IC11-17 CNS disorders Flashcards by Eunice Teo

Management algorithm of schizophrenia

Single FGA/SGA
Alt single FGA/SGA
Clozapine for 3 months

How well did you know this?

Not at all

Perfectly

Trial period for antipsychotics

2-6 weeks, except clozapine for 3 months

How well did you know this?

Not at all

Perfectly

Non-adherent patient

IM long acting injections: decanoate/risperidone microspheres

How well did you know this?

Not at all

Perfectly

Examples of first gen antipsychotics

Haloperidol, chlorpromazine

How well did you know this?

Not at all

Perfectly

ADR of first gen antipsychotics

EPSE, gynaecomastia

How well did you know this?

Not at all

Perfectly

Examples of second gen antipsychotics

Olanzapine, quetiapine, risperidone, clozapine, amisulpride, aripiprazole, paliperidone

How well did you know this?

Not at all

Perfectly

ADR of second gen antipsychotics

Metabolic side effects: Lipid, glucose elevation
Sedation
Less EPSE

How well did you know this?

Not at all

Perfectly

Examples of EPSE

Dystonia, pseudoparkinsonism, akathisia, tardive dyskinesia (worsons with anticholinergics, give IV valbenazine)

How well did you know this?

Not at all

Perfectly

Other ADR of antipsychotics

Orthostatic hypotension
Agranulocytosis with clozapine
Neuroepileptic malignant syndrone: leadpipe rigidity, fever, increased CK, sweating –> IV dantrolene

How well did you know this?

Not at all

Perfectly

Monitoring for antipsychotics

First gen
- EPSE exam
- Serum prolactin

Second gen
- Metabolic panel: BMI, lipid, Hba1c, waist circumference, BP

How well did you know this?

Not at all

Perfectly

DDI of antipsychotics

CNS depressants: alcohol, opioids
Worsen ADR: antimuscarinic, antihistamine, antihypertensive, dopamine antagonist/agonist (metoclopramide/levodopa)

How well did you know this?

Not at all

Perfectly

DDI of clozapine

CYP1A2 inhibitors: fluvoxamine, quinolones, macrolides
Carbamazepine –> agranulocytosis

How well did you know this?

Not at all

Perfectly

Duration of treatment for MDD

Acute: 4-8 weeks
Continuation: 4-9 months
Total: 6-12 months

How well did you know this?

Not at all

Perfectly

ADR of SSRI

Hyponatremia
GI: n/v/d
Sexual dysfunction
CNS: headache, insomnia, nervousness

How well did you know this?

Not at all

Perfectly

ADR of SNRI

Similar to SSRI
Venlafaxine: worsen BP
Duloxetine: good for chronic MSK pain, fibromyalgia, diabetic neuropathy

How well did you know this?

Not at all

Perfectly

ADR of mirtazapine

Weight gain
Reverse GI and sexual SE of SSRI

How well did you know this?

Not at all

Perfectly

ADR of Bupropion

Seizures, insomnia
Not for eating disorder, hx of psychosis or seizures

How well did you know this?

Not at all

Perfectly

Monitoring for SSRI

Serum Na: baseline, 2 weeks, 4 weeks, every 3 months
Suicidality for 24 years or less

How well did you know this?

Not at all

Perfectly

DDI with other serotonergic medications

Triptans, dextromethorphan, linezolid, MAOi, opioids
Precipitate serotonin syndrome: hyperreflexia, tachycardia, sweating

How well did you know this?

Not at all

Perfectly

Indication of lithium

Mania and bipolar depression

How well did you know this?

Not at all

Perfectly

Benefits of lithium

Suicide prevention, 1st line for maintenance and relapse

How well did you know this?

Not at all

Perfectly

ADR of lithium (lithium toxicity)

n/v/d, tremors, polyuria, weight gain, confusion, hypothyroidism

How well did you know this?

Not at all

Perfectly

DDI of lithium

Sodium depletion
Thiazide diuretics
ACEi/ARBs
NSAIDs
Dehydration

How well did you know this?

Not at all

Perfectly

Monitoring for lithium

RP: since cleared by kidneys
Pregnancy test
TFT
Full blood count
Physical exam
Metabolic panel
TDM

How well did you know this?

Not at all

Perfectly

Indication for valproate

Mania

ADR of valproate

Rash, SJS/TEN Reversible weight gain Pancreatitis

Monitoring for valproate

Pregnancy test Physical exam Full blood count Liver function test Metabolic panel

Indication for lamotrigine

Bipolar depression

ADR of lamotrigine

Rash, SJS

Monitoring of lamotrigine

Physical exam Full blood count LFT RP

Indication for SGA in bipolar disorder

Mania: all can be used Bipolar depression: Quetiapine or Olanzapine + Fluoxetine

Indication of carbamazepine

Mania

ADR of carbamazepine

Rash, SJS Agranulocytosis with clozapine

Monitoring for carbamazepine

HLAB1502 allele genotyping Physical exam Pregnancy test FBC TFT RP

Medications for anxiety

SSRI/SNRI for mood symptoms Adjunct benzodiazepines for physical symptoms: PO lorazepam

Indication for levodopa

Motor symptoms

Administration instructions for levodopa

Empty stomach, separate from high protein/fat meal

DDI of levodopa

Pyridoxine (Vit B6) Iron Protein Dopamine agonist: metoclopramide, domperidone (preferred) 1st gen antipsychotics Risperidone

ADR of levodopa

Orthostatic hypotension Sudden sleep CNS: drowsiness, hallucinations, psychosis Dyskinesia: long term use + peak dose On off phenomenon Wearing off

Indications for dopamine agonists

Monotherapy for younger patients Adjunct to levodopa for moderate to severe PD

Examples of dopamine agonists

Ropinirole Rotigotine Pramipexole Apomorphine

ADR of dopamine agonists

Compulsive behaviours Orthostatic hypotension Leg edema n/v CNS: somnolence, daytime sleepiness, hallucinations

Indication for MAOBi

Early stage: monotherapy Late stage: Adjunct

Examples of MAOBi

Selegiline, Rasagiline

ADR of MAOBi

Heartburn, loss of appetite CNS: anxiety, nightmares, insomnia, palpitations, hallucinations

DDI of MAOBi

Serotonergic medications: - Opioids - Dextromethorphan, pseudoephdrine, phenylephdrine - TCA, SSRI, SNRI - Linezolid (ABX)

Food interactions of MAOBi

Tyramine containing foods Fermented kimchi, draft beer, marmite

Administration instructions for Selegiline

Cannot dose at night, since metabolised to stimulants

Examples of COMTi

Entacapone, tolcapone

Indications for COMTi

Decreases off time for levodopa Need to use with levodopa

ADR of COMTi

Orange urine Diarrhoea CNS: daytime sleepiness, hallucinations Liver dysfunction for tolcapone

DDI of COMTi

Iron Calcium Catecholamines: adrenaline, norepinephrine Warfarin: increases anticoagulation

NMDA antagonist examples

Amantadine (Memantine not used in PD, for dementia)

Indication for NMDA antagonist

Reduce levodopa induced dyskinesia

ADR of NMDA antagonist

Livedo reticularis CNS: cannot concentrate, insomnia, confusion, hallucination, nightmares

Administration instructions for amantadine

Do not dose at night since stimulating

Amantadine is ___ excreted

Renally excreted, lower dose in renal impairment

Indication for acetylcholinesterase inhibitors

Mild to moderate AD

Examples of acetylcholinesterase inhibitors

Rivastigmine, galantamine: Mild to moderate AD Donepezil: all types of AD

ADR of ACECHi

Loss of appetite Increased bowel movements, n/v CNS: vivid dreams, insomnia

Contraindications of ACECHi

Bradycardia Caution in: PUD, respiratory disease, seizures, urinary tract obstruction

Monitoring and titration of ACECHi

4-8 weeks titration Monitor for improvement of cognitive symptoms and ADL

Indication for Memantine

Moderate to severe dementia 2nd line if cannot tolerate ACECHi

ADR of memantine

CNS: confusion, dizziness, insomnia, seizures

BPSD treatment

Severe BPSD which poses risk SSRI for depression and anxiety Citalopram for agitation Second gen antipsychotic Risperidone

Medications contributing to BPSD

Anticholinergics Antihistamines High dose GC Opioids, benzo, Z hypnotics Anti PD medications