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CNS Flashcards

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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
Which anti-epileptic(s) are more slowly metabolised in children?
Lamotrigine and Phenobarbital
26
Which anti-epileptic(s) are inhibit the sucking reflex in newborns?
Phenobarbital and Primodine
27
Which anti-epileptic(s) have an established risk of causing drowsiness in babies?
Benzodiazepines, Phenobarbitone and Primodine
28
Which drugs should be avoided in abrupt withdrawal for breastfeeding children?
Phenobarbital and Primodine
29
Why are depot injections used?
To aid in compliance
30
What is the difference between normal and decanoate versions?
Decanoate - maintenance treatment | Normal - for acute episodes
31
Which antipsychotics can cause hypotension and temperature irregulation?
Clozapine Chlorpromazine Lurasidone Quetiapine
32
What can be used to treat neuroleptic malignant syndrome?
Bromocrptine or dantrolene (Dopamine agonists)
33
What antipsychotics can prolong the QT interval?
Primozide and Haloperidol
34
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 ```
35
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
36
What is Parkinson's disease?
Parkinson's disease is the degredation of neurones in the nigral striatal pathway
37
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 ```
38
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 ```
39
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
40
Which drug groups can be used as antiemetics?
``` Antimuscarinics 5HT3 receptor antagonists Antihistamines Antipsychotics Dexamethasone, Nabilone and Aprepitant ```
41
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
42
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
43
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 ```
44
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 ```
45
What should patients do if they are experiencing signs of breathing difficulties with fentanyl patches?
They must remove the patch as soon as possible
46
Should fentanyl be given to patients who are experiencing rapid cycling pain?
No they should not- dose and pain should be stable
47
If fentanyl patches need to be stopped, what should the dose of the new opioid be reduced by?
25-50%
48
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
49
What is special about tramadol?
It is an opioid, 5 HT and noradrenaline agonist
50
What are the side effects of tramadol?
Bleeding, psychiatric reactions and lowers seizure threshold
51
What interactions occur with tramadol?
Bleeding risk with warfarin, serotonin syndrome and decreased seizure threshold
52
What are the signs and symptoms of migraines?
Visual disturbances, audiosensitivity and pins and needles
53
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
54
Migraine prophylaxis
Propranolol, Beta blockers, Antiepileptics, Pizotifen
55
What is the treatment for compression neuropathy?
Corticosteroids
56
What is the treatment for trigeminal neuralgia?
Phenytoin or Carbamazepine
57
What are the three types of insomnia and how long do they last?
Transient <24 hours Short term ~ 3 weeks Chronic> a while
58
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
59
Alcohol dependence drugs for seizures?
Chlordiazepoxide or Diazepam
60
Alcohol dependence drugs for seizures?
Lorazepam
61
What are the 3 drugs that can be used for alcohol withdrawal?
Acamprosate, Naltrexone and Disulfiram
62
What vitamins do alcoholics lack that has been associated with Wernicke's encephalopathy?
Vitamin B1- Thiamine
63
NRT drugs and symptoms?
Bupropion | Varenicline- report suicidal ideation
64
Opioid withdrawal methadone - daily dosing, half life and SEs
OD Long half life QT prolongation
65
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

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