Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BNF > Chapter 4 CNS > Flashcards

Chapter 4 CNS Flashcards

1
Q

Anxiolytics (‘sedatives’) and most hypnotics action?

A

Anxiolytics will induce sleep at night and most hypnotics sedate during the day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Dependence

A

Both physical and psychological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Acute conditions

A

Risk of dependence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Most commonly used anxiolytics and hypnotics

A

Benzodiazepines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which are not recommended?

A

Meprobamate and Barbiturates - they have more side effects and interactions than benzodiazepines and are much more dangerous in overdosage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Benzodiazepines indications:

A

Short term relief (two to four weeks only) of anxiety that is severe, disabling, or causing the patient unacceptable distress

Short term mild anxiety inappropriate

Insomnia only when it is severe, disabling or causing the patient extreme distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Dependence and withdrawal

A

Withdrawal should be gradual because abrupt withdrawal may produce confusion, toxic psychosis, convulsions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Benzodiazepines withdrawal syndrome

A

Anytime up to 3 weeks after stopping a long acting benzodiazepines, but may occur within a day in the case of short acting one

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Before benzodiazepines use:

A

Cause of insomnia should be established and alcohol consumption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Sleep onset insomnia

A

Short acting hypnotic preferred, sedation following day undesirable or elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Long acting hypnotics

A

Poor sleep maintenance - early morning weakening that has daytime effects

When anxiolytics needed during the day

When next day sedation acceptable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Transient insomnia

A

Sleep well but other factors affect sleep - noise, work, jet lag

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Short term insomnia

A

Related to emotional problems or medical illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Chronic insomnia

A

Caused by psychiatric disorders e.g anxiety, drug abuse, depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When can dependence develop?

A

After 3-14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Withdrawal of hypnotic

A

Rebound insomnia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Stopping hypnotic

A

Broken sleep with vivid dreams may persist for several weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Short acting hypnotics

A

Loprazolam, lormetazepam and temazepam act for short time and have little hangover effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Withdrawal phenomena common with?

A

Short acting benzodiazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Insomnia + anxiety

A

Long acting benzodiazepines e.g diazepam single dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Coma

A

Benzodiazepines can cause coma in hepatic impairment, so shorter half life benzodiazepines are safer (temazepam and oxazepam)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Pregnancy and breast feeding

A

Avoid - neonatal hypothermia, hypotonia, respiratory depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Zaleplon, Zolpidem and Zopiclone

A

Non benzodiazepines hypnotics but act at the benzodiazepines receptor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Shortest duration of action

A

Zaleplon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Short duration of action

A

Zolpidem and Zopiclone

26
Q

Antihistamines

A

Promethazine - on sale for occasional insomnia

Prolonged action - can cause drowsiness the following day

27
Q

How long does sedative effect of antihistamine last

A

Reduce after a few days of continuous use

28
Q

Side effect of antihistamines

A

Headache, psychomotor impairment and anti-muscarinic

29
Q

Alcohol

A

Poor hypnotic as diuretic action interferes with sleep

Also disturbs sleep pattern and can worsen sleep disorders

30
Q

Melatonin

A

Pineal hormone - licensed for short term treatment of insomnia

For adults over 55

31
Q

Anxiety

A

Benzodiazepines anxiolytics affective in relieving anxiety states

32
Q

Inhibit psychological adjustment in bereavement

A

Benzodiazepines

33
Q

Dependence likely

A

history of alcohol or drug abuse

34
Q

Beta-blockers and anxiety - DONT

A

Don’t affect psychological symptoms of anxiety - fear, worry, tension

35
Q

What beta-blockers do in anxiety

A

Reduce autonomic symptoms - palpitations and tremor

But not muscular tension

36
Q

Diazepam

A

Short term use in anxiety or insomnia, also use in epilepsy febrile convulsions, muscle spasm

37
Q

Diazepam contraindications

A

CI – resp depression, myasthenia gravis, muscle weakness, alcohol or drug
abuse, personality dis.

38
Q

Side effects of diazepam

A

drowsiness, lightheadedness the next day, confusion and ataxia,
amnesia, dependence, Overdosage

39
Q

Diazepam schedule and others

A

amnesia, dependence, Overdosage – see pg 39
 Schedule CD4-1
 Others – chlordiazepoxide, lorazepam, oxazepam, nitrazepam (all CD4-1)

40
Q

Buspirone

A

 Acts at 5HT1A serotonin receptors
 Response to treatment can take up to 2 weeks
 Does not alleviate symptoms of benzo withdrawal, so benzo should be slowly stopped before starting buspirone

41
Q

Barbiturates

A

 Long acting barbiturate phenobarbital – has some use in epilepsy but use as sedative unjustified

 Only used for severe insomnia in patients already taking barbiturates – avoided in elderly

 Very short acting barbiturate thiopental used in anaesthesia Antipsychotics

42
Q

Antipsychotics

A

 Neuroleptics/’tranquilisers’ 

 Short term – calm disturbed patients in schizophrenia, brain damage,
mania, delirium, severe anxiety or depression

43
Q

Schizophrenia

A

 Aim – alleviate suffering and improve cognitive functioning

 Antipsychotic drugs relieve Positive symptoms – thought disorder,hallucinations and delusions

 Less effective on negative symptoms – apathy and social withdrawal

44
Q

First generation antipsychotic drugs

A

 Block dopamine D2 receptors in brain

 Not selective – many side effects, EPS and elevated Prolactin

45
Q

Phenothiazines

A

Group 1 – chlorpromazine, levopromazine and promazine (very sedative and moderate EPS)

Group 2 – pericyazine and pipotiazine (moderate sedative and fewer EPS than 1 and 3)

Group 3 – prochlorperazine, trifluroperazine, fluphenazine, perphenazine (few sedative and antimuscarinic effects but more EPS than 1 and 2)

46
Q

Butyrophenones

A

 Butyrophenones – benperidol and haloperidol resemble group 3

Thioxanthenes – flupentixol and zuclopentixol

47
Q

Second generation antipsychotic drugs

A

 Atypical antipsychotics
 Have higher affinity for specific D receptors – less side effects  Act on a range of receptors unlike first generation

48
Q

Cautions second generation antipsychotic

A

High risk of withdrawal, should be stopped gradually

Patients with CV disease, Parkinson’s (exacerbation), epilepsy, seizures, MG prostatic hypertrophy, angle closure glaucoma
CI in comatose states, CNS depression and phaeochromocytoma
Caution in elderly – only used in severe psychotic cases and initial dose should be half of adult dose

49
Q

Side effects

A

 EPS occur most frequently with phenothiazines, butyrophenones and first gen depot preparations

 Parkinsonian symptoms
 Dystonia – abnormal face and body movements
 Akathesia – restlessness
 Tardive dyskinesia – involuntary movements of jaw, tongue
 Increased prolactin concentration and hyperprolactinaemia – sexual
dysfunction, reduced bone density, breast enlargement, menstrual changes, galactorrhoea
 Parkinsonian symptoms can be supressed if antimuscarinic drugs given  Tardive dyskinesia is most serious EPS and often irreversible
o Stopping drug at earliest signs can stop full progression of it

50
Q

Antipsychotics

A

Other s/e
 Decreased libido
 Tachycardia, arrhythmias and hypotension, QT interval prolongation  Hyperglycaemia, Diabetes
 Weight gain
 Temperature changes

 Neuroleptic malignant syndrome – hyperthermia, fluctuating consciousness, muscle rigidity, autonomic dysfunction, tachycardia, sweating, urinary incontinence (rare)

Overdose

51
Q

Antipsychotics choice

A

 Little difference between them
 Second gen may be better at treating negative symptoms of schizophrenia and should be used if EPS are a concern
 Aripiprazole, clozapine, olanzapine and quetiapine are least likely to cause EPS
 Patients should use antipsychotic for 4-6 weeks before it is deemed ineffective

52
Q

Antipsychotics monitoring

A

 FBC, U&E, LFT at start and then annually
 Blood lipids, fasting blood glucose, ECG
 BP, prolactin conc, physical health monitoring

53
Q

Antipsychotic Depot preps

A

 Long acting – maintenance therapy (every 4 weeks)
 Can cause higher incidence of EPS than oral preps, but less freq with 2nd gen depot
 Zupenthixol and Flupentixol most common
 Small test doses, Z track technique and injection site rotation essential

54
Q

Antimanic Drugs

A

 Use in mania and hypomania and long term bipolar treatment

 Antidepressant can be used for co-existing depression but avoid in rapid cycling bipolar disorder

 Antipsychotic drugs can also be used as well as lithium, valproate, carbamazepine, olanzapine

 Valproate – NOT in women of child bearing age

55
Q

Lithium

A

 Often as concomitant therapy with antidepressants
 Full prophylactic effect of lithium may not be seen until 6-12 months of treatment
 Used in prophylaxis and treatment of mania and bipolar disorder

 Long term use – associated with thyroid disorders, cognitive and memory
impairment
 Risk factors – ACEi, NSAIDS, Diuretics
 Patients should be given Lithium treatment packs

56
Q

Serum Conc lithium

A

 Narrow therapeutic range – regular monitoring and same brand prescribing
 0.8-1mmol/L target range (0.4-1mmol/L in elderly)
 Routine monitoring every 3 months and if patient has any other disease or significant change in fluid intake
 Lithium intoxication: blurred vision, increased GI disturbances (anorexia, vomiting, diarrhoea), muscle weakness, drowsiness, lack of co-ordination  Overdose can have fatal toxic effects, signs:
o Tremor, ataxia, dysarthria
o Nystagmus, renal impairment and convulsions

57
Q

Interactions

A

 Lithium toxicity made worse by sodium depletion – diuretics (esp. thiazides) can be hazardous so avoid

 Narrow therapeutic range

58
Q

Withdrawal

A

 Abrupt discontinuation increases risk of relapse – but no real evidence of withdrawal

 Should discontinue dose slowly over 4 weeks – 3 months

59
Q

S/E

A

 GI, fine tremor, renal impairment
 Polydipsia, leucocytosis, weight gain, oedema

60
Q

Antidepressant

A

 TCA, MAOI, SSRI, and others
 Should not be used for mild cases

61
Q

How long does it take for antidepressant affect to occur?

A

2 weeks

BNF (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions