Neurology Flashcards
1) What is the first line treatment for focal (partial) seizures?
2) What is the first line treatment for generalised (tonic clonic) seizures?
1) Carbamazepine
2) Valproate
Carbamazepine
1) list the 3 main indications
2) indicate a normal starting dose, and maintenance dose, for epilepsy
3) What is the therapeutic range, and how is it measured?
4) How long does it take to reach steady state concentration and why?
5) Give FIVE counselling points, and the most important referral point
6) Give THREE monitoring points
1) Focal (partial) seizures/generalised seizures, trigeminal neuralgia, bipolar disorder
2) Initially 100mg bd, increase to maintenance of 400-1200mg in 2 or more daily doses
3) 4-12mg/L, measured as steady state trough plasma concentration
4) 2-4 weeks, due to autoinduction of metabolism
5) Take tablets with food, swallow CR tablets whole, avoid grapefruit juice, may cause drowsiness/dizziness, have regular blood tests, do not stop taking abruptly, wear a medic alert bracelet, interacts with other meds, REFERRAL POINT = skin reaction (risk of SJS/DRESS if dose increased too quickly)
6) Monitor serum concentration, BMD, calcium, FBC, LFT, renal, skin reactions etc
What supplement is recommended for pregnant women taking anti epileptic medication (drug and dose); when to start taking and how long to take?
Folic acid, 5mg od. Start taking at least 1 month before conception, and for 3 months after.
Which four forms does sodium valproate come as? (plus bonus points for strengths)
Enteric coated tablets - 200mg, 500mg
Crushable tablets - 100mg
Oral liquid - 40mg/ml, 300ml bottle
Injection - 400mg vial
Sodium valproate
1) Give a starting dose and maintenance dose for epilepsy
2) Is therapeutic monitoring routinely done? What is the range and how long does it take to reach steady state?
3) List 3 common adverse effects and 3 rare adverse effects
1) Starting dose 600mg daily in 2 doses, maintenance 1-2g daily in 2 doses (e.g. 500-1000mg bd).
2) Not routinely done (normally to confirm toxicity or compliance). Range is 40-100mg/L (max 150mg/L), takes 3-5 days to reach steady state (therefore increase dose every 3 days if required).
3) Common = nausea, weight gain, tremor (thinning of hair, drowsiness, hirsutism, menstrual irregularities)
Rare = hepatic failure, pancreatitis, EPSE (hypersensitivity, neutropenia, reduced BMD and bone fractures)
Match the five drugs with their most significant adverse effect
a) Pregabalin
b) Perampanel
c) Levetiracetam
d) Vigabatrin
e) Topiramate
1) Irreversible vision defects
2) Steven Johnson Syndrome
3) Metabolic acidosis
4) Drowsiness
5) Psychiatric disorders eg euphoria, aggression
a) Pregabalin = drowsiness
b) Perampanel = Psychiatric disorders
c) Levetiracetam = Steven Johnson Syndrome
d) Vigabatrin = Irreversible vision defects
e) Topiramate = metabolic acidosis
How do anticholinesterases ‘work’ in alzheimers?
List the three anticholinesterases used in alzheimers and their starting doses
Anticholinesterases inhibit the breakdown of acetylcholine; this decreases the deficit of cholinergic neurotransmitter activity present in alzheimers disease.
1) donepezil 5mg od for min 4 weeks
2) Galantamine 8mg od for min 4 weeks
3) Rivastigmine oral 1.5mg bd, patch 4.6mg/24hrs
Give the indication and starting dose for baclofen - can it be ceased abruptly if ineffective?
Indication = baclofen is a muscle relaxant, it inhibits transmission at spinal level and depresses the CNS. Used for spasticity associated with MS/spinal cord damage. Starting dose is usually 5mg tds, increase as per response every 4 days if required.
Should not be ceased abruptly! Can increase risk of withdrawal syndrome (symptoms = anxiety, fever, seizures, rebound spasticity, altered mental status).
