Nervous System

Question 1

What anti-cholinergic has a high risk of SJS?

Answer 1

Galantamine

Question 2

What is used in severe Alzheimers and what is the drug class?

Answer 2

Memantine

NMDA

Question 3

What anti-cholinergic can imcrease the risk of neuroleptic malignant syndrome with concomitant use with antipsychotics?

Answer 3

Donepezil

Question 4

What are the anticholinergic S/E?

Answer 4

Constipation
Dizziness
Drowsiness
Urinary retention 
Dry mouth 
Tachycardia
Blurred vision
Confusion (more common in elderly)
Nausea and vomitting

Question 5

What is the MHRA warning about elderly patient with dementia who are on antipsychotics?

Answer 5

Increased risk of stroke/TIA

Question 6

What is used to treat anxiety that works on 5HT1

Answer 6

Buspirone

Question 7

When to measure lithium?

Answer 7

12 hours post dose

Question 8

What electrolyte can precipitate lithium toxicity?

Answer 8

Hyponatremia

Question 9

Lithium toxic S/E

Answer 9

Fine tremor 
Confusion 
Hypotension
Tachycardia 
Polyuria
Visual disturbances

Question 10

Least sedating TCA’s?

Answer 10

Imipramine and nortriptyline

Question 11

Max dose of citalopram in the elderly ?

Answer 11

20mg

Question 12

How long do anti-depressants take to work?

Answer 12

2 weeks

Question 13

Is St John’s wort an enzyme inducer or inhibitor?

Answer 13

Enzyme inducer

Question 14

How long should anti-depressant treatment be tried before it is switched of deemed ineffective?

Answer 14

4 weeks

6 weeks elderly

Question 15

What are the effects of Serotonin syndrome?

Answer 15

Neuromuscular (tremor and rigidity), autonomic (Tachycardia, hyperthermia, shivering)
Altered mental state (confusion,mania and agitation)

Question 16

What class is moclobemide?

Answer 16

MAOI

Question 17

Wash out period compared to MAOIs?

Answer 17

MAOI-MAOI 2 weeks
TCA-MAOI 1-2 weeks (3 weeks for clomipramime and imipramine)
SSRI- MAOI 1 week (flouxetine 5 weeks)

Question 18

How long should anti-depressants be continues after remision?

Answer 18

6 months
1 year elderly
2 years recurrent depression

Question 19

How long should an antipsychotic be tried before it is deemed to be ineffective or switched?

Answer 19

4-6 weeks

Question 20

What is the treatment for the 1st episode of psychosis?

Answer 20

CBT and anti-psychotics

Question 21

What are antipsychotics better and relieving positive or negative symptoms?

Answer 21

Positive symptoms

Question 22

What are the positive symptoms of schizophrenia?

Answer 22

Hallucinations and delusions

Question 23

What are the negative symptoms of schizophrenia?

Answer 23

Emotional apathy

Social withdrawal

Question 24

When can clozapine be used for schizophrenia?

Answer 24

After 2 antipsychotics have been tried (one of them being a second generation)

Question 25

What are the general s/e of most 1st generation anti-psychotics?

Answer 25

EPSE symptoms •Parkinsonism symptoms such as tremor, bradykinesia •Dystonia (uncontrolled muscle spasm) •Akathisia (restlessness) •Tardive dyskinesia (uncontrollable muscle movements of face e.g.lips, jaw, tounge) Hypetprolactinaemia

Question 26

What are the 1st generation anti-psychotics?

Answer 26

``` Phenothiazines (chlorpromazine, promazine, prochlorperazine etc) Butyphenones (Haloperidol) Thioxanthenes (flupentixol) Pimozide Sulpride ```

Question 27

What are some 2nd generation anti-psychotics?

Answer 27

``` Quetiapine Clozapine Aripiprazole Risperidone Olanzipine Amisulpride Asenapine Paliperidone ```

Question 28

What anti-psychotic does not increase prolactin concentration?

Answer 28

Aripiprazole

Question 29

Which anti-psychotics increase the concentration of prolactin?

Answer 29

1st generation Riperidone Amisulpride

Question 30

Which anti-psychotics cause an increase in sexual dysfunction?

Answer 30

Risperidone Haloperidol Olanzapine

Question 31

Which anti-psychotics are low risk at causing sexual dysfunction?

Answer 31

Aripiprazole | Quetiapine

Question 32

What anti-psychotics have an increased risk of CV effects?

Answer 32

IV anti-psychotics | Pimozide

Question 33

What is used to treat NMS?

Answer 33

Dantrolene | Bromocriptine

Question 34

What should be monitored with anti-psychotics?

Answer 34

``` Weight HbA1C Lipids Prolactin (before starting) BP ECG FBC Urea and electrolytes Liver ```

Question 35

What is the MHRA warning about Anti-epileptics?

Answer 35

Small risk of suicide

Question 36

What antiepileptics cause antiepileptic hypersensitivity syndrome?

Answer 36

CPPP3L2R | Carbamazepine, primidome, phenytoin, phenobarbital, lacodamide, lamatrogine and rufinamide

Question 37

If you've had your 1st seizure and a specialist says you are fit to drive how long should you wait?

Answer 37

6 months

Question 38

If you have been diagnosed with epilepsy how long would you need to be seizure free for if you are not a danger to the public?

Answer 38

1 year

Question 39

How long can you license be revoked for if you've had a prescribed change to your antiepileptic or withdraw?

Answer 39

1 year

Question 40

What anti-epileptic can cause SJS?

Answer 40

Lamatrogine

Question 41

What antiepileptics can cause blood dycrasias?

Answer 41

``` Carbamazapine Phenytoin Lamatrogine Valproate Ethosuxamide ```

Question 42

What are the toxic side effects of phenytoin?

Answer 42

``` Slurred speech Nyastagmus Ataxia Confusion Hyperglycaemia Diplopia ```

Question 43

How is narcolepsy managed?

Answer 43

1st good sleep hygiene | Drugs such as methylphenidate,modafinil and dexamphetamine

Question 44

What is used 1st line for PD for patients whose motor symptoms effect their quality of life?

Answer 44

Levodopa | Co-bendelopa or co-careldopa

Question 45

What is 1st line for PD patients whose motor symptoms do not effect their quality of life?

Answer 45

``` Levodopa/dopamine agonists or MAOI Adjunct to levodopa can be dopamine agonist/COMT/MAOI Then non ergot Then ergot Amantadine last line ```

Question 46

What is the treatment for excessive day time sleepiness in PD?

Answer 46

Excessive modafinil (not for pregnancy)

Question 47

What is used to treat hallucinations/delusions in PD patients?

Answer 47

Quetiapine or clozapine

Question 48

What are the dopamine receptor agonists?

Answer 48

Pramipexole, rotigotine, ropinorole

Question 49

What colour does entacapone colour your urine?

Answer 49

Red/brown

Question 50

What corticosteroid can be used as an anti-emetic for cancer chemotherapy?

Answer 50

Dexamethasone

Question 51

What are neurokinin 1 receptor antagonist?

Answer 51

E.g. aprepitant used for moderate and severe nausea and vomitting

Question 52

What anti-emetic is licenced for pregnancy ?

Answer 52

Metoclopramide/prochlorperazine/promethazine

Question 53

What supplement should be given to pregnant women who have severe vomitting ?

Answer 53

Thiamine to prevent wernickes encephalopayhy

Question 54

What is used to treat nausea and vomitting with migraine?

Answer 54

Cinnarazine/prochlorperazine (use for acute)

Question 55

How long does chronic pain last for?

Answer 55

3 months