Neuro

Question 1

What should be used for tonic-clinic status epilepticus?

Answer 1

Buccal midazolam 1st line in community
Rectal diazepam 2nd line
IV lorazepam if IV access already established

Question 2

In what circumstances should an ambulance be called during a seizure?

Answer 2

Status epilepticus
If it is their 1st seizure
If there is high risk of reoccurrence e.g hx of repeated seizures or status epilepticus
There are difficulties monitoring the patients condition

Question 3

What are the common adverse reactions Dexter for antiepiletics (non-specific)

Answer 3

Sedation and dizziness
Suicidal thoughts or behaviour
Acute psychotic reactions
Weight loss or gain
Skin rashes (Steven-Johnson syndrome, toxic antiepileptic hypersensitivity syndrome) - phenytoin, lamotrigine, carbamazepine
Impaired bone health
Minor blood dyscrasias
Elevation of liver enzymes

Question 4

What is 1st line for generalised tonic-clinic seizures? What if they are female and of child-baring age?

Answer 4

1st line: Sodium valproate (if unsuccessful offer as below

1st line if female and of child-baring age: lamotrigine or levetiracetam

Question 5

What are the add on treatment options for generalised tonic clinic seizures?

Answer 5

Clobazam
Lamotrigine
Levetiracetam
Perampanel
Sodium valproate
Toparimate

Question 6

What is 1st line for focal seizures? What are the alternatives?

Answer 6

Lamotrigine or levetiracetam

Alternatives: carbamazepine, oxcarbazepine, zonisamide

Question 7

What is 1st line for absence seizures?

Answer 7

Ethosuxamide

2nd line: sodium valproate, lamotrigine or levetiracetam

Question 8

Which antiepileptics can exacerbate absence seizures?

Answer 8

Carbamazepine, oxcarbazepine, gabapentin, phenobarbital, phenytoin, pregabalin, tiagabine, vigabatrin

Question 9

What is 1st line for myoclonic seizures?

Answer 9

Sodium valproate (non-child-baring)
Levetiracetam or lamotrigine

Question 10

Which antiepileptic requires a dose reduction of eGFR is less than 80ml/min?

Answer 10

Levetiracetam

Question 11

What are the 3 acetylcholinesterase inhibitors recommended for Alzheimer’s disease?

Answer 11

Donepizil, galantamine, rivastigmine

Question 12

What class is memantine and when is is used?

Answer 12

Glutamate receptor antagonist
Used for moderate/severe Alzheimer’s disease

Question 13

What are the contraindications for AChE inhibitors?

Answer 13

Pregnant and breastfeeding, hypersensitivity

For galantamine: severe renal impairment (eGFR less than 9), severe hepatic impairment, ironed outflow obstruction, GI obstruction,

Question 14

Why are the commmon side effects of AChE inhibitors?

Answer 14

Nausea, vomiting, diarrhoea, anorexia, fatigue, insomnia, headache, hallucinations, rash, purities, tremor, Parkinsonism, urinary incontinence

Question 15

What is the interaction between AChE inhibitors and antipsychotics?

Answer 15

Increased risk of neuroleptic malignant syndrome (hyperthermia, muscle rigidity, autonomic instability and fluctuating consciousness)

Question 16

What is the interaction between AChE inhibitors and beta-blockers?

Answer 16

Bradycardia

Question 17

Which dementia should either AChE inhibitors or memantine not be used?

Answer 17

Vascular dementia

Question 18

What should be used to manage insomnia in Alzheimer’s disease?

Answer 18

Sleep hygiene

Not melatonin

Question 19

In Parkinson’s, which type of dopamine agonists is preferred and why?

Answer 19

Non-ergot derived - less monitoring required (risk of fibrosis)