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Pre-reg revision > Nervous system > Flashcards

Nervous system Flashcards

1
Q

What is a side effect associated with ALL epilepsy drugs?

A

Increased risk of suicidal thoughts and behaviours

Patients should seek medical advice if they develop mood changes/distressing thoughts etc

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2
Q

How long must established epileptic patients be seizure-free for before they can drive?

A

1 year

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3
Q

When are epilepsy sufferers banned from driving?

A
  • During medication changes
  • 6 months after last dose if stopping medication
  • 6 months if single isolate seizure/first unprovoked seizure
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4
Q

If an epileptic patient has a seizure due to withdrawal of treatment, how long are they banned from driving for?

A

1 year

Relicensing may be considered earlier if treatment is reinstated and no seizures for 6 months

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5
Q

For which type of seziure is sodium valproate NOT a recommended first line treatment?

A

Focal seizures

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6
Q

First line treatment for focal seizures?

A

Carbamazepine or lamotrigine

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7
Q

First line treatment for tonic-clonic seizures?

A

Sodium valproate/carbamazepine

- lamotigine if SV not appropriate

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8
Q

First line treatment for absence seizures?

A

Sodium valproate / ethosuximide

- alternative = lamotrigine

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9
Q

First line treatment for myoclonic seizures?

A

Sodium valproate

alternative - topiramate or levetiracetam

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10
Q

In which type of generalised seizure is lamotrigine not recommended as an alternative first line therapy to sodium valproate in pre-menopausal women?

A

Myclonic seizures

recommended alternatives are topiramate or levetiracetam

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11
Q

Which are category 1 anti-epileptics that should always be maintained on the same product/brand?

A

Phenytoin, carbamazepine, phenobarbital, primidone

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12
Q

Which anti-epileptic has the HIGHEST risk of teratogenicity?

A

Sodium valproate

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13
Q

Which anti-epileptic has a risk of causing cleft palate if it is used in the first trimester?

A

Topiramate

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14
Q

What supplements should pregnant women on anti-epileptics take to reduce the risk of neural tube defects?

A

Folic acid 5mg until week 12

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15
Q

What treatment should be given to neonates at birth if their mothers have been taking anti-epileptics in pregnancy?

A

Vitamin K to reduce risk of neonatal haemorrhage

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16
Q

How should anti-epileptics be withdrawn?

A
  • Gradually

- withdraw one anti-epileptic at a time

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17
Q

‘In the treatment of epilepsy monotherapy should be prescribed wherever possible, particularly in pregnancy or breastfeeding’
True or false?

A

TRUE

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18
Q

Can women taking anti-epileptics breast feed?

A

Yes if on monotherapy.

Monitor infants for sedation, feeding difficulties, weight gain and developmental milestones

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19
Q

Which anti-epileptics might affect foetal growth?

A

Topiramate and levetiracetam

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20
Q

Which anti-epileptics are associated with blood dyscrasias and require patients to report any bruising, bleeding or signs of infection?

A 
Carbamazepine
Valproate
Ethosuximide
Topiramate
Phenytoin
Lamotrigine
Zonisamide

C Vet Plz

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21
Q

Which anti-epileptic is an enzyme inducer that may reduce efficacy of hormonal contraception?

A

Carbamazepine

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22
Q

What is the maximum dose of Gabapentin when used to treat neuropathic pain?

A

3.6g /day

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23
Q

Which anti-epileptic is also effective in migraine prophylaxis?

A

Gabapentin (this is an unlicensed use)

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24
Q

Which anti-epileptic is associated with the risk of serious skin reactions including Steven-Johnson syndrome?

A

Lamotrigine
Most rashes occur within first 8 weeks
Higher risk if high initial dose, rapid dose increase or used with valproate

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25
Q

Which anti-epileptic can be associated with severe respiratory depression even without opioids?

A

Gabapentin

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26
Q

Which anti-epileptics are enzyme inducers?

A

Carbamazepine, phenytoin + phenobarbital

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27
Q

What is the therapeutic range of phenytoin?

A

10-20 mg/L or 40-80 micromol/L

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28
Q

When should plasma levels of phenytoin be taken?

A

After 10 days (trough level - pre dose)

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29
Q

What are the signs of phenytoin toxicity?

A

Nystagmus (uncontrolled/involuntary eye movements), slurred speech, ataxia, confusion, hyperglycaemia

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30
Q

What is the risk if phenytoin is administered too quickly?

A

Risk of bradycardia and hypotension - C/I in heart block

Max infusion rate 50mg/min

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31
Q

Which anti-epileptic is also licensed for generalised anxiety disorder?

A

Pregabalin

32
Q

What is the maximum dose of Pregabalin when used to treat neuropathic pain?

A

600mg / day

33
Q

100mg phenytoin sodium is equivalent to how much phenytoin base?

A

92mg

34
Q

Which anti-epileptic is an enzyme inhibitor?

A

Sodium valproate

35
Q

What is the therapeutic range for carbamazepine?

A

4-12 mg/L

36
Q

What are the signs of carbamazepine toxicity?

A

Vomiting, arrythmias, visual disturbances, incoordination, hyponatraemia, ataxia

37
Q

What are the signs of anti-epileptic hypersensitivity syndrome?

A

Fever, rash, lympadenopathy - potentially fatal

38
Q

What is a potential visual side effect of topiramate?

A

Acute myopia (short-sightedness) with secondary angle glaucoma

  • usually occurs after a month of treatment
  • seek specialist advice and discontinue as fast as possible if raised intra-ocular pressure
39
Q

What is a potential visual side effect of vigabatrin?

A

Visual field defects

  • can persist despite discontinuation
  • new visual symptoms should be referred
40
Q

Which anti-epileptic is associated with encephalopathic symptoms?

A

Vigabatrin

signs include sedation/stupor/confusion

41
Q

MHRA advice with sodium valproate?

A

Contra-indicated in women and girls off child bearing potential unless conditions of the pregnancy prevention programme are met and only if other treatments are ineffective/not tolerated

42
Q

What is the risk of teratogenicity with valproate?

A 
Neurodevelopmental disorders (30-40%)
Congenital malformations (11%)
43
Q

Other than epilepsy, what is valproate licensed for?

A

Migraine prophylaxis and bipolar disorder

44
Q

What should pharmacists dispensing valproate do?

A
  • Provide a patient card every time it is dispensed
  • Remind patients of the risks in pregnancy and the need for annual specialist review
  • Dispense in whole packs where available, always give PIL and warning sticker on box
45
Q

What would you advise a woman taking valproate who had an unplanned pregnancy?

A

See their prescriber urgently and not stop treatment in the mean time

46
Q

Is sodium valproate a black triangle drug?

A

Yes

47
Q

What are some serious side effects of valproate?

A
  • liver toxicity
  • pancreatitis
  • blood dyscrasias
48
Q

What are the non-cognitive symptoms of dementia?

A
  • psychiatric/behavioural problems (aggression)

- difficulties with daily activities

49
Q

What are the cognitive symptoms of dementia?

A
  • memory loss
  • difficulty thinking
  • problems with language
  • problems with orientation
50
Q

Which 3 acetylcholinesterase inhibitors are used to treat mild to moderate dementia due to Alzheimers disease?

A
  • Donepezil
  • Rivastigmine
  • Galantamine
51
Q

What are the side effects of rivastigmine?

A
  • Hallucinations / sleep disorders

- GI disturbance (less likely with patch)

52
Q

Which acetylcholinesterase inhibitor has a risk of neuroleptic malignancy syndrome?

A

Donepezil

53
Q

Which drug is used to treat severe cognitive symptoms in dementia due to Alzheimers disease?

A

Memantine

Can also be used if acetlcholinesterases are C/I

54
Q

‘Memantine is cautioned in epilepsy’

True or false?

A

True - can cause seizures

55
Q

What are cholinergic side effects?

A 
Diarrhoea
Urination
Muscle weakness/cramps
Bronchospasm
Emesis
Lacrimation (teary eyes)
Sweating
56
Q

Which type of drugs are likely to cause cholinergic side effects?

A

Acetylcholinesterase inhibitors
Donepezil, rivastigmine, galantamine
- usually dose related, start low and titrate slow

57
Q

How should convulsive seizures lasting >5 mins be treated in the community? (medical emergency)

A

EITHER Diazepam rectal solution

OR midazolam oromucosal solution

58
Q

Which antidepressants cause mydriasis?

A

Tricyclic antidepressants eg, amitripyline

Mydriasis = dilation of the pupils

59
Q

What schedule are most BZDs?

A

CD 4 part 1

60
Q

Which BZDs are short acting?

A

Lorazepam + oxazepam

61
Q

‘BZDs can cause a paradoxical increase in hostility and aggression’
True or false?

A

True - can be associated with behaviours such as talkativeness + excitement or aggression + antisocial behaviour

62
Q

Signs of benzodiazepine overdose?

A

Ataxia, drowsiness, nystagmus, dysarthria, coma, respiratory depression

63
Q

Why should BZDs be used with caution in renal impairment?

A

Chance of increased cerebral sensitivty to BZDs

64
Q

How should BZDs be withdrawn?

A
  1. Gradually convert to an equivalent diazepam dose ON
  2. Reduce diazepam by 1-2mg/week
  3. Reduce in smaller steps at the end of withdrawal
65
Q

What is the therapeutic index of lithium?

A

0.4-1 mmol/L
The lower end is suitable for prophylaxis/elderly
The higher end is used for acute manic episodes

66
Q

How should lithium levels be taken?

A

Take 12 hours after dose

Should be taken 1 week after initiation, after any dose changes and every 3 months for maintenance

67
Q

What are the signs of lithium toxicity?

A

N - Nervous system disturbance (confusion, drowsiness, incoordination, restlessness)
E - Extrapyrimidal symptoms (tremor, nystagmus, muscle weakness)
R - Renal disturbance (polyuria. incontinence, hypernatraemia)
V - Visual disturbance (blurred vision)
G - GI effects (diarrhoea and vomiting)

68
Q

Can lithium be used in pregnancy?

A

No, risk of teratogenicity including cardiac abnormalities in the first trimester

69
Q

What monitoring is required for patients on lithium?

A
  • Bodyweight/BMI (can increase weight)
  • eGFR (risk of renal impairment)
  • Electorlytes (hyponatraemia can increase levels)
  • FBC
  • TFTs (risk of impaired thyroid func)
70
Q

What adverse effects are associated with long term lithium use?

A

Thyroid disorders and mild cognitive and memory impairment

71
Q

Contraindication for lithium?

A

Dehydration/low sodium diet - can increase lithium levels

72
Q

Can lithium be given to epileptics?

A

Cautioned - can lower seizure threshold

73
Q

Which drugs interact with lithium?

A

ACEi - reduce Li excretion
NSAIDs - reduce Li exretion
Diuretics - can cause hyponatraemia
Amiodarone - risk of arrythmias

74
Q

Which SSRI is safe to use following MI/ in angina?

A

Sertraline

75
Q

Why does St Johns Wort have many drug interactions?

A

It is an enzyme inducer

If patient stops taking this then the conc. of drugs can increase causing toxicity

Pre-reg revision (14 decks)

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