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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
Q

Common side effects of Valproate

A

HYPONATREMIA

26
Q

Serious valproate interaction with Lamotrigine

A

Valproate
Increases the exposure of Lamotrigine. Adjust dose of Lamotrigine and monitor rash. Lamotrigine causes SJS

27
Q

Valproate interaction with Olanzapine

A

Increases risk of ADRs

28
Q

Interaction of valproate with PHENytoin

A

Valproate affects the concentration of PHENytoin.
PHENytoin decreases the conc of Valproate.
Monitor concentration

29
Q

Topiramate interaction with valproate

A

Topiramate increases the risk of toxicity when given with Valproate.
Monitor

30
Q

Valproate interaction with pivmecillam

A

Avoid as it increases risk of ADR

31
Q

How valproate interact with Ertapenem, imipenem and meropenem

A

Avoid because it decreases concentration of valproate

32
Q

Patients and carer advise for those on valproate

A

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
Q

Facts about Vigabatrin

A

Use for focal seizures
Worsens absence myoclonic, Tonic Nd atonic seizures

34
Q

State the side effect of Vigabatrin

A

VI
Visual disturbance
It persist even after stopping drug
Test before tx and 6months interval
Report any visual symptoms urgently

35
Q

Facts about Gabapentine and pregabalin

A

Use to treat focal seizure
Licensed for neuropathic pain
Tx of GAD

36
Q

State when to avoid pregabalin and Gabapentin in seizures

A

Avoid in Tonic, myoclonic and absence seizure
MAT

37
Q

What is status epilepticus

A

Seizure that lasts for more than 5mins or go on and on with no rest in between

38
Q

Types of status epilepticus

A

Convulsive and non convulsive

39
Q

What is convulsive status epilepticus

A

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
Q

State the management of status epilepticus in the presence of a resuscitation facility

A

Use IV lorazepam

41
Q

State how to manage status epilepticus in the absence of a resuscitation facility

A

Give Diazepam rectal solution or midazolam oromucusal solution into buccal cavity

42
Q

State how to manage status epilepticus

A

Monitor pt to avoid injury support respiration including providing oxygen
Maintain BP and correct any Hypo

43
Q

State how to manage status epilepticus in suspected alcohol abuse?

A

Give Parenteral Thiamine

44
Q

State how to manage status epilepticus caused by pyridoxine deficiency

A

Give Pyridoxine

45
Q

Adr when using Iv Diazepam in tx status epilepticus

A

IV Diazepam is effective but has a high risk of Thrombophlebitis ( reduced by using emulsion)

46
Q

What’s the challenge with using I.M and suppository Diazepam in tx status epilepticus

A

Absorption is too slow to treat Status epilepticus

47
Q

State what to give after 25mins if no response in status epilepticus

A

Give PHENytoin sodium or PHENOBARBITAL sodium or fosphenytoin
Contact intensive care if seizure continues

48
Q

State what to do 45mins later, if status epilepticus persists

A

Anaesthesia with thiopental sodium, midazolam or propofol should be used with ITU support

49
Q

How to tx a non convulsive status epilepticus

A

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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