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GPhC Exam Revision > CNS > Flashcards

CNS Flashcards

1
Q

Outline the treatment of Alzheimer’s

A

Mild to moderate: Donepezil, Galantamine or Rivastigmine

Moderate to severe: Memantine

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2
Q

What can happen if a patient with dementia is given an antipsychotic?

A
  • Neuroleptic Malignant Syndrome if AcetylCI given with antipsychotic
  • Clear risk of stroke and death when patient with dementia given antipsychotic
  • If unavoidable give haloperidol, olanzapine or lorazepam for agitation
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3
Q

What is the only Acetylcholinesterase inhibitor licensed in Parkinsons (LBD)?

A

-Rivastigmine

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4
Q

Which antiepileptics are category 1?

A
  • Carbamazepine
  • Phenytoin
  • Phenobarbital
  • Primidone
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5
Q

Which antiepileptics are category 2?

A
  • Valproate
  • Lamotrigine
  • Clobazam
  • Clonazepam
  • Zonisamide
  • Topiramate
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6
Q

Which antiepileptics are category 3?

A
  • Levetiracetam
  • Gabapentin
  • Pregabalin
  • Ethosuximide
  • Vigabatrin
  • Brivaracetam
  • Lacosamide
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7
Q

Outline driving rules for epileptics

A
  • Must be seizure free for 1 year
  • Must be seizure free for 6 months following a dose change
  • Driving banned during medication changes and withdrawal until 6 months after last dose
  • Must wait 6 months after single unprovoked/isolated seizure
  • Can drive if only sleep seizures for 3 years since last awake seizure
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8
Q

Outline common general antiepileptic side effects

A
  • Antiepileptic hypersensitivity syndrome
  • Suicidal thoughts
  • Rash (Lamotrigine)
  • Blood dyscrasias
  • Visual problems |(Vigabatrin + Topiramate)
  • Encephalopathy (Vigabatrin)
  • Severe respiratory depression (Gabapentin)
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9
Q

How is acute mania or hypomania treated?

A
  • Short term benzos
  • Antipsychotic (Quetiapine, olanzapine or risperidone)
  • Add lithium or valproate if necessary
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10
Q

How long should antidepressants be taken for following remission?

A
  • At least 6 months (12 in elderly)
  • At least 12 months for GAD
  • At least 2 years for recurrent depression
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11
Q

What is the washout period for MAOIs?

A

-2 weeks

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12
Q

What is the washout period for SSRIs?

A
  • 1 week for most
  • 2 weeks for sertraline
  • 5 weeks for fluoxetine
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13
Q

What is the washout period for TCAs?

A
  • 1-3 weeks

- 3 weeks for imipramine and clomipramine

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14
Q

Which TCAs are the most and least dangerous in overdose?

A
  • Dosulepin is most

- Lofepramine is least

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15
Q

Over how long should MAOIs be withdrawn?

A

-At least 4 weeks

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16
Q

What foods must be avoided whilst taking MAOIs and for 2 weeks after stopping?

A
  • Mature cheese
  • Pickled herring
  • Game
  • Broad beans
  • Yeast
  • Soya
  • Anything “going off” (Meat, fish, poultry, offal)
  • Alcohol/dealcoholized drinks
17
Q

Describe MAOI interactions

A
  • Antimuscarinics (Increased effects)
  • Hepatotoxics
  • Hypertensives
  • Linezolid (Avoid until after washout period)
  • Toxicity with other antidepressants (TCAs/SSRIs)
18
Q

Which antipsychotics are classed as 1st generation/typical?

A
  • End in “zine” (Prochlorperazine, promazine, pericyazine, etc)
  • End in “ol” (Haloperidol, flupentixol, zuclopenthixol)
  • Sulpiride
  • Pimozide
19
Q

Which antipsychotics are classed as 2nd generation/atypical?

A
  • End in “pine” (Olanzapine, quetiapine, clozapine)
  • End in “one” (Risperidone, paliperidone)
  • Aripiprazole
  • Amisulpride
20
Q

Which side effects are more common with 1st generation antipsychotics?

A
  • EPS

- Hyperprolactinaemia (Not caused at all by the 2nd gen APs: Clozapine, olanzapine, quetiapine, and aripiprazole)

21
Q

Which side effects are more common with 2nd generation antipsychotics?

A
  • Metabolic disorders
  • Eg weight gain/diabetes (Clozapine and olanzapine cause most)
  • Hypertension
22
Q

Outline general antipsychotic side effects

A
  • Dyslipidaemia (“zines”, “pines” and risperidone)
  • Sedation (Most = chlorpromazine, clozapine and promazine, Least = Amisulpride, aripiprazole and sulpiride)
  • Sleep apnoea (Quetiapine)
  • Anticholinergic effects (Quetiapine, chlorpromazine and clozapine)
  • Postural hypotension (clozapine, chlorpromazine, quetiapine, and risperidone)
  • Seizures (clozapine)
  • QTc (haloperidol, pimozide)
  • VTE
  • NMS
  • Skin issues (olanzapine, Quetiapine)
  • Photosensitivity (chlorpromazine)
  • Abnormal LFTs
23
Q

What monitoring is required for antipsychotics?

A
  • FBC, U+E, LFT at start and annually
  • Lipids and weight at start, 3 months, then yearly
  • Fasting BG at start, 6 monthly, then yearly
  • ECG, BP at start and CVD risk annually
24
Q

What word do depot antipsychotic preparations usually end in?

A

-Decanoate

25
Q

What are the important side effects of clozapine?

A
  • Agranulocytosis/Blood dyscrasias/Neutropenia
  • Myocarditis/Cardiomyopathy
  • GI obstruction (Report any constipation)
26
Q

What are the monitoring requirements for clozapine?

A
  • FBC + leucocytes every week for 18 weeks, then fortnightly for 1 year, then monthly
  • Patient, prescriber and pharmacist must be registered on monitoring system
27
Q

What anti-emetic is used in Parkinsons?

A
  • Domperidone

- Metoclopramide is contraindicated

28
Q

What are the side effects of levodopa?

A
  • ICD
  • Excessive sleepiness/sudden onset sleep
  • Motor issues
  • End dose deterioration
29
Q

What are the side effects of dopamine receptor agonists?

A
  • ICD
  • Hallucinations
  • Excessive sleepiness
  • Higher incidence of these than levodopa*
  • Hypotension
  • Fibrosis (Lungs, abdomen, CVS)
30
Q

Which drugs are in the class dopamine receptor agonists?

A
  • Pramipexole, ropinirole, rotigotine (Non-ergot)
  • Cabergoline, bromocriptine
  • Apomorphine (Specialist, QTc), amantadine (weak agonist)
31
Q

Which drugs are in the class MOABIs?

A
  • Rasagiline

- Selegiline

32
Q

Which drugs are classed as COMTIs

A
  • Entacapone

- Tolcapone

33
Q

What side effects do COMTIs cause?

A
  • Hypertension/CVS effects (Sympathomimetics)
  • Red/brown urine (Entacapone)
  • Hepatotoxicity (Tolcapone)

GPhC Exam Revision (9 decks)

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