CNS Flashcards
what symptoms should patients taking carbamazepine immediately seek medical attention for
symptoms such as fever, rash, mouth ulcers, bruising, or bleeding
Patients or their carers should be told how to recognise signs of blood, liver, or skin disorders, and advised to seek immediate medical attention if symptoms develop
which antiepileptic can be used for diabetic neuropathy
Carbemazepine
what are the cautions for clozapine
clozapine (2nd genereation antipsychotic) can cause:
- Agranulocytosis ( deficiency of granulocytes in the blood, causing increased vulnerability to infection)
- Myocarditis and cardiomyopathy
- Intestinal obstruction (impairment of intestinal peristalsis, including constipation, intestinal obstruction, faecal impaction, and paralytic ileus)
which drug is used for the treatment of persistent aggression in patients with moderate to severe Alzheimers
Risperidone
which antipsychotic should be used with caution if the patient is taking other medication which can cause constipation
clozapine
note: clozapine can cause Intestinal obstruction (impairment of intestinal peristalsis, including constipation, intestinal obstruction, faecal impaction, and paralytic ileus)
which drug can be given via I.V to stabilise a patient during a seizure
Chloral hydrate
can patients with epilepsy drive heavy goods vehicles provided they have had a seizure-free period of one yea
no
Patients must be seizure free for one year to drive a motor vehicle but not a HGV or public service vehicle
who can prescribe medication for ADHD
only a specialist trained in the diagnosis and management of ADHD
note: GPs may be able to diagnose but not start treatment
how long should patients who have suffered RECURRENT depression take maintenance treatment for
at least 2 years
note: if they don’t have recurrent depression, it s 6 months. elderly patients + patients being treated for generalised anxiety disorder have maintenance for 12 months
how often would the dose of diazepam be reduced during withdrawal
dose reduced (usually by 1- 2mg) every 1-2 weeks
note: towards the end of withdrawal treatment, can reduce by 500mcg each time then stop
can you use the Triptans (e.g sumatriptan, zolmitriptan, naratriptan) in patients who have had a previous myocardial infarction
no - contraindicated to use triptans in these patients
*note: also contraindicated to use triptans in patients with other cardiovascular diseases such as:
current/previous ischaemic heart disease; mild uncontrolled hypertension; moderate and severe hypertension; peripheral vascular disease, Prinzmetal’s angina*
why do you need to monitor fibrotic disease when starting treatment with cabergoline
Cabergoline has been associated with pulmonary, retroperitoneal, and pericardial fibrotic reactions
what is they key counselling point for mirtazapine
This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol
which patient are groups are not licensed to take sumatriptan
- children (17 and under)
- elderly (65 and over)
if a patient takes a dose of sumatriptan but it is ineffective, can they take another dose for the same attack
no. patient not responding to initial dose should not take second dose for same attack
* note: you can take another dose at least 2 hours if required, to be taken only if migraine recurs - meaning the initial dose worked on the first attack but another attack has come*
what should you do if a patient taking clozapine gets constipation
- immediately refer to prescriber
MHRA warning: Clozapine has been associated with varying degrees of impairment of intestinal peristalsis which can be fatal. seek immediate medical advice before taking the next dose of clozapine if constipation develops
what need to be monitored if a patient is taking clozapine
MHRA recommends monitoring blood concentration of clozapine for toxicity in certain clinical situations such as when:
- a patient stops smoking or switches to an e-cigarette;
- concomitant medicines may interact to increase blood clozapine levels;
- a patient has pneumonia or other serious infection;
- reduced clozapine metabolism is suspected;
- toxicity is suspected.
what happens if an SSRI and lithium are given together
can increase the risk of serotonin syndrome
what are the symptoms of serotonin syndrome
serotonin syndrome fall into 3 main areas, although features from each group may not be seen in all patients
—neuromuscular hyperactivity (such as tremor, hyperreflexia, clonus, myoclonus, rigidity)
- autonomic dysfunction (tachycardia, blood pressure changes, hyperthermia, diaphoresis, shivering, diarrhoea),
- altered mental state (agitation, confusion, mania).
which antiepileptic can cause Stevens-Johnson Syndrome (SJS)
lamotrigine
note: patients can also get other serious skin reactions with this medication such as toxic epidermal necrolysis have developed (especially in children)
which contraceptives should be stopped at least 4 weeks prior to major surgery
combined hormonal contraceptives
*note: Combined hormone contraceptives may be recommenced 2 weeks after full remobilisation *
why might antidepressants lead to falls
Antidepressants are known to cause hyponatremia which can lead to falls; therefore, you will review his sodium levels closely.
what is the first line treatment for parkinsons disease
- if motor symptoms decrease quality of life: levodopa combined with carbidopa (co-careldopa) or benserazide (co-beneldopa)
- if motor symptoms DO NOT affect quality of life: choice of levodopa, non-ergot-derived dopamine-receptor agonists (pramipexole, ropinirole or rotigotine) or monoamine-oxidase-B inhibitors (rasagiline or selegiline hydrochloride)
- note: levodopa eventually associated with “end-of-dose” deterioration
should you treat hallucinations + delusions in parkinson’s disease if they are well tolerated
no - try and avoid antipsychotics if pt can tolerate hallucinations + delusions
if pt can’t tolerate, reduce the dose of medication causing symptoms. can use quetiapine or clozapine
which antiparkinson medication can cause impulse control disorders
dopamine-receptor agonists: pramipexole, ropinirole, rotigotine
note: therapy may be reduced or stopped gradually if problematic impulse control disorders develop
how do you treat Rapid eye movement sleep behaviour disorder in parkinson’s disease
give clonazepam or melatonin
how do you manage drooling of saliva in parkinson’s
first line: Glycopyrronium bromide
2nd line: botulinum toxin type A
what should you do if a pt doesn’t respond to SSRIs doe depression
- increase the dose or - switch to a different SSRI or - mirtazapine
