CNS Qs Flashcards
Pregabalin dose for neuropathic pain/ GAD
initially 150mg OD, MAX 600mg in 2-3 divided doses
Which antipsychotic is most likely to cause weight gain
Think 2nd gen cause metabolic syndromes
Clozapine and olanzapine
What metabolic side effects do 2nd gen antipsychotics have?
- weight gain
- raised BP
- rasied BG
- raised cholesterol
Gabapentin and opioids
Increased resp dep
deteriorated renal function, opioid in syringe driver
alfentanyl
What are the monitoring requirements for the use of methadone?
ECG monitoring recommended in those with INCREASED QT-PROLONGATION RISK FACTORS or >100mg DAILY
What schedule is methadone
2
Methadone SE
- Mood changes
- Exacerbation of asthma
- Tiredness
- Hyperprolactinaemia
- QT interval prolongation
Which SSRIs are most associated with QT interval prolongation?
- Citalopram, Escitalopram
- Fluoxetine and sertraline = some evidence
- Paroxetine and venlafaxine – not typically associated
Which antidepressants is the most likely cause of the patient’s abnormal menstrual cycle?
Fluoxetine
Symptoms of subarachnoid haemorrhage
- thunderclap headache
- stiff neck
- blurred vision
- nausea
Treated with nimodipine
what ingredient excipient in tegretol oral solution may be responsible for a patient experiencing bloating and gastro-intestinal side effects?
sorbitol
ACEi/ ARBs and surgery
- severe hypotension after induction of anaesthesia
- these drugs may need to be discontinued 24 hours before surgery
Which blood test must be normal before starting pt on clozapine?
Leucocyte and differential blood counts
Which drug can be detected using roadside screening device
Cannabis
Ketamine
Methadone
Morphine
Opiates
Levetiracetam + NSAIDs =
OK no significant interaction and do not affect seizure control
1.
SSRI toxicity
N+V, agitation, tremor, nystagmus, sinus tachy
TCA toxicity
dry mouth, seizures, coma, arrythmias
Fentanyl toxicity
resp dep, euphoria, reduced consciousness
Aspirin toxicity
tinnitus, hyperventilagion, deafness
SS symptoms
Confusion
Dizziness
Tachycardia
Tremor
MIDRID
Paracetamol + isometheptene = acute attacks in migraines MIDRID
Aripiprazole MHRA update
Increased risk of impulse control disorders
TCA washout period
at least 1-2 weeks
3 weeks if its clomi/ imi
SSRI washout period
Fluoxetine = 5 weeks
Sertraline = 2 weeks
How long does Madopar capsules/tablets last once dispensed into another container before it expires? →
2 weeks
Which drug is preferred in renal impairment? Codeine, Oxycodone or morphine
Oxycodone - similar properties to morphine, but preferred in renal impairment
Clozapine and smoking
induces metabolism = significant increase in levels when smoking.
Clozapine and stopping smoking
increased levels of clozapine
Autonomic neuropathy symptoms
- Excessive facial sweating
- Postural hypotension
Donepezil common SE
Aggression
No renal restrictions
Which drug is effective for a pregnant woman with bipolar and epilepsy?
Lamotrigine
Antipsychotic with the lowest risk of sexual dysfunction
Aripiprazole
Treatment for overdose of diazepam
Flumanezil
Which Parkison’d medication causes hepatotoxicity
Tolcapone
Which antiemetic can cause oculogyric crisis?
involuntary upward deviation of both eyes
Metoclopramide
- Acute dystonic reaction
What is the best method to switch from fluoxetine to paroxetine?
Stop fluoxetine; wait 4-7 days before starting paroxetine.
Duloxetine + aspirin
Increased risk of bleeding
Pt on lithium with dry skin and brittle nails - what should we monitor?
- Hypothyroidism symptoms
- Long term use = thyroid disorder
- Monitor thyroid function
