CNS Flashcards
Outline the treatment of Alzheimer’s
Mild to moderate: Donepezil, Galantamine or Rivastigmine
Moderate to severe: Memantine
What can happen if a patient with dementia is given an antipsychotic?
- 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
What is the only Acetylcholinesterase inhibitor licensed in Parkinsons (LBD)?
-Rivastigmine
Which antiepileptics are category 1?
- Carbamazepine
- Phenytoin
- Phenobarbital
- Primidone
Which antiepileptics are category 2?
- Valproate
- Lamotrigine
- Clobazam
- Clonazepam
- Zonisamide
- Topiramate
Which antiepileptics are category 3?
- Levetiracetam
- Gabapentin
- Pregabalin
- Ethosuximide
- Vigabatrin
- Brivaracetam
- Lacosamide
Outline driving rules for epileptics
- 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
Outline common general antiepileptic side effects
- Antiepileptic hypersensitivity syndrome
- Suicidal thoughts
- Rash (Lamotrigine)
- Blood dyscrasias
- Visual problems |(Vigabatrin + Topiramate)
- Encephalopathy (Vigabatrin)
- Severe respiratory depression (Gabapentin)
How is acute mania or hypomania treated?
- Short term benzos
- Antipsychotic (Quetiapine, olanzapine or risperidone)
- Add lithium or valproate if necessary
How long should antidepressants be taken for following remission?
- At least 6 months (12 in elderly)
- At least 12 months for GAD
- At least 2 years for recurrent depression
What is the washout period for MAOIs?
-2 weeks
What is the washout period for SSRIs?
- 1 week for most
- 2 weeks for sertraline
- 5 weeks for fluoxetine
What is the washout period for TCAs?
- 1-3 weeks
- 3 weeks for imipramine and clomipramine
Which TCAs are the most and least dangerous in overdose?
- Dosulepin is most
- Lofepramine is least
Over how long should MAOIs be withdrawn?
-At least 4 weeks
What foods must be avoided whilst taking MAOIs and for 2 weeks after stopping?
- Mature cheese
- Pickled herring
- Game
- Broad beans
- Yeast
- Soya
- Anything “going off” (Meat, fish, poultry, offal)
- Alcohol/dealcoholized drinks
Describe MAOI interactions
- Antimuscarinics (Increased effects)
- Hepatotoxics
- Hypertensives
- Linezolid (Avoid until after washout period)
- Toxicity with other antidepressants (TCAs/SSRIs)
Which antipsychotics are classed as 1st generation/typical?
- End in “zine” (Prochlorperazine, promazine, pericyazine, etc)
- End in “ol” (Haloperidol, flupentixol, zuclopenthixol)
- Sulpiride
- Pimozide
Which antipsychotics are classed as 2nd generation/atypical?
- End in “pine” (Olanzapine, quetiapine, clozapine)
- End in “one” (Risperidone, paliperidone)
- Aripiprazole
- Amisulpride
Which side effects are more common with 1st generation antipsychotics?
- EPS
- Hyperprolactinaemia (Not caused at all by the 2nd gen APs: Clozapine, olanzapine, quetiapine, and aripiprazole)
Which side effects are more common with 2nd generation antipsychotics?
- Metabolic disorders
- Eg weight gain/diabetes (Clozapine and olanzapine cause most)
- Hypertension
Outline general antipsychotic side effects
- 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
What monitoring is required for antipsychotics?
- 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
What word do depot antipsychotic preparations usually end in?
-Decanoate
What are the important side effects of clozapine?
- Agranulocytosis/Blood dyscrasias/Neutropenia
- Myocarditis/Cardiomyopathy
- GI obstruction (Report any constipation)
What are the monitoring requirements for clozapine?
- FBC + leucocytes every week for 18 weeks, then fortnightly for 1 year, then monthly
- Patient, prescriber and pharmacist must be registered on monitoring system
What anti-emetic is used in Parkinsons?
- Domperidone
- Metoclopramide is contraindicated
What are the side effects of levodopa?
- ICD
- Excessive sleepiness/sudden onset sleep
- Motor issues
- End dose deterioration
What are the side effects of dopamine receptor agonists?
- ICD
- Hallucinations
- Excessive sleepiness
- Higher incidence of these than levodopa*
- Hypotension
- Fibrosis (Lungs, abdomen, CVS)
Which drugs are in the class dopamine receptor agonists?
- Pramipexole, ropinirole, rotigotine (Non-ergot)
- Cabergoline, bromocriptine
- Apomorphine (Specialist, QTc), amantadine (weak agonist)
Which drugs are in the class MOABIs?
- Rasagiline
- Selegiline
Which drugs are classed as COMTIs
- Entacapone
- Tolcapone
What side effects do COMTIs cause?
- Hypertension/CVS effects (Sympathomimetics)
- Red/brown urine (Entacapone)
- Hepatotoxicity (Tolcapone)
