Chapter 4 CNS

Question 1

Aminophylline/ Amphotericin/ Beclometasone/ Bendro/ Bumetanide & Lithium

Answer 1

Increased risk of hypokalaemia, potentially increased risk of torsades de pointes

Question 2

Amiodarone/ Amisulpride / Citalopram & Lithium

Answer 2

Both prolong QT prolongation. Risk factors are age, female gender, cardiac disease, hypokalaemia predispose QT prolongation

Question 3

Amitriptyline/ Carbamazepine & Lithium

Answer 3

Increased risk of neurotoxicity

Question 4

Bendro / Benzydamide/ Captopril/ Candensartan & Lithium

Answer 4

Increased concentration of Lithium

Question 5

When should the samples of lithium be taken?

Answer 5

Samples should be taken 12 hours after dose to achieve serum concentration of 0.4-1mmol/L

Question 6

Monitoring requirements of lithium

Answer 6

• cardiac
• renal
• and thyroid before initiation of treatment
• monitor weight, ECG if cardio problem
• serum electrolytes and
• FBC

Question 7

Lithium advice

Answer 7

Maintain fluid intake and avoid changing diet which increase or reduce sodium intake

Question 8

Lithium toxicity

Answer 8

Report signs and symptoms of lithium toxicity

• renal dysfunction (polyuria and polydipsia)
• benign hypertension (persistent headache & visual disturbances)
• hypothyroidism

Question 9

Lithium Withdrawal

Answer 9

Abrupt withdrawal of lithium, increase risk of relapse. This, it should be gradually reduced at least over a period of four weeks ( preferably up to 3 months)

Question 10

Lithium in pregnancy

Answer 10

Advice for effective contraceptive methods during treatment for women with child bearing potential

Question 11

Alcohol withdrawal

Answer 11

Abrupt withdrawal/ reduction of alcohol intake will lead to the development of alcohol withdrawal syndrome. Long acting benzos (diazepam) is recommended to attenuate alcohol withdrawal syndrome

Question 12

Acamprosate in combo of psychological therapy

Answer 12

• maintenance of alcohol dependent
• 666mg OM and 333mg BD midday and night <60kg
• 666mg TDS >60kg

For 16-65years old

Question 13

Disulfiram (alternative to acamprosate)

Answer 13

200mg daily (up to 500mg daily) 
Contraindications: cardiac and HTN

Question 14

Disulfiram & Alcohol

Answer 14

• Avoid alcohol for (24hrs before treatment and for 14 days after treatment)
• Metronidazole & disulfiram risk of acute psychosis (no recommendation)
• Warfarin increases anticoagulant effect (monitor and adjust dose)
• phenytoin increases concentration