Nervous System - Chap 4 Flashcards
Which of the acetylcholinesterases used for dementia is also licensed for mild/moderate dementia associated with Parkinsons?
Rivastigmine
This has TWICE daily dosing!
When should donepezil be given?
Once daily (unlike the other acetylcholinesterases that are BD) Give at bedtime Usual dose 5-10mg
What conditions are cholinergic drugs (acetylcholinerase inhibitors used in dementia) cautioned in?
Asthma
Epilepsy/ history of seizures
Those with a slow pulse
History of gastric ulcers
What are the common side effects of the Acetylcholinersterase inhibitors used in dementia?
Diarrhoea and vomiting Dizziness Headache Hallucinations Anorexia (weight loss)
Name the 4 drugs used in dementia?
Donepezil
Galantamine
Rivastigmine
(above 3 are Acetylcholinesterase inhibitors)
Memantine (a NMDA receptor antagonist)
Which acetylcholinesterase inhibitor comes as a patch?
Rivastigmine
24 hour patch
Short acting benzodiazepines?
Midazolam
Used for epileptic seizures and febrile convulsions due to its fast onset to action
Triazolam
Intermediate acting benzo’s?
Clonazepam
Lorazepam
Oxazepam
Temazepam
Remember CLOT
(Hence why some of these are used for agitation in our patients: not too longer acting to make them too drowsy but act for long enough)
Long acting benzo’s?
Chlordiazepoxide
Diazepam
Alprazolam
Used as sedatives (diazepam for insomnia associated with anxiety) and used or ANXIETY
What is Buspirone?
A serotonin receptor agonist used for anxiety
Name some medication used in ADHD?
CNS Stimulants:
Dexamfetamine
Lisdexamfetamine (prodrug of dexamfetamine, Elvanse, Elvanse Adult)
Atomoxetine (POM)
Methylphenidate (Ritalin, Concerta, Medikinet, Equasym)
What are the common side effects of CNS stimulants used in ADHD? Remember a patient described it as being on ‘speed’
Sleep disturbance; take in morning or will keep patient awake! Irritability, aggression Diarrhoea, vomiting Nervousness Tachycardia (with methylphenidate) Headache
When should antidepressants be avoided in bipolar?
Rapid cycling bipolar
recent history of hypomania (mild form of mania, marked by elation and hyperactivity)
rapid mood fluctuations
This is because the antidepressant will increase manic symptoms so if their bipolar is more manic based then avoid!
What mood stabilisers do we see used in Bipolar disorder?
Carbamazepine
Valproate
Lithium
When should lithium be taken?
At night- blood test needs to be 12 hours post-dose and blood test usually in the morning
Lithium toxicity is made worse by sodium depletion, therefore what drugs should be avoided?
Concurrent use of diuretics, particularly thiazides.
Signs of lithium toxicity?
Vomiting and diarrhoea Coarse tremor (progressed from fine tremor) Visual disturbance, blurred vision Muscle weakness Confusion Restlessness HYPERNATREAMIA
Can lithium be used in pregnancy?
Avoid if possible, especially in first trimester
If used in 2nd and 3rd trimester- dose may need to be increased but put back down to normal once child born.
What are the two different Lithium salts?
Lithium Carbonate
Lithium Citrate
Brands of carbonate: Camcolit, priadel tablets
Brand of citrate: priadel liquid (citrate only comes as a liquid)
Why is it important to stick to the same brand of lithium?
Different preparations have different bioavailability
Changing the preparation would require the same precautions and monitoring as initiation of treatment!
Dexamfetamine and lisdexamfetamine are cautioned in those with Tics and Tourrettes
May also cause growth restriction in children
Patients and carers should be advised to monitor for suicidal ideation when taking this ADHD drug
Atomoxetine is a POM drug used for ADHD
This is also the case for Agomelatine, a drug with a similar name, a melatonin receptor agonist used for depression, can cause suicidal behaviour
Which antipsychotic drug should be handled with care?
Chlorpromazine
Causes contact sensitisation (irritates skin)
Hyponatreamia has been linked to all antidepressants, but is more likely with which class?
SSRIs
Suicidal behaviour, especially during the first 2 weeks, has been linked to antidepressant use
Serotonin syndrome also a risk, particularly with MAOIs
MAOIs can interact with a lot of drugs and this is a particular problem as they can still interact even when discontinued
Interactions can occur for up to 2 weeks after discontinuation due to long half life.
Which antidepressant can be hepatotoxic?
Agomelatine
LFTs need to be monitored regularly throughout
