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CNS November 23 > CNS Part 1 November 23 > Flashcards

CNS Part 1 November 23 Flashcards

Dementia|Epilepsy|

1
Q

Question

A

Answer

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2
Q

A1: What is dementia?

A

Decline in mental capability caused by various factors including Alzheimer’s, Parkinson’s, Vascular disease.

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3
Q

A2: Which drugs can make dementia symptoms worse?

A

Anticholinergic/antimuscarinic drugs.

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4
Q

A3: Which drug can cause a stroke in dementia patients?

A

Antipsychotics.

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5
Q

A4: What are the main risk factors for dementia (both modifiable and non-modifiable)?

A

Answer not provided.

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6
Q

A5: Which type of dementia is the most common and what are the causes?

A

Alzheimer’s is the most common, caused by mutations in brain tissue and the production of tau proteins.

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7
Q

A6: What are the different types of non-Alzheimer’s dementia?

A

Vascular dementia, Dementia with Lewy bodies, Mixed dementia, Frontotemporal dementia.

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8
Q

A7: What is frontotemporal dementia and how is it treated?

A

Degeneration of frontal and temporal lobes,

treated with antidepressants and antipsychotics,

AChE inhibitors and memantine are not recommended.

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9
Q

A8: What’s the MHRA warning around antipsychotics and dementia?

A

Increased risk of stroke and death, especially in elderly patients with dementia.

Use at the lowest effective dose and for the shortest time with regular reviews.

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10
Q

A9: What are the main symptoms of dementia?

A

Becoming disabled
unable to self-care,
cognitive loss,
abnormal behavior.

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11
Q

A10: What are the 3 main aims of treating dementia?

A

Promote independence,
maintain function,
manage symptoms.

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12
Q

A11: What are the non-drug treatments for dementia?

A

Structured group cognitive stimulation program.

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13
Q

A12: What drugs are used to treat Alzheimer’s dementia and what’s the treatment pathway?

A

Donepezil,
Rivastigmine,
Galantamine (1st line),
Memantine (2nd line or if 1st line not tolerated).

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14
Q

A13: What drugs are used to treat non-Alzheimer’s dementia and what’s the treatment pathway?

A

Various drugs in a specific order depending on the type of non-Alzheimer’s dementia.

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15
Q

A14: If antipsychotics are needed to manage dementia symptoms, when are they needed and what must be done?

A

Risk vs benefit analysis, regular reviews, lowest effective dose, especially for non-cognitive symptoms of dementia.

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16
Q

A15: Which type of dementia can antipsychotics worsen motor symptoms?

A

Dementia with Lewy bodies, Parkinson’s disease dementia.

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17
Q

A16: What are the 6 key points about using antiepileptic drugs?

A
  1. Monotherapy preferred,
  2. start low and increase slowly,
  3. don’t withdraw abruptly
  4. stick to the same brand for category 1 antiepileptic drugs,
  5. all cause suicidal thoughts,
  6. teratogenic potential.
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18
Q

A17: What is the main treatment aim when managing epilepsy with drugs?

A

Optimize seizure control by preventing seizures, use monotherapy if possible.

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19
Q

A18: What factors influence the choice of drug to use for epilepsy?

A

Comorbidity,
concomitant medication,
age, sex,
epilepsy syndrome.

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20
Q

A19: Which antiepileptic drugs can be taken once daily at bedtime due to their long half-life?

A

Lamotrigine,
Perampanel,
Phenobarbital,
Phenytoin.

LP3

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21
Q

A20: If monotherapy with 1 antiepileptic drug fails, what must you do?

A

Give monotherapy with a 2nd drug,
slowly withdraw the 1st drug when the new therapy is established.

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22
Q

A21: If switching from one antiepileptic drug to another, how is it done?

A
  • Add the new drug into the regime,
  • never stop abruptly,
  • titrate down the old drug once stabilized.
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23
Q

A22: What happens to someone if you abruptly withdraw an antiepileptic drug?

A

It may cause rebound seizures.

24
Q

A23: What are the main problems that occur when someone is taking more than 1 antiepileptic drug?

A

Drug-drug interactions and side effects.

25
Q

A24: If combo therapy is unsuccessful at managing epilepsy, what 2 things must prescribers balance when choosing drugs for patients?

A

Balance between tolerability and efficacy,
prescribe a single antiepileptic wherever possible.

26
Q

A25: What’s the MHRA warning when dealing with antiepileptic drugs, and does this warning apply when using it for other conditions?

A

Harm when switching to different brands for some antiepileptic drugs,

applies only to treating epilepsy.

27
Q

A26: How many risk categories are antiepileptic drugs divided into to help HCPs decide if brand continuity is important?

A

Divided into 3 risk categories.

28
Q

A27: Why is it important for patients to maintain the same brand when treating epilepsy?

A

Product name,
packaging, appearance,
taste may affect patient compliance
lead to dosing errors and reduced adherence.

29
Q

A28: Which brand category is brand continuity most important for, and which drugs must always be given by brand?

A

Category 1 drugs like

Carbamazepine,
Phenytoin,
Phenobarbital,
Primidone.

30
Q

A29: Which drugs are included in category 2 and 3 and what does each category mean?

A

Category 2 includes drugs like
Lamotrigine
and Clobazam, while
Category 3 includes drugs where brand continuity is not essential.

31
Q

A30: What is antiepileptic hypersensitivity syndrome, which drugs are more associated with this, and what are the main symptoms?

A

A rare but potentially fatal syndrome associated with certain antiepileptic drugs.
Drugs associated with this syndrome are listed,and symptoms include
1. fever,
2. rash,
3. liver dysfunction,
4. renal
5. Pulmonary abnormalities.

32
Q

A31: What MHRA warning applies to all antiepileptic drugs, when do these symptoms occur, and what must patients do to protect themselves?

A

Small increased risk of suicidal thoughts and behavior,

usually occurring 1 week after initiation.

Patients should seek medical advice if they experience mood changes, distressing thoughts, suicidal ideation, or self-harm.

33
Q

A32: What can happen regarding drug interactions in terms of antiepileptic activity?

A

Interaction between antiepileptics can be complex,

toxicity may increase without enhancing antiepileptic effects.

34
Q

A33: Apart from antiepileptic drugs, which 2 other classes of drugs can cause rebound seizures if stopped abruptly?

A

Barbiturates and Benzodiazepines.

35
Q

A34: If a patient is using multiple drugs to manage epilepsy, how many can be stopped gradually?

A

Withdraw ONE drug at a time.

36
Q

A35: For antiepileptic drugs, how long does it take to withdraw treatment completely?

A

It varies depending on the specific drug, but

a general minimum is 2-3 months.

37
Q

A36: For antiepileptic drugs, when does the dose reduction occur and by how much does it go down by?

A

Withdraw the drug gradually over at least 2-3 months

by reducing the daily dose by 10-25%

at intervals for 1-2 weeks.

38
Q

A37: How long will it take to completely withdraw from taking benzodiazepines?

A

6 months or longer, especially if the patient has been on them for an extended period.

39
Q

A38: What is the general DVLA advice regarding antiepileptic patients?

A

STOP driving and report to DVLA if you have any seizures,
especially after the first unprovoked seizure
or a single isolated seizure.

To continue driving, you must be seizure-free for at least 1 year and not have a history of unprovoked seizures.

40
Q

A39: Under what 2 conditions must patients stop driving for, and how long must they wait until they can drive again?

A

After the first presentation of an unprovoked epileptic seizure

or a single isolated seizure,

patients must stop driving for 6 months.

41
Q

A40: When must epileptic patients stop driving immediately?

A

If someone has any type of seizure, they must stop driving and inform DVLA.

42
Q

A41: Under what circumstance must a patient stop driving for at least 1 year?

A

If they’ve had a seizure due to withdrawing a drug or changes in the current drug dosing.

43
Q

A42: Are all antiepileptic drugs teratogenic?

A

No,
but there’s an increased risk of teratogenicity with some antiepileptic drugs,

especially during the first trimester,
and especially when multiple drugs are taken.

44
Q

A43: Which antiepileptic drug is the most teratogenic?

A
  1. Valproate has the highest risk, followed by
  2. carbamazepine,
  3. phenytoin,
  4. phenobarbital,
  5. primidone,
  6. Lamotrigine.
45
Q

A44: What patient group must valproate be avoided in and under what circumstances should it be given to this patient group?

A

Valproate must be avoided in females of childbearing potential

unless specific conditions are met or there’s no alternative.

46
Q

A45: If women need valproate because nothing else works, what must they do?

A

Follow the Pregnancy Prevention Program (PPP),

use effective contraception, and have regular medical check-ups.
Girls must also be educated about the risks associated with valproate during pregnancy.

47
Q

A46: Which antiepileptic drugs have an increased risk of teratogenicity?

A

Valproate and other drugs listed.

48
Q

A47: Which congenital defect is observed in children when their mothers are taking topiramate?

A

Cleft palate.

49
Q

A48: If pregnancy occurs and a woman is on antiepileptic meds, what 5 things must be done to ensure the baby is okay?

A

Various monitoring and precautions for both the mother and baby.

50
Q

A49: Which 2 classes of drugs can babies experience withdrawal effects if their mothers are taking them while pregnant?

A

Benzodiazepines and Phenobarbital.

51
Q

A50: Which 3 drugs cause drowsiness in breastfed babies?

A

Benzodiazepines, Primidone, Phenobarbital.

52
Q

A51: Which drugs can cause withdrawal symptoms in babies if the mother stops breastfeeding them?

A

Phenobarbital, Primidone, Lamotrigine.

53
Q

A52: What are the 2 main types of seizures and what’s the difference?

A

Generalized seizures affect almost the whole brain,

while focal seizures affect only one part.

54
Q

A53: What are the 4 types of generalized seizures?

A

Myoclonic,
Absence,
Tonic-clonic,
Atonic & Tonic seizures.

M.A.T.A

55
Q

A54: What type of generalized seizure is the most common and what is the 1st line drug treatment for all of them?

A

Tonic-clonic seizures are the most common,

sodium valproate is the 1st line treatment for all of them

**except for absence seizures**.

56
Q

A55: Which 2 drugs exacerbate the 3 types of generalized seizures and which type of generalized seizure can they be used for?

A

Carbamazepine
Vigabatrin

exacerbate the three types of generalized seizures

but are safe for absence seizures, tonic-clonic seizures, myoclonic seizures, atonic seizures, and tonic seizures.

57
Q

A56: What are the main symptoms of tonic-clonic seizures and what drugs are used to treat it?

A

Symptoms include
stiffening of the body (tonic phase)
followed by convulsions (clonic phase).

Sodium valproate is the 1st line treatment for tonic-clonic seizures.

CNS November 23 (7 decks)

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