Chapter 4: Nervous system Flashcards
In what situations would you consider migraine prophylaxis?
- suffer at least two attacks a month;- suffer an increasing frequency of headaches;- suffer significant disability despite suitable treatment for migraine attacks;- cannot take suitable treatment for migraine attacks
What are the most effective drug treatments for smoking cessation?
VareniclineorCombination of long acting NRT (patch) AND short acting NRT (gum, lozenge etc)
What are the symptoms of carbamazepine toxicity (I HANDBAG)?
In co-cordinationHyponatraemiaAtaxiaNystagmusDrowsinessBlurred vision, diplopiaArrhythmiasGI disturbances
Are SSRIs or TCAs more sedating?
TCAs are more sedating also have more antimuscarinic and cardiotoxic side effects
Which antipsychotics commonly cause weight gain?
ClozapineOlanzipine
The ability to metabolise codeine into morphine can vary greatly between individuals. Ultra rapid metabolisers are more susceptible to toxicity. What enzyme is involved?
CYP2D6
What withdrawal period is required for fluoxetine what about other SSRIs
5 weeks Other SSRIs: Up to 2 weeks
What patient advice is needed for galantamine?
Risk of serious skin reaction including Stevens-JohnsonStop taking if reaction occurs
Can antipsychotics interfere with your temperature regulation?
Haloperidol and risperidone
Are first or second generation antipsychotics more likely to cause insulin resistance and diabetes?
Second generation is more likely
What is the problem with enteric coated aspirin in acute pain?
Slow onset of action
At what body weight should IV paracetamol be adjusted and what dose should you use?
<50kg15mg/kg
What are the main side effects to look out for if a patient is on carbamazepine?
Blood or skin disorders Antiepileptic hypersensitivity syndromeSeek medical help if fever, rash, mouth ulcers etc occurALSO can cause hepatotoxicity so report signs of dark urine, nausea, vomiting
CD schedule is Morphine sulphate solution 2mg/ml?
CD Schedule 5 Inv POM It is only when the level of morphine exceeds 13mg/ 5ml (2.6mg/ml) that the solution becomes CD Schedule 2
What is first line treatment options for patients with mild to moderate Alzheimer’s?
Monotherapy with one of the following Ach inhibitors: Donepezil Rivastigmine Galantamine Drug treatment should only be initiated under a specialist (however can then be managed in primary care)
Can Fentanyl be used in opioid naive patients
NO Manufacturer advises use only in opioid tolerant patients due to risk of respiratory depression
What monitoring is required at the start of antipsychotic treatment?
Full blood count, urea and electrolytes, and liver function test monitoringBlood lipidsWeight Fasting blood glucose and blood pressureECG if history of cardiovascular risk factors present
Which antipsychotic is least likely to cause hyperprolactinaemia?
Ariprazole
What is the max daily dose of sumatriptan bought OTC dose previously diagnosed migraine?
comes as 50mg tabs OTC: Max 2 daily (100mg)
What is 1st line for newly diagnosed focal seizures?
Carbamazepine or Lamotrigine
What is first line for patients with severe Alzheimer’s in someone who is not on any medication for the condition?
Memantine
What are specific side effects of IV phenytoin?
Bradycardia Hypotension
What can cause sensations of tingling, heat, pressure, tightness in the body?
Triptans! Discontinue if intense
How would you treat trigeminal neuralgia (facial pain with electric shocks in the jaw)?
True but symptoms must have been improved after taking the first tablet