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cardiovascular system 1 > CNS 6 > Flashcards

CNS 6 Flashcards

1
Q

What are motor neurone disease

A

Neurodegenerative condition which affects the brain and spinal cord

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2
Q

State the non drug tx for motor neurone disease

A

Nutrition, psychological support , physio, exercise , use of mobility aids and special equipment

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3
Q

What is the first line tx for managing muscular symptoms such as muscle cramp

A

Quinine (Unlicensed)

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4
Q

What is the second line tx for muscle cramp

A

Baclofen

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5
Q

State the other unlicensed tx for muscle cramp?

A

Tizanidine, dantrolene sodium or gabapentine( all.unlicensed used

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6
Q

What’s the tx for muscle stiffness?

A

Baclofen, tizanidine, gabapentine, dantrolene

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7
Q

What’s the tx for saliva problems

A

Antimuscarinic drugs( unlicensed)
Glycopyrronium bromide For pt with cognitive impairment if ineffective, specialist referral for botulinum toxin type A

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8
Q

Tx for thick tenacious saliva

A

Humidification, nebulizer or carbocysteine

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9
Q

Tx for respiratory symptoms

A

Breathlessness ( opiods) or benzodiazapine if symptoms Exacerbated by anxiety

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10
Q

Tx for amyotrophic lateral sclerosis aka motor neurone disease

A

Riluzole used as tx to extend life

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11
Q

What is Parkinson’s disease

A

Progressive neurodegenerative condition results from the death of dopamine cells of substantia nigra in the brain

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12
Q

What are eg of motor symptoms of PD

A

Hypokinesia( small movement)
Bradykinesia( slow movement)
Rigidity
Rest tremor
Postural instability

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13
Q

Non motor symptoms of PD

A

Dementia
Depression
Sleep disturbance
Bladder and bowel dysfunction
Speech and language changes
Swallowing problems
Weight loss

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14
Q

Inform DVLA and car insurers once diagnosis of PD confirmed . T/false?

A

True

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15
Q

Refer a pt with PD to a specialist and review every 6-12 months T/ F

A

True

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16
Q

Non- drug tx for PD

A

Physiotherapy
SLT
Occupational therapy
Dietitian

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17
Q

Eg of drugs used in PD

A

See photo Fav.

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18
Q

List the two main drug classes used to tx PD

A

Antimuscarinic and DA drugs

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19
Q

List eg of Antimuscarinic drugs used to tx PD

A

Procyclidine
Trihexyphenyl
Orphenadrine

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20
Q

DA drugs used in PD

A

Catechol-o- methyltransferase inhibitors eg Entacapone, opicapone, tolcapone)

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21
Q

List eg of Dopamine precursors used in PD

A

Co- beneldopa, co- careldopa) - more neurone complications

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22
Q

List eg of Dopamine receptor agonist used in PD

A

Amantadine, apomorphine, bromocriprine , carbergoline, pergolide, pramipexole , ropinirole and rotigotine

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23
Q

List eg of Monamine - Oxidase B Inhibitor used in PD

A

Rasagaline, selegiline , safinamide

24
Q

What’s the first line tx of motor symptoms of PD that affect QOL

A

Levodopa + carbidopa ( co-careldopa)
Or Benserazide( co-beneldopa)

25
Q

Management of motor symptoms of PD that does not affect QOL

A

Levodopa or
Non ergot derived dopamine receptor agonist eg Pramipexole, ropinirole or rotigotine
Rasagaline or selegline- Monoamine Oxidase B inhibitor

26
Q

Can you abruptly withdrawal Antiparkinson drugs?

A

Nope to avoid side effects

27
Q

Pt and carer advice on Antipakison’s drug

A

Inform pt of risk of adverse reactions including psychotic symptoms

28
Q

Which antiparkinson drug causes sudden onset of sleep as an ADR

A

Dopamine agonist such as Pramipexole, ropinirole or rotigotine and co-careldopa

29
Q

Which antiparkinson drug is associated with more motor Complication eg Dyskinesia

A

Levodopa

30
Q

State what to offer pts who develop Dyskinesia or motor fluctuations despite optimal levodopa

A

Offer a choice of non-ergotic DA agonist such as Pramipexole or Ropinirole, rotigotine or Rasagiline or Selegiline or COMT inhibitor entacapone or tolcapone as adjunct

31
Q

State when to use an ergot derived Dopamine agonist as an adjunct therapy to tx dyskinesia

A

Only use if non ergot DA agonist are not adequate

32
Q

Amantadine is indicatied for?

A

Used if dyskinesia is still not adequately managed by modifying existing therapy

33
Q

State what drug is used to manage excessive day time sleepiness and sudden onset of sleep in PD

A

Modafinil
Review tx every 12months
Inform DVLA
Advise pt not to drive

34
Q

State what to use in the management of Nocturnal akinesia

A

Levodopa or oral dopamine receptor agonist(1st line)
Rotigotine(2nd line)

35
Q

What is nocturnal akinesia

A

Inability to turn in bed or rise to pass urine at night

36
Q

What drug is used to tx postural hypotension in PD?

A

Midodrine HCL( ist line)
Fludrocortisone (alternative)

37
Q

What drug is used to tx psychotic symptoms?

A

Hallucinations and Delusion- no tx is needed if well tolerated

38
Q

State when Quetiapine or Clozapine is used in tx psychotic symptoms in PD

A

It is used in pt with no cognitive impairment

39
Q

What Antisychotics used in tx non motor symptoms of PD worsen the motor symptoms of Parkinson’s

A

Phenothiazines or butyrophenones

40
Q

State the drug used to tx rapid eye movement sleep behaviour disorder in PD

A

Clonazepam or melatonin

41
Q

Drug used to tx drooling saliva in PD

A

Only use if SALT is not available or Non effective
Ist line- Glycopyrronium bromide (ist line)
Botulinum toxin type A (2nd line)

42
Q

Drug management of Parkinson’s disease dementia

A

Offer a cholinesterase inhibitor to pt with mild- moderate PD
Offer Memantine if C.I is contraindicated

43
Q

What’s the drug management for advanced PD?

A

Offer apomorphine HCl injection or infusions
Give Domperidone to counter N and V side effects from Apomorphine

44
Q

Impulse control disorder can develop in Parkinson’s pt on Dopaminergic therapy. T/false

A

True

45
Q

State how to manage impulse control disorder

A

Reduce dose of DA receptor agonist gradually and monitor withdrawal symptoms
Offer CBT if dose reduction not effective

46
Q

Important Safety advice for anti parkinsons drugs

A

Fibrotic runs
Monitor for dyspnoea ( laboured breathing) ,persistent cough, chest pain, cardiac failure and abdominal pain (Bromocriptine, carbegoline ,pergolide)

Impulse control disorder

47
Q

Stopping parkinsons drug abruptly causes what …

A

NMS - neuroleptic malignant syndrome; high fever, confusion, rigid muscle, sweating, fast Heart rate]

48
Q

What is the drug of choice to tx N and V in PD?

A

Domperidone

49
Q

State why Metoclopramide isn’t used to tx N and V in PD

A

Increases EPSE, exacerbations PD and antagonises effect of Antiparkinson drug

50
Q

State the appropriate time to tx n and V caused by apormorphine in PD

A

2 days before apormorphine tx and discontinue ASAP

51
Q

Domperidone increases risk of QT prolongation when given with what drug?

A

Apomorphine
It can cause serious Arrhythmia.
Monitor ECG and cardiac risk factor

52
Q

State the indication of COMT inhibitors

A

Use as adjunct to levodopa eg Tolcapone and Entacapone

53
Q

What’s the patient carer advice for Tolcapone?

A

Liver toxicity

54
Q

Signs of liver toxicity for pts on Tolcapone

A

Anorexia, N and V, Fatigue, Abdominal pain, dark Urine or Pruritus develop

55
Q

Pt and carer advise for Entacapone

A

May colour urine [ Reddish brown) label 14

cardiovascular system 1 (42 decks)

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