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GPhC Exam > Central Nervous System > Flashcards

Central Nervous System Flashcards

1
Q

Migraine symptoms

A

unilateral, pulsating, maybe NV, photophobia, phonophobia, aura (comes before headache)

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2
Q

Aura symptoms

A
  • visual (zigzag, flickering, lights, spots, lines)
  • sensory (pins&needles)
  • dysphagia
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3
Q

Lifestyle advice for migraines

A
  • maintain hydration
  • sleep & exercise
  • avoid chocolate and wine
  • relax after stress
  • headache diary for triggers
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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
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5
Q

Migraine prophylaxis

A
  1. propranolol –> metoprolol or nadalol
  2. amitriptyline effective but sedating
  3. valproate, pizotifen, botox - specialist use
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6
Q

What is a cluster headache

A

intense unilateral pain in/around one eye

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7
Q

Acute treatment of cluster headache

A
  1. subcutaneous sumatriptan
  2. nasal suma/zolmi-triptan if unavailable
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8
Q

Prophylactic treatment of cluster headache

A

verapamil, lithium, prednisolone, ergotamine tartare (rare)

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9
Q

What is trigeminal neuralgia

A
  • severe facial pain
  • like electric shock in jaw, teeth or gums
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10
Q

Trigeminal neuralgia treatment

A
  • carbamazepine
  • send to A&E
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11
Q

What is a tension headache

A

bilateral throbbing pain like tight band around head

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12
Q

Tension headache treatment

A

paracetamol/ibuprofen

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13
Q

What is a subarachnoid hemorrhage

A
  • sudden sharp pain at back of neck
  • send to A&E
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14
Q

Parkinsons general treatment mechanism

A

increase dopamine to alleviate symptoms

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15
Q

Parkinsons motor effects treatment

A

levodopa + carbidopa/benserazide

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16
Q

Parkinsons - treatment for motor effects that don’t affect QoL

A
  1. levodopa + carbidopa/benserazide
  2. non-ergot derived dopamine receptor agonist (pramiprexole, ropinorole, rotigotine)
  3. MAOB inhibitors (rasagiline, selegline)
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17
Q

Parkinsons - treatment for dyskinesia/motor fluctuations

A
  1. non-ergot derived dopamine receptor agonist is (pramiprexole, ropinorole, rotigotine) OR MAOBi (rasagiline, selegiline)
  2. COMT inhibitor (entecapone, talcapone)
  3. ergot-derived dopamine receptor agonist (cabergoline, bromocriptine)
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18
Q

What is the MoA of carbidopa/benserazide

A

stops breakdown of levodopa
- administered together to reduce side effects of levodopa

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19
Q

Side effects of levodopa and carbidopa/benserazide

A
  • impulse disorders - gambling, eating, sex
  • sudden onset sleep - modafinil
  • red urine
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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
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21
Q

MAOB inhibitors side effects

A
  • rasagiline, selegiline
  • hypertensive crisis with phenylephedrine/pseudoephedrine, tyramine (cheese, salami, tofu, marmite, yeast)
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22
Q

COMT inhibitors side effects

A
  • increase sympathetic side effects = increase in CVD
  • tachycardia, fast breathing
  • entecapone = red/brown urine
  • talcapone = hepatotoxic
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23
Q

Ergot - derived dopamine receptor agonists side effects

A
  • bromocriptine, cabergoline
  • pulmonary reaction - SOB, chest pain, cough
  • pericardial reaction - chest pain
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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
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25
Q

Name the 4 types of dementia

A
  1. alzheimers
  2. vascular
  3. lewy body
  4. frontotemporal
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26
Q

Dementia general treatment

A

increase acetylcholine to alleviate symptoms

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27
Q

Mild to moderate dementia treatment

A
  • acetylcholine esterase inhibitors - act on parasympathetic pathway
  • Donepezil - ON, neuroleptic malignant syndrome
  • Rivastigmine - GI effects (reduced in transdermal)
  • galantamine - steven johnson syndrome
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28
Q

Moderate to severe dementia treatment

A
  • memantine - NMDA receptor antagonists
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29
Q

Aggravation with dementia treatment

A

benzodiazepines or antipsychotics

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30
Q

Side effects of increased acetylcholine with acetylcholine esterase inhibitors

A
  • 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
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31
Q

Focal seizures treatment

A
  1. lamotrigine or levetiracetam
  2. carbamazepine, oxcarbazepine, zonisamide
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32
Q

Absence seizure alone treatment

A
  1. ethosuximide
  2. valproate (avoid in child bearing PPP)
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33
Q

Absence seizure + other seizure OR tonic-clonic treatment

A
  1. valproate
  2. Lamotrigine –> levetiracetam
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34
Q

Myoclonic seizure treatment

A
  1. valproate
  2. levetiracetam
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35
Q

All other seizures treatment

A
  1. valproate
  2. lamotrigine
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36
Q

Status epilepticus treatment

A
  • 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
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37
Q

Category 1 epilepsy meds (brand specific)

A
  • carbamazepine
  • phenytoin
  • primidone
  • phenobarbital
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38
Q

Category 2 epilepsy meds (brand specific recommended)

A
  • lamotrigine
  • valproate
  • clobazam
  • topiramate
  • clonazepam
  • oxcarbazepine
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39
Q

Category 3 epilepsy meds (no specific requirements)

A
  • levetiracetam
  • gabapentin
  • pregabalin
  • ethosuximide
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40
Q

Driving rules with epilepsy

A
  • 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
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41
Q

Pregnancy information with epilepsy

A
  • 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
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42
Q

Breast feeding with epilepsy

A
  • 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
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43
Q

Epilepsy medications interactions

A
  • 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
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44
Q

Carbamazepine, phenytoin and valproate side effects

A
  • depression + suicide
  • hepatotoxicity
  • hypersensitivity
  • blood dyscrasia
  • vit D deficiency (bone pain)
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45
Q

Carbamazepine side effects

A
  • hyponatraemia
  • oedema
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46
Q

Phenytoin side effects

A
  • coarsening appearance
  • facial hair
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47
Q

Valproate side effects

A
  • pancreatitis
  • teratogenic (ensure PPP)
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48
Q

Which anti-epileptics may cause hypersensitivity reactions

A
  • carbamazepine
  • phenobarbital
  • phenytoin
  • primidone
  • lamotrigine
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49
Q

Which anti-epileptics cause skin rash

A
  • lamotrigine (steven johnson syndrome)
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50
Q

Which anti-epileptics cause blood dyscrasias

A
  • carbamazepine
  • valproate
  • ethosuxamide
  • topiramate
  • phenytoin
  • lamotrigine
  • zonisamide
  • C.VET.PLZ
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51
Q

Which anti-epileptics cause eye disorders

A
  • vigabatrin (reduced visual field)
  • topiramate (secondary glaucoma)
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52
Q

Which anti-epileptics cause encephalopathy

A
  • vigabatrin
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53
Q

Which anti-epileptics cause respiratory depression

A
  • gabapentin
  • pregabalin
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54
Q

What is bipolar disorder

A
  • fluctuation between manic and depression
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55
Q

Bipolar acute treatment

A
  1. benzodiazepines
  2. antipsychotics ( quetiapine, olanzapine, risperidone)(2nd gen)
  3. lithium or valproate
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56
Q

Bipolar prophylaxis treatment

A

carbamazepine, valproate or lithium

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57
Q

Lithium therapeutic range

A
  • 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
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58
Q

Lithium toxicity symptoms

A
  • Renal impairment
  • EPS - tremors
  • Visual disturbances - blurred vision
  • Nervous system disorder - confusion and restlessness
  • GI disorders - DV
  • REVNG
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59
Q

Lithium side effects

A
  • thyroid disorder
  • nephrotoxicity
  • rhabdomyolysis
  • QT prolongation
  • benign intercranial hypertension - vertigo, headache
  • 1st trimester = teratogenic
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60
Q

Lithium interactions

A
  • 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
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61
Q

carbamazepine therapeutic range

A

4 - 12 mg/L

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62
Q

carbamazepine toxicity symptoms

A
  • Hyponatraemia
  • Ataxia
  • Nystagmus
  • Drowsiness
  • Blurred vision
  • Arrhythmias
  • GI disturbances
  • HANDBAG
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63
Q

Phenytoin therapeutic range

A

10 - 20 mg/L

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64
Q

Phenytoin toxicity symptoms

A
  • Slurred speech
  • Nystagmus
  • Ataxia
  • Confusion
  • Hyperglycaemia
  • Double vision
  • SNACHD
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65
Q

1st generation antipsychotics

A
  • Thioxanthenes
  • Butyrophenones
  • Group 1, 2, 3 phenothiazines
  • Others = primazide, sulpride
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66
Q

Thioxanthenes information

A
  • flupentixol, zuclopenthixol
  • moderate sedation
  • antimuscarinic effects
  • EPS
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67
Q

Butyrophenones information

A
  • benperidol, haloperidol
  • moderate sedation
  • high EPS
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68
Q

Group 1 phenothiazines information

A
  • chlorpromazine, levomepromazine, promazine
  • most sedation
  • moderate antimuscarinic
  • EPS
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69
Q

Group 2 phenothiazines information

A
  • pericyazine
  • moderate sedation
  • least EPS
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70
Q

Group 3 phenothiazines information

A
  • fluphenazine, prochlorperazine, trifluoperazine
  • moderate sedation
  • high EPS
71
Q

Primazide and sulpride information

A
  • reduced sedation
  • antimuscarinic effects
  • EPS
72
Q

Name second generation antipsychotics

A
  • amisulpride
  • aripiprazole - least side effects
  • clozapine
  • olanzapine
  • quetiapine
  • risperidone
73
Q

Schizophrenia positive symptoms

A
  • delusions
  • hallucinations
  • disorganisation
74
Q

Schizophrenia negative symptoms

A
  • social withdrawal
  • neglect
  • poor hygiene
  • depression
75
Q

Antipsychotics side effects

A
  • 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
Q

Which antipsychotics cause CV side effects

A
  • QT prolongation - primazide, haloperidol
77
Q

Which antipsychotics cause hypotension

A
  • clozapine
  • quetiapine
78
Q

Which antipsychotics cause hyperglycaemia

A
  • clozapine
  • risperidone
  • olanzapine
  • quetiapine
  • CiROQ - vodka - sweet
79
Q

Which antipsychotics cause weight gain

A
  • olanzapine
  • clozapine
  • WOC
80
Q

Antipsychotics monitoring

A
  • 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
Q

Clozapine indication

A
  • resistant schizophrenia
  • only when 2 + antipsychotics including one 2nd gen has been used for 6-8 weeks each
82
Q

Clozapine missed doses

A

if missed 2 + doses - specialist reinitiation

83
Q

Clozapine monitoring

A
  • 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
Q

Clozapine side effects

A
  • 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
Q

Mild depression treatment

A

Cognitive behavioural therapy

86
Q

Moderate to severe depression treatment

A
  • 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
Q

Depression treatment pathway

A
  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
Q

Serotonin syndrome

A
  • 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
Q

MAO inhibitors wash out period

A
  • 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
Q

Name MAO inhibitors

A
  • isocarboxazid
  • phenelzine
  • selegiline
  • tranylcypromine
91
Q

SSRIs key information

A
  • better tolerated and safer in over dose
  • sertraline safest in patients with cardiac events
  • fluoxetine for ages 5-17 yrs
92
Q

SSRIs side effects

A
  • GI
  • appetite change
  • sexual dysfunction
  • risk of bleed (offer PPI, avoid NSAIDs, warfarin, DOACs, antiplatelets)
  • insomnia (take in morning)
  • QT prolongation (escitalopram + citalopram)
93
Q

SSRIs interactions

A
  • 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
Q

Sedating TCAs

A
  • better for agitated/anxious patients
  • amitriptyline
  • clomipramine
  • dosulepin
  • trazodone
95
Q

Less sedating TCAs

A
  • for withdrawn/apethetic patients
  • imipramine
  • lofepramine
  • nortriptyline
96
Q

TCAs indication

A

depression and for sedating/non-sedating effects

97
Q

TCAs side effects

A
  • 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
Q

TCAs interactions

A
  • CYP inhibitors - avoid grapefruit, increase plasma concs
  • CYP inducers - reduce effectiveness
  • QT prolongation - amiodarone, sotalol, quinolones
  • anti-muscarinics
  • anti-hypertensives
  • serotonin syndroms
99
Q

MAO inhibitors interactions

A
  • specialist use only
  • causes hepatotoxicity (phenelzine & isocarboxazid)
  • hypertensive crisis - pseudoephedrine/ephedrine
  • avoid tyramine rich foods
  • tranylcypromine (MAOI) + clomipramine (TCA) = FATAL
100
Q

Anxiety acute treatment

A

benzodiazepines e.g. diazepam - short term use at lowest dose e.g. 3-4 tabs

101
Q

Anxiety chronic treatment

A
  1. SSRIs - sertraline, citalopram, fluoxetine, escitalopram
  2. propranolol - alleviates physical symptoms e.g. panic = increased BP and HR
102
Q

Name long acting benzodiazepines

A
  • diazepam
  • alprazolam
  • chlordiazepoxide
  • clobazam
103
Q

Name short acting benzodiazepines

A
  • lorazepam
  • oxazepam
104
Q

Short acting vs long acting benzodiazepines

A
  • 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
Q

Benzodiazepines paradoxical effects

A
  • aggression
  • hostility
  • talkative
  • anxious
  • excited
  • treat with flumazenil
106
Q

Benzodiazepines - sedation increased with

A
  • alcohol
  • CNS depressants
  • CYP inhibitors
  • avoid concomitant use
107
Q

Legal driving limit with which benzodiazepines

A
  • Clonazepam
  • Oxazepam
  • Lorazepam
  • Diazepam
  • Flunitrazepam
  • Temazepam
  • COLDFT
108
Q

Benzodiazepines overdose treatment

A

flumazenil

109
Q

Benzodiazepines withdrawal initiation

A
  • 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
Q

What is transient insomnia

A
  • external factors e.g. noise, shift work, jet lag
  • rapidly eliminated hypnotic used for 1-2 doses only
111
Q

What is short-term insomnia

A
  • emotional problem or serious medical illness
  • hypnotic useful, no more than 3 wks, prefer 1 wk
112
Q

What is chronic insomnia

A
  • anxiety, depression, alcohol/drug abuse - treat underlying cause
113
Q

Long acting benzodiazepines for sleep disorders

A
  • nitrazepam, diazepam, flurazepam
  • hangover effect next day
  • sleep maintenance
114
Q

Short acting benzodiazepines for sleep disorders

A
  • lorazepam, loprazolam, lormetazepam, temazepam
  • no/little hangover effect
  • for sleep onset
  • increase risk of withdrawal symptoms
115
Q

Z-hypnotics key information

A
  • Zolpidem, zopiclone
  • increases GABA = CNS depression
  • dependency within 3-14 days of use
  • take intermittently e.g. every other night
  • 4 wks max
116
Q

Z-hypnotics side effects

A
  • benzos and Z-drugs - avoid in elderly - risk of falls and injury
  • paradoxical side effects on toxicity
  • drowsiness
  • dependence
117
Q

ADHD treatment for 5yrs +

A
  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
Q

ADHD treatment for adults

A
  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
Q

methylphenidate MoA

A

CNS stimulant

120
Q

methylphenidate side effects

A
  • increase BP, tachycardia, arrhythmias
  • behaviour/mood change, drowsiness, sleep disorders
  • reduced appetite, growth retardation, weight loss
121
Q

methylphenidate monitoring

A
  • pulse, BP, psychiatric symptoms, appetite
  • weight + height at initiation, following dose adjustments, then 6 monthly
122
Q

Lisdexamfetamine/dexamfetamine side effects

A
  • increase BP, tachycardia, arrhythmias
  • behaviour/mood change, drowsiness, sleep disorders
  • reduced appetite, growth retardation, weight loss
123
Q

lisdexamfetmine/dexamfetamine monitoring

A
  • pulse, BP, psychiatric symptoms, appetite
  • weight + height at initiation, following dose adjustments, then 6 monthly
124
Q

lisdexamfetamine/dexamfetamine overdose

A
  • wakefulness, excessive activity, paranoia, hallucinations, hypertension
  • THEN - exhaustion, convulsions, hyperthermia, coma
125
Q

Mild alcohol dependence treatment

A

dont need assisted withdrawal

126
Q

Moderate alcohol dependence treatment

A
  • treated in community unless high risk of developing withdrawal seizures/delirium
127
Q

Severe alcohol dependence treatment

A
  • withdrawal as an inpatient
128
Q

Treatment of alcohol withdrawal

A
  • 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
Q

Nicotine dependence treatment

A
  • 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
Q

Opioid dependence treatment key information

A
  • 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
Q

Buprenorphine for opioid dependence

A
  • less sedating than methadone
  • milder withdrawal symptoms
  • lower risk of overdose
  • suboxone (naloxone with buprenorphine) if risk of injecting
132
Q

Methadone for opioid dependence

A
  • QT prolongation
  • more sedating, more withdrawals
  • carefully titrated to patients need to exact mL
133
Q

What is used for mild pain management

A
  • non-opioids = paracetamol, NSAIDs, aspirin
134
Q

What is used for mild to moderate pain management

A
  • weak opioids = codeine, dihydrocodeine
  • moderate opioids = tramadol (reduced seizure threshold, serotonin syndrome, increase risk of bleed, psychiatric disorder)
135
Q

What is used for moderate to severe pain management

A
  • strong opioids = morphine, oxycodone, methadone, buprenorphine, fentanyl
136
Q

Codeine key information

A
  • 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
Q

Opiate side effects

A
  • act on mu - pathway =
  • dry mouth
  • constipation
  • CNS depression
  • NV
  • hypotension
  • miosis (pupil constriction)
138
Q

Strong opioids key information

A
  • 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
Q

Opioid doses

A
  • 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
Q

Neuropathic pain treatment options

A
  • TCAs = amitriptyline, nortriptyline
  • Anti-epileptics = gabapentin, pregabalin - 1 wk withdrawal regimen
  • opiates = tramadol, morphine, oxycodone
  • topical localised = lidocaine, capsaicin
141
Q

What is used for prophylaxis and treatment of Nausea and vomiting

A

antihistamines (cyclizine and promethazine) or phenothiazines (prochlorperazine)

142
Q

Nausea and vomiting in pregnancy

A

avoid drug therapy, use promethazine if needed

143
Q

Nausea and vomiting post-op

A

5HT3 receptor antagonist (ondansetron) or dexamethasone

144
Q

Nausea and vomiting pre-op anticipatory

A

lorazepam

145
Q

Nausea and vomiting motion sickness

A

hyoscine hydrobromide

146
Q

Nausea and vomiting Parkinson’s

A

domperidone

147
Q

Nausea and vomiting chemo-induced

A

ondansetron

148
Q

Domperidone key information

A
  • 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
Q

Metoclopramide key information

A
  • causes EPS - don’t use in Parkinson’s
  • 10mg TDS
  • max use - 5 days
  • min age - 18 years
150
Q

How often should lithium monitoring happen if the patient is stabilised on lithium

A

3 monthly for 1 year then 6 monthly

151
Q

Patient has PD, new dementia, which dementia treatment should be prescribed

A

Rivastigmine

152
Q

Over how many weeks should clozapine dose be reduced

A

over 1-2 weeks

153
Q

Name a group 2 drug under section 4 of driving road traffic act

A

amfetamine

154
Q

Name a drug used for migraine prophylaxis that causes weight gain

A

pizotifen

155
Q

Which CNS drug can also be used for nocturnal enuresis in children

A

imipramine

156
Q

Lithium counselling points

A
  • 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
Q

Which drug is used for short-term relief of severe anxiety

A

Lorazepam

158
Q

Which drug is used for conscious sedation for dental procedures 30-60 minutes before the procedure

A

temazepam

159
Q

What is apomorphine

A
  • a potent dopamine-receptor agonist for advanced Parkinson’s for ‘off’ periods
  • patients are taught to self administer SC
160
Q

Rivastigmine licensed use

A

BD orally

161
Q

Name an atypical antipsychotic

A

clozapine

162
Q

Methadone and fludrocortisone interaction

A

increased risk of QT interval prolongation - AVOID

163
Q

Phenytoin target level for a 2 year old

A

6-15mg/L

164
Q

Describe symptoms of neuroleptic malignant syndrome

A
  • hyperthermia
  • fluctuating levels of consciousness
  • muscle rigidity
  • autonomic dysfunction with pallor
  • tachycardia
  • labile BP
  • sweating
  • urinary incontinence
165
Q

describe symptoms of hepatotoxicity

A
  • vomiting
  • abdominal pain
  • anorexia
  • jaundice
  • seek immediate medical attention
166
Q

Lithium and ibuprofen interaction

A

increased risk of lithium toxicity = diarrhoea, vomiting, drowsiness, muscle twitching

167
Q

Why would depot injections be used in psychosis/schizophrenia patients

A

to improve adherence

168
Q

Describe symptoms of serotonin syndrome

A
  • tremors
  • diarrhoea
  • agitation
  • anxiety
  • tachycardia
169
Q

Drug adjustments in suspected serotonin syndrome

A

stop e.g. venlafaxine and lithium and make urgent appointment with GP or go to A&E

170
Q

What are the withdrawal symptoms of benzodiazepines

A
  • insomnia
  • increased anxiety
  • tinnitus
  • tremors
  • perceptual disorders
  • reduced appetite
  • weight loss
171
Q

Tolcapone side effects

A
  • reduced appetite
  • chest pain
  • constipation
  • diarrhoea
  • dry mouth
  • confusion
  • GI discomfort
  • hallucination
  • headache
  • urine discolouration
  • NOT a dopamine receptor agonist
172
Q

Myoclonic seizure in children treatment

A
  1. sodium valproate
  2. levetiracetam
  3. topiramate
173
Q

Name an anti-epileptic with a long half-life

A

perampanel

GPhC Exam (22 decks)

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