CNS Flashcards
You are a locum pharmacist at a local community pharmacy, and you receive a FP10 prescription with the following medications: Co-beneldopa 12.5/50mg – 1 capsule TDS (06.00, 14:00, 22:00), Metoclopramide 10mg tablets – 1 tablet TDS x 5 days. Which ONE of the following is the most appropriate action to take?
A) Contact the GP as metoclopramide is contraindicated in this patient. Therefore, Co-beneldopa should be switched to Selegeline
B) Dispense the prescription as prescribed
C) Contact the GP as metoclopramide should be prescribed for 7 days
D) Contact the GP as metoclopramide is contraindicated in this patient. Therefore, Co-beneldopa should be switched to Co-careldopa
E) Contact the GP as metoclopramide is contraindicated in this patient. Therefore, it should be switched to Domperidone 10mg TDS, to be taken for 7 days.
E
RATIONALE: METOCLOPRAMIDE SHOULD BE AVOIDED IN PATIENTS WITH PARKINSON’S DISEASE AS IT HAS A HIGH RISK OF WORSENING PARKINSON’S DISEASE SYMPTOMS THROUGH ITS MECHANISM OF ACTION OF BLOCKING D2 RECEPTORS. THEREFORE, DOMPERIDONE SHOULD BE USED AS AN ALTERNATIVE. .
During your CNS teaching session with your trainee pharmacist, you are asked for which types of dementia are acetylcholinesterase inhibitors NOT recommended in. Which ONE of the following is the correct answer?
A) Alzheimer’s disease dementia
B) Dementia with Lewy bodies
C) Frontotemporal dementia
D) Parkinson’s disease dementia
E) Mixed dementia
C
RATIONALE: ACETYLCHOLINESTERASE INHIBITORS SHOULD NOT BE USED IN FRONTOTEMPORAL DEMENTIA. THESE MEDICATIONS TEMPORARILY INCREASE ACETYLCHOLINE TO DAMAGED NERVES BUT IN FTD, NERVES IN THE ACETYLCHOLINE COMMUNICATION SYSTEM ARE NOT AFFECTED.
You are the clinical pharmacist on a ward. A junior doctor approaches you and states that one of his patients has been prescribed lithium for acute episodes of mania. You are aware that lithium is a narrow therapeutic drug and must be maintained within a target range. Which ONE of the following is the correct therapeutic range for lithium serum levels?
A) 0.4 – 1mmol/L
B) 10 – 20mmol/L
C) 0.2 – 0.4mmol/L
D) 0.8 – 1mmol/L
E) < 1 mmol/L
D
RATIONALE: LITHIUM TARGET RANGE FOR ACUTE EPISODES
OF MANIA = 0.8-1MMOL/L
Mrs FR who is 43 years old and is of Thai origin has been diagnosed with focal seizures. The mental health team decide the patient should be initiated on antiepileptic treatment. A test for the HLA-B*1502 allele has been conducted which has been reported as positive. Which ONE of the following antiepileptic medications can NOT be initiated for Mr PQ?
A) Sodium Valproate
B) Carbamazepine
C) Levetiracetam
D) Lamotrigine + Gabapentin
E) Clobazam + Levetiracetam
B
RATIONALE: POSITIVE ALLELE HAS BEEN REPORTED. THERE IS A RISK OF STEVENS-JOHNSON SYNDROME IN PRESENCE OF
HLA-B*1502 ALLELE.
You are explaining narrow therapeutic drugs to your trainee pharmacist, and you are asked what the therapeutic range for phenytoin is. Which ONE of the following is the correct answer?
A) 5 – 10mg/L
B) 20 – 40mg/L
C) 10 – 20mg/L
D) 4- 8 mg/L
E) 8 – 12 mg/L
C
RATIONALE: PHENYTOIN TARGET RANGE = 10-20MG/L
You are the community pharmacist at a local pharmacy. A patient attends your pharmacy complaining of severe headaches and palpitations. She states she has been compliant with her medications. On further questioning of the patient’s lifestyle, you determine she has recently been consuming more recipes of broad bean pods. You notice the patient is taking the following medications: You notice the patient is taking the following medications: Paracetamol 1g QDS PRN, Isocarboxazid 60mg OD, Metformin 500mg OD, Amlodipine 10mg OD. You identify that the presenting symptoms could be due to an interaction. Which ONE of the following interactions could contribute to the patient’s symptoms?
A) Amlodipine and Isocarboxazid
B) Metformin and Isocarboxazid
C) Amlodipine and broad bean pods
D) Isocarboxazid and broad bean pods
E) Paracetamol and Amlodipine
D
HTN CRISIS CAN DEVELOP IN PTS ON MONOAMINE OXIDASE INHIBITORS (MAOIS) WHO ALSO EAT TYRAMINE RICH FOODS (SUCH AS MATURE CHEESE, SALAMI, PICKLED HERRING, BOVRIL, OXO, MARMITE, YEAST EXTRACT, FERMENTED SOYA BEAN EXTRACT) OR FOODS CONTAINING DOPA SUCH AS BROAD BEAN PODS.
AVOID TYRAMINE RICH OR DOPA RICH FOODS OR DRINKS WITH MAOIS OR FOR 2-3 WEEKS AFTER STOPPING MAOIS.
HTN CRISIS SYMPTOMS INCLUDE SEVERE HEADACHES, PALPITATIONS, CONFUSION, NAUSEA AND VOMITING, CHEST PAIN ETC.
Mr TY has been admitted into A&E following a seizure. From his medical records you ascertain that this is Mr TY’s first seizure with no specific cause, and it has been deemed as an unprovoked seizure. The registrar approaches you as he is unsure of the rules regarding DVLA. Which ONE of the following is the most appropriate advice to give to the doctor?
A) The patient can continue to drive as normal. If he experiences 3 consecutive unprovoked seizures, he should contact DVLA immediately and stop driving for 6 months
B) The patient should contact DVLA immediately and stop driving for 6 months
C) The patient can continue to drive as normal and should only contact DVLA if he experiences a provoked seizure
D) The patient should contact DVLA immediately and stop driving for 8 months
E) The patient does not need to contact DVLA but should complete a questionnaire to deem whether he is a danger to the public
B
RATIONALE: PATIENTS WHO HAVE HAD A FIRST UNPROVOKED EPILEPTIC SEIZURE OR A SINGLE ISOLATED SEIZURE MUST NOT DRIVE FOR 6 MONTHS; DRIVING MAY THEN BE RESUMED, PROVIDED THE PATIENT HAS BEEN ASSESSED BY A SPECIALIST AS FIT TO DRIVE AND INVESTIGATIONS DO NOT SUGGEST A RISK OF FURTHER SEIZURES.
Your trainee pharmacist is learning about the management of status epilepticus and asks you what the appropriate management is when facilities for resuscitation are not immediately available to the patient. Which ONE of the following is the correct answer?
A) Oral Diazepam
B) IM phenytoin
C) SC sodium valproate
D) IM Levetiracetam
E) Oromucosal Midazolam
E
RATIONALE: WHEN FACILITIES FOR RESUSCITATION ARE NOT IMMEDIATELY AVAILABLE RECTAL DIAZEPAM OR OROMUCOSAL MIDAZOLAM CAN BE ADMINISTERED.
Mrs FG attends your community pharmacy. She complains of weakness in her muscles, nausea, and diarrhoea. You notice she also has a fine tremor in her hands. From her summary care record, you notice Mrs FG has recently been prescribed a new medication and suspect her presentation may be due to this medication interacting with her lithium. Which ONE of the following is most likely to interact with lithium?
A) Digoxin
B) Spironolactone
C) Gabapentin
D) Codeine
E) Bendroflumethiazide
E
RATIONALE: DIURETICS CAN INCREASE LITHIUM LEVELS. PATIENT IS PRESENTING WITH SYMPTOMS OF LITHIUM TOXICITY (WEAKNESS IN MUSCLES, NAUSEA, DIARRHOEA, AND FINE TREMOR IN HANDS).
You are the community pharmacist at a local pharmacy. You receive the following prescription for Mr ER for the treatment of H.pylori: Omeprazole 20mg BD for 7 days, Clarithromycin 500mg BD for 7 days, Metronidazole 400mg BD for 7 days. You confirm the patient has no allergies to any antibiotics. From the patient’s PMR you notice he is taking the following repeat medications: Aspirin 75mg OD, Citalopram 20mg OM, Ramipril 10mg OD, Bisoprolol 5mg OD, Atorvastatin 80mg OD. Which ONE of the following actions is the most appropriate to take?
A) Dispense the prescription
B) Contact the GP as the dose of Clarithromycin is too low
C) Contact the GP as there is an interaction between Omeprazole and Aspirin. Omeprazole should be switched to Lansoprazole
D) Contact the GP as the dose of Omeprazole is too high
E) Contact the GP as there is an interaction between Citalopram and Clarithromycin. Clarithromycin should be switched to Amoxicillin
E
RATIONALE:
BOTH CITALOPRAM AND CLARITHROMYCIN CAN PROLONG THE QT INTERVAL.
CLARITHROMYCIN DOSE FOR H.PYLORI IS 500MG BD AS PER BNF.
OMEPRAZOLE DOSE FOR H.PYLORI IS 20MG-40MG BD AS PER BNF
THERE IS NO INTERACTION BETWEEN OMEPRAZOLE AND
Mrs IP who is 3 months pregnant has been diagnosed with tonic/clonic seizures and has been initiated on a single antiepileptic drug. Which ONE of the following medications is deemed as the most appropriate for Mrs IP?
A) Sodium valproate
B) Topiramate
C) Lamotrigine
D) Levetiracetam
E) Diazepam
C
RATIONALE: SODIUM VALPROATE IS ASSOCIATED WITH RISK OF DEVELOPMENTAL DISORDERS SO IS NOT SAFE IN PREGNANCY. TOPIRAMATE IS ASSOCIATED WITH CLEFT PALATE AND NOT CONSIDERED SAFE IN PREGNANCY. LAMOTRIGINE IS SAFE IN PREGNANCY.
LEVETIRACETAM IS LICENSED FOR ADJUNCTIVE THERAPY IN TONIC-CLONIC SEZIURES.
DIAZEPAM IS NOT LICENSED FOR TONIC-CLONIC SEZIURES
You are the clinical pharmacist on a ward and are reviewing a patient who has been admitted with confusion, convulsions, and lethargy. On reviewing the patient’s electrolyte levels you notice the sodium levels appear deranged. Which ONE of the following medications can contribute to the altered electrolyte level?
A) Carbamazepine
B) Amlodipine
C) Paracetamol
D) Bisoprolol
E) Cetirizine
A
RATIONALE: CARBAMAZEPINE CAN CAUSE LOW SODIUM LEVELS. CONFUSION, CONVULSION, AND LETHARGY ARE SYMPTOMS ASSOCIATED WITH HYPONATREMIA.
You are the clinical pharmacist on a ward. A junior doctor states that a patient who has been initiated on an antipsychotic is now showing signs of involuntary muscle contraction and facial movements and tremor. He would like to know which antipsychotic has a lower risk of the above symptoms. Which ONE of the following is the most appropriate answer?
A) Flupentixol
B) Haloperidol
C) Promazine
D) Benperidol
E) Quetiapine
E
RATIONALE: EXTRAPYRAMIDAL SYMPTOMS ARE LESS COMMON WITH SOME SECOND-GENERATION ANTIPSYCHOTICS WHICH HAS A LOWER LIABILITY FOR BOTH ACUTE AND LATE ONSET EPS; PARTICULARLY CLOZAPINE, OLANZAPINE, QUETIAPINE, AND ARIPIPRAZOLE
Mrs YT attends your local community pharmacy. She complains she has been feeling constipated for the past 5 days and would like to buy Movicol sachets. You ascertain that Mrs YT is prescribed the following medication: Paracetamol 1g QDS PRN, Clozapine 25mg OD. Which ONE of the following is the most appropriate action to take?
A) Advise Mrs YT to speak to her GP immediately before taking the next dose of clozapine
B) Supply Mrs YT with Movicol sachets
C) Advise Mrs YT to purchase senna tablets as they would be more appropriate for her symptoms
D) Advise Mrs YT to stop taking paracetamol
E) Advise Mrs YT to reduce her dose of clozapine
A
RATIONALE: CLOZAPINE IS CONTRAINDICATED IN PATIENTS WITH PARALYTIC ILEUS. ADVISE PATIENTS THAT IF THEY DEVELOP CONSTIPATION, THEY SHOULD TELL THEIR DOCTOR IMMEDIATELY BEFORE TAKING THE NEXT DOSE OF CLOZAPINE. IT IS VITAL THAT CONSTIPATION IS RECOGNISED EARLY AND ACTIVELY TREATED
Which ONE of the following is the correct therapeutic range for Carbamazepine?
A) 10-12mg/L
B) 10-20mg/L
C) 4-12mg/L
D) 2-8mg/L
E) 5-10mg/L
C
Your trainee pharmacist is learning about serotonin syndrome and asks for an example of a medication interaction that can cause serotonin syndrome. Which ONE of the following is the correct answer?
A) Citalopram and Bisoprolol
B) Citalopram and Atorvastatin
C) Citalopram and Sumatriptan
D) Citalopram and Amlodipine
E) Citalopram and Metformin
C- SSRI and triptans can cause serotonin syndrome
You are the clinical pharmacist on a ward. A junior doctor states that a patient who has diabetes will be initiated on an antipsychotic. He would like to know which antipsychotic has a lower risk of worsening diabetes. Which ONE of the following is the most appropriate answer?
A) Quetiapine
B) Aripiprazole
C) Clozapine
D) Olanzapine
E) Risperidone
B
RATIONALE: SECOND GENERATION ANTIPSYCHOTICS ARE ASSOCIATED WITH HIGHER RISK OF DIABETES. FIRST GENERATION HAVE A LOWER RISK.
You are the clinical pharmacist on a ward, and you are reviewing a patient who has QT prolongation. You notice this patient’s GP has started a new medication which may have been one of the contributing factors for the QT prolongation. Which ONE of the following medications can cause QT prolongation?
A) Nifedipine
B) Sertraline
C) Indapamide
D) Gabapentin
E) Metformin
B- SSRI ARE ASSOCIATED WITH QT PROLONGATION
You are the clinical pharmacist on a ward, and you are reviewing a patient who has presented with black tarry stool and abdominal cramps. You notice this patient has been started on a new medication which may have caused the presenting symptoms. Which ONE of the following medications is most likely the cause?
A) Amlodipine
B) Sertraline
C) Paracetamol
D) Cetirizine
E) Bisoprolol
B- SSRI CAN CAUSE GI BLEED
Mr BU attends your community pharmacy complaining of dry mouth and urinary retention. He states these symptoms appeared after a new medication was initiated by his GP. Which ONE of the following is most likely to cause the symptoms described?
A) Sertraline
B) Phenelzine
C) Imipramine
D) Citalopram
E) Fluoxetine
C
RATIONALE: TRICYCLIC ANTIDEPRESSANTS (IMIPRAMINE) ARE COMMONLY ASSOCIATED WITH ANTIMUSCARINIC SIDE EFFECTS SUCH AS DRY MOUTH AND URINARY RETENTION.
You are the clinical pharmacist on a ward, and you are reviewing a patient who has presented with confusion, slurred speech, lethargy, and vomiting. From the summary care record, you ascertain this may be due to toxicity with one of the patient’s newly started medication. Which ONE of the following medications is most likely the cause?
A) Amlodipine
B) Phenytoin
C) Ramipril
D) Metformin
E) Loratadine
B- Slurred speech, lethargy, vomiting are all signs of phenytoin toxicity
You are the prescribing pharmacist at a local GP practice. Miss TR who is 23 years old attends the practice and states she has been taking an antidepressant for one week but still feels low. She believes her medication is not working and would like an alternative. You explain to Miss TR that treatment should be continued for a minimum number of weeks before switching an antidepressant due to lack of efficacy. Which ONE of the following number of weeks should treatment be continued for before considering an alternative antidepressant?
A) 2 weeks
B) 6 weeks
C) 3 weeks
D) 8 weeks
E) 4 weeks
E
RATIONALE: TREATMENT SHOULD BE CONTINUED FOR AT LEAST 4 WEEKS (6WEEKS IN THE ELDERLY) BEFORE CONSIDERING WHETHER TO SWITCH ANTIDEPRESSANT DUE TO LACK OF EFFICACY.
You are the line manager of a trainee pharmacist. During your 1:1 meeting, you are explaining to your pre-reg about interactions between monoamine oxidase inhibitors (MAOIs) and foods containing tyramine. Your pre-reg asks you for examples of tyramine rich foods. Which ONE of the following foods interacts with MAOIs?
A) Fermented cheese
B) Pickled onion
C) Yeast extracts
D) Almond milk
E) Fresh meat
C
RATIONALE: TYRAMINE RICH FOODS INCLUDE MATURE CHEESE, YEAST EXTRACTS, FERMENTED SOYA BEAN PRODUCTS. PATIENTS SHOULD ALSO BE ADVISED TO EAT ONLY FRESH FOODS AND AVOID FOOD THAT IS SUSPECTED OF BEING STALE OR GOING OFF.
You are the community pharmacist at a local pharmacy. Mr ER attends your pharmacy to buy Sudafed decongestant tablets for a cold. You obtain a history of Mr ER’s medical conditions and a list of medications he takes. Which ONE of the following medications would cause you to NOT supply Sudafed?
A) Propranolol
B) Phenelzine
C) Metformin
D) Naproxen
E) Lactulose
B
RATIONALE: PSEUDOEPHEDRINE IS PREDICTED TO INCREASE THE RISK OF HYPERTENSIVE CRISIS WHEN GIVEN WITH PHENELZINE (MAOI).
