CNS

Question 1

what symptoms should patients taking carbamazepine immediately seek medical attention for

Answer 1

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

Question 2

which antiepileptic can be used for diabetic neuropathy

Answer 2

Carbemazepine

Question 3

what are the cautions for clozapine

Answer 3

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)

Question 4

which drug is used for the treatment of persistent aggression in patients with moderate to severe Alzheimers

Answer 4

Risperidone

Question 5

which antipsychotic should be used with caution if the patient is taking other medication which can cause constipation

Answer 5

clozapine

note: clozapine can cause Intestinal obstruction (impairment of intestinal peristalsis, including constipation, intestinal obstruction, faecal impaction, and paralytic ileus)

Question 6

which drug can be given via I.V to stabilise a patient during a seizure

Answer 6

Chloral hydrate

Question 7

can patients with epilepsy drive heavy goods vehicles provided they have had a seizure-free period of one yea

Answer 7

no

Patients must be seizure free for one year to drive a motor vehicle but not a HGV or public service vehicle

Question 8

who can prescribe medication for ADHD

Answer 8

only a specialist trained in the diagnosis and management of ADHD

note: GPs may be able to diagnose but not start treatment

Question 9

how long should patients who have suffered RECURRENT depression take maintenance treatment for

Answer 9

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

Question 10

how often would the dose of diazepam be reduced during withdrawal

Answer 10

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

Question 11

can you use the Triptans (e.g sumatriptan, zolmitriptan, naratriptan) in patients who have had a previous myocardial infarction

Answer 11

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*

Question 12

why do you need to monitor fibrotic disease when starting treatment with cabergoline

Answer 12

Cabergoline has been associated with pulmonary, retroperitoneal, and pericardial fibrotic reactions

Question 13

what is they key counselling point for mirtazapine

Answer 13

This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol

Question 14

which patient are groups are not licensed to take sumatriptan

Answer 14

• children (17 and under)

- elderly (65 and over)

Question 15

if a patient takes a dose of sumatriptan but it is ineffective, can they take another dose for the same attack

Answer 15

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*

Question 16

what should you do if a patient taking clozapine gets constipation

Answer 16

• 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

Question 17

what need to be monitored if a patient is taking clozapine

Answer 17

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.

Question 18

what happens if an SSRI and lithium are given together

Answer 18

can increase the risk of serotonin syndrome

Question 19

what are the symptoms of serotonin syndrome

Answer 19

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).

Question 20

which antiepileptic can cause Stevens-Johnson Syndrome (SJS)

Answer 20

lamotrigine

note: patients can also get other serious skin reactions with this medication such as toxic epidermal necrolysis have developed (especially in children)

Question 21

which contraceptives should be stopped at least 4 weeks prior to major surgery

Answer 21

combined hormonal contraceptives

*note: Combined hormone contraceptives may be recommenced 2 weeks after full remobilisation *

Question 22

why might antidepressants lead to falls

Answer 22

Antidepressants are known to cause hyponatremia which can lead to falls; therefore, you will review his sodium levels closely.

Question 23

what is the first line treatment for parkinsons disease

Answer 23

• 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

Question 24

should you treat hallucinations + delusions in parkinson’s disease if they are well tolerated

Answer 24

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

Question 25

which antiparkinson medication can cause impulse control disorders

Answer 25

dopamine-receptor agonists: pramipexole, ropinirole, rotigotine

note: therapy may be reduced or stopped gradually if problematic impulse control disorders develop

Question 26

how do you treat Rapid eye movement sleep behaviour disorder in parkinson’s disease

Answer 26

give clonazepam or melatonin

Question 27

how do you manage drooling of saliva in parkinson’s

Answer 27

first line: Glycopyrronium bromide

2nd line: botulinum toxin type A

Question 28

what should you do if a pt doesn’t respond to SSRIs doe depression

Answer 28

- increase the dose 
or
-  switch to a different SSRI 
or 
- mirtazapine