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cardiovascular system 1 > CNS > Flashcards

CNS Flashcards

1
Q

What is the first line tx for Tonic clo nic seizure in post menopausal women?

A

Sodium valproate

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2
Q

What is the first line tx for Tonic clonic seizure in premenopausal women?

A

Lamotrigine

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3
Q

Other drugs used in Tonic clonic seizure are?

A

Carbamezepine, Oxcarbazepine, topiramate, clobazam and levetiracetam

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4
Q

Mnemonic for drugs used in Tonic clonic seizure is?

A

SALTCO
Sodium valproate
Alternatively
Lamotrigine
Topiramate
Carbamezepine
Oxcarbazepine

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5
Q

Define Tonic clonic seizure

A

The body becomes stiff, loss of consciousness and convulsions
Loss of Bladder and bowel motion
Biting of tongue/cheek and difficulty breathing

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6
Q

Absence seizure meaning

A

Brief loss of consciousness and awareness for a second
No fall over
Last only for a few seconds
Mainly occur in children

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7
Q

Drug tx in Absence seizure

A

SEAL
Sodium valproate- second line
Ethosuximide- first line tx
Alternatively
Lamotrigine/ levetiracetam - unsuccessful or unsuitable tx

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8
Q

What’s myoclonic seizure?

A

A sudden contraction of the muscles which cause a jerk

Can affect the whole body, one arm or both arms

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9
Q

Tx for Myoclonic seizure

A

SALT LEVELS
Sodium valproate
Alternatively
Leviteracetam or Topiramate

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10
Q

What is Tonic or atonic seizure?

A

Brief loss of consciousness
May become stiff and fall to the ground

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11
Q

Tx of atonic/Tonic seizure

A

SLART
Sodium valproate
Lamotrigine
Alternatively
Rufinamide
Topiramate

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12
Q

What is the drug of choice for all generalised seizure?

A

Sodium valproate

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13
Q

First line tx for focal seizure

A

CL
Carbamazepine and Lamotrigine

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14
Q

State alternative tx for focal seizure

A

Oxcarbazepine, sodium valproate and levetiracetam [SOL]

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15
Q

What is the patient and carer advice for Carbamezepine?

A

Can cause blood, hepatic and Skin disorders
Seek medical attention if fever, rash, sore throat, mouth ulcers, bruising or bleeding

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16
Q

What’s the drug of choice for simple and complex focal seizure?

A

Carbamezepine

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17
Q

What is the plasma concentration range for optimum response for Carbamezepine?

A

4-12mg/L
(20-50micro/L)
Measured after 1-2weeks

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18
Q

Signs of Carbamezepine toxicity?

A

Hand bag
Hyponatremia
Nystagmus
Drowsiness
Blurred vision
Arrhythmia
GI(N and V)

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19
Q

Carbamezepine pre treatment

A

Test for HLA-B 1502 allele in Han Chinese or Thai Region increases risk of Steven Johnson’s Syndrome
The risk of SJS found mainly in Han Chinese and Thai Population.
Avoid unless no alternative

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20
Q

What AED can cause serious skin reaction especially in children in first 8weeks?

A

Lamotrigine

21
Q

Indication of Lamotrigine

A

Focal seizure
Secondary generalised Tonic clonic seizures
Bipolar disorder

22
Q

Valproate increases plasma Lamotrigine concentration and inducers reduce it .T/F

23
Q

Counselling point for Lamotrigine

A

Withdraw if rash or hypersensitivity develops and see GP and signs of blood disorders

24
Q

Side effects of valproate

A

Valproate
A- appetite increased
L- liver failure
P- Pancreatitis- p450 inhibitors
R- Reversible Hair Loss
O- Oedema
A- Ataxia
T- Teratogenicity
E- Encephalopathy

25
Common side effects of Valproate
HYPONATREMIA
26
Serious valproate interaction with Lamotrigine
Valproate Increases the exposure of Lamotrigine. Adjust dose of Lamotrigine and monitor rash. Lamotrigine causes SJS
27
Valproate interaction with Olanzapine
Increases risk of ADRs
28
Interaction of valproate with PHENytoin
Valproate affects the concentration of PHENytoin. PHENytoin decreases the conc of Valproate. Monitor concentration
29
Topiramate interaction with valproate
Topiramate increases the risk of toxicity when given with Valproate. Monitor
30
Valproate interaction with pivmecillam
Avoid as it increases risk of ADR
31
How valproate interact with Ertapenem, imipenem and meropenem
Avoid because it decreases concentration of valproate
32
Patients and carer advise for those on valproate
Recognise signs of blood, hepatic disorders and pancreatic Women and girls should not stop taking valproate without discussing it with their doctor Pharmacist must ensure that femal patient have a patient card and all important safety information including leaflets
33
Facts about Vigabatrin
Use for focal seizures Worsens absence myoclonic, Tonic Nd atonic seizures
34
State the side effect of Vigabatrin
VI Visual disturbance It persist even after stopping drug Test before tx and 6months interval Report any visual symptoms urgently
35
Facts about Gabapentine and pregabalin
Use to treat focal seizure Licensed for neuropathic pain Tx of GAD
36
State when to avoid pregabalin and Gabapentin in seizures
Avoid in Tonic, myoclonic and absence seizure MAT
37
What is status epilepticus
Seizure that lasts for more than 5mins or go on and on with no rest in between
38
Types of status epilepticus
Convulsive and non convulsive
39
What is convulsive status epilepticus
A convulsive seizure which continues for a prolonged period greater than 5mins It is an emergency Non convulsive is less common and less urgent
40
State the management of status epilepticus in the presence of a resuscitation facility
Use IV lorazepam
41
State how to manage status epilepticus in the absence of a resuscitation facility
Give Diazepam rectal solution or midazolam oromucusal solution into buccal cavity
42
State how to manage status epilepticus
Monitor pt to avoid injury support respiration including providing oxygen Maintain BP and correct any Hypo
43
State how to manage status epilepticus in suspected alcohol abuse?
Give Parenteral Thiamine
44
State how to manage status epilepticus caused by pyridoxine deficiency
Give Pyridoxine
45
Adr when using Iv Diazepam in tx status epilepticus
IV Diazepam is effective but has a high risk of Thrombophlebitis ( reduced by using emulsion)
46
What's the challenge with using I.M and suppository Diazepam in tx status epilepticus
Absorption is too slow to treat Status epilepticus
47
State what to give after 25mins if no response in status epilepticus
Give PHENytoin sodium or PHENOBARBITAL sodium or fosphenytoin Contact intensive care if seizure continues
48
State what to do 45mins later, if status epilepticus persists
Anaesthesia with thiopental sodium, midazolam or propofol should be used with ITU support
49
How to tx a non convulsive status epilepticus
If there's partial loss of awareness, give, give oral AED If there Full loss of awareness, tx as you would tx a convulsive status epilepticus

cardiovascular system 1 (42 decks)

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