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OTC > CNS > Flashcards

CNS Flashcards

1
Q

Symptoms of motion sickness?

A

Nausea
Vomiting
Cold sweats
Pallor (pale appearance)

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2
Q

What should you look out for & when to refer for motion sickness?

A

If patient is taking other medicines that may be causing additive anti-cholinergic side effects

Medicines such as
Tricyclic antidepressants - amitriptyline
Butyrophenones - haloperidol
Phenothiazines - chlorpromazine

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3
Q

Pharmacological treatments available for travel sickness?

Include generic and brand name + min age for formulations

A
  1. Anticholinergics such as

Hyoscine (Kwells, Joy rides & Scopaderm patches 10+)

  1. Antihistamines such as

Cinnarizine (Stugeron) 5+

Promethazine (Phenergran & Avomine)

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4
Q

Non-pharmacological alternatives and advice to patient for travel sickness?

A

Ginger - especially for drivers/pregnant/breastfeeding
Acupuncture Wrist bands

Avoid heavy, rich meals 
Avoid alcohol & smoking 
Avoid reading/watching tv
Look ahead in a car/watch the horizon 
Sit near the wings on a plane 
Get fresh air
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5
Q

What types of headaches are there and characteristics of each?

A
  1. Tension headache - most common, persistent dull pain around base of skull and top of neck
    May be caused by stress, eye strain, bad posture, anxiety etc
  2. Sinus headache - caused by build up of pressure in sinuses often during or after a cold. Pain may be worse in the morning and or when moving the head
  3. Cluster headache - usually affects one side and around one ye . Happens in clusters over a 6-12 week period
  4. Medication overuse headache - withdrawal from pain relief causes a new headache
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6
Q

What are the two types of migraines?

A 
Classic migraine - with aura 
Usually can see zigzag patterns, flashing lights, feeling of tingling in arms, nausea and vomiting before a migraine sets in 
Light, smell and sound sensitivity 
More in women than men 
(Uncommon - 25%)

Common migraine - without aura
No aura symtpoms

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7
Q

Treatment options for a headache?

Brand, generic

A

Paracetamol
NSAID - Nurofen
Paracetamol + opioid - Sulpadeine

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8
Q

Treatment options for a migraine?

Brand, generic

A 
Paracetamol 1000mg
Or
Aspirin (900mg)
Or
Ibuprofen (400mg)

Sumatriptan 50-100mg (Imigran)

Migraleve Pink (Paracetamol, Codiene, Buclizine)

Migraleve Yellow (Para + codiene)

Buccastem - prochlorperizine

Midrid ( Paracetamol + isometheptene) less suitable for prescribing tho)

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9
Q

Treatment options for a migraine in children 12- 17 years?

A

Paracetamol or NSAID
No aspirin to under 16 - Reye’s syndrome

(POM) Oral triptans not licensed to under 18 - so can prescribe nasal triptan

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10
Q

Treatment options for a migraine in pregnant and breastfeeding women?

A

Try non-pharmacological measures such as avoiding triggers, relaxation, ginger etc

Refer to Dr - POM options

1st line paracetamol
Or ibuprofen (Only in 1st and 2nd trimester)

Or a triptan if paracetamol not effective. Sumatriptan preferred triptan in pregnancy.

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11
Q

When should NSAIDs not be used in pregnancy and why?

A

3rd trimester

risk of premature closure of ductus arteriosus

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12
Q

Referral and warning signs of headache/migraine? (8)

A
  1. First migraine over the age 40
  2. Recurrent headache - could be medication overuse
  3. Does not respond to any OTC within a day
  4. Increasing frequency and severity
  5. Children under 12
  6. Women taking oral combined contraceptives
  7. Lasting more than 4 hours
  8. Neck stiffness
  9. Following from recent injury or trauma
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13
Q

What drug class does sumitriptan belong to?

Licensed age group?

Contraindicated in which patients?

A

Triptan /5HT1 receptor agonist

18-65

Cardiovascular conditions
Avoid in preg/breastfeeding 
Hypertension
Liver/Kidney disorders
Epilepsy
Neurological condition
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14
Q

Migraleve Pink & Yellow

Age?
Counselling points?

A

Pink & Yellow 12+

12-15 One Pink when migraine starting. If further treatment then One Yellow every 4 hours.

Adults: 2 Pink at the start then if needed 2 yellow every 4 hours.

Duration 3 days only.

Not suitable for under 12 - codeine toxicity and unpredictable metabolism of codeine to morphine

No to breastfeeding
CYP2D6 (liver enzyme) ultra-rapid metabolisers - African/Ethiopian

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15
Q

Buccastem

Age
Counselling points?
Contraindications?

A

prochlorperazine buccal tabs

18+
2days max - 1 or 2 tabs BD

  1. Impaired liver function
  2. Pregnancy
  3. Narrow angle glaucoma
  4. Parkinsons/Epilepsy
  5. Prostatic hypertrophy
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16
Q

Signs and symptoms of Insomnia? (4)

Classification based on time?

A

Disturbed sleep (waking up night)
Difficulty falling asleep
Feeling tired despite full sleep
Waking early in morning

Transient - lasting days
Short term - 3 weeks
Chronic - longer than 3 weeks

17
Q

Referral and warning signs of insomnia? (7)

A
  1. Signs of depression
  2. Chronic insomnia
  3. Under 16 years
  4. Failed treatment
  5. Preg/breastfeeding
  6. Due to medication e.g.
    Fluoxetine, MAOIs,
    Corticosteroids, Phenytoin, Theophylline
  7. Close angle glaucoma and prostatic hypertrophy Because antihistamine therapy is contraindicated!!
18
Q

OTC treatments for insomnia?

A
  1. Antihistamines
    e.g. Sominex/Phenegran (Promethazine) 16+
    Nytol (Diphenydramine) 16+
  2. Herbal - Nytol Herbal, Kalms - promotes calmness to encourage sleep
19
Q

Common/general side effects of antihistamines?

A

Antichloingeric side effects e.g.

Dry mouth
Constipation
Blurred vision
Tinnitus

20
Q

Counselling/Advice for insomnia (5)

A
  1. Avoid caffeine and nicotine 4-6 hours before
  2. Good sleep hygiene - get in routine
  3. Regular exercise
  4. Environment - lights, heat, minimise noise
  5. Relaxation - breathing, lavender oils
21
Q

Medicines that can cause Insomnia?

Drug class and examples

A
  1. Stimulants - theophylline, MAOIs, Pseudoephedrine
  2. Anti-epileptics - carbamazepine, phenytoin
  3. Alcohol
  4. Beta-blockers - propranolol (especially - reported nightmares)
  5. SSRIs - fluoxetine
  6. Diuretics - urination, ensure last dose is before midday
  7. Griseofulvin (antifungal)

OTC (11 decks)

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