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Pre Reg > Nervous system > Flashcards

Nervous system Flashcards

1
Q

Which classes of drugs have anitmuscarinic (anticholinergic) burden?

A

Antimuscarinic drugs result in cognitive impairment (use minimised in dementia)

  • antidepressants (e.g. amitriptyline & paroxetine)
  • antihistamines (e.g. chlorphenamine & promethazine)
  • antipsychotics (e.g. olazapine & quetiapine)
  • urinary spasmodics (solifenacin & tolterodine)
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2
Q

How do you treat cognitive symptoms in mild-moderate Alzheimer’s disease?

A

1st line: Acetylcholinesterase inhibitors - monotherapy with donepezil, galantamine, or rivastigmine

2nd line: memantine (in moderate AD)

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3
Q

How do you treat cognitive symptoms in severe Alzheimer’s disease?

A

1st line: memantine

If pt already receiving Acetylcholinesterse inhibitor already, the addition of memantine can be started in primary care

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4
Q

How do you treat cognitive symptoms in mild-to-moderate non-alzheimer’s dementia?

A

Donepezil or rivastigmine in mild-moderate non-alzheimer’s dementia with Lewy bodies
- if both not tolerated then galantamine can be considered

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5
Q

How do you treat cognitive symptoms in severe non-alzheimer’s dementia?

A

Donepezil or rivastigmine in severe non-alzheimer’s dementia with Lewy bodies
- C/I or not tolerated = memantine

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6
Q

When can memantine be considered to treat cognitive symptoms in non-alzheimer’s dementia?

A

In patients with vascular dementia if they have suspected co-morbid AD, parkinsons disease dementia or dementia with Lewy bodies

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7
Q

Who are acetylcholinesterase inhibitors and memantine contraindicated in?

A

Patient with frontotemportal dementia or cognitive impairment caused by multiple sclerosis

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8
Q

What should you consider before treating agitation, aggression, distress and psychosis in patient with dementia?

A

Antipsychotics should ONLY be considered if:
- Pt is at risk of harming themselves or others
- experiencing agitation, hallucinations or delusions that are causing severe distress

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9
Q

What is the MHRA warning for antipsychotics and dementia?

A

Increases risk of stroke and small increases risk of death when antipsychotics are used in elderly patient WITH dementia

Assess risks v benefits
- including previous history of stroke or TIA
- risk factors for cerebrovascular disease: e.g. hypertension, diabetes, smoking and AF

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10
Q

If antipsychotic medication is decided to commence in patients with dementia, when should they be reviewed?

A

Every 6 weeks

Treat with the lowest dose for the shortest period of time

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11
Q

What types of dementia do antipsychotics worsen?

A

Patient with dementia with lewy bodies or parkinsons disease dementia - antipsychotic drugs worsen motor features of condition and in some cases cause antipsychotic sensitivity reactions

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12
Q

How is depression and anxiety treated in dementia?

A

Psychological treatments for mild-moderate dementia - CBT, multi-sensory stimulation, relaxation or animal-assisted therapies

Antidepressants should be reserved for pre-existing severe mental health problems

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13
Q

What is the STOPP criteria for donepezil, galantamine and rivastigmine?

A
  • known history of persistent bradycardia
  • HR less than 60 beats per minute
  • heart block
  • recurrent unexplained syncope
  • concurrent treatments with drugs that reduce HR
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14
Q

What is the patient and carer advise for galantamine?

A

Warn of the signs of serious skin reactions - advised to stop taking immediately and seek medical advise (steven-johnsons syndrome)

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15
Q

When should rivastigmine treatment be interrupted?

A

If dehydration resulting in prolonged vomiting or diarrhoea occurs and withheld until resolution - retitrate dose if necessary

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16
Q

What is the conversion between oral rivastigmine and transdermal patch?

A

Taking between 3-9mg orally = start with 4.6mg/24 hr patch

Taking 9mg orally = switch to 9.5mg/24hr patch

Taking 12mg orally = switch to 9.5mg/24 hr patch

Patch can be started the day following last oral dose

Transdermal patches less likely to cause side effects

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17
Q

Where do you apply the rivastigmine patch?

A

clean, dry, non-hairy, non-irritated skin on:
- back
- arm
- check

Removing after 24 hours

Avoid using the same area for 14 days

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18
Q

Which anti-epileptics have a long half-life and can be taken OD at night?

A

Lamotrigine
Perampanel
Phenobarbital
Phenytoin

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19
Q

What are the MHRA warnings for anti-epileptic drugs?

A
  • risk of suicidal thoughts and behaviours (symptoms may occur as early as 1 week after starting treatment)
  • advice on switching between different manufacturer’s products
  • teratogenicity: valportate must not be used in females of child-bearing age unless conditions of the PPP are met and alternative treatments contraindicated or not appropriate
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20
Q

What anti-epileptic drugs are category 1 and should be prescribed and maintained on a specific brand?

A

Carbamazepine
Phenobarbital
Phenytoin
Primidone

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21
Q

What anti-epileptic drugs are category 2 and prescribing by brand is based on clinical judgment and the patient?

A

Clobazam
Clonazepam
Lamotrigine
Topiramate
Valporate

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22
Q

Which drugs is anti-epileptic hypersensitivity syndrome associated with?

A

Carbamazepine
Lacosamide
Lamotrigine
Oxcarbazepine
Phenobarbital
Primidone
Rufinamide

Symptoms start between 1-8 weeks of exposure

Withdraw drug immediately - do not re-expose

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23
Q

What are the symptoms of hypersensitivity syndrome?

A

common: fever, rash and lymphadenopathy

other systemic signs: liver dysfunction, haematological, renal and pulmonary abnormalities, vasculitis and multi-organ failure

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24
Q

Which anti-epileptics can precipitate severe rebound seizures if stopped abruptly?

A

Barbiturates
Benzodiiazepines

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25
Q

How do you withdraw anti-epileptic medication?

A

Patient should be seizure for 2 years at least
Assessment to determine seizure recurrence should be carried out
Withdrawal should do done over a minimum of 3 months

If a seizure occurs during this process - the last dose reduction should be reversed and clinicians must seek advise from epilepsy specialist

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26
Q

How long must patients who have had an unprovoked or single isolated seizure not drive for?

A

6 months

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27
Q

How long must patients with established epilepsy not drive for?

A

Must be seizure free for at least 1 year or have a pattern of seizures established for one year where there is no influence on their level of consciousness or their ability to act

They must also have no history of unprovoked seizures

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28
Q

What are the exemptions for people who have seizures while asleep?

A

They must not drive for a year from last date of seizure unless:
- a history or pattern of sleep seizure’s occurring ONLY ever while asleep has been established over the course of at least one year from the date of the first sleep seizure
- an established pattern of purely asleep seizures can be demonstrated over the course of 3 years if the patient has previously had seizures whilst awake (or awake and asleep)

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29
Q

What should patients take if on anti-epileptics and becomes pregnant?

A

Folate especially during the first trimester is recommended

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30
Q

How do you minimise the risk of neonatal haemorrhage associated with anti-epileptics?

A

Routine injection of vitamin K

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31
Q

Who should pregnant females with epilepsy be encourages to notify?

A

Epilepsy and Pregnancy Register

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32
Q

Which anti-epileptics are readily transferred into breast-milk causing high infant serum-drug concentrations?

A

ethosuximide
Lamotrigine
primidone
zonisamide

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33
Q

Which anti-epileptics slow metabolism in infants causing it to accumulate?

A

Phenobarbital
Lamotrigine

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34
Q

Which anti-epileptics have established risk of drowsiness in breast-fed babies?

A

Primidone
Phenobarbital
Benzodiazepines

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35
Q

Which anti-epileptics may cause withdrawal effect if mother suddenly stops breast-feeding?

A

Phenobarbital
Primidone
Lamotrigine

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36
Q

How do you treat focal seizures with or without secondary generalisation?

A

1st line: monotherapy with lamotrigine or levetiracetam

2nd line: monotherapy with carbamazepine, oxcarbazepine or zonisamide

3rd line: lacosamide

Conjunctive therapy:
1st line: carbamazepine, lacosamide, lamotrigine, levetiracetam, oxcarbazepine, topiramate

2nd line: brivaracetam, cenobamate, eslicarbazepine, perampanel, pregabalin, sodium valporate (in males and females unable to have children)

3rd line: phenobarbital, phenytoin, tiagabine, vigabatrin

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37
Q

How do you treat tonic-clonic generalised seizures?

A

Males or females unable to have children:
1st line: sodium valporate
2nd line: lamotrigine or levetiracetam

Females who are able to have children:
1st line: lamotrigine or levetiracetam

Adjunctive treatment
1st line: clobazam, lamotrigine, levetiracetam, perampanel, sodium valporate (men and females unable to have children), or topiramate

2nd line: brivaracetam, lacosamide, phenobarbital, primidone, zonisamide

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38
Q

How do you treat generalised absence seizures?

A

1st line: ethosuximide
2nd line: sodium valpoerate as monotherapy or adjunctive therapy for males and females unable to have children
3rd line: monotherapy or adjunctive therapy with lamotrigine or levetiracetam

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39
Q

How do you treat generalised myoclonic seizures?

A

1st line: sodium valporate
2nd line: levetiracetam (1st line if females of childbearing age) monotherapy or adjunctive

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40
Q

How do you treat generalised atonic or tonic seizures?

A

Usually seen in childhood

1st line: sodium valproate
2nd line: lamotrigine monotherapy or adjunctive (1st line in females of childbearing age)

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41
Q

Which type of epilepsy is associated with cerebral damage or learning difficulties?

A

Atonic or tonic seizures

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42
Q

How do you treat Dravet’s syndrome?

A

1st line: sodium valporate in all patients (ensure PPP)

If monotherapy fails, consider triple therapy: Sodium valporate + clobazam + stiripentol

Cannibidiol with clobazam may be considered as 2nd line in certain patients

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43
Q

How do you treat lennox gastaut syndrome?

A

1st line: sodium valporate in all patients (PPP)

2nd line: lamotrigine monotherapy or adjunctive therapy

3rd line: adjunctive therapy with cannabidiol + clobazam

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44
Q

What is considered as a repeated or cluster seizure?

A

3 or more self-terminating seizures in 24 hours

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45
Q

What is considered as a prolonged convulsive seizure?

A

A seizure that continued for 2 minutes longer than the usual patients seizure

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46
Q

What is considered as convulsive status epilepticus?

A

A seizure that lasts for 5 minutes or more - medical emergency

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47
Q

How are repeated/ cluster seizures or prolonged seizures treated?

A

1st line: individualised emergency management plan
2nd line: benzodiazepine e.g. clobazam or midazolam urgently considered

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48
Q

How do you treat convulsive status epilepticus?

A
  • position to avoid injury
  • support respiratory : provision or oxygen, maintaining BP and correction of any hypoglycaemia
  • consider parenteral thiamine if alcohol abuse suspected
  1. patients individualised emergency plan
  2. urgent buccal midazolam or rectal diazepam if in community
    - if resuscitation resources available then IV lorazepam

Call emergency services and if 1st dose doesnt work, provide a 2nd dose after 5-10 minutes

No response to 2 doses of benzodiazepines: levetiracetam, phenytoin or sodium valporate

3rd line: phenobarbital or general anaesthesia

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49
Q

How do you treat convulsive status epilepticus if caused by pyridoxine deficiency (vitamin B6)?

A

Pyridoxine hydrochloride

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50
Q

How do you treat non-convulsive status epilepticus?

A

Depends of severity of condition

If incomplete loss of awareness = usual antiepileptic therapy should be continued or restarted

Fail to respond/ lack of awareness = treat the same way as convulsive status epilepticus

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51
Q

Which antiepileptic drugs do MRHA suggest vitamin D supplementation in immobilised patients or those lacking exposure to sunlight or dietary intake of calcium?

A

Carbamazepine and phenytoin

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52
Q

What are the cautions for carbamazepine?

A

Blood, hepatic of skin disorders
HLA allele

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53
Q

What is the optimum plasma concentration response range for carbamazepine?

A

4-12mg/L OR
20-50micromol/L
Measured after 1-2 weeks

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54
Q

What additional MHRA warnings doses gabapentin have?

A

Risk of respiratory depression
Risk of abuse and dependence: now sch 3

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55
Q

What is a serious side effect of lamotrigine?

A

Serious skin reactions - Stevens-Johnson syndrome and toxic epidermal necrolysis have developed (especially in children)
Most rashes occur within 8 weeks

Factors associated with this: rapid dose increase, use with valporate and initial high dose

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56
Q

What is the additional MHRA warning for pregabalin?

A

Respiratory depression

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57
Q

What is the additional MHRA warning for phenytoin?

A

risk of death and severe harm from error with injectable phenytoin

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58
Q

What is the additional MHRA warning for topiramate?

A

Start of safety review triggered by a study reporting an increased risk of neurodevelopmental disabilities (e.g. autism) in children with prenatal exposure

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59
Q

When can drug treatment be commenced in ADHD?

A

In patient with ADHD whose symptoms are still causing significant impairment in at least one area of function despite environmental modifications

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60
Q

How do you treat ADHD?

A

1st line: lisdexamfetamine or methylphenidate (6 week trial)

(dexamfetamine can be tried if the patient is having beneficial reponse to lisdexamfetamine but cannot tolerate its longer duration of effect

2nd lime: atomexetine

3rd line: guanfacine

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61
Q

What is the patient and carer advise for atomoxetine?

A

suicidal ideation
hepatic impairment

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62
Q

What are the administration instructions for guanfacine

A

avoid administration with hifh fat meals - may increase absorption

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63
Q

When should antidepressants be avoided in bipolar disporder?

A

In patients with rapid-cycling bipolar disorder, a recent history or mania or hypomania or with rapid mood fluctuations

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64
Q

What is used to treat acute episodes of mania or hypomania?

A

Antipsychotics: haloperidol, olanzapine, quetiapine and risperidone

if inadequate response: lithium or valporate may be added

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65
Q

How do you treat moderate to severe manic episodes associated with bipolar?

A

Asenapine - second generation antipsychotic

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66
Q

What is used for long-term management of bipolar?

A

Olanzapine - licensed for prevention of recurrence in patients whose manic episode has responded to olanzapine therapy

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67
Q

What is the minimum time antipsychotics should be discontinued over?

A

4 weeks

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68
Q

When are benzodiazepines used in bipolar?

A

(e.g. lorazepam)
May be helpful in initial stages of treatment for behavioural disturbance or agitation

Do not use for long periods due to risk of dependence

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69
Q

How long does the prophylactic effect of lithium take to occur?

A

6-12 months after initiating therpy

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70
Q

When is valproic acid used in bipolar?

A

Used for treatment of manic episodes associated with bipolar is lithium not tolerated or contraindicated

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71
Q

When is carbamazepine used in bipolar?

A

long-term management to prevent recurrence of acute episodes in patients unresponsive to lithium therapy

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72
Q

What are the specific side effects for valproic acid?

A

hepatic dysfunction - withdraw treatment immediately symptoms develop
Pancreatitis - discontinue if symptoms develop

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73
Q

What is the criteria for chronic depression?

A

for at least 2 years, either continually meet the criteria for diagnosis of major depression episodes, or have persistent subthreshold symptoms, or persistent low mood (with or without concurrent episodes of major depression)

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74
Q

What is the initial treatment for depression?

A

The use of antidepressants and/ or psychological or psychosocial treatment

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75
Q

When should patients on antidepressants be reviewed?

A

2-4 weeks for after initiation

Those at high risk of suicide or ages 18-25 should be reviewed 1 week after staring treatment or increasing dose

Effects seen within 4 weeks (6 weeks in elderly) and continue treatment for at least 6 months (12 months in elderly and patients being treated for anxiety)

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76
Q

How do you treat subthreshold or mild depression?

A

1st line: psychological and psychosocial therapy

2nd line: antidepressants if patient preference
- SSRI: citalopram, escitalopram, sertraline, fluoxetine, fluvoxamine or paroxetine

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77
Q

How do you treat moderate or severe depression?

A

1st line: combination therapy + antidepressants
- SSRI

2nd line: SNRI
- duloxetine or venlafaxine

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78
Q

Which class of antidepressants have the highest risk of overdose?

A

TCA

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79
Q

Which TCA has the best safety profile?

A

Lofepramine

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80
Q

What can be used in severe depression if rapid response is required?

A

electroconvulsive therapy

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81
Q

What can used if a patient has limited or no response to at least 2 antidepressants?

A

Vortioxetine

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82
Q

Which antidepressant is safest for patient who had recent MI or has unstable angina?

A

Sertraline

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83
Q

Which class of antidepressants have highest association with hyponatraemia?

A

SSRIs

consider hyponatraeia in all patients with symptoms including drowsiness, confusion, or convulsions

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84
Q

Which class of drugs is serotonin syndrome associated with?

A

MOAI

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85
Q

What are the symptoms of serotonin syndrome?

A

Neuromuscular hyperactivity - tremor, hyperreflexia, clonus, myoclonus, rigidity

Autonomic dysfunction - tachycardia, BP changes, hyperthermia, diaphoresis, shivering, diarrhoea

Altered mental state - agitation, confusion, mania

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86
Q

How do you treat anxiety?

A

usually benzodiazepines or buspirone

Chronic anxiety: antidepressant - can be combined with benzo until antidepressant takes effect
- SSRI e.g. escitalopram, paroxetine or sertraline
- 2nd line: SNRI - duloxetine ir venlafaxine
-3rd line: pregabaline

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87
Q

How do you treat panic disorders?

A

SSRI
2nd line: clomipramine or imipramine
Venlafaxine also licensed for panic disorders

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88
Q

How is OCD/ PTSD treated?

A

SSRI
2nd line: clomipramine

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89
Q

Which drug is licensed for social anxiety?

A

Moclobemide

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90
Q

Which tricyclics are more sedating?

A

Clomipramine
Dosulepin
Doxepin
Mianserin
Trazodone
Trimipramine

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91
Q

Which tricyclics are less sedating?

A

Imipramine
lofepramine
nortriptyline

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92
Q

Which MAOI has greater stimulant action is likely to cause hypertensive crisis?

A

Tranylcypromine

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93
Q

Which MAOI should be reserved for 2nd line?

A

Moclobemide (reversible MAOI)

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94
Q

What should be done when stopped an MAOI but started other antidepressants?

A

Do not start another antidepressant for 2 weeks after MAOI stopped but 3 weeks if staring clomipramine or imipramine

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95
Q

What should be done when stopping an antidepressant and starting an MAOI?

A

Do not start MAOI until:
- at least 2 weeks after previous MAOI has been stopped (then start at reduced dose)
- at least 7-14 days after tricyclic (3 weeks if clomipramine or imipramine) has been nstopped
- at least a week after am SSRI (5 weeks in the case of fluoxetine) has been stopped

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96
Q

What are the specific MAOI side effects?

A

Postural hypotension and hypertensive responses

Discontinue if palpitations or frequent headaches occur

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97
Q

What are the contraindicated of MAOIs?

A

Cerebrovascular disease
Not indicated for manic phase
Phaeochromocytoma
Severe cardiovascular disease

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98
Q

What is the patient and carer advise foe MAOIs?

A

Eat only fresh foods, avoid stale or going off foods

Danger of interaction persists for 2 weeks after stopping drug

Avoid alcoholic or de-alcoholised drinks

May cause drowsiness

Avoid foods and beverages containing tyramine - e.g. cheese, salami. herring, oxo, marmite, beers, largers, wines

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99
Q

What is the MHRA warning for SSRIs/SNRIs?

A

small increased risk of postpartum haemorrhage when used in the month before delivery

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100
Q

What are the contraindications of SSRIs?

A

Poorly controlled epilepsy
Should not be used if patients enters manic phase

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101
Q

What are the specific side effects of SSRIs?

A

Sexual dysfunction may persist after treatment has stopped

SSRIs can cause GI bleeds

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102
Q

Which the contraindication for citalopram and escitalopram?

A

Prolonged QT

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103
Q

What is the maximum citalopram dose in hepatic impairment?

A

20mg

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104
Q

Which SSRI has a higher risk of withdrawal reactions?

A

Paroxetine

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105
Q

What is the contraindication for venlafaxine

A

uncontrolled hypertension

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106
Q

What are the contraindications for amitriptyline?

A

Arrhythmias
During manic phase of bipolar
heart block
Immediate recovery period after MI

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107
Q

Which drug is used for control of deviant antisocial sexual behaviours?

A

Benperidol

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108
Q

What are the positive symptoms of psychosis?

A

Hallucinations
Delusions

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109
Q

What are the negative symptoms of psychosis?

A

Emotional empathy
Social withdrawal

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110
Q

Which psychosis symptoms are antipsychotics better at alleviating?

A

Positive symptoms

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111
Q

How long do patients need to be on antipsychotics before they are deemed unsuccessful?

A

At optimum dose frr 4-6 weeks

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112
Q

When is the only time 2 antipsychotics can be prescribed at the same time?

A

Clozapine augmentation OR
when changing medication during titration

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113
Q

What are the risks associated with prescribing 2 antipsychotics?

A

Extrapyrimadol side effects
QT prolongation
Sudeen cardiac death

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114
Q

When can clozapine be prescribed for schizophrenia?

A

When there has been sequential use of at least 2 different antipsychotics (1 of which should be 2nd generation antipsychotic) each for an adequate time and could not control schizophrenia

Allow 8-10 weeks to assess response - patient must be registered with clozapine patient monitoring service

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115
Q

What would you consider if patient not adhering to antipsychotic for psychosis and schizophrenia?

A

Long-acting depot injectable antipsychotic drugs

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116
Q

Which antipsychotics are more likely to cause extrapyramidal symptoms and hyperprolactinaemia?

A

first-generation antipsychotic drugs

e.g. piperazine
Phenothiazines
butyrophenones
Depot preparations

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117
Q

Name some 1st generation antipsychotics (typical/conventional)

A

Phenothiazine derivatives - chlorpromazine, fluphenazine, levomepromazine, pericyazine, prochlorperazine, promazine, trifluperazine

Butyrophenones - benperidol, haloperidol

Thioxanthenes - flupentixol, zuclopenthixol

Diphenylbutylpiperidines - pimozide

Substituted benzamides - sulpiride

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118
Q

Name some 2nd generation antipsychotics (atypical)

A

Amisulpride
Aripiprazole
Asenapine
Cariprazine
Clozapine
Paliperidone
Quetiapine
Risperidone

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119
Q

What adverse effects are 2nd generation antipsychotics associated with?

A

Glucose intolerance
Weight gain

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120
Q

How should antipsychotics be prescribed in emergency situations?

A

Initial prescription should be written as a single dose

oral and IM drugs should be prescribed separately

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121
Q

What are the risks of antipsychotics in elderly patients with dementia?

A

Increased risk of mortality
Increased risk of stroke and TIA
Higher risk of postural hypotension

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122
Q

When can antipsychotics be used in elderly patients with dementia?

A

When there is a risk of harming themselves or others, or experiencing agitation, hallucinations or delusions that are causing themselves severe distress

Lowest effective dose for shortest time

Patient should be reviewed at least every 6 weeks

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123
Q

What should be considered in patients with learning disabilities taking antipsychotics but not experiencing psychotic symptoms?

A
  • reduction in dose or discontinuation
  • reviewing patients condition after dose reduction or discontinuation
  • refer to psychiatrist experienced in working with the patient
  • annual documentation of reasons for continuing and not reducing or discontinuing
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124
Q

Which 2nd generation antipsychotics are associated with late-onset extrapyramidal symptoms?

A

Clozapine
Olanzapine
Quetiapine
Aripiprazole

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125
Q

What are extrapyramidal parkinsonian symptoms?

A

Bradykineasia - slow movement and speed
Tremor

126
Q

Who are extrapyramidal parkinsonian symptoms more common in?

A

Female elderly patients
Those with pre-existing neurological damage e.g. stroke and may appear gradually

127
Q

What are extrapyramidal dystonia symptoms?

A

Uncontrolled muscle spasms in any part of the body

128
Q

Who are extrapyramidal dystonia symptoms more common in?

A

Young males
Can appear within hours of starting antipsychotics

129
Q

What are extrapyramidal akathisia symptoms?

A

Restlessness - start within hours to weeks of starting antipsychotics or dose increase and can be mistaken for psychotic agitation

130
Q

What are extrapyramidal tardive dyskinesia symptoms?

A

Abnormal involuntary movements of lips, tongue, face and jaw - can develop on long-term or high-dose therapy, or even after discontinuation

in some patients, it can irreversible

More common in elderly females

131
Q

Which antipsychotic drugs are most likely to cause hyperprolactinaemia?

A

Risperadone
Amisulpride
Sulpiride
First generation antipsychotics

132
Q

Which antipsychotic reduces prolactin concentration in a dose-dependent manner?

A

Aripiprazole

133
Q

What are the symptoms of hyperprolactinaemia?

A

Sexual dysfunction
Reduced bone mineral density
Menstrual disturbances
Breast enlargement
Galactorrhoea
Increased risk of breast cancer

134
Q

Which antipsychotic drugs have a lowest association with sexual dysfunction?

A

Aripiprazole
Quetiapine

135
Q

Which antipsychotic drugs have a highest association with sexual dysfunction?

A

Riseperidone
Haloperidol
Olanzapine

136
Q

Which cardiovascular side effects are associated with antipsychotics?

A

Tachycardia
Arrhythmias
Hypotension

137
Q

Which antipsychotic is concerned with QT prolongation

A

pimozide

Also high risk in patients using IV antipsychotics or combination of antipsychotics whose doses exceed recommended amount

138
Q

Which type of antipsychotics are most likely to cause postural hypotension?

A

2nd generation - clozapine and quetiapine

139
Q

Which type of antipsychotics is most likely to cause diabetes?

A

2nd generation are more likely to cause diabetes
- amisulpride and aripiprazole have the lowest risk

From 1st generation antipsychotics - fluphenazine and haloperidol have the lowest risk of this

140
Q

Which antipsychotics are associated with weight gain?

A

Clozapine and olanzapine

141
Q

What are the symptoms of neuroleptic malignant syndrome?

A

Rare but fatal side effect of all antipsychotics

Hyperthermia. fluctuating level of consciousness, muscle rigidity, autonomic dysfunction with fever, tachycardia, liable BP and sweating

142
Q

How should you act if neuroleptic malignant syndrome is suspected with antipsychotics?

A

Discontinue drug for at least 5 days preferably longer - symptoms should be allowed to resolve completely

Bromocriptine and dantrolene have been used for treatment

143
Q

What is the monitoring requirements for antipsychotics?

A

Weight - baseline then weekly for 6 weeks then 12 weeks then yearly

Fasting glucose, HbA1c, blood lipid concentration - baseline, 12 weeks, yearly

Prolactin - baseline, 6 months then yearly

ECG - before treatment

BP - before treatment, 12 weeks, yearly

FBC, urea, electrolytes, LFTs - start of therapy and yearly

144
Q

What if the MHRA warning for clozapine and other antipsychotics?

A

Monitoring blood concentration for toxicity

145
Q

Which antipsychotic should pharmacists, nurses and other HCP be warned about handling?

A

chlorpromazine - risk of contact sensation

146
Q

What are the safety and MHRA warnings for haloperidol?

A

Safety - no to confuse the IM/SC injections with depot preparations of haloperidol decanoate

MHRA - risks when used in elderly patients for acute treatment of delirium: increased risk of adverse neurological and cardiac effects

147
Q

What are the oral and parenteral specific side effects for haloperidol?

A

Oral - angioedema
Parenteral - hypertension and severe cutaneous adverse reactions (SCARs)

148
Q

What is the specific caution for prochlorperazine?

A

Hypothyroidism

149
Q

What are the specific side effects for prochlorperazine?

A

With buccal use: blood disorders and hepatic disorders

150
Q

Which 1st generation antipsychotics are available as depot injections?

A

No more than 2-3ml of oily injection at any one site

Flupentixol deconate
Haloperidol deconate
Zuclopenthixol deconate

151
Q

What are the MHRA warnings for clozapine?

A

Potential fatal risk of intestinal obstruction, faecal impaction and paralytic ileus

Monitoring blood concentrations for toxicity

152
Q

What is a specific caution for clozapine?

A

Agranulocytosis - neutropenia and potentially fatal agranulocytosis

Myocarditis and cardiomyopathy (most common in first 2 months)

Intestinal obstruction

153
Q

How do you teat hypersalvation with clozapine?

A

hyoscine hydrobromide provided that the patient is not at risk of additive antimuscarinic side effects

154
Q

What are common specific side effects of olanzapine?

A

IM: dyslipidaemia
Oral: hypersomnia

155
Q

Which 2nd generation antipsychotics are available as depot injections?

A

Olanzapine embonate

156
Q

How do you treat muscular symptoms of motor neurone disease?

A

1st line: Quinine
2nd line: baclofen

Subsequent treatment: tizanidine, dantrolene or gabapentin

157
Q

How do you treat saliva problems in motor neurone disease?

A

Trial of antimuscarinic for excessive drooling of saliva
- glycopyrronium recommended in patients who have cognitive impairment as has fewer central nervous system side effects

2nd line: botulinum toxin type A

Treating thick, tenacious saliva - humidification, nebulisers and carboscisteinne

158
Q

How do you treat breathlessness in motor neurone disease?

A

benzodiazepines or opioids

159
Q

How do you treat amyotrophic lateral sclerosis in motor neurone disease?

A

Riluzole

160
Q

What is used to control movement disorders in Huntington’s chorea and related disorders?

A

Terabenazine - also used for tardive dyskinesia if switching or withdrawing causative antipsychotic

Haloperidol, olanzapine, risperidone, quetiapine - also used to suppress chorea in Huntington’s disease

161
Q

What is used to treat tourette’s syndrome and related choreas?

A

Haloperidol - improves motor tics

Pimozide (ECG monitoring required), clonidine, sulpiride,

162
Q

How do you relieve intractable hiccups?

A

Chlorpromazine and haloperidol

163
Q

How do you treat tremors associated with anxiety and thyrotoxicosis?

A

Propranolol and other beta blockers

Benginin essential tremor - primidone

164
Q

What is the first line management of Parkinson’s disease in patients who’s motor symptoms are decreasing their QoL?

A

Levodopa combined with either carbidopa or benserazide (co-careldopa or co-benldopa)

165
Q

What is the first line management of Parkinson’s disease in patients whos motor symptoms are NOT decreasing their QoL?

A

Levodopa OR
non-ergot-derived dopamine-receptor agonists: pramipexole, ropinirole, rotigotine OR
Monoamine-oxidase-B inhibitors: rasagiline or selegiline

166
Q

What type of side effects are expected with antiparkinsonian drugs?

A

Psychotic symptoms
Excessive sleepiness
Sudden onset of sleep - especially dopamine receptor agonists
Impulse control

167
Q

What motor complication is levadopa associated with?

A

Response fluctuations and dyskinesia

If end-of-dose deterioration = MR tablets

168
Q

How do you treat daytime sleepiness and sudden onset of sleep in parkinsons?

A

Modafinil - review every 12 months

169
Q

How do you treat nocturnal akinesia in parkinsons?

A

1st line: levodopa or oral dopamine-receptor agonists
2nd line: rotigotine

170
Q

How do you treat postural hypotension in parkinsons?

A

1st line: midodrine
2nd line: fludrocortisone

171
Q

How do you treat hallucinations and delusions and parkinsons?

A

patient with no cognitive impairment:
- 1st: quetiapine
- 2nd: clozapine

172
Q

How do you treat rapid eye movement sleep disorder behaviour in parkinsons?

A

clonazapam

173
Q

How do you treat drooling of saliva in parkinsons?

A

1st line: glycopyrronium
2nd line: botulinium toxin type A

Risk of cognitive adverse effects
- topical atropine

174
Q

Which antiemetic can be used for chemo and radiotherapy induced N/V and is less sedating?

A

Prochlorperazine

175
Q

Which antiemetic is used for N/V in palliative care?

A

Haloperidol

176
Q

Which antiemetic is less likely to cause central effects?

A

Domperidone - it does not cross the BBB

Central effects examples:
- sedation
- dystonic reactions

177
Q

Which antiemetic is used to treat N/V in parkinsons caused by dopaminergic drugs?

A

Domperidone

178
Q

Which anti-emetics are used to prevent N/V from cytotoxics?

A

Ondansetron
Granisetron
Palonosetron
Palonosetron with netupitant

179
Q

Which antiemetics are used in chemo-therapy induced N/V?

A

dexamethasone
aprepitant

180
Q

What drug can be considered as add-on therapy for chemotherapy induced N/V when unresponsive to conventional antiemetic?

A

Nabilone - a synthetic cannabinoid with antiemetic properties

181
Q

Which food can be helpful for pregnant women experiencing prolonged N/V?

A

Ginger

182
Q

Which antiemetic options are there for N/V in pregnancy?

A

Chlorpromazine
Metoclopramide
Cyclizine
Doxylamine with pyridoxine
Prochlorperazine
Promethazine *
Ondansetron

183
Q

Which antiemetics are used for post-operative N/V?

A

Granisetron
Ondansetron
Dexamethasone
Droperidol

Cyclizine - licensed for prevention and treatment of post-op N/V caused by opioids and general anaesthesia

184
Q

Which antiemetic is licensed for motion sickness?

A

Hyoscine
Antihistamines

185
Q

What is the MHRA warning for metoclopramide?

A

risk of neurological adverse effects - use only for 5 days
10mg TDS

186
Q

Which antiemetic should be avoided in GI problems or obstruction?

A

Metoclopramide
(3-4 days after GI surgery)

187
Q

What is the MHRA warning for ondansetron?

A

small increased risk of oral clefts following use in first 12 weeks of pregnancy

188
Q

What is the definition of chronic pain?

A

Pain that persists more than 12 weels

189
Q

What is a common co-morbidity of chronic pain?

A

Depression

190
Q

Which analgesic should be avoided in pain in sickle-cell disease?

A

Pethidine because accumulation of neurotoxic metabolite can precipitate seizures

191
Q

Which analgesic does naloxone only partially reverse?

A

Buprenorphine

192
Q

Which analgesic has greater solubility and so allowed effective doses to be injected in smaller volumes?

A

Diamorphine hydrochloride (heroin)

193
Q

What is the maximum number of times methadone can be administered per day?

A

twice to avoid risk of accumulation

194
Q

How do you treat a cluster headache?

A

Sumatriptan s/c

if unsuitable - sumatriptan nasal spray or zolmitriptan nasal spray

195
Q

What is considered as prophylaxis of cluster headache?

A

frequent attacks last of 3 weeks

196
Q

What is the treatment for prophylaxis cluster headache?

A

Verapamil or lithium

197
Q

What is used short-term for prophylaxis of episodic cluster headaches?

A

Prednisolone monotherapy or in combination with verapamil

198
Q

What are the characteristics of a migraine?

A

Recurrent attacks of typically moderate-severe headaches lasting between 4-72 hours

Unilateral, pulsating, aggravated by routine physical activity

Usually accompanied by N/V, photophobia and phonophobia or both

199
Q

What is a migraine WITH aura?

A

Consists of visual symptoms
- zigzag/ flickering lights, spots, lines or loss of vision
- dysphasia
- sensory symptoms e.g. pins and needles and numbness

200
Q

What is considered as an episodic migraine?

A

headache which occurs less than 15 days per month
- low frequency = 1-9 days
- high frequency 10-14 days

201
Q

What is considered as a chronic migraine?

A

Headache which occurs on at least 15 days per month and has characteristics of a migraine on at least 8 days per month for greater than 3 months

202
Q

What is the first line treatment for acute migraine?

A

aspirin, ibuprofen or a triptan (sumatriptan drug of choice)

Should be taken as soon as patient knows they are developing a migraine

203
Q

How should patients with migraines with aura take triptans?

A

Take at the start of the headache and not at the start of aura unless they both happen at the same time

Treatment can be repeated after 2 hours with the same or different drug if there was inadequate response

204
Q

What should be used in patients presenting with severe N/V in acute migraines?

A

diclofenac sodium suppositories

205
Q

What should be given to patients with acute migraines if they fail to response to monotherapy?

A

Sumatriptan and naproxen

206
Q

Which antiemetics can be given to relieve N/V in acute migraines?

A

Metoclopramide or prochlorperazine
Domperidone - alternative

207
Q

What is recommended treatment for preventative migraine treatment?

A

1st line: Propranolol - episodic or chronic migraine
- unsuitable: other beta blockers

2nd line: topiramate (risks of birth defects - highly effective contraception)

other drugs that can be used
- amitriptyline
- candesartan

These should be used for at least 3 months before considering it ineffective - a good response is a 50% reduction in severity and frequency of migraines

3 or more prophylactic treatments ineffective - botox

208
Q

How do you treat menstrual migraine prophylaxis?

A

Frovatriptan - instead of or in addition to standard prophylactic treatment
- 2 days before until 3 days after menstruation starts

Alternatives: zolmitriptan or naratriptan

Patient must have regular cycle for medication to be effective

209
Q

What is recommended for postherpetic neuralgia?

A

Capsaicin

210
Q

What is recommended for trigeminal neuralgia?

A

Carbamazepine - reduces frequency and severity of attachs

211
Q

What are the characteristics of benzodiazepines withdrawal syndrome?

A

isnomnia
anxiety
loss of appetite and body weight
tremor
perspiration
tinnitus
perceptual disturbances

Can occur up to 3 weeks after stopping

212
Q

What is the recommended withdrawal regimen for diazepam?

A

reduce by 1-2mg every 2-4 weeks: in patients taking higher doses it may be suitable to reduce by 1/10th every 1-2 weeks

Towards end of withdrawal may be necessary to reduce in steps of2 500mcg

213
Q

What are the risks of hypnotics and z-drugs in elderly patients?

A

risk of becoming ataxic and confused leading to falls and injury

214
Q

Which benzodiazepines are used as hypnotics?

A

Nitrazepam and flurazepam - longer acting
Loprazolam, lormetazepam and temazepam - shorted acting (little to no hangover effect)

215
Q

Which hypnotic is referred in elderly?

A

Clomethiazole - freedom from hangover

216
Q

What is the treatment for precipitated withdrawal with buprenorphine?

A

Lofexidine if symptoms are severe

217
Q

How do you reduce the risk of precipitated withdrawal?

A

first dose of buprenorphine should be given when patient is exhibiting signs of withdrawal or 6-12 hours after last use of heroin or 24-48 hours after last dose of methadone

218
Q

When is methadone initiated?

A

at least 8 hours after last heroin dose

219
Q

When is methadone and buprenorphine withdrawal preferable in pregnancy?

A

during second trimester with dose reductions made every 3-5 days
- first trimester poses a risk of spontaneous miscarriage
- third trimester not recommended because of maternal withdrawal

220
Q

What are the symptoms of neonatal withdrawal?

A

High-pitched cry
Rapid breathing
Hungry but ineffective suckling
Excessive wakefulness
Severe but rare symptoms include - hypertonicity and convulsions

221
Q

What is used to attenuate alcohol withdrawal symptoms?

A

Chlordiazepoxide or diazepam
Carbamazepine
Clomethiazole - if taking with alcohol can lead to fatal respiratory depression (particularly with cirrhosis)

222
Q

What is used first line for delirium tremens and alcohol-induced seizure?

A

Lorazepam

223
Q

What should be used in patients with mild alcohol dependence where psychological intervention alone not successful?

A

Acamprosate calcium or oral naltrexone

224
Q

What is recommended for reducing alcohol consuming in patients who have a high risk drinking level?

A

Nalmefene

225
Q

What are the preferred options for stop smoking drug treatment?

A

Varenicline (unavailable in the UK)
Long-acting NRT - patch
Short-acting NRT - lozenges, gum, sublingual tablets, inhalator, nasal and oral spray

If not appropriate - use bupropion or single therapy NRT

Do not combine therapies

226
Q

What is the MHRA warning for bupropion?

A

risk of serotonin syndrome when used with other serotonergic drugs

227
Q

What is the treatment for depression in childnre?

A

1st line: fluxoetine 10mg (Can be increased up to 20mg after a week if required)

2nd line: sertraline ot citalopram

228
Q

Which drugs should NOT be used in the treatment of depression in children and young people?

A

Paroxetine
Venlafaxine
TCAs

229
Q

What is the normal serum lithium concentration?

A

0.4-1 mmol/L

Target in acute mania: 0.8-1 mmol/L

230
Q

What do MAOIs interact with to cause hypertensive crisis?

A

Tyramine rich food
Ephedrine or pseudoephedrine
Levodopa
Stimulants e.g. methylphenidate and amphetamine

231
Q

What predisposes patients to seratonin syndrome with MAOIs?

A

Tramadol
Other antidepressants

232
Q

What predisposes patients to CNS excitation or depression with MAOIs?

A

Tramadol
Pholcodine
Opioids

Avoid the above during MAOI treatment and for 14 days after stopping the MAOI

233
Q

What are the side effects of methylphenidate?

A

Decreased appetite
Growth retardation
CV abnormalities
Psychiatric symptoms
Hypertension
Arrhythmia

In children - monitor weight and height every 6 months

234
Q

Which benzodiazepines are short-acting?

A

<1-12 hours

Midazolam
Oxazepam
Triazolam

235
Q

Which benzodiazepines are intermediate acting?

A

12-24 hours

Flunitrazepam
Lorazepam
Alprazolam
Clonazepam
Temazepam

236
Q

Which benzodiazepines are long-acting?

A

> 24 hours

Flurazepam
Nitrazepam
Chlordiazepoxide
Diazepam

237
Q

What are the anti-cholinergic side effects?

A

Dry mouth
Blurred vision
Urinary retention
Constipation

238
Q

What is used for extrapyrimadole side effects?

A

Procyclidine

239
Q

What are the ADRs of atypical antipsychotics?

A

Weight gain
Dyslipidaemia
Diabetes
Drowsiness
Reduced seizure threshold
Anticholinergic side effects
Hyperprolactinaemia
- ED
- Galactorrhoea
- Gynaecomastia
CV effects
- Postural hypotension
- QT prolongation

240
Q

What are the ADRs of clozapine?

A

Agranulocytosis
Neutropenia
Hypersalivation
Constipation
Cardiomyopathy
Myocarditis
Intestinal obstruction

241
Q

What are the SSRI interactions?

A

NSAIDs - risk of bleeding (PPI if given together)
Warfarin/Heparin/NOAC - risk of bleeding
Aspirin - risk of bleeding
Triptans - risk of sertonin syndrome
MAOIs - risk of sertonin syndrome
Drugs that prolonged QT with citalopram e.g. antipsychotics

242
Q

What is antidote for benzodiazepines?

A

Flumazenil

243
Q

What is antidote for antidepressants?

A

Activated charcoal
IV loarzepam od diazepam
Sodium bicarbonate

244
Q

What is antidote for lithium?

A

Haemodialysis
Gastric lavage

245
Q

What is antidote for stimulant drugs?

A

Diazepam or lorazepam

246
Q

What is antidote for iron?

A

Desfferioxamine

247
Q

For which drugs do you need to screen test for HLA-B*1502 allele in Han-chinese and thai patients before treatment?

A

Carbamazepines
Phenytoin

Higher risk of stevens-johnson syndrome

248
Q

What are the interactions of lithium?

A

Diuretics especially thiazides - increases lithium concentration
ACEi/ARBs - increases lithium concentration
NSAIDs - increases lithium concentration
Metronidazole - increases lithium concentration

Iodine salts - risk of hypothyroidism

Carbamazepine - risk of neurotoxicity

Antipsychotics - QT prolongation

249
Q

Which anti-epileptic can be prescribed by a dentist?

A

Carbamazepine for forms of neuralgia

250
Q

What are the side effects of carbamazepine?

A

GI upset - N/V
Neurological effects - ataxia and dizziness
Oedema
Hyponatraemia

251
Q

Which parkinsons medication turns urine colour reddish-brown?

A

Entacapone

252
Q

Which antiepileptics are enzyme inducers?

A

Carbamazepine
Phenobarbital
Eslicarbazepine
Oxcarbazepine
Phenytoin
Primidone

253
Q

What is the contraindication of tramadol?

A

Uncontrolled epilsepsy

254
Q

Which anti-epileptic drugs does not reduce the effectiveness of oral contraception?

A

Lamotrigine

255
Q

What is the maximum dose of citalopram in patients ages 65+?

A

20mg

256
Q

Which OTC product reduces lithium concentrations?

A

Antacids containing sodium bicarbonate increase lithium excretion

257
Q

What records are kept in the lithium therapy record book?

A

Lithium blood results
TFTs
Renal checks
Weight/ BMI

258
Q

What is the maximum total duration of therapy when using clomethiazole for alcohol withdrawal?

A

9 days

259
Q

Which antiemetic is considered safe in parkinsons diease?

A

Domperidone - doesn’t cross BBB

2nd line - ondansetron but causes constipation

260
Q

Which antiemetics worsen parkinsons disease?

A

Metoclopramide
Haloperidol
Prochlorperazine

261
Q

Which test should be done monthly before supple of clozapine

A

White blood cells - due to risk of fatal agranulocytosis

262
Q

What is donepezil associated with?

A

Neuroleptic malignant syndrome

263
Q

What is galantamine associated with?

A

Serious skin reactions - stop at first sign of rash (stevens-johnson syndrome)

264
Q

What is rivastigmine associated with?

A

GI problems - withhold

265
Q

What are cholinergic side effects?

A

DUMB BELS

Diarrhoea
Urination
Muscle weakness/ miosis (small pupils)
Bronchospasm

Bradycardia
Emesis (vomiting)
Lacrimation (tears)
Salivation

(opposite of antimuscarinic effects)

266
Q

Which antiepileptic drugs are in high amounts in breastmilk?

A

ZELP

Zosinamide
Ethosuximide
Lamotrigine
Primidone

267
Q

What is the treatment for menstruation epilepsy?

A

Acetazolamide

268
Q

What is the only benzodiazepine that can be prescribed for alcohol withdrawal?

A

Chlordiazepoxide hydrochloride

269
Q

What is the interaction between phenytoin and ciprofloxacin?

A

Can increase or decrease the concentration of phenytoin

270
Q

What if the interaction between phenytoin and St Johns Worts?

A

Decrease in phenytoin serum concentration

271
Q

Which triptan drug requires dose adjustments when given with propranolol?

A

Rizatriptan

272
Q

What is a common SSRI electrolyte imbalance?

A

Hyponatraemia
- n/v
- confusion
- headache

273
Q

When is a lithium level taken?

A

12 hours after dose otherwise levels may be too high but not accurate

274
Q

What needs to be monitored for clozepine?

A

Neutropenia

275
Q

is the maintenance dose of donepezil?

A

10mg ON

276
Q

Which acetylcholinesterase causes sleep probelms?

A

Donepezil - try changing dose to the morning time

277
Q

What do you do if the patient is experiencing bradycardia with donepezil?

A

Stop donepezil and start memantine - giving them another acetylcholinesterase is not helpful because they have the similar side effects

278
Q

What is the therapeutic range for phenytoin?

A

10-20mg/L

279
Q

What increases the risk of phenytoin toxicity?

A

Hypoalbuminaemia
Hepatic impairment
Hyperbilirubinaemia

280
Q

What are the signs of phenytoin toxicity?

A
  • nystagmus (involuntary movement of the eyes)
  • diplopia/blurred vision
  • slurred speech
  • ataxia
  • confusion
  • hyperglycaemia
281
Q

Which antidepressant used for chronic pain has an anticholinergic burden?

A

Amitriptyline (TCAs)

282
Q

What are the side effects of phenytoin?

A
  • Agranulocytosis
  • Skin rashes, toxic epidermal necrolysis
  • Suicidal thoughts
  • Low vitamin D- rickets, osteomalacia
283
Q

Which drug causes a sudden onset of sleep?

A

Levodopa

284
Q

How much time should be left in between different levodopa preperations?

A

At least 12 hours

285
Q

Which drug requires regular monitoring of neutrophils and leucocytes?

A

Clozapine

286
Q

Which drug is licensed for treating Meniere’s disease?

A

prochlorperazine

286
Q

What is a licensed treatment for behavioural and psychological symptoms of Alzeihmers disease?

A

Risperidone

287
Q

Which antidepressant is associated with weight gain?

A

Mirtazapine

288
Q

Which anti-emetic is associated with muscle-rigidity, movement disorders, tremor and parkinsonism?

A

Droperidol

289
Q

What factors slow down metabolism of antipsychotics?

A

Females
Geriatric age
Non-smokig status

290
Q

How long should remission period last for antidepressants?

A

6 months

12 months - in elderly and those being treated for generalised anxiety

2 years in patients with recurrent remission

291
Q

Which TCA has more marked anti-muscarinic effects?

A

Imipramine

292
Q

What is the counselling for antipsychotics?

A

Photosensitisation may occur with higher doses - avoid direct sunlight

293
Q

Which drugs can aid smoking cessation and be used alongside behavioural support?

A

Varenicline and bupropion

294
Q

Which Parkinson’s Medication is more likely to cause impulse reactions?

A

Non-ergot derived! More than levodopa
E.g. pramipexole, ropinirole, rotigotine

295
Q

Which CNS drugs tend to cause hyponatraemia?

A

SSRIs
Carbamazepine
(diuretics and desmopressin too)

296
Q

What side effects do non-ergot derived drugs cause?

A

Pramipexole, ropinirole, rotigotine
- impulse disorders
- sudden onset of bleed
- hypotensio

297
Q

What is usually prescribed for wernicke’s encephalopathy?

A

thiamine (b1)

298
Q

What are paradoxical side effects of benzodiazepines and how is it treated?

A

SE: increase talkativeness, emotional release, excitement, excessive movement, hostility and aggression

It is essentially benzodiazepine toxicity = treat with flumazenil

299
Q

How often is clozapine monitored?

A

weekly for first 18 weeks
fortnightly from 18 weeks - 52 weeks
Then monthly

Blood lipids and weight - baseline then every 3 months

Fasting blood glucose - at baseline, after 1 month then every 4-6 months

300
Q

What is the age restriction for domperidone?

A

12+

301
Q

What is offered for advanced parkinsons disease with ‘off episodes’?

A

apomorphine hydrochloride as intermittent injections or continuous subcutaneous infusions

  • if pt experiences nausea and vomiting with this = domperidone started 2 days before apomorphine
    –> assess cardiac risk factor first due serious arrhythmia from to prolonged QT
302
Q

What are some important methadone interactions?

A

Citalopram, amiodarone, aripiprazole, tetracyclines - QT prolongation

Clarithromycin increases methadone exposure

Bendroflumethiazide, budesonide, betamethasone - hypokalaemia

303
Q

Which drugs are likely to cause seratonin syndrome?

A

SSRI
TCA
Triptans
Tramadol
Lithium

304
Q

Which benzodiazepines have a driving limit?

A

COLD FeeT

Clonazepam
Oxazepam
Lorazepam
Diazepam
Flunitrazepam
Temazepam

305
Q

What colour can amitriptyline colour urine?

A

Greenish-blue

305
Q

What are the signs of carbamazepine toxicity?

A

HANGBAGS

Hyponatraemia
Ataxia
Nystagmus
Drowsiness
Blurred vision
Arrhythmia
GI disturbances

306
Q

Which 1st generation antipsychotics have the least extrapyramidal side effects?

A

Group 2 phenothiazines:
pericyazine

307
Q

Which 1st generation antipsychotics have the highest risk of extrapyramimdal side effects?

A

Group 3 phenothiazines:
fluphenazine, prochlorperazine and trifluoperazine

Also:
Benperidol and haloperidol

308
Q

What antidepressants does tamoxifen interact with?

A

Fluoxetine and paroxetine - they decrease efficacy of tamoxifen

309
Q

Which drug reduces your visual field?

A

Vigabatrin

310
Q

Which benzodiazepine is not associated with blood dyscrasias?

A

Clonazepam

Pre Reg (14 decks)

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