Parkinson's & Epilepsy recap Flashcards

1
Q

DTs

A

hyperadrenergic state - highly excitable
hallucinations, confusion, delusions, severe agitation, generalised tonic clonic seizures

Tx is based on a symptom score, depending on the symptoms, and if the patient scores high enough they are treated with benzodiazepines as required

management: ABC assessment
treat any hypoglycaemia
sedations with benzodiazepines
barbiturates?ICU may be required
screen for Wernicke's encephelopathy
treat with oral thiamine (vit B1) eg pabrinex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

wernickes encephalopathy

A

signs and symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

korsakoffs

A

signs and symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

benzodiazepines

A

resp depression
can precipitate hepatic encephalopathy
in patients with ALD use lower dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

phenytoin

A

10-20mg/l
measured using both free and protein bound phenytoin
in patients with low albumin, the free phenytoin may be normal even if the total level is low due to the low amount protein bound

important info:
inhibitor of p450 enzymes
inducder of p450
narrow therapeutic index
first order kinetics within therapeutic range
highly protein bound
causes hypotension and arrhythmias when given IVI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

phenytoin kinetics

A

metabolism is dose dependent
first order kinetics at low concentrations - constantly increasing as dose increases
zero order kinetics at high concentrations - plateaus and metabolised at the same rate even in higher doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

sodium valproate

A

inhibitor of p450 enzymes
teratogenic
monitor levels
pancreatitis is a side effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

status epilepticus

A

> 5mins: IV lorazepam, PR diazepam, buccal midazolam
20mins: alert anaesthetist for further sedation

if benzodiazepines don’t work –> slow IV phenytoin (caution arrhythmias and hypotension)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

carbamazepine and warfarin

A

carbamazepine is an enzyme inducer and will therefore induce the metabolism of warfarin, so the dose of warfarin must be increased accordingly, and INR monitored
it would be acceptable to continue using both, with more INR monitoring or to stop carbamazepine in favour of an alternative eg lamotrigine. patient discussion and choice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

carbamazepine

A

p450 enzyme inducer
raised GGT due to enzyme induction
hyponatraemia due to carbamazepine causing (rarely) SIADH
can induce its own metabolism

toxicity (as with most anti-epileptics):
cerebellar signs
reduce the dose and monitor until symptoms are under control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

drug induced parkinsonism

A

subacute, bilateral onset is unusual in normal parkinson’s, usually tremor starts in one hand

high risk drugs are dopamine antagonists, like haloperidol, stemetil (for vertigo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly