CNS Flashcards
What is dementia?
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.
What are the symptoms associated with dementia?
The symptoms of dementia can be categorised into two sections: cognitive and non-cognitive symptoms
What are the cognitive symptoms of dementia?
Difficulty thinking, memory issues, communication (via speaking issues) and unaware of time
What are the non-cognitive symptoms of dementia?
The psychiatric and behavioural changes and difficulties in daily activities
What pharmacological treatment is available for the cognitive symptoms of dementia?
ACHEis such as donepezil, galantamine and rivastigmine - Mild to Moderate
NMDA receptor antagonists - Memantine in the case of severe dementia
What are cautions for the following:
Donepezil
Galantamine
Rivastigmine
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
Where are NMDA receptor antagonists used?
NMDA receptor antagonists can be used if ACHEi are contraindicated or the patient’s Alzheimer’s is severe
What are the side-effects associated with ACHEis?
D - Diarrhoea U - Urination M - Muscle tone falls B - Bronchospasm B - Bradycardia E - Emesis L - Lacrination (watery eyes) S - Salivation/Sweating DUMB BELS
What treatment is available for non-cognitive symptoms?
Anti-psychotics can be used in those individuals may cause self-harm or harm to others.
What MHRA warning is issued regarding anti-psychotics for patients with non-cognitive symptoms?
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.
What treatment is available in those who have non-cognitive symptoms that display severe violence?
IM halpoeridol, olanzapine or lorazepam
What treatment are not recommended in those who have non-cognitive symptoms that display severe violence?
Diazepam and Chlorpromazine
Define epilepsy
Epilepsy is defined as a sudden surge in electrical activity within the brain
What can non-epileptic seizures be categorised under?
Organic- eg: in cases of fever
Psychogenic - in cases of distressing thoughts
What are the two classes of epileptic seizures and what are the differences?
Focal & Generalised
Focal seizures affect one part of the brain
Generalised seizures affect both sides of the brain
Which anti-epileptics require dose adjustments according to plasma concentration during pregnancy?
Phenytoin, Levetiracetam and Carbamazepine
Which anti-epileptics require foetal growth monitoring?
Levetiracetam and Topiramate
What advice should be given to a woman who is taking anti-epileptic medication and is planning a pregnancy?
See a specialist
Alternatively, withdraw anti-epileptic meds until first trimester is complete
If mandatory, opt for monotherapy with lowest dose of anti-epileptic
What dose of folic acid is recommended in women expecting a baby, with a low risk of neural tube defect?
Folic Acid - 400mcg
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?
Folic Acid - 5mg taken from before conception to the first 12 weeks
What can be administered in neonates to reduce the likelihood of neonatal haemorrhages?
Vitamin K injection
Which drugs are likely to display withdrawal effects in newborns?
Benzodiazepines and phenobarbital
What monitoring should be required for infants who breastfeed if their mother takes anti-epileptic medication?
Drowsiness, Weight gain, Feeding Difficulties, Adverse effects
Which drugs are present in large amounts of breast milk?
Z- Zosinamide E- Ethosuximide L- Lamotrigine P- Primidone ZELP
Which anti-epileptic(s) are more slowly metabolised in children?
Lamotrigine and Phenobarbital
Which anti-epileptic(s) are inhibit the sucking reflex in newborns?
Phenobarbital and Primodine
Which anti-epileptic(s) have an established risk of causing drowsiness in babies?
Benzodiazepines, Phenobarbitone and Primodine
Which drugs should be avoided in abrupt withdrawal for breastfeeding children?
Phenobarbital and Primodine
Why are depot injections used?
To aid in compliance
What is the difference between normal and decanoate versions?
Decanoate - maintenance treatment
Normal - for acute episodes
Which antipsychotics can cause hypotension and temperature irregulation?
Clozapine
Chlorpromazine
Lurasidone
Quetiapine
What can be used to treat neuroleptic malignant syndrome?
Bromocrptine or dantrolene (Dopamine agonists)
What antipsychotics can prolong the QT interval?
Primozide and Haloperidol
What are the monitoring requirements for antipsychotics?
B- Blood pressure F- FBC, U&Es, LFTs E- ECG F- Fasting blood glucose B- Blood lipids and weight
What drug interactions occur with antipsychotics?
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
What is Parkinson’s disease?
Parkinson’s disease is the degredation of neurones in the nigral striatal pathway
What drugs can be used in the treatment of Parkinson’s disease?
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
What SEs can occur with Parkinson’s disease drugs?
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
What is the heirachy of Parkinson’s treatment?
QOL affected - Levodopa
QOL not affected - Levodopa, Non ergot alkaloid or MAOBi
Adjunct - Non ergot alkaloid or MAOBi, or COMTi
Which drug groups can be used as antiemetics?
Antimuscarinics 5HT3 receptor antagonists Antihistamines Antipsychotics Dexamethasone, Nabilone and Aprepitant
Metoclopramide licensing, dose, SEs and interactions
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
Domperidone licensing, dose, SEs and interactions
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
5HT3 indications, SEs and interactions
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
What are the side-effects of opioids?
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
What should patients do if they are experiencing signs of breathing difficulties with fentanyl patches?
They must remove the patch as soon as possible
Should fentanyl be given to patients who are experiencing rapid cycling pain?
No they should not- dose and pain should be stable
If fentanyl patches need to be stopped, what should the dose of the new opioid be reduced by?
25-50%
Where can codeine be used and where is it CI?
240mg daily max, CI in children under 12, pregnant and breasteeding, <18 with tonsils removed and not recommended in asthmatics
What is special about tramadol?
It is an opioid, 5 HT and noradrenaline agonist
What are the side effects of tramadol?
Bleeding, psychiatric reactions and lowers seizure threshold
What interactions occur with tramadol?
Bleeding risk with warfarin, serotonin syndrome and decreased seizure threshold
What are the signs and symptoms of migraines?
Visual disturbances, audiosensitivity and pins and needles
What can be used to treat migraines?
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
Migraine prophylaxis
Propranolol, Beta blockers, Antiepileptics, Pizotifen
What is the treatment for compression neuropathy?
Corticosteroids
What is the treatment for trigeminal neuralgia?
Phenytoin or Carbamazepine
What are the three types of insomnia and how long do they last?
Transient <24 hours
Short term ~ 3 weeks
Chronic> a while
What are the 3 -drugs that can be used for insomnia?
Zopiclone - tastes funny
Zolpidem - 8 hours before driving
Zaleplon - for up to 2 weeks
Alcohol dependence drugs for seizures?
Chlordiazepoxide or Diazepam
Alcohol dependence drugs for seizures?
Lorazepam
What are the 3 drugs that can be used for alcohol withdrawal?
Acamprosate, Naltrexone and Disulfiram
What vitamins do alcoholics lack that has been associated with Wernicke’s encephalopathy?
Vitamin B1- Thiamine
NRT drugs and symptoms?
Bupropion
Varenicline- report suicidal ideation
Opioid withdrawal methadone - daily dosing, half life and SEs
OD
Long half life
QT prolongation
Opioid withdrawal buprenorphine - daily dosing, half life and period of administation after : a) heroin and b) methadone?
OD
Shorter half life
a) Heroin - 6-12 hours after
b) Methadone - 24-48 hours after
