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CNS Flashcards

1
Q

What is dementia?

A

Dementia is the progressive and largely irreversible syndrome associated with damage to the brain caused by a variety of conditions such as Alzheimer’s and Parkinson’s disease.

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2
Q

What are the symptoms associated with dementia?

A

The symptoms of dementia can be categorised into two sections: cognitive and non-cognitive symptoms

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3
Q

What are the cognitive symptoms of dementia?

A

Difficulty thinking, memory issues, communication (via speaking issues) and unaware of time

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4
Q

What are the non-cognitive symptoms of dementia?

A

The psychiatric and behavioural changes and difficulties in daily activities

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5
Q

What pharmacological treatment is available for the cognitive symptoms of dementia?

A

ACHEis such as donepezil, galantamine and rivastigmine - Mild to Moderate

NMDA receptor antagonists - Memantine in the case of severe dementia

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6
Q

What are cautions for the following:
Donepezil
Galantamine
Rivastigmine

A

Donepezil - Narcoleptic Malignant Syndrome
Galantamine - Stop at sight of skin rash - may be a sign of Steven Johnson Syndrome
Rivastigmine - Can cause GI upset ; should be witheld until GI upset is resolved

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7
Q

Where are NMDA receptor antagonists used?

A

NMDA receptor antagonists can be used if ACHEi are contraindicated or the patient’s Alzheimer’s is severe

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8
Q

What are the side-effects associated with ACHEis?

A 
D - Diarrhoea
U - Urination
M - Muscle tone falls
B - Bronchospasm
B - Bradycardia 
E - Emesis
L - Lacrination (watery eyes)
S - Salivation/Sweating
DUMB BELS
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9
Q

What treatment is available for non-cognitive symptoms?

A

Anti-psychotics can be used in those individuals may cause self-harm or harm to others.

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10
Q

What MHRA warning is issued regarding anti-psychotics for patients with non-cognitive symptoms?

A

Antipsychotics may increase the likelihood of a stroke occuring in elderly patients with dementia. This would require factoring in co-morbidities such as: diabetes, past history of CV events.

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11
Q

What treatment is available in those who have non-cognitive symptoms that display severe violence?

A

IM halpoeridol, olanzapine or lorazepam

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12
Q

What treatment are not recommended in those who have non-cognitive symptoms that display severe violence?

A

Diazepam and Chlorpromazine

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13
Q

Define epilepsy

A

Epilepsy is defined as a sudden surge in electrical activity within the brain

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14
Q

What can non-epileptic seizures be categorised under?

A

Organic- eg: in cases of fever

Psychogenic - in cases of distressing thoughts

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15
Q

What are the two classes of epileptic seizures and what are the differences?

A

Focal & Generalised
Focal seizures affect one part of the brain
Generalised seizures affect both sides of the brain

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16
Q

Which anti-epileptics require dose adjustments according to plasma concentration during pregnancy?

A

Phenytoin, Levetiracetam and Carbamazepine

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17
Q

Which anti-epileptics require foetal growth monitoring?

A

Levetiracetam and Topiramate

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18
Q

What advice should be given to a woman who is taking anti-epileptic medication and is planning a pregnancy?

A

See a specialist
Alternatively, withdraw anti-epileptic meds until first trimester is complete
If mandatory, opt for monotherapy with lowest dose of anti-epileptic

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19
Q

What dose of folic acid is recommended in women expecting a baby, with a low risk of neural tube defect?

A

Folic Acid - 400mcg

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20
Q

What dose of folic acid is recommended in women expecting a baby, with a high risk of neural tube defect? and how long should it be taken for?

A

Folic Acid - 5mg taken from before conception to the first 12 weeks

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21
Q

What can be administered in neonates to reduce the likelihood of neonatal haemorrhages?

A

Vitamin K injection

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22
Q

Which drugs are likely to display withdrawal effects in newborns?

A

Benzodiazepines and phenobarbital

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23
Q

What monitoring should be required for infants who breastfeed if their mother takes anti-epileptic medication?

A

Drowsiness, Weight gain, Feeding Difficulties, Adverse effects

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24
Q

Which drugs are present in large amounts of breast milk?

A 
Z- Zosinamide
E- Ethosuximide
L- Lamotrigine
P- Primidone
ZELP
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25
Q

Which anti-epileptic(s) are more slowly metabolised in children?

A

Lamotrigine and Phenobarbital

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26
Q

Which anti-epileptic(s) are inhibit the sucking reflex in newborns?

A

Phenobarbital and Primodine

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27
Q

Which anti-epileptic(s) have an established risk of causing drowsiness in babies?

A

Benzodiazepines, Phenobarbitone and Primodine

28
Q

Which drugs should be avoided in abrupt withdrawal for breastfeeding children?

A

Phenobarbital and Primodine

29
Q

Why are depot injections used?

A

To aid in compliance

30
Q

What is the difference between normal and decanoate versions?

A

Decanoate - maintenance treatment

Normal - for acute episodes

31
Q

Which antipsychotics can cause hypotension and temperature irregulation?

A

Clozapine
Chlorpromazine
Lurasidone
Quetiapine

32
Q

What can be used to treat neuroleptic malignant syndrome?

A

Bromocrptine or dantrolene (Dopamine agonists)

33
Q

What antipsychotics can prolong the QT interval?

A

Primozide and Haloperidol

34
Q

What are the monitoring requirements for antipsychotics?

A 
B- Blood pressure
F- FBC, U&Es, LFTs
E- ECG
F- Fasting blood glucose
B- Blood lipids and weight
35
Q

What drug interactions occur with antipsychotics?

A

QT- prolongation - MASTAQ
Hypotension - with BP medication
EPSEs - Metoclopramide and a NO NO in Parkinson’s
Sedation - Benzodiazepines, opioids, antiepileptics
Antmuscarinic- Antimuscarinic drugs, TCAs + anti-histamines

36
Q

What is Parkinson’s disease?

A

Parkinson’s disease is the degredation of neurones in the nigral striatal pathway

37
Q

What drugs can be used in the treatment of Parkinson’s disease?

A 
Levodopa + (Benserazide or Carbidopa)
Dopamine agoinsts (Bromocriptine - ergot alkaloid)
Dopamine agonists (Pramipexole, Rotigotine, Ropinirole - non - ergot derived)
Amantadine - Weak dopamine agonist
Apomorphine - Advanced Parkinson's with unpredictable off periods
MAOBis- Seleginline (Metabolised into Amfetamine) and Rasagiline 
COMT inhibitors - Entacapone and Talcapone (not for monotheraphy - only an adjunct with levodopa) - End of dose motor fluctuations
38
Q

What SEs can occur with Parkinson’s disease drugs?

A 
Levodopa + (Benserazide or Carbidopa) - Red/dark urine, impulsive, sudden sleepiness & motor fluctuations
Dopamine agoinsts (Bromocriptine - ergot alkaloid) - Fibrotic reactions in the lungs, abdomen and the heart
Dopamine agonists (Pramipexole, Rotigotine, Ropinirole - non - ergot derived) - Impulsive, sudden sleepiness, hallucinations and hypotension
Amantadine - Weak dopamine agonist
Apomorphine - Advanced Parkinson's with unpredictable off periods - QT prolongation - take Domepridone two days before for anti-emetic reasons but stop ASAP as both can prolong the QT interval
MAOBis- Seleginline (Metabolised into Amfetamine) and Rasagiline - Hypeternsive crisis with sympathomimetics
COMT inhibitors - Entacapone and Talcapone (not for monotheraphy - only an adjunct with levodopa) - End of dose motor fluctuations - Red urine + Sympathomimetics
39
Q

What is the heirachy of Parkinson’s treatment?

A

QOL affected - Levodopa
QOL not affected - Levodopa, Non ergot alkaloid or MAOBi
Adjunct - Non ergot alkaloid or MAOBi, or COMTi

40
Q

Which drug groups can be used as antiemetics?

A 
Antimuscarinics
5HT3 receptor antagonists
Antihistamines
Antipsychotics
Dexamethasone, Nabilone and Aprepitant
41
Q

Metoclopramide licensing, dose, SEs and interactions

A

Metoclopramide is only for 18+
It is to be used for a maximum of 5 days - 1 tab TDS for 5 days
SEs: Acute dystonia for the face -> can use procyclidine to treat it
EPSEs with lithium and antipsychotics
Parkinson’s

42
Q

Domperidone licensing, dose, SEs and interactions

A

Domperidone is only for 12+
It is to be used for a maximum of 7 days - 1 tab TDS for 7 days
SEs: QT prolongation, ventricular arrhythmias and sudden death
CIs: Impaired cardiac conduction, cardiac disease and severe renal impairment
Interactions: QT prolongation MASTAQ
SICKFACES.COM

43
Q

5HT3 indications, SEs and interactions

A 
5HT3 receptor antagonists can be used for post-operative nausea and vomiting as well as chemotherapy-induced nausea and vomiting
SEs: hypokalaemaia 
Interactions: QT prolongation MASTAQ
Serotonin syndrome
Hypokalaemia
44
Q

What are the side-effects of opioids?

A 
M- Miosis
O- Out of it (sedation)
R- Respiratory depression
P- Postural hypotension
H- Hallucinations
I- Infrequency (Urination/Constipation 
N- Nausea and vomiting
E- Euphoria
45
Q

What should patients do if they are experiencing signs of breathing difficulties with fentanyl patches?

A

They must remove the patch as soon as possible

46
Q

Should fentanyl be given to patients who are experiencing rapid cycling pain?

A

No they should not- dose and pain should be stable

47
Q

If fentanyl patches need to be stopped, what should the dose of the new opioid be reduced by?

A

25-50%

48
Q

Where can codeine be used and where is it CI?

A

240mg daily max, CI in children under 12, pregnant and breasteeding, <18 with tonsils removed and not recommended in asthmatics

49
Q

What is special about tramadol?

A

It is an opioid, 5 HT and noradrenaline agonist

50
Q

What are the side effects of tramadol?

A

Bleeding, psychiatric reactions and lowers seizure threshold

51
Q

What interactions occur with tramadol?

A

Bleeding risk with warfarin, serotonin syndrome and decreased seizure threshold

52
Q

What are the signs and symptoms of migraines?

A

Visual disturbances, audiosensitivity and pins and needles

53
Q

What can be used to treat migraines?

A

For treating migraines, analgesics can be used initially. Triptans can be used after but they must not be taken again less than 2 hours after the first unless it is naratriptan which can be taken 4 hours after

54
Q

Migraine prophylaxis

A

Propranolol, Beta blockers, Antiepileptics, Pizotifen

55
Q

What is the treatment for compression neuropathy?

A

Corticosteroids

56
Q

What is the treatment for trigeminal neuralgia?

A

Phenytoin or Carbamazepine

57
Q

What are the three types of insomnia and how long do they last?

A

Transient <24 hours
Short term ~ 3 weeks
Chronic> a while

58
Q

What are the 3 -drugs that can be used for insomnia?

A

Zopiclone - tastes funny
Zolpidem - 8 hours before driving
Zaleplon - for up to 2 weeks

59
Q

Alcohol dependence drugs for seizures?

A

Chlordiazepoxide or Diazepam

60
Q

Alcohol dependence drugs for seizures?

A

Lorazepam

61
Q

What are the 3 drugs that can be used for alcohol withdrawal?

A

Acamprosate, Naltrexone and Disulfiram

62
Q

What vitamins do alcoholics lack that has been associated with Wernicke’s encephalopathy?

A

Vitamin B1- Thiamine

63
Q

NRT drugs and symptoms?

A

Bupropion

Varenicline- report suicidal ideation

64
Q

Opioid withdrawal methadone - daily dosing, half life and SEs

A

OD
Long half life
QT prolongation

65
Q

Opioid withdrawal buprenorphine - daily dosing, half life and period of administation after : a) heroin and b) methadone?

A

OD
Shorter half life
a) Heroin - 6-12 hours after
b) Methadone - 24-48 hours after

Errors (6 decks)

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