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CNS November 23 > CNS Part 6 November 23 > Flashcards

CNS Part 6 November 23 Flashcards

1
Q

Question

A

Answer

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2
Q
  1. What is motor neurone disease?
A
  • A neurodegenerative disease that affects the brain and spinal cord.
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3
Q
  1. What drugs are used for muscular symptoms in MND?
A
  • Quinine (unlicensed) as the 1st line treatment for muscle cramps.
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4
Q
  1. What drugs are used for saliva issues in MND?
A
  • Antimuscarinic drugs (unlicensed).
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5
Q
  1. What drugs are used for respiratory symptoms in MND?
A
  • Opioids (unlicensed) for breathlessness.
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6
Q
  1. What drugs are used for saliva associated with MND?
A
  • Humidification (moisture), nebulizers, and carbocisteine.
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7
Q
  1. What drugs are used for amyotrophic lateral sclerosis?
A
  • Riluzole is used as a treatment to extend life.
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8
Q
  1. What is Parkinson’s disease?
A
  • A progressive neurodegenerative condition resulting from the death of dopamine cells in the brain’s substantia nigra.
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9
Q
  1. What are the non-motor symptoms associated with Parkinson’s?
A
  • Dementia.
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10
Q
  1. What’s the DVLA advice for patients with Parkinson’s?
A
  • Inform DVLA and car insurers once the diagnosis is confirmed.
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11
Q
  1. What are the main aims for managing Parkinson’s?
A
  • Control symptoms.
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12
Q
  1. What are the non-drug treatments for Parkinson’s?
A
  • Physiotherapy.
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13
Q
  1. Which antimuscarinic drugs are used for Parkinson’s?
A
  • Procyclidine.
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14
Q
  1. Which dopaminergic drugs are used for Parkinson’s?
A
  1. Catechol-o-methyltransferase (COMT) inhibitors:
  2. Entacapone,
  3. Opicapone,
  4. Tolcapone.
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15
Q
  1. What’s used first line in the management of motor symptoms affecting quality of life in Parkinson’s?
A
  1. Levodopa + carbidopa (co-careldopa)
  2. or benserazide (co-beneldopa).
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16
Q
  1. What’s used in the management of motor symptoms that don’t adversely affect quality of life in Parkinson’s?
A
  • Levodopa.
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17
Q
  1. If a patient needs to stop treatment for Parkinson’s, how is it done?
A
  • Patients are not to stop drugs abruptly.
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18
Q
  1. What patient and care advice would you give to a patient taking antiparkinsonian drugs?
A
  1. Inform them of the risks of adverse reactions,
  2. including psychotic symptoms
  3. and sudden onset of sleep with dopamine agonists.
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19
Q
  1. What drugs are used to treat dyskinesias associated with levodopa, 1st line?
A
  • 1st line non-ergot dopamine receptor agonists as an adjunct to levodopa.
20
Q
  1. What drugs are used to treat dyskinesias associated with levodopa, 2nd line?
A
  • 2nd line ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, or pergolide)

used as an adjunct to levodopa if non-ergot is not adequate.

21
Q
  1. What’s used in the management of excessive daytime sleepiness/sudden onset sleep associated with antiparkinsonian drugs, and what patient advice would you give?
A
  • Modafinil.
22
Q
  1. What’s used in the management of nocturnal akinesia associated with antiparkinsonian drugs?
A

Options include levodopa or oral dopamine receptor agonists as 1st line.

23
Q
  1. What’s used for the postural hypotension associated with antiparkinsonian drugs, and what patient advice would you give?
A

Midodrine Hydrochloride (1st line).

24
Q
  1. What’s used in the management of depression associated with Parkinson’s?
A

Standard antidepressant therapy, with 1st-line options being SSRIs.

25
Q
  1. What’s used in the management of psychosis associated with Parkinson’s?
A
  • Quetiapine (unlicensed) can be used to treat hallucinations and delusions.
26
Q
  1. What’s used in the management of rapid eye movements associated with Parkinson’s?
A
  • Clonazepam or melatonin.
27
Q
  1. What’s used in the management of drooling associated with Parkinson’s?
A
  • Glycopyrronium bromide (1st line).
28
Q
  1. What’s used in the management of dementia associated with Parkinson’s?
A
  • Cholinesterase inhibitors like Donepezil.
29
Q
  1. What’s used in the management of advanced Parkinson’s?
A
  • Apomorphine hydrochloride injections or infusions.
30
Q
  1. What key disorder can patients get if they take dopaminergic drugs, and what can be done to prevent this?
A
  • Impulse control disorders,
    1. - such as compulsive gambling,
    2. hypersexuality,
    3. binge eating,
    4. or obsessive shopping.
31
Q
  1. What’s the main safety advice for antiparkinsonian drugs?
A
  • Warn about impulse control disorders, which can develop on dopaminergic therapy, especially with levodopa and apomorphine.
32
Q
  1. Which drugs should you always avoid when you have Parkinson’s?
A

- Metoclopramide, as it can exacerbate Parkinson’s symptoms and antagonize the effects of anti-Parkinson drugs.

33
Q
  1. What’s the best drug to give a Parkinson patient if they have N&V?
A
  • Domperidone.
34
Q
  1. What are the main drug interactions of domperidone?
A
  • Increases the risk of QT prolongation when given with apomorphine,

which can cause serious arrhythmias.

Start domperidone 2 days before apomorphine treatment and discontinue it as soon as possible.

35
Q
  1. What should patients watch out for when taking tolcapone?
A
  • Liver toxicity, characterized by symptoms such as anorexia, nausea, vomiting, fatigue, abdominal pain, dark urine, or pruritus.
36
Q
  1. What are the 3 main side effects patients should be advised about when taking antiparkinsonian drugs?
A
  • Sudden onset of sleep, especially with dopamine receptor agonists.
37
Q
  1. When are antiemetics given?
A
  • Only when the cause of vomiting is known, especially in children.
38
Q
  1. When are antiemetics avoided or not necessary?
A
  • Antiemetics should be avoided or considered unnecessary when the cause of vomiting is known, especially in children.
39
Q
  1. Which antiemetic is the only one that can be used in patients with Parkinson’s?
A
  • Domperidone to control N&V associated with apomorphine.
40
Q
  1. What is the main MHRA warning for domperidone?
A
  • Domperidone is no longer indicated for relief of N&V in children under 12 years old and weighing less than 35kg.
41
Q
  1. Which antiemetics are used for chemotherapy-induced N&V and postoperative N&V?
A
  • Dexamethasone (alone or with 5HT3 antagonist).
42
Q
  1. Which antiemetics are used in the terminally ill?
A
  • Levomepromazine.
43
Q
  1. What are the steps for managing N&V associated with pregnancy?
A
  1. Self-care.
44
Q
  1. What is used for motion sickness?
A
  • Antiemetics are used to prevent motion sickness, with hyoscine hydrobromide being a common choice.
45
Q
  1. What drugs are used in Meniere’s disease?
A
  • Betahistine.
46
Q
  1. What’s the safety advice for metoclopramide?
A
  • There is a risk of neurological adverse drug reactions.
47
Q
  1. What’s the MHRA safety advice for promethazine?
A
  • Promethazine should not be given to children under 6 years old in OTC cough and cold medicines containing promethazine.

CNS November 23 (7 decks)

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