx -> bromocriptine -> should resolve 5-7 days
76
Which antipsychotics cause CV side effects
- QT prolongation - primazide, haloperidol
77
Which antipsychotics cause hypotension
- clozapine
- quetiapine
78
Which antipsychotics cause hyperglycaemia
- clozapine
- risperidone
- olanzapine
- quetiapine
- CiROQ - vodka - sweet
79
Which antipsychotics cause weight gain
- olanzapine
- clozapine
- WOC
80
Antipsychotics monitoring
- weight - weekly for 6 wks, at 12 wks, at 1 year, annually
- FBG, HbA1c, blood lipid concs, BP - at 12 wks, 1 yr, annually
- ECG - before initiation
- FBC, U&Es, LFTs - annually
81
Clozapine indication
- resistant schizophrenia
- only when 2 + antipsychotics including one 2nd gen has been used for 6-8 weeks each
82
Clozapine missed doses
if missed 2 + doses - specialist reinitiation
83
Clozapine monitoring
- monitor leucocyte and differential blood counts:
- weekly for 18 weeks
- fortnightly until one year later (further 34 weeks)
- monthly until stopped
- 1 month after stopping
84
Clozapine side effects
- Myocarditis and cardiomyopathy - report and stop if tachycardia
- Agranulocytosis and neutropenia - monitor leucocytes and differential blood counts
- GI disturbances - report and stop on constipation - intestinal block - refer to A&E
85
Mild depression treatment
Cognitive behavioural therapy
86
Moderate to severe depression treatment
- antidepressants
- may feel worse in the first 1-2 weeks
- take for 4 weeks (6wks elderly) before deemed ineffective
- take for 6 months after remission, 1 year elderly, 2 years in recurrent
87
Depression treatment pathway
1. SSRIs (<17yrs, >5yrs = fluoxetine)
2. increase dose, change SSRI
3. TCA or venlafaxine (severe)
4. MAOI - specialist - tyramine interaction - not cost effective
5. another class e.g. lithium or antipsychotics
- severe refractory depression = electroconclusive therapy
88
Serotonin syndrome
- cognitive effects = headache, agitation, hypomania, coma, confusion
- autonomic effects = sweating, hyperthermia, nausea, diarrhoea
- neuromuscular excitation = myoclonus, tremor, teeth grinding
- caused by: SSRIs, TCAs, MAOI, triptans, tramadol, lithium
89
MAO inhibitors wash out period
- don't start anti-depressants for 2 wks after MAOi (3 wks with clomipramine or imipramine)
- don't start MAOi until:
- 2 wks after previous MAOI stopped (0wks for moclobemide)
- 1-2 wks after a TCA/other antidepressant stopped
- 1 wk after SSRI/other antidepressant stopped
- 5 wks after fluoxetine stopped
90
Name MAO inhibitors
- isocarboxazid
- phenelzine
- selegiline
- tranylcypromine
91
SSRIs key information
- better tolerated and safer in over dose
- sertraline safest in patients with cardiac events
- fluoxetine for ages 5-17 yrs
92
SSRIs side effects
- GI
- appetite change
- sexual dysfunction
- risk of bleed (offer PPI, avoid NSAIDs, warfarin, DOACs, antiplatelets)
- insomnia (take in morning)
- QT prolongation (escitalopram + citalopram)
93
SSRIs interactions
- CYP inhibitors - avoid grapefruit, increase plasma conc
- CYP inducers - reduce effectiveness
- QT prolongation - amiodarone, sotalol, quinolones
- drugs that increase the risk of bleed
- hyponatraemia (carbamazepine, diuretics)
- serotonin syndrome
94
Sedating TCAs
- better for agitated/anxious patients
- amitriptyline
- clomipramine
- dosulepin
- trazodone
95
Less sedating TCAs
- for withdrawn/apethetic patients
- imipramine
- lofepramine
- nortriptyline
96
TCAs indication
depression and for sedating/non-sedating effects
97
TCAs side effects
- amitriptyline and dosulepin = dangerous in overdose - specialist, not recommended for depression
- Cardiac events
- Anti-muscarinics
- Seizures
- Hypotension
- Hallucinations
- CASHH
- dangerous in overdose so prefer SSRIs
98
TCAs interactions
- CYP inhibitors - avoid grapefruit, increase plasma concs
- CYP inducers - reduce effectiveness
- QT prolongation - amiodarone, sotalol, quinolones
- anti-muscarinics
- anti-hypertensives
- serotonin syndroms
99
MAO inhibitors interactions
- specialist use only
- causes hepatotoxicity (phenelzine & isocarboxazid)
- hypertensive crisis - pseudoephedrine/ephedrine
- avoid tyramine rich foods
- tranylcypromine (MAOI) + clomipramine (TCA) = FATAL
100
Anxiety acute treatment
benzodiazepines e.g. diazepam - short term use at lowest dose e.g. 3-4 tabs
101
Anxiety chronic treatment
1. SSRIs - sertraline, citalopram, fluoxetine, escitalopram
2. propranolol - alleviates physical symptoms e.g. panic = increased BP and HR
102
Name long acting benzodiazepines
- diazepam
- alprazolam
- chlordiazepoxide
- clobazam
103
Name short acting benzodiazepines
- lorazepam
- oxazepam
104
Short acting vs long acting benzodiazepines
- both can induce hepatic coma, especially long acting benzodiazepines
- short acting preferred in in hepatic impairment and elderly
- short acting has increased risk of withdrawals (use for 2-4 wks)
105
Benzodiazepines paradoxical effects
- aggression
- hostility
- talkative
- anxious
- excited
- treat with flumazenil
106
Benzodiazepines - sedation increased with
- alcohol
- CNS depressants
- CYP inhibitors
- avoid concomitant use
107
Legal driving limit with which benzodiazepines
- Clonazepam
- Oxazepam
- Lorazepam
- Diazepam
- Flunitrazepam
- Temazepam
- COLDFT
108
Benzodiazepines overdose treatment
flumazenil
109
Benzodiazepines withdrawal initiation
- dependence = anxiety, sweating, weight loss, tremors, reduced appetite
1. convert all benzos to ON dose of diazepam
2. reduce by 1-2mg (1/10th on larger doses) every 2-4wks - only further withdraw if pt has overcome withdrawal symptoms
3. reduce further (by 0.5mg near the end)
110
What is transient insomnia
- external factors e.g. noise, shift work, jet lag
- rapidly eliminated hypnotic used for 1-2 doses only
111
What is short-term insomnia
- emotional problem or serious medical illness
- hypnotic useful, no more than 3 wks, prefer 1 wk
112
What is chronic insomnia
- anxiety, depression, alcohol/drug abuse - treat underlying cause
113
Long acting benzodiazepines for sleep disorders
- nitrazepam, diazepam, flurazepam
- hangover effect next day
- sleep maintenance
114
Short acting benzodiazepines for sleep disorders
- lorazepam, loprazolam, lormetazepam, temazepam
- no/little hangover effect
- for sleep onset
- increase risk of withdrawal symptoms
115
Z-hypnotics key information
- Zolpidem, zopiclone
- increases GABA = CNS depression
- dependency within 3-14 days of use
- take intermittently e.g. every other night
- 4 wks max
116
Z-hypnotics side effects
- benzos and Z-drugs - avoid in elderly - risk of falls and injury
- paradoxical side effects on toxicity
- drowsiness
- dependence
117
ADHD treatment for 5yrs +
1. methylphenidate
2. lisdexamfetamine (if 6wks of 1. at max dose not working)
3. dexamfetamine (if 2. not tolerated for longer duration)
4. atomoxetine or guafacine (if intolerant to above)
118
ADHD treatment for adults
1. methylphenidate OR lisdexamfetamine/dexamfetamine
2. atomoxetine (QT prolongation, hepatotoxicity, suicidal ideation)
- MR preps of all preferred - due to pharmacokinetic profile, convenience & improved adherence - prescribe as brand only
119
methylphenidate MoA
CNS stimulant
120
methylphenidate side effects
- increase BP, tachycardia, arrhythmias
- behaviour/mood change, drowsiness, sleep disorders
- reduced appetite, growth retardation, weight loss
121
methylphenidate monitoring
- pulse, BP, psychiatric symptoms, appetite
- weight + height at initiation, following dose adjustments, then 6 monthly
122
Lisdexamfetamine/dexamfetamine side effects
- increase BP, tachycardia, arrhythmias
- behaviour/mood change, drowsiness, sleep disorders
- reduced appetite, growth retardation, weight loss
123
lisdexamfetmine/dexamfetamine monitoring
- pulse, BP, psychiatric symptoms, appetite
- weight + height at initiation, following dose adjustments, then 6 monthly
124
lisdexamfetamine/dexamfetamine overdose
- wakefulness, excessive activity, paranoia, hallucinations, hypertension
- THEN - exhaustion, convulsions, hyperthermia, coma
125
Mild alcohol dependence treatment
dont need assisted withdrawal
126
Moderate alcohol dependence treatment
- treated in community unless high risk of developing withdrawal seizures/delirium
127
Severe alcohol dependence treatment
- withdrawal as an inpatient
128
Treatment of alcohol withdrawal
- CBT, acamprosate or naltrexone (alternative: disulfram)
- for withdrawal = long-acting benzos e.g. chlordiazepoxide or diazepam (alt: carbamazepine or clomethiazole)
- for delirium = lorazepam
- for wernickes encephalopathy = thiamine (vit B1)
129
Nicotine dependence treatment
- varenicline - avoid in epilepsy, CVD, psychiatric illness
- bupropion - avoid in psychiatric illness, seizures, eating disorders, can cause serotonin syndrome
- NRT - 24 hr patch (16hr in preg or has nightmares) AND short term reliever e.g. lozenges, gum, sublingual tabs, inhalator, nasal spray, oral spray
130
Opioid dependence treatment key information
- FP10MDA (blue) by appropriate prescriber - max 14 days
- 3 or more missed doses - refer back to specialist
- continue throughout pregnancy
- naloxone prescribed if high risk of overdose
131
Buprenorphine for opioid dependence
- less sedating than methadone
- milder withdrawal symptoms
- lower risk of overdose
- suboxone (naloxone with buprenorphine) if risk of injecting
132
Methadone for opioid dependence
- QT prolongation
- more sedating, more withdrawals
- carefully titrated to patients need to exact mL
133
What is used for mild pain management
- non-opioids = paracetamol, NSAIDs, aspirin
134
What is used for mild to moderate pain management
- weak opioids = codeine, dihydrocodeine
- moderate opioids = tramadol (reduced seizure threshold, serotonin syndrome, increase risk of bleed, psychiatric disorder)
135
What is used for moderate to severe pain management
- strong opioids = morphine, oxycodone, methadone, buprenorphine, fentanyl
136
Codeine key information
- 12 + but codeine linctus = 18 +
- don't use in <18 yrs if no tonsils due to sleep apnoea
- avoid in afro-caribbean - ultra-rapid metabolisers = toxicity
- avoid in breastfeeding/pregnancy
137
Opiate side effects
- act on mu - pathway =
- dry mouth
- constipation
- CNS depression
- NV
- hypotension
- miosis (pupil constriction)
138
Strong opioids key information
- prolonged use = hypogonadism, adrenal insufficiency, hyperalgesia
- overdose = naloxone
- avoid in paralytic ileus, respiratory disease, head injury (CNS depression)
- breakthrough pain - 1/6th to 1/10th of daily dose every 24 hours
139
Opioid doses
- increase by 1/2 to 1/3 each day
- reduce by 1/2 to 1/3 each day when switching between opiates to prevent overdose
- oxycodone more potent than morphine = better if reduced quantity required
- patches = no heat, apply to dry, hairless area, rotate sites
- fentanyl = remove immediately if signs of toxicity
140
Neuropathic pain treatment options
- TCAs = amitriptyline, nortriptyline
- Anti-epileptics = gabapentin, pregabalin - 1 wk withdrawal regimen
- opiates = tramadol, morphine, oxycodone
- topical localised = lidocaine, capsaicin
141
What is used for prophylaxis and treatment of Nausea and vomiting
antihistamines (cyclizine and promethazine) or phenothiazines (prochlorperazine)
142
Nausea and vomiting in pregnancy
avoid drug therapy, use promethazine if needed
143
Nausea and vomiting post-op
5HT3 receptor antagonist (ondansetron) or dexamethasone
144
Nausea and vomiting pre-op anticipatory
lorazepam
145
Nausea and vomiting motion sickness
hyoscine hydrobromide
146
Nausea and vomiting Parkinson's
domperidone
147
Nausea and vomiting chemo-induced
ondansetron
148
Domperidone key information
- doesn't cross BBB so suitable in Parkinson's
- 10mg TDS
- max use - 7 days
- min age - 12 years
- patients should be 35kg +
- causes QT prolongation
149
Metoclopramide key information
- causes EPS - don't use in Parkinson's
- 10mg TDS
- max use - 5 days
- min age - 18 years
150
How often should lithium monitoring happen if the patient is stabilised on lithium
3 monthly for 1 year then 6 monthly
151
Patient has PD, new dementia, which dementia treatment should be prescribed
Rivastigmine
152
Over how many weeks should clozapine dose be reduced
over 1-2 weeks
153
Name a group 2 drug under section 4 of driving road traffic act
amfetamine
154
Name a drug used for migraine prophylaxis that causes weight gain
pizotifen
155
Which CNS drug can also be used for nocturnal enuresis in children
imipramine
156
Lithium counselling points
- maintain fluid intake
- report signs of toxicity e.g. polyuria, polydipsia, headache & visual disturbance (benign intracranial hypertension)
- avoid dietary changes that affect sodium levels
- contraception advised for women of child bearing age
157
Which drug is used for short-term relief of severe anxiety
Lorazepam
158
Which drug is used for conscious sedation for dental procedures 30-60 minutes before the procedure
temazepam
159
What is apomorphine
- a potent dopamine-receptor agonist for advanced Parkinson's for 'off' periods
- patients are taught to self administer SC
160
Rivastigmine licensed use
BD orally
161
Name an atypical antipsychotic
clozapine
162
Methadone and fludrocortisone interaction
increased risk of QT interval prolongation - AVOID
163
Phenytoin target level for a 2 year old
6-15mg/L
164
Describe symptoms of neuroleptic malignant syndrome
- hyperthermia
- fluctuating levels of consciousness
- muscle rigidity
- autonomic dysfunction with pallor
- tachycardia
- labile BP
- sweating
- urinary incontinence
165
describe symptoms of hepatotoxicity
- vomiting
- abdominal pain
- anorexia
- jaundice
- seek immediate medical attention
166
Lithium and ibuprofen interaction
increased risk of lithium toxicity = diarrhoea, vomiting, drowsiness, muscle twitching
167
Why would depot injections be used in psychosis/schizophrenia patients
to improve adherence
168
Describe symptoms of serotonin syndrome
- tremors
- diarrhoea
- agitation
- anxiety
- tachycardia
169
Drug adjustments in suspected serotonin syndrome
stop e.g. venlafaxine and lithium and make urgent appointment with GP or go to A&E
170
What are the withdrawal symptoms of benzodiazepines
- insomnia
- increased anxiety
- tinnitus
- tremors
- perceptual disorders
- reduced appetite
- weight loss
171
Tolcapone side effects
- reduced appetite
- chest pain
- constipation
- diarrhoea
- dry mouth
- confusion
- GI discomfort
- hallucination
- headache
- urine discolouration
- NOT a dopamine receptor agonist
172
Myoclonic seizure in children treatment
1. sodium valproate
2. levetiracetam
3. topiramate
173
Name an anti-epileptic with a long half-life
perampanel
