CNS

Question 1

Elderly Patients with Dementia

Answer 1

Risk of stroke if take anti-psychotics
Review every 6/52

Question 2

Mild - Moderate Alzheimer’s Treatment

Answer 2

AchE Inhibitors Monotherapy 1st line
Donepezil
Galantamine
Rivastigmine

Question 3

Moderate - Severe Alzheimer’s Treatment

Answer 3

Memantine
Initially 5mg OD
Max 20mg daily
Alternative/add-on to AchE inhibitors

Question 4

Mild - Severe Lewy Body Dementia

Answer 4

Donepezil/Rivastigmine 1st line
Galantamine if D and R not tolerated
Memantine if DRG ineffective or C/I

Question 5

Epilepsy General

Answer 5

Monotherapy preferred
Start at low dose and increase slowly
Don’t withdraw abruptly (withdraw over 2-6 months)
Withdraw 1 AED at a time
All AEDs cause suicidal thoughts

Question 6

AEDs with Long T1/2

Answer 6

LP3 (Long Period 3)
Lamotrigine
Phenytoin
Perampanel
Phenobarbital

Question 7

Category 1

Answer 7

Same brand (only for Epilepsy)
CPr3
Carbamazepine
Primidone
Phenytoin
Phenobarbital

Question 8

Category 2

Answer 8

Specific brand based on clinical judgement and chat with patient
LCCTV
Lamotrigine
Clonazepam
Clobazam
Topiramate
Valproate

Question 9

Category 3

Answer 9

Only need specific brand if concerns for patient anxiety/risk of confusion/dosing errors
Levetiracetam
Pregabalin
Gabapentin
Vigabatrin
Ethosuximide
Tiagabine
Brivaracetam
Lacosamide

Question 10

Anti-Epileptic Hypersensitivity Syndrome

Answer 10

Rare but fatal syndrome
CPr3
Lacosamide
Lamotrigine
Rufinamide
Oxcarbazepine
Symptoms start 1-8 weeks after starting
Fever
Rash Lymphadenopathy
Other symptoms - liver problems, multi organ failure
Stop drug immediately
Don’t give drug again
Expert advice

Question 11

AEDs MHRA

Answer 11

All AEDs risk of suicidal thoughts/behaviour
Can occur within 1 week of starting
Seek advice if mood changes

Question 12

Withdrawing AEDs

Answer 12

Specialist supervision
Abrupt withdrawal causes rebound seizures (esp BZDs and Barbiturates)
Withdraw 1 drug at a time
Withdraw over at least 2-3 months
Reduced dose by 10-25% every 1-2 weeks

Question 13

Epilepsy Driving

Answer 13

Seizure of any type - stop driving and tell DVLA
1st unprovoked seizure/single isolated seizure - stop driving for 6 months
Can drive - must be seizure free for at least 1 year and no history of unprovoked seizures
No driving during AED change/withdrawal and for 6 months after last dose
If seizure due to AED change/withdrawal - no driving for 1 year

Question 14

Epilepsy Pregnancy

Answer 14

All AEDs are teratogenic
Esp. teratogenic during 1st trimester
Esp. teratogenic if 2 or more AEDs
Valproate highest risk
Lamotrigine and Levetiracetam safer in pregnancy

Question 15

PPP for GPs

Answer 15

Provide Patient Guide to pt
Check PT reviewed by specialist in last year
Pt is on at least 1 method of highly effective contraception or 2 methods of complementary contraception

Question 16

Highly Effective Contraception

Answer 16

Copper Intrauterine Device
Levonorgestrel intrauterine device
Progestogen-only implant

Question 17

PPP for Specialist

Answer 17

Review appointments at least one a year
Complete risk assessment form

Question 18

PPP for Pharmacists

Answer 18

Always dispense PIL
Dispense whole packs (sticker on skillet when not possible)
Discuss pregnancy each time dispensing
Ensure pt has the Patient Guide
Ensure pt has seen GP/specialist

Question 19

AEDs Pregnancy

Answer 19

High risk with CPr3 and Lamotrigine
TopiramATE - high risk congenital malformation (cleft palATE) in 1st trimester - monitor fetal growth
Folic acid to reduce neural tube defects
Adjust doses of Phenytoin, Carbamazepine and Lamotrigine
VitK injection to newborns to reduce risk neonatal haemorrhage
Withdrawal effects in newborns BZDs and Phenobarbital