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Random Pre Reg Questions > CNS > Flashcards

CNS Flashcards

1
Q

What drugs are used for nausea and vomiting in pregnancy

A
  1. Cyclizine
  2. Metoclopramide or Prochlorperazine
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2
Q

What is used in motion sickness

A
  • Hyoscine hydrobromide
  • Promethazine if sedative effect required (or cyclizine / cinnarizine)
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3
Q

What is used in post operative nausea and vomiting

A
  • Ondanseron
  • Dexamethasone
  • Droperidol & haloperidol
  • Prochloperazine
  • Cyclizine - N&V caused by opioid or general anaesthetics
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4
Q

Side effect of domepridone

A

Risk of cardiac side effects

Max treatment duration should not exceed 7 days

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5
Q

Side effect of metoclopramide

A

Risk of neurological adverse effects

Short term use up to 5 days

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6
Q

What age can Promethazine not be sold OTC

A

Children < 6 yrs for cough and cold

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7
Q

Pain ladder

A

Step 1: Mild pain
- Non-opiods - paracetamol, aspirin, NSAIDs

Step 2: Mild to Moderate pain
- Weak opioids - codeine, tramadol

Step 3: Moderate to Severe
- Strong opioid - morphine, oxycodone, methadone, fentanyl

Adjuvants:
• neuropathic pain → TCA, gabapentin / pregablin
• bone metastases → bisphosphonates, strontium ranelate
• nerve compression by tumors → dexamethasone

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8
Q

What is used in mild to moderate Alzheimer’s

A
  • Donepazil
  • Galantamine
  • Rivastigmine
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9
Q

What is used in severe Alzheimer’s

A

Memantine

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10
Q

What is used in non-alzheimer’s with lewy bodies

A

Donepazil
Rivastigmine

If not tolerated: galantamine

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11
Q

What is used in severe dementia with Lewy bodies

A

Donepazil
Rivastigmine

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12
Q

What is used to treat extreme violence, aggression and agitation in dementia

A
  • Oral IM haloperidol
  • Olanzapine
  • Lorazepam
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13
Q

What is used in dementia with Lewy body (Parkinson’s disease)

A

Rivastigmine

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14
Q

Can you use Acetylcholine inhibitors and memantine in pts with frontotemporal dementia or cognitive impairment caused by sclerosis

A

No

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15
Q

Side effect associated with Donezapil

A

Neuroleptic malignant syndrome

high fever, sweating, unstable blood pressure

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16
Q

Side effect associated with Rivastigmine

A
  • Dehydration
  • GI side effects - STOP/ Switch to patch
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17
Q

When to stop Rivastigmine

A

GI side effects

switch to patch

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18
Q

Side effect of Galantamine

A

Stevens Johnson’s Syndrome

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19
Q

How do we treat Focal seizures

A
  • 1st: Lamotrigine or Levetiractem
  • 2nd: Carbamazapine. Oxcabazepine, zonisamide
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20
Q

How do we treat Tonic-clonic seizures

A

Valporate Alt. Lamotrigine or Levetiracetam

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21
Q

How do we treat Absence seizures

A

Ethosuximide or Valporate
Alt. Lamotrigine or Levetiracetam

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22
Q

How do we treat Myoclonic seizures

A

Valporate Alt. Topiramate, Levetiracetam

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23
Q

How do we treat Atonic/tonic seizures

A

Valporate Alt. Lamotrigine

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24
Q

What are category 1 anti-epileptic drugs

A

’CP3’

  • Carbamazepine
  • Phenytoin
  • Phenobarbital
  • Primidone

Prescribed by brand

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25
Q

What are category 2 anti-epileptic drugs

A

‘TV Loan @ Currys’

  • Valporate
  • Lamotrigine
  • Clonazepam
  • Topiramate
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26
Q

What are category 3 anti-epileptic drugs

A
  • Levetiractem
  • Gabapebtin
  • Pregablin
  • Ethosuximide
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27
Q

How are anti-epileptic drugs withdrawn

A
  • Gradually reduce dose with supervision
  • avoid abrupt withdrawal
  • withdraw one drug at a time
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28
Q

How long is the driving ban after last dose of anti-epeleptic (withdrawal)

A

6 months

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29
Q

How long is the driving ban after first unprovoked seizure

  • normal car
  • large vehicles
A
  • 6 months
  • 5 years for large vehicles
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30
Q

How long must patient be seizure free to drive

A

1 year

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31
Q

How long are patients not allowed to drive for if they have seizures while asleep

A

1 year

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32
Q

How long are patients not allowed to drive for if they have seizures while asleep and awake

A

3 years

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33
Q

What anti epileptic are associated with anti epileptic hypersensitivity syndrome

A

‘CP3RLOL’

  • carbamazepine
  • phenobarbital
  • phenytoin
  • Primidone
  • rufinamide
  • lamotrigine
  • oxcarbazepine
  • lacosamide
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34
Q

MHRA warning with antiepileptics

A

Suicidal thoughts

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35
Q

Antiepileptic drugs with highest teratogenic risk

A

Valproate

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36
Q

Antiepileptic with increased risk of teratogenicity

A

‘CP3’

  • carbamazepine
  • phenytoin
  • Phenobarbital
  • primidone
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37
Q

Which drug is associated with cleft palate

A

Topiramate (1st trimester)

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38
Q

What antiepileptic drugs require monitoring of fatal growth

A

tira

Levetiracetam and topiramate

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39
Q

What dose and duration should folic acid be given to women at high risk of conceiving a child with neural tube defects

A

5 mg OD
before conception and until 12th week

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40
Q

Withdrawal effects in new-borns occur more with?

A

Benzodiazepines and phenobarbital

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41
Q

What antiepileptics are found in high concentration in breast milk

A

‘ZELP’

  • zosinamide
  • ethosuximide
  • lamotrigine
  • primidone
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42
Q

What antiepileptics accumulate in infants

A

Lamotrigine
Phenobarbital

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43
Q

What antiepileptics inhibit sucking reflex

A

Phenobarbital
Primodine

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44
Q

Symptoms of antiepileptic hypersensitivity syndrome

• what to do if this occurs?

A

Rash, fever, lymphadenopathy, systemic involvement

  • occurs in first 1-8 weeks of starting
  • discontinue immediately
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45
Q

Which antiepileptic is associated with severe skin reactions especially in children

A

Lamotirigine

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46
Q

What drug increases lamotrigine side effects and why?

A

Sodium valproate

Enzyme inhibitor so increases concentration of lamotrigine

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47
Q

What two antiepileptics are at risk of cross-sensitivity

A

Carbamezapin
Phenytoin

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48
Q

Side effect of gabapentin

A

Severe respiratory depression

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49
Q

What antiepileptics are associated with blood dyscrasias

A

’C Vet Plz’

  • carbamazepine
  • valproate
  • ethosuximide
  • topiramate
  • phenytoin
  • lamotrigine
  • zonisamide

report signs of infection, bruising, bleeding

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50
Q

What antiepileptics are associated with eye problems

A

Vigabatrin
Topiramate

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51
Q

What antiepileptics are associated with encephalopathic symptoms

sedation, super and confusions

A

Vigabatrin
Topiramate
Valproate

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52
Q

Nature of interaction between valproate and digoxin

A

Increase plasma conc.
Increased toxicity

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53
Q

Nature of interaction between carbamazepine and phenytoin

A

Decreased concentration of carbamazepine

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54
Q

What is used to treat Diavet syndrome

A

Valporate
OR
‘CVS’
Clobazam + valproate + stiripentol

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55
Q

Which anetylchorinesterase inhibitor is avoided in hepatic and renal impairment <9ml/min

A

Galantine

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56
Q

What are the acteyl chloringenic side effects?

dementia drugs

A

‘Dumbbels’

Diarrhoea
Urination
Muscle cramps
Bronchospasm
Bradycardia
Emesis (vomiting)
Lacrimation (teary eyes)
Salivation / sweating

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57
Q

Monitoring requirement for rivastigmine

A

Body weight

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58
Q

Side effect of memantine

A

Constipation

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59
Q

When to avoid phenytoin

A
  • Absence seizures
  • myoclonic seizures

Exarcebates

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60
Q

Therapeutic range of phenytoin

A

10-20 mg/L

6 -15 mg/l in neonates

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61
Q

What to look out for in phenytoin toxicity

A

‘SNACHD’

  • slurred speech
  • nystagmus (uncontrolled eye movement)
  • ataxia (lack of voluntary coordination of movement)
  • confusion
  • hypERglycaemia
  • diploma (double vision), blurred vision
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62
Q

Side effects of phenytoin

A

Long term: change in appearance
- low vitamin D
- hepatic toxicity

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63
Q

When to discontinue phenytoin

A

Signs of liver toxicity

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64
Q

Nature of interaction between phenytoin and Amiodarone

A

Increase concentration of phenytoin

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65
Q

Nature of interaction: phenytoin and St. John’s wort

A

Decrease concentration of phenytoin

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66
Q

Nature of interaction: phenytoin and quinones

A

Anticonvulsant effect antagonised

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67
Q

Nature of interaction: phenytoin and contraceptives

A

Reduce plasma conc. Of contraceptive

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68
Q

When to avoid carbamazepine

A
  • atonic seizure
  • clonic seizure
  • myoclonic seizure
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69
Q

Therapeutic range of carbamazepine

A

4-12 mg/l

Monitor after 1-2 weeks

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70
Q

Signs of toxicity with carbamazepine

A

‘I HANDBAG’
- inco-coordination
- hypONatraemia
- ataxia
- nystagmus
- drowsiness
- blurred vision
- arrhythmias
- gastro - intestinal disturbance

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71
Q

Nature of interaction: carbamerapine and SSRI

A

Hyponatramia

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72
Q

Nature of interaction: carbamerapine and valproate

A

Hepatotoxicity

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73
Q

Nature of interaction: carbamerapine and fluoxetine

A

Increase conc. Of carbamazepine

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74
Q

How often should liver function be monitored with valproate

A

Every 6 months

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75
Q

How is status epilepticus treated

A

• Urgently with lV lorazepam
• repeat once after 10 minutes if no response

Rectal Diazepam or buccal mudazolam - community

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76
Q

What is avoided in status epilepticus

A

IV diazepam

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77
Q

If patient has a seizure after treatment with benzodiazepine in status epilepticus, what should be given?

A

‘Ph=F’

  • phenytoin
  • Phenobarbital
  • fosphenytoin
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78
Q

What is given first line in febrile convulsions

A

Paracetamol

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79
Q

What is used to treat convulsive seizures of febrile convulsions lasting more than 5 minutes in community setting

A
  • Diazepam rectally
  • midazolam solution (in the buccal cavity)

Repeat once after 10-15 minutes if necessary

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80
Q

What is used in chronic anxiety?

A

Antidepressant (SSRI)

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81
Q

What are the hypnotic drugs

A
  • Benzodiazepines
  • z-drugs
  • chlomethiazole
  • promethazine
  • melatonin
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82
Q

Examples of benzodiazepines

A

Lorazepam
Diazepam

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83
Q

Benzodiazepines metabolised by the liver

A

‘Found A CD in the liver**’

  • Florazepam
  • alprazolam
  • cholerdiazepoxide
  • diazepam
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84
Q

What benzodiazepines are not affected by the liver

A

‘This LOT are not metabolised by liver’

  • lorazepam
  • Oxazepam
  • temazepam
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85
Q

Side effect of benzodiazepine in elderly

A

Hypotension

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86
Q

Benzodiazepine in pregnancy

A

Neonatal depression (floppy syndrome)

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87
Q

When are benzodiazepines contraindicated

A

Respiratory distressed patients

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88
Q

Benzodiazepine and alcohol

A

Enhances side effects

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89
Q

What route can’t Benzos be given

A

Intramuscularly - eratic absorption at site

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90
Q

What antiemetic is given for chemically induced nausea and vomiting (most drugs including opioids)

A

Haloperidol
Oral: 1.5mg ON/BD, titrate up to a max of 10mg daily

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91
Q

How is oxycodone immediate release prescribed?

A

QDS

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92
Q

What is used to test for cognitive impairment

A

MMSE
MoCA

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93
Q

Side effects of valproate

A

GI
Weight gain

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94
Q

What electrolyte imbalance puts patient at high risk of lithium toxicity

A

HypONatraemia - low sodium

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95
Q

Side effect of benzodiazepines and z-drugs (urine)

A

Reduce awareness of the need to urinate

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96
Q

Drugs that have antimuscarinic effects (anticholinergic)

A
  • Tricyclic Antidepressants (eg. Amitriptyline, dosulepin)
  • Antihistamines *(eg. Chlorphenamine and Promethazine)
  • Antipsychotic (eg. Olanzapine and quetiapine)
  • Urinary antispasmodic (eg. Solifenacin and tolterodine)
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97
Q

When should rivastigmine be reviewed

A

Dehydration resulting from prolonged vomiting or diarrhoea

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98
Q

Antipsychotic and elderly dementia patients

A

MHRA: increased risk of stroke and small increased risk of death

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99
Q

What class and schedule are gabapentin and pregabalin

A

Class 3 Schedule 3

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100
Q

Nature of interaction: phenytoin and anti-folate

A

Methotrexate and trimethoprim

Increased anti-folate effect

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101
Q

Side effects of benzodiazepines

A
  • Paradoxical increase in hostility and aggression
  • Sedation
  • Dependence
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102
Q

Signs of benzodiazepines overdose

A
  • Ataxia
  • Nystagmus
  • Drowsiness
  • Respiratory depression
  • Coma
  • Hangover effect when taken at night
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103
Q

What is used to treat benzodiazepine poisoning

A

Flumenazel

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104
Q

Withdrawal process of benzodiazepines

A
  1. Transfer to equivalent daily dose of diazepam preferably taken at night for 1 week
  2. Reduce diazepam dose by 1-2mg every 2-4 weeks
  3. Reduce the dose further then stop

Withdrawal symptoms for long term users usually resolve within 6-18 months of the last dose

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105
Q

What benzodiazepine is used in conscious sedation in dental procedures

A

Temazepam

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106
Q

Examples of barbiturates

A

Phenobarbital
Pentobarbital
Secobarbital

107
Q

Short acting barbiturates

A

‘SecPen’

  • Secobarbital
  • Pentobarbital
108
Q

Long acting barbiturates

A

’Phen’

  • Phenobarbital
  • Phenobarbitone
109
Q

When is barbiturates not recommended

A

Insomnia

110
Q

Main use of barbiturates

A

Sedation and hypnosis

111
Q

Side effect of phenobarbitone

A

Neonatal jaundice
Anticonvulsant effects

112
Q

Adverse effects of barbiturates

A
  • CNS depression - drowsiness, respiratory depression
  • Hypersensitivity - skin rash, itching
  • Acute intermittent porphyria - severe pain, digestive problems, red/brown urine, mental changes
113
Q

What are Z-drugs licensed for

A

Only Insomnia

114
Q

Main side effect of Z-drugs

A

Cognitive impairment
Metallic taste in mouth
GI disturbance

115
Q

What are Z drugs

A

Short term insomnia
- Zolpidem
- Zopiclone
- Zaleplon (shortest acting)

Short and long term
- Eszopiclon

116
Q

Antidote for Z-drug toxicity

A

Flumezanil

117
Q

What is used to treat ADHD

A
  • behavioural psychotherapy
  • Medication
    1. Methylphenidate + Atomoxetine
    2. Lisdexamfetamine + Dexamfetamine (children who don’t respond)
118
Q

Side effects of ADHD drugs

A
  • Stevens - Johnsons syndrome
  • Increased blood pressure and heart rate
119
Q

Adverse effect with ADHD drugs

A

Tics
Growth impairment

120
Q

When to stop and go to A&E with atomoxetine

A

Signs of liver failure

121
Q

What class of drug is methylphenidate

A

CD2

brand specific for MR preparations

122
Q

What is the main drug used to treat manic phase

A

Lithium

123
Q

What anti epileptics can be used in mania

A
  • Valporate - acute mania
  • Carbamazepine - mood stabiliser
124
Q

What are class of antipsychotics are used in mania

A

2nd generation

125
Q

How long is lithium given as prophylaxis after manic episode

A

At least 2 years

Risk of relapse: 5 years

126
Q

Therapeutic index of lithium

A

0.4 to 1 mmol/L - maintenance and elderly

0.8 to 1 mmol/L - acute episodes and relapse

127
Q

Warning signs of lithium toxicity

A

‘REVeNGe’

  • Renal disturbances
  • Extrapyramidal symptoms
  • Visual disturbances
  • Nervous system disturbances
  • Gastro-intestinal effects
128
Q

Side effects of atomoxetine

A
  • QT prolongation
  • Hepatoxicity
  • Suicidal ideation
129
Q

What level is lithium considered toxic

A

> 2 mmol/L

130
Q

When to monitor of lithium plasma conc

A
  • Blood samples taken 12 hours post dose
  • Monitor every 3 months first year
  • Every 6 months after
131
Q

Monitoring requirements of lithium

A

6 monthly

  • Serum concentration
  • Renal function
  • Thyroid function
  • Cardiac function
  • BMI
  • Electrolytes
  • eGFR
132
Q

Side effect of lithium

A
  • Thyroid disorders
  • Renal impairment
  • Benign inter cranial hypertension
  • QT prolongation
  • Lowers seizure threshold
  • Weight gain
  • Muscle weakness
  • Hypernatraemia / Hypokalaemia
133
Q

Lithium in pregnancy

A

Teratogenic

134
Q

Nature of interaction: ACE/ARB + Lithium

A

Increased toxicity

  • reduced eGFR
  • diarrhoea
135
Q

Nature of interaction: Lithium + SSRI

A

Increased toxicity
Risk of seizures
Serotonin syndrome

136
Q

Nature of interaction: Lithium + NSAID

A

Increased toxicity

137
Q

Nature of interaction: Lithium + amiodarone

A

Risk of arrhythmias

138
Q

Nature of interaction: Lithium + Methyldopa

A

Risk of neurotoxicity

139
Q

Nature of interaction: Lithium + antipsychotics

A

Risk of EPS effects

140
Q

OTC interaction with lithium

A

Ibuprofen
Soluble analgesics
Antacids

141
Q

Nature of interaction: Lithium + quinolone

A

Risk of seizures

142
Q

Nature of interaction: Lithium + antidepressants

A

Serotonin syndrome

143
Q

Classes of reuptake inhibitors antidepressants

A
  • Tricyclic antidepressant (TCA)
  • Selective serotonin reuptake inhibitors (SSRI)
  • Serotonin Noradrenaline reuptake inhibitors (SNRI)
  • Noradrenaline Dopamine reuptake inhibitors (NDRI)
144
Q

What is used in post operative nausea and vomiting

A

Ondansetran

145
Q

Examples of TCA

A

‘ANTI-DeP-C’ - ‘ine’

  • Amitriptyline
  • Nortryptyline
  • Trimipromine
  • Imipromine
  • Doxepin
  • Protryptyline
  • Clomipramine
146
Q

Side effects of TCA

A
  • Adrenergic over stimulation
  • Serotonin syndrome
  • Postural hypotension
  • Weight gain
  • Sedation
  • Atropine like side effects
  • Antimuscaranic effect
147
Q

Long acting TCAs

A
  • Amitriptyline
  • Imipromine
148
Q

Which TCA is used in nocturnal enuresis

A

Imipromine

149
Q

Early warning symptoms of serotonin syndrome

A

Throbbing headache

  • Tremor, tachycardia, shivering, mania
150
Q

TCA used in neuropathic pain

A

Amitriptyline
Nortryptyline

151
Q

What antidepressant is safe for use in unstable angina or MI

A

Sertraline

152
Q

How long is the wash out period for antidepressants before starting MAOI

A
  • 2 weeks with MAOI
  • 1-2 weeks with Tricyclic
    (3 weeks if starting clomipramine or imipramine)
  • 1 week with SSRI
    (5 weeks with fluoxetine and 2 weeks with sertraline)
153
Q

Which antidepressants doesn’t require washout period

A

Moclobamide

154
Q

What antiemetic is used in nausea and vomiting caused by Parkinson’s drug

A

Domperidone

155
Q

What benzodiazepine is used in alcohol withdrawal syndrome

A

Chlordiazepoxide hydrochloride
Diazepam

156
Q

What are TCA related drugs

A
  • Mianserin
  • Trazodone
157
Q

Examples of SSRIs

A
  • Fluoxetine
  • citalopram
  • paroxeline
  • sertraline
  • escitalopram
158
Q

Which SSRI has a long half life

A

Fluoxetine

159
Q

Which SSRIs cause QT prolongation

A
  • Citalopram
  • escitalopram
160
Q

Which SSRI has a great risk of withdrawal

A

Paroxetine

161
Q

Which SSRI is safe after MI or unstable angina

A

Sertraline

162
Q

Which SSRI is licensed in children below 18

A

Fluoxetine

163
Q

Side effects of SSRI

A
  • Insomnia
  • impotence
  • Bruxism (grinding of teeth)
  • hyponaetramia
  • suicidal thoughts - MHRA
  • increased bleeding risk - interacts with warfarin, NSAIDs, DOACs
164
Q

Example of SNRIs

A
  • Venlafaxine
  • duloxetine
165
Q

Which SNRI is used in diabetic neuropathy?

when diabetes cause damage to nerves

A

Duloxetine

166
Q

Example of NDRI

A

Bupropion

167
Q

Which antidepressant can be used in smoking cessation

A

Buproprion

168
Q

Side effect of NDRI

A

Can precipitate seizures

169
Q

Autoreceptor inhibitors and their side effects
(TCA related drugs)

A
  • Trazodone - hypotension
  • mianserin - seizure
  • mirtazapine - sedation, weight gain, blood dyscrasias
170
Q

Examples of MAOi

A
  • Meclobemide (selective - short acting, no cheese reaction)
  • phenalzapine (non selective - cheese reaction)
171
Q

What two antidepressant classes are fatal when given together

A

TCA + MAOIs

172
Q

Treatment pathway for depression

A
  1. SSRI - first line
  2. Increase SSRI dose or different SSRI
  3. Swap to mirtazapine or SNRI
  4. Reversible MAOI
173
Q

Duration of treatment with antidepressants

A
  • Takes at least 2 weeks to show effect
  • May feel worse initially
  • Wait 4 weeks (6 in elderly) to see if effective
  • Continue for atleast 6 months (12 in elderly)
  • 2 years in recurrent depression
174
Q

What is used to treat cheese reaction

A

IV phentolamine

175
Q

Monitoring requirements for antipsychotics

A
  • Full blood count, urea and electrolytes and liver ( start, yearly)
  • blood lipids and weight (baseline, 3 months, yearly)
  • fasting blood glucose (baseline, 4-6 months, yearly)
  • blood pressure (before, dose titration)
  • prolactin (start, 6 months, yearly)
176
Q

Which antipsychotics doesn’t have prolactin side effects

A

Aripiprazole

(production of breast milk or breast in men)

177
Q

What are the extrapyramidal symptoms

A
  • Parkinsonism
  • dystopia ( abnormal face and body movement)
  • dyskinesia (more common in children)
  • akathisia (inner restlessness)
  • tardive dyskinesia (rhythmic involuntary movement of tongue, face and jaw)

STOP at first sign of fine vermicular movements of tongue

178
Q

Other drugs that interact with antipsychotics to increase EPSEs

A
  • Metoclopramide
  • levodopa
179
Q

Drugs that increase risk of CNS depression with antipsychotics

A
  • Hypnotics
  • benzodiazepines
  • opioids
  • antiepileptics
180
Q

Drugs that increase risk of hypotension with antipsychotics

A
  • Antihypertensive’s
  • diuretics
  • nitrates
181
Q

Examples of first generation antipsychotics

A
  • Haloperidol
  • chlorpromazine, theoridarines, fluphenazine
  • thiothixene
  • pimozide
  • loxapine
182
Q

Effect of first generation antipsychotics

A
  • increase risk of Parkinson’s (EPSE)
  • increase negative symptoms (depression)
  • decrease manic symptoms
  • increase in prolactin (sexual dysfunction)
183
Q

What first generation antipsychotics have highest risk of cardiovascular risk (QT prolongation)

A

Pimozide
Haloperidol

184
Q

What is used to treat or prevent EPSEs

A

Procyclidine

185
Q

Which first gen antipsychotic has low potency

A

Chlorpromazine

the others have high potency: stronger antipsychotic effect and more EPSE

186
Q

Patient counselling with chlorpromazine

A

Avoid direct contact with tablets
Tablets should not be crushed and solutions should be handled with care

187
Q

Which antipsychotic should not be taken at night

A

Flupentixol

188
Q

Which antipsychotic causes bronchospasm

A

Loxapine

189
Q

Examples of second gen antipsychotics

A
  • Aripiprazole
  • clozapine
  • lurasidone
  • olanzapine
  • quetiapine
  • risperidone
  • ziprasidone
190
Q

Which second gen antipsychotic has highest potential to cause EPSE and prolactinemia

A

Risperidone

191
Q

Second gen antipsychotics with strong affinity for serotonin receptors

A

‘CiROQ’

  • Clozapine
  • Risperidone
  • Olanzapine
  • Quetiapine

Metabolic side effects: weight gain, hyperglycaemia, dislipidemia

192
Q

Which second gen antipsychotics have the most sedative effects

A

Clozapine
Olanzapine
Quetiapine

193
Q

What second gen cause postural hypotension and temp regulation

A

Clozapine
Risperidone
Quetiapine

194
Q

Which second gen cause agranulocytosis and requires regular blood count monitoring

A

Clozapine

report signs of infection

195
Q

Which second gen causes constipation

A

Clozapine

196
Q

Which antipsychotic is most effective in resistant schizophrenia

A

Clozapine

197
Q

Which antipsychotics is sexual dysfunction most common with

A
  • Haloperidol
  • risperidone
198
Q

Which second gen antipsychotic causes CNS and respiratory depression

A

Olanzapine

199
Q
  1. How long should clozapine be given to assess effectiveness
  2. What happens if patient misses more than 2 doses
  3. How should clozapine be withdrawn
A
  1. At least 8-10 weeks
  2. Reinitiate
  3. Reduce dose over 1-2 weeks
200
Q

Drugs that interact with clozapine

A
  • Aminosalicylates
  • immunosuppressants (eg. Methotrexate)
  • cytoxic drugs
201
Q

When to discontinue clozapine

A

Myocarditis
Cardiomyopathy

202
Q

Side effects of clozapine

A
  • Constipation
  • agranulocytosis
  • risk of fatal myocarditis and cardiomyopathy
  • hypersalivation
  • postural hypotension
  • sedation, weight gain
  • hyperglycaemia
  • dislipidemia
203
Q

What is used to treat hypersalivation caused by clozapine

A

Hyoscine

204
Q

Monitoring requirements with clozapine

A
  • Full blood count → weekly for 18 weeks, then every 2 weeks for a year, monthly onward
  • physical examination and full med history before starting
  • report constipation before taking next dose
  • blood glucose
  • lipid concentration
205
Q

Drugs used in Parkinson’s

A

aim to increase dopamine activity

  • levodopa
  • selegiline / rasagiline
  • tolcapone
  • bromocriptine, ropinirole, pramipexole, rotigotine, apomorphine
  • antimuscaranic agents (procyclicline,biperiden)
  • amentadine
206
Q

Which antiemetic is used in Parkinson’s

A

Domperidone

doesn’t cross bbb

207
Q

Side effects of levodopa

A

• Impulse control disorders
• Sudden onset of sleep

  • Nausea, loss of appetite - give domperidone
  • hypotension
  • mental disturbances
  • red urine, sweat and saliva
208
Q

Side effect of selegiline and rasagiline

A
  • Nausea
  • Insomnia
  • dyskinesia
  • visual hallucinations

Selegiline: cheese reaction

209
Q

Side effects of entacapone and tolcapone

A
  • Disacoloration of body fluids

Tolcapone: severe diarrhoea and liver toxicity

210
Q

Side effect of dopamine agonists

Rotigotine, pramipexole

A
  • Nausea
  • postural hypotension
  • mental disturbance
  • day time sleepliness
211
Q

Side effect of bromocriptine

A

Pulmonary and cardiac fibrosis

212
Q

Treatment pathway for Parkinson’s

A
  1. Levodopa - pts whose motor symptoms reduce quality of life
  2. Pramipexole, ropinirole, rotigotine - enhanced side effects (non-ergot)
  3. Selegiline, rasagiline
  4. Entalcopone, tolcapone
  5. If not we’ll managed then bromo and carbeh
  • Amantadine if dyskinesia not adequately managed
  • apomorphine SC in ‘Off’ episodes (start domperidone 2 days before to stop nausea and vomiting)
213
Q

Risk of using apomorphine for too long in Parkinson’s

A

QT prolongation

214
Q

What colour does entacappone make urine

A

Reddish-brown

215
Q

When are entacapone and tolcapone used

A

With levodopa in ‘end of life’ motor flunctuation

216
Q

What is used in nausea and vomiting related to motion sickness or morning sickness?

A

Antihistamines
Eg. Promethazine
side effect: drowsiness and sedation

217
Q

What antiemetic is good for chemo patients, radiation and post surgery

A
  • 5-ht 3 receptor antagonist ’setron’
    Eg. ondasetron
    side effect: headache and GI upset
  • doperidol
218
Q

What is used in pregnancy for bad nausea and vomiting
- when should it be avoided

A

Ondasetron
- avoid in 1st trimester

219
Q

How long should metaclopromide be used?

A

Only for 5 days

  • good in chemo and patients with reflux and hepatobile
  • Side effect: EPSE and GI disturbance
220
Q

What antiemetic is used in prophylaxis and motion sickness
- which is preferred if sedative effect is desired

A

Muscurinic receptor antagonist
Eg. Hyoscine

  • sedative: cyclizine or cinnarizine
  • antimuscurinic side effects
221
Q

What is used to treat nausea and vomiting in pregnancy

A
  • Promethazine
  • prochorperazine
  • metoclopramide
222
Q

Side effect of domperidone

A

Increased risk of serious cardiac side effects

223
Q

Duration of treatment with domperidone
- dose adult / children

A

Do not exceed 1 week

  • adult (>12 years,>35 kg) → 10mg TDS
  • children (<12 years, <35 kg) → 250 mcg/kg TDS
224
Q

How long does chronic pain last?

A

> 12 weeks

225
Q

What is noceceptive pain?

A

Caused by damage to the nerves
- burning, prickling, pins and needles, shooting or stabbing sensation
- eg. Musculoskeletal pain, dental pain, moderate- severe pain, period pain

226
Q

What is used in musculoskeletal pain

A

NSAIDs including aspirin

227
Q

What is used in dental pain

A

NSAIDs temporarily (1-7 days)
- ibuprofen, diclofenac, aspirin

If associated with acute problems of the oral mucosa
- benzydamine hydrochloride mouthwash or spray

227
Q

What is used in dental pain

A

NSAIDs temporarily (1-7 days)
- ibuprofen, diclofenac, aspirin

If associated with acute problems of the oral mucosa
- benzydamine hydrochloride mouthwash or spray

228
Q

What is used in period pain

A
  • Oral contraceptives
  • antispasmodics (peppermint oil, hyoscine butylbromide)
  • NSAIDs more useful
229
Q

What is used in neuropathic pain

A
  • TCA (amnitriptyline, nortryptiline)
  • gabapentin and pregablin (risk of suicidal thoughts)
230
Q

What is used in visceral pain

A

Opioids

*trunk, heart, abdominal and pelvic organs *

231
Q

What is used to treat swelling caused by pressure from tumors

A

Dexamethasone

232
Q

What should be avoided in sickle cell

A

Pethidine → can cause seizures

233
Q

What is used to treat paracetamol overdose

A

Acetylcysteine

234
Q

Aspirin dose in severe and pain

A

300 - 900 mcg, 4-6 hours, PRN

  • take with food
  • CI under 16
235
Q

Dose of ibuprofen for child 2-3 months in post-immunisation pyrexia

A

50 mg STAT
Repeat after 6 hours if necessary

236
Q

Which opined can be used in nociceptive and neuropathic pain

A

Methadone

237
Q

Side effects of opioids

A

’MORPHINE’

  • Miosis (pin point pupils), muscle rigidity
  • Out of it (sedation)
  • Respiratory depression
  • Postural hypotension
  • Hyperalgesia, hallucination
  • Infrequency (urinary retention, constipation)
  • Nausea and vomiting
  • Euphoria
238
Q

Side effect specific to morphine and meperidine

A

Hypotension
provoke release of histamines

Meperidine → tachycardia

239
Q

When are opioids contraindicated

A
  • Coma patients → CNS depression
  • IBD → reduces GI motility
  • Respiratory disease → respiratory depression
  • head injury or raised intracranial pressure
  • increased sedation
  • MAOIs → hypertension/ hypotension
240
Q

When is codeine contraindicated

A
  • Children < 12 years
  • ultra rapid CYP2D6 metabolisers
  • breast feeding mothers
  • <18 years with surgery for tonsils or adenoids for sleep apnoea
241
Q

Counselling and advice with fentanyl

A
  • Avoid exposing application site to external heat
  • monitor for up to 24 hours after patch removal for patients with severe side effects
  • patches should be removed immediately in case of breathing difficulties, marked drowsiness, confusion, dizziness or impaired speech.
  • For patches, apply to dry, non-irritated, non-irradiated, non-hairy skin on torso or upper arm, removing after 72 hours and siting replacement patch on a different area (avoid using the same area for several days).
242
Q

What is used to treat migraine

A
  1. Acute: aspirin, paracetamol or NSAIDs
  2. If analgesics are in adequeate; ‘triptans’
  3. Ergotamine → stop if numbness or tingling of extremities
243
Q

What is used in prophylaxis of migraine

A

Pizotifen
Propanol → associated with cardiovascular events

244
Q

What is used in opioid toxicity

A

Naloxone

245
Q

When is tramadol contraindicated

A
  • Hypothyroidism
  • epilepsy
246
Q

What side effects do Carbamezapine, phenytoin and valporate have in common

A
  • hepatic impairment
  • hypersensitivity
  • behaviour + suicidal
  • blood dyscrasia
  • Vit D deficiency
247
Q

Carbamazepine electrolyte imbalance

A

Hyponatraemia

248
Q

Lamotrigine side effect

A

Steven Johnson syndrome

249
Q

Therapeutic range for carbamazepine and phenytoin

A

Carbamazepine - 4-12
Phenytoin - 10-20

250
Q

What to give for sudden onset of sleep

A

Modafinil

251
Q

If Parkinson’s pt gets hypotension

A

Midodrine

252
Q

MAO-B OTC interaction

A

NO pseudoephedine/ phenylephedine

hypertensive crisis

Selegiline, rasagiline

253
Q

Which antipsychotics cause the most weight gain

A

COw

  • clozapine
  • olanzapine
254
Q

Which antipsychotic is given to fix sexual dysfunction

A

Aripirazole

255
Q

Acute anxiety tx

A

Benzodiazepines - 14 days
Busiprone

256
Q

Maintenance of anxiety

A

SSRI

257
Q

Which antidepressant can be given to under 17

A

Fluoxetine

258
Q

Which antidepressant is safe in cardiac event

A

Sertraline

259
Q

What age can codeine be taken OTC

A

12

18 - if associated to linctus

260
Q

Increase of morphine per day in palliative care

A

1/3 to 1/2 increase per day

261
Q

Which drug is not in the initial plan for Parkinson’s

A

Entacapone
Talcapone

262
Q

Which SSRI has sedative effect

A

Mirtazapine

263
Q

What pain drug should be avoided in sickl cell

A

Pechidine

Random Pre Reg Questions (12 decks)

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