Chapter 4 - Nervous System

Question 1

What are the warning signs for carbamazepine?

Answer 1

1) Toxicity - incordination, blurred vision, double visinio, nystagmus, ataxia
2) Blood disorders - fever, sore throats
3) Skin disorders - rashs or mouth ulcers
4) Hepatic disorders - jaundice, dark urine, fatigue
5) Antiepileptic hypersensitivity syndrome - swollen lymph nodes (due to disease of lymph nodes)

Question 2

What monitoring does carbamazepine require?

Answer 2

Plasma concentration - 2 weeks after treatment to ensure that it is within therapeutic range

Full blood count - due to blood disorders

Hepatic and renal function 0 as per literature

Question 3

What are the drugs that can increase plasma concentrations of carbamazepine?

Answer 3

ACCE
Acetazolamide
Cimetidine
Clarithromycin
Erythromycin

Question 4

What are the drugs that can decrease plasma concentrations of carbamazepine?

Answer 4

PRS
Phenytoin
Rifabutin
Sy John’s Wort

Question 5

Can orlistat be given with carbamazepine?

Answer 5

No, it can increase the risk of convulsions

Question 6

Cardiac patient has epilepsy, will they be on fosphenytoin?

Answer 6

No - it is a prodrug of phenytoin and has a lot of cardiovascular reactions e.g. heart block…

Question 7

What are the side effects/cautions associated with lamotrigine

Answer 7

Blood disorders

Bone marrow depression 0 anaemia, bruising, infection

Aplatic anaemia - body cant make enough RBC to function properly

Skin reactions e.g. stevens johnston syndrome, toxic epidermal necrolysis
Rash - indicative of hypersensitivity reaction

Question 8

What is the therapeutic range of phenytoin

Answer 8

10 to 20mg/L

Question 9

What is the dose equivalence of phenytoin

Answer 9

100mg to 92mg - formulation changes needs to be made where appropriate

Question 10

what are the side effects of phenytoin

Answer 10

Toxicity - nystagmus, double vision, confusion, HYPERGLYCAEMIA

Skin disorders -rash and toxic epidermal necroylsis

Hepatoxcicity - jaundice, GI pain, dark urine

Blood disorders- fever, sore throat, bleeding, bruising

suicidal thoughs

Low vitamin D levels - due to phenytoin

Question 11

What are the conditions associated with low levels of vitamin D in children and adults?

Answer 11

Rickets - children

Osteomalacia - adults

Question 12

What are the drugs that can increase plasma concentration of phenytoin

Answer 12

§ Amiodarone
			§ Chloramphenicol
			§ Cimetidine
			§ Diltiazem
			§ Fluconazole
			§ Fluoxetine
			§ Miconazole
			§ Topiramate
			§ Trimethoprim
			§ Metronidazole
Clarithromycin

Question 13

What are the drugs that can decrease plasma concentrations of phenytoin

Answer 13

St Johns Wort
Theophylline
Itraconazole
cicloposrins (need to be same brand)

Question 14

When would you discontinue sodium valproate?

Answer 14

If prolonged pro-thrombin time persists

Question 15

What are some examples of benzodiazepines

Answer 15

Clonazepam

Chlordiazepoxide

Diazepam

Lorazepam

Question 16

What are benzodiazepines used for?

Answer 16

A range of things

• hyponotics
• anxiolytics
• sedation
• insomnia

Question 17

What are some hyponotics

Answer 17

Benzos

Z -drugs e.g. zopiclone, zolpiderm, zaleplon

Promethiazine

Melatonin - usually used in kids and before procedures (AS A SINGLE DOSE)

Question 18

What are some anxiolytics

Answer 18

Benzos

Buspirone

Meprobamate

Barbiturates

Question 19

What are the short acting benzos

Answer 19

○ Temazepam
		○ Oxazepam
		○ Loprazolam
		○ Lormetazepam
Lorazepam

Question 20

What are the different types of ADHD medication

Answer 20

• Methylphenidate
• Atomoxetine
Dexafetamine