Chapter 4: Nervous system Flashcards
Which of the acetylcholinesterase inhibitors is used for dementia is also licensed for mild/moderate dementia associated with Parkinsons?
Rivastigmine - This has TWICE daily dosing!
When should donepezil be given?
Once daily (Other drugs in class are BD)
Give at bedtime
What conditions are cholinergic drugs (acetylcholinerase inhibitors used in dementia) cautioned in?
Asthma
Epilepsy/history of seizures
Bradycardia
History of gastric ulcers
What are the common side effects of the Acetylcholinesterase inhibitors used in dementia?
Diarrhoea and vomiting, Dizziness, Headache, Hallucinations, Anorexia (weight loss)
Dogs Vomit Dogs Hate Hallucinating Alone
Name the 4 drugs used in dementia?
Donepezil Galantamine Rivastigmine (Acetylcholinesterase inhibitors)
Memantine (a NMDA receptor antagonist) for severe
Which acetylcholinesterase inhibitor comes as a patch?
Rivastigmine 24 hour patch
Short acting benzodiazepines?
Midazolam - Used for epileptic seizures (SE) and febrile convulsions due to its fast onset
what are the intermediate acting benzodiazepines
Clonazepam Lorazepam Oxazepam Temazepam
CLOT (Hence why some of these are used for agitation in our patients: As long-acting ones increase drowsiness)
What are the Long acting Benzodiazepines?
Chlordiazepoxide Diazepam Alprazolam
Used as sedatives (diazepam for insomnia associated with anxiety), chlordiazepoxide (alcohol withdrawal)
What is Buspirone?
A serotonin receptor agonist used for anxiety
Name some medication used in ADHD?
CNS Stimulants:
- Methylphenidate (Ritalin (IR), Concerta (SR), Medikinet, Equasym)
- Dexamfetamine Lisdexamfetamine (prodrug of dexamfetamine, Elvanse, Elvanse Adult)
Atomoxetine
Clonidine (specialist)
name 5 common side effects of CNS stimulants (lisdexamfetamine/methylphenidate)?
Aggression/Irritable: mood changes Addiction Growth deceleration - anorexia Insomnia (Take OM) Nausea/Vomiting/Diarrhoea Touretts/Tics
Tachycardia (methylphenidate)
When should antidepressants be avoided in bipolar?
In MANIC phase
Rapid cycling bipolar - recent history of hypomania (mild mania, marked by elation and hyperactivity) rapid mood fluctuations
Antidepressant exacerbates manic symptoms
What mood stabilisers do we see used in Bipolar disorder?
Carbamazepine
Valproate
Lithium
When should lithium be taken?
At night- blood test needs to be 12 hours post-dose and blood test usually in the morning
Lithium toxicity is made worse by sodium depletion, therefore what drugs should be avoided?
B2 agonists (salbutamol/terbutaline) Inhaled corticosteroids diuretic (loop - furosemide) (TLD - indapamide) NSAIDs (nephrotoxic too) PPIs Steroids SSRIs TCAs
Signs of lithium toxicity?
Within therapeutic range:
Nausea, vomiting, diarrhoea, weight gain, dehydration - polyuria, hypernatraemia
Severe:
Hand tremor, irritability, slurred speech, stupor (numbness), nephrotoxicity, arrhythmias, coma, seizures
(H I S, S N A C S)
Can lithium be used in pregnancy?
Teratogenic including cardiac abnormalities - avoid if possible
Especially in 1st trimester
In 2nd and 3rd trimester: dose may need to be increased but on delivery return abruptly to normal
What are the two different Lithium salts?
Lithium Carbonate: Camcolit, Priadel, Liskonium tablets
Lithium Citrate: Li-liquid, Priadel liquid (citrate only comes as a liquid)
Rx by brand
Why is it important to stick to the same brand of lithium?
Not all brands are bioequivalent. Brands are typically within 5% (95%-105%)
Changing the preparation would require the same precautions and monitoring as initiating treatment for the first time
In what patients are Dexamfetamine and Lisdexamfetamine cautioned
Tics & Tourettes
History of epilepsy
Mild hypertension
Susceptibility to angle closure glaucoma
May also cause growth restriction in children
Patients and carers should be advised to monitor for suicidal ideation when taking this ADHD drug
Atomoxetine
Which antipsychotic drug should be handled with care?
Chlorpromazine - Causes contact sensitisation (irritates skin)
Hyponatreamia has been linked to all antidepressants, but is more likely with which class?
SSRIs