CNS disorders

Question 1

What are the monoamine neurotransmitters?

Answer 1

dopamine
norephedrine
serotonin

Question 2

the mood: MANIA is known as what condition

Answer 2

BIPOLAR: one mood to another

Question 3

Bipolar Disorder
definition

Answer 3

Bipolar disorder is a mental health condition that affects your moods, which can swing from one extreme to another. It used to be known as manic depression.

Question 4

Treatment for bipolar

Answer 4

antipsychotics: Haloperidol, olanzapine, quetiapine and risperidone

Question 5

What should happen when discontinuing antipsychotics?

Answer 5

dose should be reduced gradually over at least 4 weeks to minimise recurrence

Question 6

Example of benzodiazepines

Answer 6

e.g lorazepam - used in initial stages of treatment for behavioural disturbance or agitation
Should not be used for long periods due to dependence

Question 7

What does valporate contain?

Answer 7

Valproic acid and sodium valproate - can be used for manic episodes if lithium is not tolerated or contra-indicated.

Question 8

pregnant women, valporate?

Answer 8

MHRA - high teratogenic risk in females of child-bearing potential

Question 9

What to give if patients are unresponsive yo lithium therapy?

Answer 9

Carbamazepine - long term management

Question 10

what are the therapeutic levels for lithium?

Answer 10

Therapeutic levels
0.4-1 mmol/litre 12-hours post dose
0.8-1 mmol/litre for patients who have previously relapsed or have sub-syndrome symptoms.

Question 11

Cautions of lithium?

Answer 11

Long-term use has been associated with
Mild cognitive and memory impairment
Lower seizure threshold
Thyroid disorders (hypo/hyperthyroidism)
QT prolongation
Renal impairment (renally cleared and nephrotoxic)
Teratogenicity in pregnancy - effective contraception in women of child-bearing age

Question 12

Parent and care advice for lithium?

Answer 12

Advise to report signs and symptoms of lithium toxicity, hypothyroidism, renal dysfunction, and benign intracranial hypertension (persistent headache and visual disturbances)
Maintain adequate fluid intake and avoid dietary changes which reduce or increase sodium intake
May cause drowsiness, avoid alcohol.
Always carry lithium alert card

Question 13

is lithium high risk drug?

Answer 13

YES

Question 14

How to monitor lithium?

Answer 14

Renal, cardiac and thyroid function
ECG in patient with cardiovascular disease
Body-weight or BMI
Serum electrolytes (hyponatraemia = toxicity)
Full blood count

Question 15

lithium - Signs of toxicity & overdose

Answer 15

GI disturbances: vomiting, diarrhoea
Visual disturbances
Renal: incontinence, hypernatraemia, polyuria
Extrapyramidal symptoms: muscle weakness, fine tremor, abnormal reflexes
CNS disturbances: confusion, drowsiness, lack of coordination, restlessness, stupor

in HIGHER DOSES
Cardiac arrhythmias, blood pressure changes, circulatory failure, renal failure, coma, sudden death

Question 16

Interactions
w lithium

Answer 16

Hyponatraemia increases risk to lithium toxicity especially when taken with diuretics and antidepressants
Increased risk of nephrotoxicity when taken with ACE-inhibitors and NSAIDs
Increased risk of seizures when taken with SSRis, quinolone antibiotics
Advise patients to avoid OTC use of sodium-containing antacids, effervescent analgesics and NSAIDs

Question 17

Valproate
from the 31st of Jan 2024

Answer 17

no-one under the age of 55 – both men and women - should be started on valproate unless two specialists independently agree that there is no other safe and effective medication.

Question 18

cautions of valporate

Answer 18

Highly teratogenic
Potential for neurodevelopmental disorders (approx. 30–40% risk) and congenital malformations (approx. 10% risk).

Must not be used in women and girls of childbearing potential unless the conditions of the Pregnancy Prevention Programme are met and only if other treatments are ineffective or not tolerated, as judged by an experienced specialist.

Question 19

Monitoring
- valporate

Answer 19

Therapeutic drug monitoring
Plasma-valproate concentrations are NOT a useful index of efficacy, therefore routine monitoring is unhelpful.

Monitoring of patient
Monitor liver function before therapy and during first 6 months especially in patients most at risk.

Measure full blood count and ensure no undue potential for bleeding before starting and before surgery.

Question 20

valporate - Treatment cessation

Answer 20

Avoid abrupt withdrawal;
if treatment with valproate is stopped, reduce the dose gradually over at least 4 weeks.

Question 21

Valproate
look out for………

Answer 21

Blood or hepatic disorders
Patiee.g. bleeding, bruising, abdominal pain, mouth ulcers, sore throat.

Pancreatitis
e.g. abdominal pain, nausea, or vomiting develop.

Pregnancy Prevention Programme
Pharmacists must ensure that female patients have a patient card.