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BNF 72/74 > Chapter 4- Nervous System > Flashcards

Chapter 4- Nervous System Flashcards

1
Q

Name three anticholinesterase inhibitors used in dementia

A

Donepezil
Rivastigmine
Galantamine

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2
Q

Name the Glutamate receptor antagonist used in more severe dementia

A

Memantine

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3
Q

Name 4 antiepileptics that have long half lives and can be given once daily at bedtime

A

Lamotrigine
Perampanel
Phenobarbital
Phenytoin

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4
Q

Name 4 antiepileptics in category 1 that are prescribed by brand

A

Phenytoin
Carbamazepine
Phenobarbital
Primidone

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5
Q

When can antiepileptic hypersensitivity syndrome start showing symptoms

A

Between 1 and 8 weeks of exposure

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6
Q

Symptoms of antiepileptic hypersensitivity syndrome

A 
Fever
Rash
Lymphadenopathy 
Liver dysfunction 
Haematological
Renal 
Pulmonary abnormalities 
Vasculitis 
Multi-organ failure
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7
Q

Is there a risk of suicidal thoughts and behaviours with all antiepileptic drugs

A

Yes

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8
Q

What interactions occur with antiepileptics

A

Usually as a result of enzyme induction or inhibition

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9
Q

Which antiepileptic has the highest teratigenicity risk

A

Valproate

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10
Q

Topiramate carries with it an increase risk of what if used in the first trimester of pregnancy?

A

Cleft palate

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11
Q

Women taking antiepileptics meds are advised to take what before conception and during first trimester?

A

Folate supplementation

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12
Q

The concentration of antiepileptic drugs in the plasma can change during preganancy - doses of which 3 antiepileptics should be adjusted on the basis of plasma drug conc

A

Phenytoin
Carbamazepine
Lamotrigine

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13
Q

What should be monitored for pregnant women taking topiramate or levetiracetam

A

Fetal growth

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14
Q

What injection at birth minimises the risk of neonatal haemorrhage associated with antiepileptics

A

Injection of vitamin K

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15
Q

Name three antiepileptics with an established risk of drowsiness in breast fed babies and that should be used with caution as a result

A

Primidone
Phenobarbital
Benzodiazepines

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16
Q

Carbamazepine may exacerbate what types of seizures and therefore should not be used?

A

Tonic
Atonic
Myoclonic
Absence

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17
Q

First line treatment option for absence seizures?

A

Ethosuximide

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18
Q

True or false: lamotrigine can exacerbate myoclonic seizures

A

True

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19
Q

True or false: valproate decreases the plasma concentration of lamotrigine

A

False - it increases it!

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20
Q

What’s responsible for the antiepileptic effects of primidone

A

It’s converted to phenobarbital

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21
Q

Antiepileptic licensed for adjunctive treatment of seizures in Lennox-gastaut syndrome

A

Rufinamide

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22
Q

Sodium valproate has widespread metabolic effects and monitoring of what is therefore essential

A

LFT

FBC

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23
Q

Treatment options for seizures lasting longer than 5 minutes

A

IV lorazepam

IV diazepam

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24
Q

There is a risk of what syndrome in patients with HLA-B*1502 allele for carbamazepine

A

Stevens-Johnson syndrome

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25
Q

For carbamazepine what’s the plasma concentration for optimum response

A

4-12mg/litre (20-50micromol/litre)

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26
Q

Name three things in the rosemont brand of gabapentin oral solution that exceed the WHO recommended limits if high doses are required

A

Propylene glycol
Acesulfame K
Saccharin sodium

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27
Q

Symptoms of phenytoin toxicity

A 
Nystagmus
Diplopia
Slurred speech 
Ataxia 
Confusion 
Hyperglycaemia
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28
Q

The usual total plasma phenytoin concentration for optimum response is what?

A

10-20 mg/litre (or 40-80micromol/litre)

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29
Q

If you take topiramate in the first trimester of pregnancy what is there an increased risk of?

A

Cleft palate

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30
Q

Topiramate has been associated with what?

A

Associated with acute myopia with secondary angle-closure glaucoma

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31
Q

Plasma phenobarbital concentration for optimum response is what?

A

15-40 mg/litre (60-180 micromol/litre)

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32
Q

What can be used in palliative care to reverse the effects of midazolam

A

Flumazenil

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33
Q

Should modified release preparations of methylphenidate be prescribed by brand?

A

Yes

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34
Q

Symptoms of overdose of afetamines

A 
Wakefulness 
Excessive activity 
Paranoia
Hallucinations
Hypertension 
Followed by exhaustion
Convulsions 
Hyperthermia 
Coma
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35
Q

Name a prodrug of dexamfetamine

A

Lisdexamfetamine

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36
Q

Long term use of lithium has been associated with what and requires what as a result

A

Thyroid disorders and mild cognitive and memory impairment - monitor thyroid function every 6 months

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37
Q

When should levels be taken for lithium and what’s the targets?

A

12 hours after dose
Target: 0.4-1mmol/litre
For acute episodes of mania the target is: 0.8-1mmol/litre

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38
Q

Drug interaction if introducing ACEI, NSAID or diuretic with lithium?

A

Renal impairment

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39
Q

Symptoms of lithium toxicity

A 
Hypothyroidism 
Renal dysfunction 
Intracranial hypertension (headache + visual disturbances)
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40
Q

During the first few weeks of antidepressant treatment there is an increased risk of what?

A

Agitation
Anxiety
Suicidal ideation

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41
Q

What class of antidepressant is first line and why?

A

SSRIs - better tolerated and safer in overdose

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42
Q

What does St. John’s wort do to metabolising enzymes?

A

Induces drug metabolising enzymes

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43
Q

What’s the active ingredient in St. John’s wort

A

Hypericum perforatum

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44
Q

True or false: elderly patients may take longer to respond to antidepressants

A

True

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45
Q

Antidepressant therapy (particularly SSRIs) have been associated with hyponatraemia and can make what symptoms develop?

A

Drowsiness
Confusion
Convulsions

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46
Q

Characteristics of serotonin syndrome fall into what three categories

A

Neuromuscular hyperactivity
Autonomic dysfunction
Altered mental state

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47
Q

Symptoms associated with neuromuscular hyperactivity in serotonin syndrome

A 
Tremor
Hyperreflexia
Clonus
Myoclonus 
Rigidity
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48
Q

Symptoms associated with autonomic dysfunction in serotonin syndrome

A 
Tachycardia 
BP changes 
Hyperthermia 
Diaphoresis
Shivering 
Diarrhoea
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49
Q

Symptoms associated with altered mental state in serotonin syndrome

A

Agitation
Confusion
Mania

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50
Q

Name the three less sedating TCAs & related antidepressants

A

Imipramine
Lofepramine
Nortriptyline

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51
Q

True or false: escitalopram is the prodrug of citalopram

A

False! It’s actually the active enantiomer of citalopram

52
Q

True or false: low gastric pH causes reduced absorption of the paroxetine oral suspension

A

False - a high gastric pH does

53
Q

First generation antipsychotic act predominantly by blocking what?

A

Dopamine D2 receptors in the rain (not not selective) therefore side effects

54
Q

First generation phenothiazine antipsychotic derivatives can be split into how many groups

A

THREE

55
Q

Name the group 1 phenothiazine derivative antipsychotics and what are their side effects

A

Chlorpromazine
Levomepromazine
Promazine

Pronounced sedative
Moderate antimuscarinic
Moderate extrapyramidal

56
Q

Name the group 2 phenothiazine antipsychotic derivatives and what are the side effects

A

Pericyazine

Moderate sedative
Fewer extrapyramidal than group 1 & 3

57
Q

Drugs in group 3 phenothiazine antipsychotic derivatives and side effects

A

Fluphenazine
Perphenazine
Prochlorperazine
Trifluoperazine

Fewer sedative and antimuscarinic effects but more pronounced extrapyramidal effects than group 1&2

58
Q

Name two butyrophenones and which class of the phenothiazine derivatives do they resemble?

A

Benperidol
Haloperidol

Group 3!

59
Q

Name a diphenylbutylpiperidine

A

Pimozide

60
Q

Name a substituted benzamide

A

Sulpiride

61
Q

Extrapyramidal symptoms of antipsychotics include what

A

Parkinsonism
Dystonia + dyskinesia
Akathisia
Tardive dyskinesia

62
Q

If dopamine inhibits prolactin release - what do first and second generation antipsychotics cause?

A

Hyperprolactinaemia because they block dopamine therefore no inhibition of the prolactin

63
Q

Aripiprazole reduces prolactin - why?

A

It’s only a dopamine receptor partial agonist

64
Q

Which antipsychotics are most likely to cause symptomatic hyperprolactinaemia

A

Risperidone
Amisulpride
First generations

65
Q

Symptoms of hyperprolactinaemia

A

Sexual dysfunction
Reduced bone mineral density
Breast enlargement
Galactorrhoea

66
Q

Antipsychotics have been associated with what cardiovascular side effects

A

Tachycardia
Arrhythmias
Hypotension
Prolong QT

67
Q

All antipsychotics can cause weight gain and hyperglycaemia- which ones are of particular concern with causing diabetes?

A

Clozapine
Olanzapine
Quetiapine
Risperidone

68
Q

Name a rare but potentially fatal side effect of all antipsychotic drugs and how long can it last for after discontinuation of the drug

A

Neuroleptic malignant syndrome

5-7 days

69
Q

True or false: first generation antipsychotics are better at treating the negative symptoms of schizophrenia

A

False! Second generation are better

70
Q

True or false: first generation antipsychotics are less likely to cause diabetes than the second generation

A

TRUE DAT

71
Q

Haloperidol dose adjustments when?

A

If smoking started or stopped during treatment

72
Q

Monitoring requirements for pimozide (1st generation antipsychotic)

A

ECG- there’s been reports of unexplained sudden death - caution QT prolongation

73
Q

What’s the name given to the phenothiazines that explains the facial and skeletal muscle spasms and ocugyric crises

A

Acute dystonic reactions

74
Q

True or false: phenothiazines are hepatotoxic

A

True dat

75
Q

Is BP monitoring mandatory for sulpiride?

A

No- does not affect blood pressure as much as other antipsychotics

76
Q

Name four first generation antipsychotic depot injections

A

Flupentixol decanoate
Fluphenazine decanoate
Haloperidol decanoate
Zuclopenthixol decanoate

77
Q

How can you treat hypersalivation side effect of clozapine

A

Hyoscine hydrobromide- aslong as patient not at risk of addictive antimuscarinic side effects of hyoscine and clozapine combined

78
Q

Treatment options for muscle cramps in motor neurone diseases

A 
Quinine
Baclofen
Tizanidine
Dantrolene
Gabapentin
79
Q

Name three non ergot derived dopamine agonists used in Parkinson’s disease

A

Pramipexole
Ropinirole
Rotigotine

80
Q

Name three ergot derived dopamine agonists used in Parkinson’s

A

Bromocriptine
Cabergoline
Pergolide

81
Q

Why are ergot derived dopamine agonists used to a less extent than non ergot derived DA in Parkinson’s

A

Risk of fibrotic reactions

82
Q

What is apomorphine

A

Potent dopamine receptor agonist used in advanced Parkinson’s disease to help with off periods

83
Q

Name two dopa decarboxylase inhibitors

A

Benserazide

Carbidopa

84
Q

Name two MAO type B inhibitors used in Parkinson’s

A

Rasagiline
Selegiline
Safinamide

85
Q

Name three antimuscarinic drugs used in Parkinson’s

A

Orphenadrine
Procyclidine
Trihexyphenidyl

86
Q

When would you introduce COMPT inhibitors in Parkinson’s disease

A

In patients on levodopa + dopa decarboxylase experiencing end of dose motor fluctuations

87
Q

When adding COMPT inhibitors to Parkinson’s meds regimen what may need to be reduced

A

Levodopa dose by around 10-30%

88
Q

Name three COMT inhibitors

A

Entacapone
Opicapone
Tolcapone

89
Q

Why is there restrictions from the MHRA on the use of domperidone

A

It’s associated with a small increased risk of serious cardiac side effects

90
Q

What are the MHRA restrictions on domperidone

A

Only indicated for N&V
lowest effective dose for max one week
Contraindicated in cardiac conditions or at risk of QT prolong and in combo with CYP3A4 inhibitors
Not in severe hepatic impairment
Recommended dose in over 12 and over 35kg is 10mg up to TDS
Recommended dose in children under 35kg is 250mcg/kg up to TDS

91
Q

MHRA recommendations on metoclopramide

A

Particular indications
Max 5 days treatment
10mg up to TDS - max daily dose 500mcg/kg
IV slow plus over 3 mins

92
Q

What’s aprepitant and fosaprepitant

A

Neurokinin receptor antagonists used for nausea and vomiting - fosaprepitant is the prodrug of aprepitant

93
Q

MHRA warning about promethazine

A

Children under 6 years should not be given OTC cough and cold meds containing promethazine

94
Q

Pain in sickle cell disease

A

Paracetamol
Ibuprofen
Codeine/dihydrocodeine
Morphine/diamorphine

95
Q

What painkiller should be avoided in sickle cell disease and why?

A

Pethidine - accumulation of a neurotoxic metabolite which can precipitate seizures

96
Q

Three drugs often adequate in dental pain

A

Paracetamol
Ibuprofen
Aspirin

97
Q

Side effects of Opioids

A 
Nausea & vom
Severe constipation 
Drowsiness 
Resp depression 
Dependence
98
Q

Which has longer duration of action: buprenorphine or morphine?

A

Buprenorphine

99
Q

Sublingual buprenorphine lasts how long

A

6-8hrs

100
Q

Benefit of diamorphine in palliative care

A

Greater solubility means smaller injection volume, less nausea and less hypotension

101
Q

Fever/increased heat to buprenorphine patch can cause what

A

Increased absorption

102
Q

Methadone/buprenorphine for opioid dependence - supervised consumption should be for how long

A

3 months

103
Q

Max dose of codeine in adults

A

240mg (60mg QDS)

104
Q

Codeine is contraindicated in patients who are what metabolisers

A

Ultra rapid metabolisers (CYP2D6 ultra rapid metabolisers)

105
Q

Why are dispersive or effervescent analgesic preferred in migraine?

A

Peristalsis is reduced therefore reducing absorption

106
Q

Name the short acting Z drugs used for insomnia

A

Zaleplon
Zolpidem
Zopiclone

107
Q

Name three shorter acting benzodiazepines with little or no hangover effect

A

Loprazolam
Lormetazepam
Temazepam

108
Q

Caution/further information for benzodiazepines

A

Paradoxical effects - increase in hostility and aggression

109
Q

Three drugs used in narcolepsy

A

Sodium oxybate
Pitolisant
Modafinil

110
Q

Drug used in alcohol withdrawal

A

Chloridazepoxide

111
Q

Three drugs used in alcohol relapse prevention

A

Acomprosate
Naltrexone
Disulfiram (2nd line)

112
Q

Drug used to reduce alcohol intake

A

Nalmefene

113
Q

Two drugs used to treat nicotine dependence

A

Bupropion

Varenicline

114
Q

Can you use nicotine replacement therapy and bupropion or varenicline together?

A

It’s not recommended

115
Q

Smoking induces what enzyme and which drugs should therefore be monitored

A 
CYP1A2 
Theophylline 
Cinacalcet
Ropinirole
Antipsychotics (cloz, olanz, chlorpromazine, haloperidol)
116
Q

Which is more sedating- methadone or buprenorphine?

A

Methadone

117
Q

How long does it take methadone to reach steady state for patients on a stable dose and why?

A

3-10 days due to long half life

118
Q

Signs of neonatal withdrawal from opioids

A 
High pitched cry 
Rapid breathing 
Hungry but ineffective suckling 
Excessive wakefulness
Hypertonicity 
Convulsions
119
Q

MHRA/CHM advice with varenicline for nicotine dependence

A

Suicidal behaviour - discontinue if they develop agitation, depressed mood, suicidal thoughts

120
Q

Hypnotics in elderly can cause what

A

Ataxia
Confusion
Falls

121
Q

Long term treatment of bipolar disorder should continue for how long after the last manic episode

A

At least 2 yrs (5 yrs in those at risk of relapse)

122
Q

Name the MAOI that has the greatest stimulant action and therefore causes increased risk of hypertensive crisis

A

Tranylcypromine

123
Q

Which two MAOIs are more likely to cause hepatotoxicity than tranylcypromine

A

Phenelzine

Isocarboxazid

124
Q

CI to SSRIs

A

Poorly controlled epilepsy and manic phase

125
Q

4 antipsychotics with increased risk of hyperglycaemia and weight gain

A

Clozapine
Olanzapine
Quetiapine
Risperidone

126
Q

Two first generations that have less risk of causing diabetes

A

Fluphenazine

Haloperidol

127
Q

Of the second generations which are less likely to cause diabetes &a weight gain

A

Amisulpride

Aripiprazole

BNF 72/74 (17 decks)

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