NERVOUS SYSTEM Flashcards
Does PPP extend to Valporic acid too?
Yes
Valproic acid - when to withdraw?
If patient experiences Sx of pancreatitis or hepatic dysfunction
For BPD and migraine prophylaxsis (unlicensed)
MHRA advises that valproate must NOT be used
Can be used in epilepsy if there is no alternative
Lithium concentrations should be taken after ____ hrs
12
Patient and carer advice for Lithium
should report signs of Lithium Toxicity, Hypothyroidism, renal dysfunction (polyuria+ polydipsia) and intracranial HTN (persistent headache + visual disturbances)
Anti-depressants should be continued for how long after remission
6 months (12 months in elderly) for depression
12 months for GAD
Those with Hx of recurrent depression = 2 years
Hyponatraemia symptoms for Antidepressants
confusion, convulsions + drowsiness
Second choices after SSRI not effective
increase dose or switch to different SSRI
Or mirtazapine
Third line: Lofepramine or moclobemide or robextine
TCA + Venlafaxine = severe depression
Irreversible MAOi = specialist initiation only
Failure to respond to second antidepressant =
adding another anti-depressant of a different class or use of augmenting agent
GAD SSRIs/ SNRIs
Paroxetine, Escitalopram or sertraline (unlicensed)
Duloxetine or Venlafaxine.
More sedative TCAs ( better for anxious pts)
Amitriptyline, Clomipramine, Trazadone, Dosulepin
Less sedative (better for depressed pts)
Imipramine and Lofepramine and nortriptyline
Safest TCA
Lofepramine
Highest anti-muscarinic SEs TCA wise
Imipramine
The TCA(s) most likely to cause Hepatoxicity
Isocarboxazid + Phenelzine
Monitoring requirements for Mianserin (TCA)
FBC every 4 weeks for 3 months. Monitor for Sx of blood disorders.
TCA should be discontinued if the patient enters a _____ phase
manic
Treatment cessation for anti-depressants
Withdrawal effects may occur within 5 days of stopping treatment with antidepressant drugs; they are usually mild and self-limiting, but in some cases may be severe. The risk of withdrawal symptoms is increased if the antidepressant is stopped suddenly after regular administration for 8 weeks or more. The dose should preferably be reduced gradually over about 4 weeks, or longer if withdrawal symptoms emerge (6 months in patients who have been on long-term maintenance treatment).
Tryptophan red flag sx
If the patient experiences symptoms of eosinophilia myalgia syndrome (affects muscles, skin and lungs) – with hold tx until EMS excluded
Vortioxetine reasons for discontinuation
Seizures (develop or there is an increase in seizure frequency)
Benperidol
Control of deviant anti-social behaviour.
When would an antipsychotic dose be deemed ineffective
After 4 to 6 weeks
Aripiprazole increases prolactin levels in a ____ dependent manner
dose
Risperidone, amisulpride, sulpiride and first gen anti-psychotics are more likely to cause
Hyperprolactinemia
Aripiprazole, Clozapine and Quetiapine less likely to cause
Hyperprolactinemia
Sx of hyperprolactaemia
Sexual dysfunction, menstrual irregularities, reduced bone mineral density , galactorrhoea and increased cancer risk
Risperidone, Olanzapine and Haloperidol have the highest risk of
Sexual dysfunction
Aripiprazole and Quetiapine have the lowest risk of
sexual dysfunction
Postural hoTN is more likely with which antipsychotics
Clozapine and Quetiapine
Antipsychotics which are least likely to cause diabetes
Aripiprazole and Amisulpiride (second gen)
Haloperidol and Fluphenazine ( first gen)
Highest risk of weight gain (antipsychotics wise)
Clozapine and Olanzapine
Discontinuation of anti-psychotics following NMS should last at least
5 days
Tx of NMS
Bromcriptine and dantrolene
Contact sensitisation associated with which drug
chlorpromazine
BP monitoring not mandatory for which antipsychotic
Sulpiride
Cariprazine requirements for contraception
Highly effective contraception in women of CBP during tx and 10 weeks after last dose
BArrier method + contraceptive.
MHRA alert for ondansetron
Risk of cleft lip/ cleft palate in babies born to women who had ondansetron in the first trimester
Hyoscine patch administation
Tapentadol MHRA alert
Can induce seizures and therefore should be used with caution in patients with a Hx of epilepsy.
Increase risk of SS with other serotonergic drugs
Post op tramadol
Extreme caution in children. Life threatening events after tonsillectomy for obstructive sleep opnoea
