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my own pre reg notes > neuro my notes > Flashcards

neuro my notes Flashcards

1
Q

treatment of dementia:

mild/moderate

severe

non cognitive symptoms?

A

mild/ mod: NMDA antag
severe memantine

NC: APs (risk of stroke and death) = must assess CV risk
benzos if aggression/ agitation

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2
Q

risk of NMDA antags

A

galant: SJS

Donepezil: neuroleptic malignant syndrome

rivastigmine: GI disturbances

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3
Q

cholinergic SEs?

A

DUMBBELS

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4
Q

Avoid Antimuscarinics with what drugs

A

AP
AD
AH
Urinary spasmodics e.g. solifenicin, tolterodine

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5
Q

severe HS reactions with AEs occur in the first _____ w

A

8 weeks

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6
Q

which AEs are OD dosing and why

A

phenobarbital, phenytoin, lamotrigine as long half life

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7
Q

drugs which are barbituates?

A

phenobarbital
primidone
thiopental

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8
Q

treatment of seizures?

A

all first line generalized: valproate except absence (ethuxamide)

pre menopausal first line: all generalised first line is lamotrigine (absence is still ethuxamide)

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9
Q

which AEs do you not need to maintain on same brand

A

gaba
pregab
ethosuxamide
levetiracetam

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10
Q

metoclopramide prokinetic effect does what

A

increases of absorption of oral analgesia

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11
Q

albumin AEs

A

phenytoin, carbamazepine, lamo

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12
Q

present in milk?

A

ZELP

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13
Q

which AEs accumlate in the infant

which decrease sucking reflex

A

accumlate: phenobarb and lamo

decrease sucking reflex: phenobarb/ prim

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14
Q

HS with which AEs

A

CPPPL

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15
Q

blood dyscrisis with which AEs?

A

C VET PLZ

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16
Q

which aes effect eyes

A

vigabatrin

topirimate (acute myopathy)

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17
Q

which seizures do you not use carba in

A

atonic tonic myoclonic and absence

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18
Q

which drugs can you not use for the following:atonic tonic myoclonic and absence

A

carbamazepine
gabapentin
pregabalin

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19
Q

what seizure should you avoid lamo in and why

A

myoclonic

rashes

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20
Q

which seizures should you avoid phenytoin in?

A

absence and myoclonic

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21
Q

side efffects phenytoin?

A

toxicity: SNAtCHeD

change in appearance
hypersensitivity
SJS
hepatotox
vitamin D def 
blood dyscriasis
suicidal ideation
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22
Q

phenytoin interactions

A

Methotrex, trimeth (increased AF effect)
enzyme inhibs/ inducers
anticonvulsant effect antagonism
drugs metabolised by CYP as it is an enzyme inducer

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23
Q

drugs which cause convulsions?

A

quinolones
tramadol
mefloquine
SSRIs, AP, TCAs

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24
Q

Carbamazepine levels: when do you measure

A

4-12mg/L

measure after 1-2 weeks

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25
Q

carbamazepine side effects and toxicity

A

I HANDBAG

hypersensitivity 
hepatotox 
blood dyscriasis 
SJS
hyponat= WATER INTOXICATION
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26
Q

carbamazepine interactions?

A

enzyme inhibs/ inducers
AC effects antagonised
hyponatraemia: aldosterone antagonists, SSRI, TCAs, diuretics, NSAIDs
hepatotox
is an enzyme inducer so anything metabolised by these

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27
Q

valproate side effects

A

hepatotox
pancreatitis
blood dyscriasis

interactions same as carba

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28
Q

formulation of lorazepam for status epilepticus

when do you give?

when would you repeat?

A

IV

after 5 minutes

repeat after 10 minutes

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29
Q

what to give if still seizing after 25 minutes of benzo

A

phenytoin

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30
Q

in community what would you give for seizure?

A

diazepam rectal or midazolam oral

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31
Q

short acting benzos

A

CLOT

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32
Q

benzodiazapine OD

A

flubendazole

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33
Q

withdrawing benzos?

A

1-2 mg every 2-4 weeks of diazepine at night

500mcg at end

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34
Q

methyphenidate whats it for and whats its class

lisdexamphetamine- used when?

A

CD Sch 2

first line in adhd

lisdex: if methylphen hasnt worked after 6 weeks- its also CD Sch 2

atomox used when stimulant effects arent tolerated

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35
Q

monitoring with ADHD drugs?

A

weight/ height of children
tik development
sexual dysfunction

monitor for misuse as study or weight loss drug
switch to non-stimulant

monitor 6 monthly

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36
Q

ADHD drugs increase what levels

A

dexam, lisdexam, methylpen: na and d

atomox: na

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37
Q

side effects of atomox

A 
hepatotox 
suicidal ideation 
QTP 
na increase= sympathomimetic effects:  dry mouth, hyperten, constipation
monitor 6m and at dose changes
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38
Q

APs used in bipolar

A

QORH

Add on li, valproate

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39
Q

withdrawal of antimanic drugs in bipolar?

A

4 weeks if continuing other drugs

3 months if nothing else

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40
Q

how long to continue therapy after last manic episode in rapid cycling

A

rapid cycling: 2 years

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41
Q

predisposing to LI tox:

A

hyponat

but li causes hypernat

42
Q

side effects with li

A

TFT, renal imp, benign intracranial hypertension- report headaches and vision changes
QTP and lowers seizure threshold

43
Q

lithium counselling

A

report signs of benign intracranial HTN
maintain hydration and salt intake
avoid alc

44
Q

lithium interactions

A

EP- AP, Metoclop, PD
decreased renal excretion: ACEI/ARB, NSAIDs
QTP
seizure risk increased
salt balance (alginates)
neurotoxic
SEROTONIN SYNDROME: 5HT ag, SSRI, Granisetron, MAOI, Tramadol

45
Q

venlafaxine MHRA

A

Increased risk of post partum haemorrhage

46
Q

the efficacy between TCAs and SSRIs is the same, what makes SSRIs the preffered choice?

A

SSRIs safer in OD

TCAs are more: AM, sedating and cardiotoxic

47
Q

when to r/v MAOIs?

A

after 2 weeks

48
Q

TCA cautioned in overdose?

A

doselupin

49
Q

examples of TCAs

A

amitryp
doseulpin OD caution
imipramide (most AM)
lofepramie (hepatotox)

50
Q

which TCA is the most AM

A

imipramide

51
Q

which TCA is safest in OD

A

Lofepramine

52
Q

which TCA is hepatotox

A

lofepramine

53
Q

MAOIs example

A

phenelzine- most hepatotox
isocarboxazid- most hepatotox
tranylcypromine- more risk of AH crisis

reversible: moclobenide

54
Q

review SSRIs how often

how long to wait before deeming ineffective

continue for how long after remission

A

1-2 weekly at start as can cause suicidal ideation as body decreases s
wait 4 weeks (6w in elderly) before saying its ineffective

6 month (12m in elderly, GAD)
2 years in recurrent
55
Q

ADs cause what electrolyte imbalance

A

hyponatraemia- esp SSRI

56
Q

Serotonin syndrome?

A
  1. autonomic dysfunction: libaile BP, hyperthermia, tachy, sweating etc (dysreg between para and sym ns)
  2. neuromuscular hyperactivity
  3. altered mental state
57
Q

MAOI washout

A

2 weeks except moclobemide

58
Q

SSRI washout

A

1 week (2w sertraline, fluox 5w)

59
Q

TCA washout

A

1-2 weeks (3 weeks for imipramine or clomipramine)

60
Q

high risk of withdrawal

A

paroxetine and velnafaxine as short half lives

61
Q

max dose citalapram in elderly and hepatic impairment

A

20mg

normally 40mg

62
Q

what does TCAs do to BP

A

hypotension as D blockaid

63
Q

when is loferamide preferred

A

less dangerous in OD and has less side effects

but hepatotoxic

64
Q

how long do MAOIs take to work

A

3 weeks for a response then continue for another 1-2 weeks for maximum response

65
Q

which MAOI is most stimulant and can cause hypertensive crisis most

A

tranylcopromine

66
Q

which generation are better for negative symptoms of PD

A

second generation

67
Q

which APs do you need to monitor concentrations for as per MHRA?

A

CLOZAPINE, ARIPIRAZOLE, OLANZ, QUETIAPINE, RISP

68
Q

would you commonly see 2 AP drugs being used at the same time

A

only in exceptional circumstances e.g. titrating

69
Q

which AP doesnt increase prolactin levels?

A

aripirazole as partial agonist

70
Q

which APs have lowest risk of sexual dysfunction

A

aripip, quetiapine

71
Q

which AP has high risk of cardiac side effects

A

pimozide

72
Q

QTP is least common with which APs?

A

aripip, clozapine, flupentixol, risp, sulpride

73
Q

which generation is more likely to cause postural hypotension

A

second gernation

74
Q

which APs cause the least hyperglycaemia?

A

haloperidol, fluphentixol

75
Q

what to do if neuroleptic malignant syndrome occurs with APs?

A

hold for 5 days

76
Q

FIRST GENERATION APs 4 categories:

A
  1. phenothiazines: e.g chlorpromazine
  2. butyrophenones: haloperidol- most EPS
  3. thioxantheses: -pentixol
  4. others e.g. pimozine, sulpiride
77
Q

which APs are hepatotoxic

A

phenothiazines

78
Q

which generation causes EPS and which causes metabolic SEs

A

1st: EPS
2nd: metabolic

79
Q

when would you rx clozapine

A

resistant schizo when tried more than 2 drugs including 2nd gen for 6-8 weeks

80
Q

when would you retitrate clozapine

A

two or more missed doses

81
Q

clozapine side effects

A

MAG: myocarditis- STOP if tachy in first 2 m

Agranulocytosis: FBC every 8 weeks then 2 weekly for a year then monthly

GI obstruction- do NOT give constipating meds

82
Q

which APs have the highest risk of EP symptoms

A

group 1 phenothiazines and haloperidol

83
Q

how could you treat EPS

A

antimuscarinics

84
Q

which generation has highest risk of hyperprolactinaemia

A

first generation

85
Q

hyperglycaemia most common with which APs?

A

CiROQ

86
Q

treating neuroleptic malignant syndrome caused by APs?

A

bromocriptine/ dantrolene- dopamine receptor agonist

87
Q

APs monitor?

A

FBC
LFT
Electrolytes
lipids- 3m then yearly

88
Q

ergot dopamine agonists examples

A

bromocrip
cabergoline
pergolide

89
Q

non ergot agonists?

A

pramipex
ropinirole
rotigotine

90
Q

MAOBs for PD?

A

Selegeline, rasageline

91
Q

what does amantadine and apomorphine treat

A

PD- weak DRA

92
Q

COMT Inhibitor examples

A

entacapone (colours urine), tolcapone (hepatotox)

93
Q

apomorphine for PD side effects- how to overcome this?

A

nausea and vomiting give with domperidone prophylaxis 2 days before

94
Q

CAUTION of using domperidone 2 days before apopmorphine to decrease nausea and vomiting?

A

both cause QTP- risk benefit

95
Q

what would you use to treat advanced PD

A

Apomorphinee SC/ IV

96
Q

what to give to treat the non cognitive symptoms of PD:

  1. day time sleepiness
  2. postural hypotension
  3. psychotic symptoms
  4. REM
  5. Salivation
A
  1. modafanil
  2. midodrine or fludrocortisone
  3. dont treat unless not tolerated- quetiapine
  4. clonazepam or melatonin
  5. glycopyronium or botox
97
Q

what do you use to treat PDD

A

Rivastigmine

98
Q

treatment of PD?

A

+ affecting QOL: levodopa

  • affecting QOL: any choice but ldopa best
99
Q

ergot derived DRAs side effects?

A

impulse conrol disorders
sleepiness and onset of sleep
psychotic symptoms
hypotension

100
Q

counselling with MAOIBs for PD

A

driving as metabolised to amphetamine
Do not purchase any sympathomimetics OTC= hypertensive crisis.
e.g. nasal decongestants: pseudoeph, phenylephedrine, zylometazoline

101
Q

when are COMT inhibitors used? examples of these?

A

entacapone, tolcapone

used for end dose flucutations

102
Q

counselling with COMT inhibitors?

A

entacapone: red urine
tolcapone: hepatotox

my own pre reg notes (5 decks)

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