Nervous System Flashcards
What are the 4 most common types of dementia and how do they differ in symptoms?
Alzheimers; memory, repeated questions
Parkinsons
Lewy body; more sleep disturbance and repeated falls/faints
Vascular: CVD and movement problems
What (with what symptoms) calls for pharmacological treatment in dementia?
Cognitive symptoms (memory, concentration, problem solving), severe disease.
Non cognitive only when severely distressed or a danger
What is the drug of choice in mild to moderate dementia due to alzheimer’s with cognitive symptoms?
Anticholinesterase inhibitor
What is the drug of choice in Parkinsons dementia and what is the issue with this treatment?
Rivastigmine. May worsen tremor.
What is the drug of choice in alzheimer’s with severe non cognitive symptoms?
Antipsychotic or benzodiazapines
What is the drug of choice in severe alzheimer’s wihh cognitive symptoms?
Memantine
What is the issue with antipsychotic use in dementia patients
Increased risk of stroke and death in elderly dementia. Balance risk factors.
In what conditions would acetylcholinesterase inhibitors be cautioned or avoided?
Caution in asthma and COPD as may exacerbate, peptic ulcers, use with NSAIDs/steroids/rate limiting drugs. Avoid in heart block and sick sinus syndrome
When should the efficacy of treatment be assessed in dementia?
At 3 months.
What are the most common side effects of acetylcholinesterase inhibitors?
Nausea, vomiting and diarrhoea
What dose considerations should be given for anti epileptic in children?
Interval may need to be reduced as metabolised quicker
What are the category 1 anti epileptics for maintaining brand?
Phenytoin, carbemazepine, phenobarbital and primidone
Which antiepileptics have the highest risk of antiepileptic hypersensitivity syndrome?
Carbemazepine, lacosamide, lamotrigine, oxcarbazepine, phenobarbital, phenytoin, primidone, and rufinamide
What are the main symptoms of antiepileptic hypersensitivity syndrome?
Fever rash lymphadenopathy
Upon withdrawal of an antiepileptic, how long before someone can normally drive?
6 months after last dose
Besides valproate, what other antiepileptic drugs have risk of teratogenicity?
Phenytoin, primidone, phenobarbital, lamotrigine, carbemazepine, topiramate
Which antiepileptics may need their doses changing during pregnancy?
Phenytoin, carbemazepine, lamotrigine
Which antiepileptics should be cautioned for use during breastfeeding and why
Primidone, phenobarbital, benzodiazepines. Established risk of drowsiness
Besides hypersensitivity, what other symptoms should patients look out for with carbemazepine?
Bruising, bleeding, mouth ulcers (blood disorders)
Reduced appetite, abdominal pain (liver toxicity)
Which antiepileptics are best tolerated?
Levetiracetam, Pregablin and gabapentin
Which antiepileptic is used in children but can cause serious rashes?
Lamotrigine
What should be monitored during dos phenytoin infusion?
Heart rate, blood pressure and respiratory function
What is the normal plasma concentration for phenytoin and when might it change?
10-20mg/L. Protein binding my be reduced in pregnancy, elderly, diseased and in first 3 months of life
At what age do symotoms normally appear for ADHD?
3 - 7
What is the first line drug treatment for ADHD and how long is it trialed for before trying others?
Methylphenidate for at least 6 weeks. Or atomoxetine if risk of abuse.
What effects should patients look out for with treatment for atomoxetine?
Agitation, suicidal thoughts, potential for liver damage (unexplained nausea, malaise, darkened urine, jaundice)
What should be recorded 6 monthly during ADHD treatment?
Pulse, BP, psychiatric symptoms, appetite, weight and height
How long should treatment persist for mania?
At least 2 years from last manic episode or 5 years if risk of relapse
What adjunctive drugs may be given in mania and when should they be avoided
Antidepressants - avoid with rapid fluctuation or hypomania
Benzodiazepine but only short term
What drug therapy is recommended in acute hypomania and mania?
Atypical antipsychotic. Add lithium or valproate if uncontrolled
What drug is useful in rapid cycling mania?
Carbemazepine
What is the target lithium levels?
0.4-1mmol/l
0.8-1 if manic episode
Samples should be taken 12h after dose.
What should be monitored in lithium patients and how often?
Body weight, electrolytes, EGFR, thyroid function. 6 monthly.
What are the symptoms of liver toxicity and what else should patients look out for with lithium treatment?
Vomiting, diarrhoea, muscle weakness, confusion, drowsiness, hypernatreamia.
Hypothyroidism, headache, visual disturbance
Patients with non cognitive symptoms in dementia should be prescribed antipsychotic drugs. True or false
Only if Severe due to increased risk of stroke and death
What side effects can anticholinesterases have?
Blurred vision, urinary incontinence
Which antiepileptics can be given once daily?
Lamotrigine, parampenel, phenobarbital and phenytoin
What monitoring should occur with fosphenytoin?
HR, BP, respiratory function during infusion and observe at least 3o minutes after
Vitamin D supplements should be considered with which antiepileptics?
Phenytoin, phenobarbital, sodium valproate, primidone
What are the symptoms of phenytoin toxicity?
Nystagmus, diplopia, slurred speech, ataxia, confusion, hyperglycemia
What symptoms to look our for and monitoring should be done with valproate?
Raised liver enzymes
Abdominal pain, anorexia, jaundice, oedema, malaise, drowsiness
Pancreatitis
Pregnancy prevention programme
How long should valproate be reduced over?
4 weeks
What issues have topiramate been associated with?
Acute myopia with secondary angle closure glaucoma within 1 month of starting. Raised intra ocular pressure
Congeniral abnormalities
What issues has vigabatrin been associated with?
Visual field defects from 1 month to several years after starting. Test 6 monthly and report visual disturbance
Whta should infants be monitored for during breastfeeding in benzodiazepine use?
Sedation, feeding difficulties adequate weight gain and development milestones
For what medicines is the risk of impaired skilled tasks period extended and for how long?
24 hours with short general anaesthetics and IV benzodiazepines
What benzodiazepines are safer in hepatic impairment?
Those with shorter half lives. Temazepam, oxazepam
Can taking benzodiazepines effect your behaviour?
Yes paradoxical effects in hostility and aggression may be reported. Talkative Ness and excitement to aggression and antisocial behaviour. Anxiety. Perceptual disorder.
An overweight patient is prescribed a benzodiazepine, which may be effected by his weight?
Midazolam accumulates in adipose tissue
Are benzodiazepines safe in pregnancy?
Risk of neonatal withdrawal symptoms. Avoid regular use and only when clear indication. High doses in late pregnancy may cause neonatal hypothermia, hypotonia and respiratory depression
What should be monitored for with lis/dexamfetamine?
Growth in children. Discontinue if tics occur. (just dex)
Pulse, BP, appetite, weight and height every 6 months. Aggressive behaviour and hostility in initial treatment in both
Can amfetamines be mixed with food?
Lis dexamfetamine can be mixed with soft food or in water/orange juice.
What should be monitored with guanfacine?
Baseline evaluation of somnolence, sedation hypotension bradycardia, qt prolongation and arrhythmia. Monitor for side effects and bmi (3m in first year then 6m)
How should antipsychotics be discontinued?
Over at least 4 weeks if continuing with other antimanic drugs or up to 3 months if not
How long does the prophylactic effect of lithium take to occur?
6-12 months
What signs should be monitored in valproate treatment?
Raised liver enzymes and prothrombin time may be transient but could be linked to liver dysfunction