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CPTP 4.9-11 > CPTP 4.9-11 > Flashcards

CPTP 4.9-11 Flashcards

1
Q

E.g. of a MAO-B inhibitor

A

selegiline

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2
Q

what is amantadine and what does it do

A

antiviral. stimulates release of dopamine. tx dyskinesias

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3
Q

difference between MAO-B inhibitors and COMT inhibitors

A

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

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4
Q

e.g. of a COMT inhibitor

A

entacapone, tolcapone

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5
Q

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

A

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

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6
Q

e.g. of dopamine agonists

A

rotigotine, apomorphine

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7
Q

Why are anticholinergics sometimes useful in PD?

A

In PD there is reduced dopamine and increased ACh.

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8
Q

When are Anticholinergics used

A

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

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9
Q

anticholinergic SEs

A

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

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10
Q

L-dopa SEs

A

nausea and vomiting, postural hypotension, visual hallucinations, insomnia

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11
Q

management of motor complications in PD tx

A

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

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12
Q

administration of DA

A

rotigotine patch. apomorphine SC.

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13
Q

DA side effects

A

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

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14
Q

when is entacapone given

A

with each lpoa dose

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15
Q

PD tx in newly diagnosed young person

A

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

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16
Q

PD tx in newly diagnosed biologically frail person

A

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

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17
Q

how are dyskinesias treated

A

amantadine, reducing ldopa dose

18
Q

what is sodium valproate first line for

A

generalised tonic clonic, absence and myoclonic seizures

19
Q

better tx of absence seizures in children

A

ethosuximide

20
Q

tx of generalised seizures in pregnancy

A

lamotrigine

21
Q

types of partial seizures

A

simple partial, complex partial, secondary generalised

22
Q

1st line tx of partial seizures

A

carbamazepine

23
Q

Adverse effects of AEDs

A

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

24
Q

drug interactions ass with AEDs

A

AEDs are hepatic enzyme INDUCERS

25
Q

what can carbamazepine cause

A

SIADH, neutropenia

26
Q

SIADH secondary to AED?

A

carbamazepine

27
Q

ARDs and OCP

A

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

28
Q

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

A

no, but can have depo provera and mirena

29
Q

which AED is monitoring very useful for

A

Phenytoin

30
Q

tx of status

A 
secure airway, o2, IV access, bloods, glucose, thiamine 
IV lorazepam (or PR diazepam or buccal midazolam), repeat after 10m if necessary. then phenytoin sodium
31
Q

risk factors for SUDEP

A

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

32
Q

features of delirium tremens

A

hallucinations, confusion, delusions, agitation GTC seizures

33
Q

when do DT sx occur

A

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

34
Q

DT mx

A

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

35
Q

phenytoin levels and cirrhosis

A

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.

36
Q

in status when is medical intervention advised

A

> 5m

37
Q

when give phenytoin sodium in status what must you also do

A

ecg - bradycardia

38
Q

which AEDs will affect INR if taken with warfarin

A

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

39
Q

high GGT and carbamazepine explanation

A

hepatic enzyme inducer

40
Q

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

A

AED toxicity

41
Q

drug induced PD

A

dopamine antagonists (neuroleptics, antiemetics)

42
Q

prevention of dyskinesias

A

ldopa sparing strategy - delaying use of ldopa in young

CPTP 4.9-11 (1 decks)

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