Nervous System Flashcards
What anti-cholinergic has a high risk of SJS?
Galantamine
What is used in severe Alzheimers and what is the drug class?
Memantine
NMDA
What anti-cholinergic can imcrease the risk of neuroleptic malignant syndrome with concomitant use with antipsychotics?
Donepezil
What are the anticholinergic S/E?
Constipation Dizziness Drowsiness Urinary retention Dry mouth Tachycardia Blurred vision Confusion (more common in elderly) Nausea and vomitting
What is the MHRA warning about elderly patient with dementia who are on antipsychotics?
Increased risk of stroke/TIA
What is used to treat anxiety that works on 5HT1
Buspirone
When to measure lithium?
12 hours post dose
What electrolyte can precipitate lithium toxicity?
Hyponatremia
Lithium toxic S/E
Fine tremor Confusion Hypotension Tachycardia Polyuria Visual disturbances
Least sedating TCA’s?
Imipramine and nortriptyline
Max dose of citalopram in the elderly ?
20mg
How long do anti-depressants take to work?
2 weeks
Is St John’s wort an enzyme inducer or inhibitor?
Enzyme inducer
How long should anti-depressant treatment be tried before it is switched of deemed ineffective?
4 weeks
6 weeks elderly
What are the effects of Serotonin syndrome?
Neuromuscular (tremor and rigidity), autonomic (Tachycardia, hyperthermia, shivering)
Altered mental state (confusion,mania and agitation)
What class is moclobemide?
MAOI
Wash out period compared to MAOIs?
MAOI-MAOI 2 weeks
TCA-MAOI 1-2 weeks (3 weeks for clomipramime and imipramine)
SSRI- MAOI 1 week (flouxetine 5 weeks)
How long should anti-depressants be continues after remision?
6 months
1 year elderly
2 years recurrent depression
How long should an antipsychotic be tried before it is deemed to be ineffective or switched?
4-6 weeks
What is the treatment for the 1st episode of psychosis?
CBT and anti-psychotics
What are antipsychotics better and relieving positive or negative symptoms?
Positive symptoms
What are the positive symptoms of schizophrenia?
Hallucinations and delusions
What are the negative symptoms of schizophrenia?
Emotional apathy
Social withdrawal
When can clozapine be used for schizophrenia?
After 2 antipsychotics have been tried (one of them being a second generation)
What are the general s/e of most 1st generation anti-psychotics?
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
What are the 1st generation anti-psychotics?
Phenothiazines (chlorpromazine, promazine, prochlorperazine etc) Butyphenones (Haloperidol) Thioxanthenes (flupentixol) Pimozide Sulpride
What are some 2nd generation anti-psychotics?
Quetiapine Clozapine Aripiprazole Risperidone Olanzipine Amisulpride Asenapine Paliperidone
What anti-psychotic does not increase prolactin concentration?
Aripiprazole
Which anti-psychotics increase the concentration of prolactin?
1st generation
Riperidone
Amisulpride
Which anti-psychotics cause an increase in sexual dysfunction?
Risperidone
Haloperidol
Olanzapine
Which anti-psychotics are low risk at causing sexual dysfunction?
Aripiprazole
Quetiapine
What anti-psychotics have an increased risk of CV effects?
IV anti-psychotics
Pimozide
What is used to treat NMS?
Dantrolene
Bromocriptine
What should be monitored with anti-psychotics?
Weight HbA1C Lipids Prolactin (before starting) BP ECG FBC Urea and electrolytes Liver
What is the MHRA warning about Anti-epileptics?
Small risk of suicide
What antiepileptics cause antiepileptic hypersensitivity syndrome?
CPPP3L2R
Carbamazepine, primidome, phenytoin, phenobarbital, lacodamide, lamatrogine and rufinamide
If you’ve had your 1st seizure and a specialist says you are fit to drive how long should you wait?
6 months
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?
1 year
How long can you license be revoked for if you’ve had a prescribed change to your antiepileptic or withdraw?
1 year
What anti-epileptic can cause SJS?
Lamatrogine
What antiepileptics can cause blood dycrasias?
Carbamazapine Phenytoin Lamatrogine Valproate Ethosuxamide
What are the toxic side effects of phenytoin?
Slurred speech Nyastagmus Ataxia Confusion Hyperglycaemia Diplopia
How is narcolepsy managed?
1st good sleep hygiene
Drugs such as methylphenidate,modafinil and dexamphetamine
What is used 1st line for PD for patients whose motor symptoms effect their quality of life?
Levodopa
Co-bendelopa or co-careldopa
What is 1st line for PD patients whose motor symptoms do not effect their quality of life?
Levodopa/dopamine agonists or MAOI Adjunct to levodopa can be dopamine agonist/COMT/MAOI Then non ergot Then ergot Amantadine last line
What is the treatment for excessive day time sleepiness in PD?
Excessive modafinil (not for pregnancy)
What is used to treat hallucinations/delusions in PD patients?
Quetiapine or clozapine
What are the dopamine receptor agonists?
Pramipexole, rotigotine, ropinorole
What colour does entacapone colour your urine?
Red/brown
What corticosteroid can be used as an anti-emetic for cancer chemotherapy?
Dexamethasone
What are neurokinin 1 receptor antagonist?
E.g. aprepitant used for moderate and severe nausea and vomitting
What anti-emetic is licenced for pregnancy ?
Metoclopramide/prochlorperazine/promethazine
What supplement should be given to pregnant women who have severe vomitting ?
Thiamine to prevent wernickes encephalopayhy
What is used to treat nausea and vomitting with migraine?
Cinnarazine/prochlorperazine (use for acute)
How long does chronic pain last for?
3 months
