NERVOUS SYSTEM -DEMENTIA

Question 1

What is alzheimer’s disease?

Answer 1

Dementia is brain damage by diseases such as Alzheimer’s of Parkinson’s

Question 2

What is 1st line drug treatment class for mild to moderate alzheimer’s?

Answer 2

Acetylcholinesterase inhibitor
donepezil hydrochloride, galantamine, or rivastigmine

Question 3

What are 3 examples of Acetylcholinesterase inhibitor?

Answer 3

Donepezil, rivastigmine and galantamine

Question 4

What drug is given for patients with mild to moderate dementia with Parkinsons?

Answer 4

Rivastigmine

Question 5

What is an alternative to Acetylcholinesterase inhibitor?

Answer 5

Memantine

Used if disease more severe- by primary care

Question 6

What is drug treatment used in SEVERE dementia?

Answer 6

Memantine

Question 7

What drug class is memantine?

Answer 7

NMDA receptor antagonist

Question 8

What are 4 symptoms of dementia?

Answer 8

Memory loss

Difficulty thinking

Language issue

Orientation

Question 9

What are some non-cognitive symptoms of dementia?

Answer 9

Psychiatric + behaviour issues

Question 10

What is an MHRA warning regarding Anti-psychotics in elderly patients with dementia?

Answer 10

Higher risk of stroke + death in elderly

Question 11

What is MOA of Acetylcholinesterase inhibitor?

Answer 11

Blocks Acetylcholinesterase enzyme
- prevents breakdown of acetylcholine

Question 12

What is a RARE SE of donepezil?

Answer 12

neuroleptic malignant syndrome

Question 13

What is a rare SE of galantamine?

Answer 13

serious skin reactions (SJS)

Question 14

What is a rare SE of rivastigmine?

Answer 14

GI issues

Question 15

What formulation of Rivastigmine is there reduced GI effects?

Answer 15

Transdermal

Question 16

When should patients be counselled to stop ACHe inhibitors?

Answer 16

STOP if they see first sign of rash

Question 17

What to do if patients gets GI issues on rivastigmine?

Answer 17

WITHHOLD oral + switch to patch

Question 18

What are 8 SE of cholinergic drugs/ AChE inhibitors? (DUMBBELS)

Answer 18

Diarrhoea

Urination

Muscle weakness, miosis (small pupils)

Bronchospasm

Bradycardia (slow HR)

Emesis (vomit)

Lacrimation (tears)

Salivation

Question 19

What is non drug treatment for mild-moderate dementia?

Answer 19

structured group cognitive stimulation programme

Therapy

Question 20

Drugs with anti-muscarinic effects do what?

Answer 20

cause cognitive impairment

Question 21

What 2 type of dementias are AcHe inhibitors + Memantine NOT recommended in?

Answer 21

frontotemporal dementia

OR

cognitive impairment caused by multiple sclerosis.

Question 22

What is epilepsy?

Answer 22

Seizure caused by hyperexcitable cortical neurones firing rapid Action potentials

Question 23

What are the 3 types of epilepsy?

Answer 23

1. Focal
2. Generalised
3. Absense

Question 24

What is 1st line tx for focal seizures? (2 drugs can be used)

Answer 24

Lamotrigine

OR

Levetiracetam

Question 25

Why are Lamotrigine OR Levetiracetam better in females

Answer 25

less risk of fetal harm

Question 26

What 3 parts is generalised seizures split into?

Answer 26

1. Tonic- clonic 2. Myoclonic 3. Atonic, tonic

Question 27

What is 1st line tx for generalised seizures?

Answer 27

Sodium valproate - males OR females unable to have kids

Question 28

What is 1st line tx for generalised seizures in women?

Answer 28

Lamotrigine or Levetiracetam

Question 29

What is 1st line tx for absence seizures? (2 options)

Answer 29

Ethosuximide Sodium valproate

Question 30

What is a recent MHRA warning regarding epilepsy medications?

Answer 30

Harm when switching between different products.

Question 31

When cannot you use anti-psychotics?

Answer 31

Not used in parkinsons, can be used in dementia

Question 32

1st line mild-mod or severe dementia with Lewy bodies?

Answer 32

donepezil or rivastigmine Galantamine ONLY if above do not work