CPTP 4.9-11

Question 1

E.g. of a MAO-B inhibitor

Answer 1

selegiline

Question 2

what is amantadine and what does it do

Answer 2

antiviral. stimulates release of dopamine. tx dyskinesias

Question 3

difference between MAO-B inhibitors and COMT inhibitors

Answer 3

MAO-B inhibitors inhibit the enzyme that degrades dopamine in the neuron. COMT inhibits degredation in the synaptic cleft

Question 4

e.g. of a COMT inhibitor

Answer 4

entacapone, tolcapone

Question 5

what is a COMT inhibitor often given with (brand names)

Answer 5

entacapone given with sinemet (carbidopa and ldopa) to form stalevo

Question 6

e.g. of dopamine agonists

Answer 6

rotigotine, apomorphine

Question 7

Why are anticholinergics sometimes useful in PD?

Answer 7

In PD there is reduced dopamine and increased ACh.

Question 8

When are Anticholinergics used

Answer 8

rarely. not in elderly ude to side effects. can use very early on in PD

Question 9

anticholinergic SEs

Answer 9

dry mouth, constipation, dizziness, blurred vision, urine retention)

Question 10

L-dopa SEs

Answer 10

nausea and vomiting, postural hypotension, visual hallucinations, insomnia

Question 11

management of motor complications in PD tx

Answer 11

fractionate ldopa dose, adjuvant tx (DA, COMT-i, MAOI), duodenal ldopa, apomophine infusion, DBS

Question 12

administration of DA

Answer 12

rotigotine patch. apomorphine SC.

Question 13

DA side effects

Answer 13

impulse control disordesr, N/V, postural hypotension, somnolence, hallucinations

Question 14

when is entacapone given

Answer 14

with each lpoa dose

Question 15

PD tx in newly diagnosed young person

Answer 15

MAO-B inhibitor, dopamine agonist initially. then progress to ldopa and COMT inh

Question 16

PD tx in newly diagnosed biologically frail person

Answer 16

ldopa. then progress to comt inh and mao-b inh

Question 17

how are dyskinesias treated

Answer 17

amantadine, reducing ldopa dose

Question 18

what is sodium valproate first line for

Answer 18

generalised tonic clonic, absence and myoclonic seizures

Question 19

better tx of absence seizures in children

Answer 19

ethosuximide

Question 20

tx of generalised seizures in pregnancy

Answer 20

lamotrigine

Question 21

types of partial seizures

Answer 21

simple partial, complex partial, secondary generalised

Question 22

1st line tx of partial seizures

Answer 22

carbamazepine

Question 23

Adverse effects of AEDs

Answer 23

acute skin rash - SJS. toxicity - ataxia, blurred vision. teratogenicity. gum hypertrophy. drug interactions

Question 24

drug interactions ass with AEDs

Answer 24

AEDs are hepatic enzyme INDUCERS

Question 25

what can carbamazepine cause

Answer 25

SIADH, neutropenia

Question 26

SIADH secondary to AED?

Answer 26

carbamazepine

Question 27

ARDs and OCP

Answer 27

carbamazepine and phenytoin interfere with OCP, need COCP with >50ng oestrogen.

Question 28

can you use POP, progesterone patch, implant with AEDs?

Answer 28

no, but can have depo provera and mirena

Question 29

which AED is monitoring very useful for

Answer 29

Phenytoin

Question 30

tx of status

Answer 30

``` secure airway, o2, IV access, bloods, glucose, thiamine IV lorazepam (or PR diazepam or buccal midazolam), repeat after 10m if necessary. then phenytoin sodium ```

Question 31

risk factors for SUDEP

Answer 31

uncontrolled epilepsy, young, GTCS, learning disabilities, poor compliance

Question 32

features of delirium tremens

Answer 32

hallucinations, confusion, delusions, agitation GTC seizures

Question 33

when do DT sx occur

Answer 33

after 8h alcohol withdrawal peak day 2 resolve day 5 with appropriate tx

Question 34

DT mx

Answer 34

sedation - benzos (chlordiazepoxide), based on CIWA score. screen and tx for Wernicke's, thiamine

Question 35

phenytoin levels and cirrhosis

Answer 35

In patients with low albumin e.g. cirrhosis, free phenytoin may be normal despite low total phenytoin. Free phenytoin proportion still normal, steady state concentration lower due to low albumin. Just because total level low doesn’t mean dose needs to be increased, free level is normal.

Question 36

in status when is medical intervention advised

Answer 36

>5m

Question 37

when give phenytoin sodium in status what must you also do

Answer 37

ecg - bradycardia

Question 38

which AEDs will affect INR if taken with warfarin

Answer 38

carbamazepine and phenytoin (induce warfarin metabolism as hepatic enzyme inducers)

Question 39

high GGT and carbamazepine explanation

Answer 39

hepatic enzyme inducer

Question 40

patient with epilepsy admitted complaining of double vision and is found to be unsteady, differential?

Answer 40

AED toxicity

Question 41

drug induced PD

Answer 41

dopamine antagonists (neuroleptics, antiemetics)

Question 42

prevention of dyskinesias

Answer 42

ldopa sparing strategy - delaying use of ldopa in young