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Pre Reg 2023 Nafisa > Neuro - My Flash Cards > Flashcards

Neuro - My Flash Cards

1
Q

What age of onset for a new headache is a red flag? And why?

A

Over 50 years

Temporal arthritis (giant cell arthritis) - particularly if uni-lateral headache in temporal region of brain

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2
Q

What can a thunderclap headache be a symptom of? Does this require referral?

A

Haemorrhage, stroke or aneurism

Refer to A+E / 999

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3
Q

Apart from a sudden onset of head pain, what are the symptoms of haemorrhage/aneurysm?

A

Nausea and vomiting
Stiff neck
Photophobia

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4
Q

Why should you refer if a patient taking CPCs experiences an aura for the 1st time?

A

Increased risk of stroke with COCs and migraine

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5
Q

What can the symptoms of red eyes with a halo be a sign of?

A

Acute glaucoma - refer to GP or optician/ ophthalmologist

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6
Q

What is temporal arthritis/giant cell arthritis? How is it treated?

A

Chronic vasculitis characterised by inflammation in the arteries

Medical emergency! Refer and treat with glucocorticoids initially

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7
Q

What is 1st line for focal seizures?

A

Lamotrigine or levetiracetam

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8
Q

What is second line for focal seizures?

A

Carbamazepine, oxcarbazepine or zonisamide

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9
Q

What is 1st line for absence seizures?

A

Ethosuximide

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10
Q

What is 2nd line for absence seizures?

A

Sodium valproate

If woman of child-baring age then lamotrigine

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11
Q

What anti-epileptics should not be used in absence or myoclonic seizures?

A

Carbamazepine
oxcarbazepine,
phenytoin,
phenobarbital,
tiagabine,
vigabatrin,
gabapentin and pregabalin

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12
Q

What is 1st line for myoclonic seizures?

A

Sodium valproate

Levetiracetam for women of child-baring age

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13
Q

What are the key side effects of phenytoin including signs of overdose?

A

Overdose: nystagmus, slurred speech, tremor, confusion

Other side effects:
Skin rashes
Bradycardia and hypotension with IV
Bone marrow suppression (due to anti-folate effects)
Increase vitamin D metabolism = osteoporosis
Arrhythmias due to blocking Na+ in the heart

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14
Q

Which antiepileptics have a long half life and therefore can be given once daily?

A

Phenytoin
Phenobarbital
Perampanel
Lamotrigine

However - tend to split large doses to avoid high peak plasma concentration

Most antiepileptics are given twice a day

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15
Q

How are phenytoin levels monitored?

A

After IV loading take levels 2-4 hours post dose then monitor every 24 hours until stabilised

Pre-dose (trough) level to be taken 5 days after starting maintenance treatment or any dose changes

Then a second sample after 5-10 days as further accumulation may occur (due to long half life)

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16
Q

Apart from drug levels, what else should be monitored when a patient is on phenytoin?

A

U+Es, LFTs, FBC and vitamin D levels

(ECG if IV)

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17
Q

Do you dilute phenytoin IV

A

You can but there is a risk of precipitation- therefore give through 5micron filter

If giving neat - high risk of extravasation so give slowly through peripheral vein

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18
Q

What are the cautions around enteral feeding and phenytoin?

A

Phenytoin reacts with feed therefore allow 2 hour feed break pre-and post drug administration

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19
Q

Which anti-epileptics are cautioned in the HLA-B allele? Which population are most at risk?

A

Carbamazepine: pre-treatment screening required for Han Chinese or Thai

Risk of SJS

Phenytoin to a lesser extent - no pre-screening required

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20
Q

Which anti-epileptics are cautioned in the HLA-A allele? Which population are most at risk?

A

Carbamazepine - no pre-screening required but increased risk of cutaneous reactions in European and Japanese origin

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21
Q

What is neuroleptic malignant syndrome?

A

Life threatening neurological disorder characterised by confusion, fever and rigidity

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22
Q

What are the key interactions for lamotrigine?

A

Carbamazepine - decreased levels of lamotrigine
COCs - decreased levels of lamotrigine
Sodium valproate - increased levels of lamotrigine (reduce dose and monitor for rash)
Desmopressin - hyponatraemia (monitor sodium)

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23
Q

Which antiepileptic can cause pancreatitis?

A

Sodium valproate

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24
Q

What are the main counselling points for sodium valproate?

A

PPP (women)
Blood or hepatic disorders
Pancreatitis signs : nausea and vomiting, abdominal pain

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25
Q

What antibiotic ass should be avoided when taking sodium valproate?

A

Carbapenems - increased clearance of valproate = risk of seizures

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26
Q

What changes are being made the the PPP for valproate in summer 2023?

A

Will include:
Men <55
Men > 55 of chance of conceiving (e.g. fertile spouse)

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27
Q

What are the highly effect forms of contraception for PPP?

A

Long acting reversible methods:
Copper coil
IUD
Progesterone implant (IMP)
Sterilisation

If using other methods, use 2 forms e.g. COCs plus barrier

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28
Q

How is levetiracetam cleared?

A

Renally - dose restrictions if eGFR <80ml/min

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29
Q

What is the major side effect of levetiracetam?

A

Neuropsychiatric effects:
Depression (suicidal ideation - report)
Irritability
Aggression
Psychosis

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30
Q

What are the common side effects of levetiracetam?

A

Sedation
Confusion
Weight changes
Visual disturbances

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31
Q

What is cannabidiol (CD2) licenced for?

A

Lennox-gastaut syndrome
Dravet’s syndrome

(In combination with clobazam)

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32
Q

What are some examples of non-ergot derived dopamine agonists?

A

Ropinirole
Rotigotine
Pramipexol
Apomorphine

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33
Q

What is the safety warning for dopamine agonists?

A

Impulse control disorders e.g. gambling, binge eating, hyper-sexuality

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34
Q

What class of drug are selegilline, rasagiline, as safinamide?

A

MAO-B inhibitors

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35
Q

What is the treatment for daytime sleepiness in Parkinson’s after non-pharmacological measures?

A

Modafinil (not in pregnancy)

Review every 12 months

36
Q

What can be used to treat hallucinations in Parkinson’s?

A

Quetiapine if no cognitive impairment

Clozapine as alternative

37
Q

What is 1st like for Parkinson’s disease dementia?

A

Rivastigmine (only UK licenced AChEi)

Donepezil, galantamine and rivastigmine are off label

Memantine only considered if others are not tolerated or contraindicated

38
Q

What can be used to control drooling of saliva in Parkinson’s disease?

A

Glycopyrronium

Botulinum toxin A

Topical atropine (if low risk of cognitive impairment)

39
Q

What are the pro-cholinergic side effects?

A

Sweating
Diarrhoea
Abdominal cramps
Urinary incontinence

40
Q

What conditions should AChEi be cautioned in?

A

Asthma / COPD
Bradycardia or condition disease
GI ulceration
Epilepsy (rivastigmine)

41
Q

What are the 3 AChEi used in dementia?

A

Donepezil
Rivastigmine
Galantamine

42
Q

Which AChEi is licenced in Parkinson’s Disease dementia?

A

Rivastigmine (capsules only - patches not licenced)

43
Q

Which type of dementia should AChEi not be used in?

A

Frontal- temporal

(Vascular - they should only be used if they have suspected co-morbid AD, PD dementia or Lewy body dementia)

44
Q

When should memantine be used 1st line?

A

Severe Alzheimer’s disease

45
Q

Which SSRI has a high cholinergic burden?

A

Paroxetine

46
Q

Which drug for urinary incontinence has the lowest cholinergic burden?

A

Mirabegron

47
Q

Which antipsychotic has the lowest cholinergic burden?

A

Aripiprazole

48
Q

What is 1st line for non-Alzheimer’s dementia?

A

Donepezil or rivastigmine

(Consider galantamine if others not tolerated)

49
Q

What class is memantine?

A

NMDA antagonist (prevents calcium influx therefore blocks excitotoxic cell death)

50
Q

What are the side effects of memantine?

A

Constipation
Hypertension
Dyspnoea
Can aggravate depression and cause seizures (rare)

51
Q

What conditions are cautioned with memantine?

A

Epilepsy
Severe hepatic impairment (avoid)
Renal impairment (adjust dose)

52
Q

What can be used for postural hypotension in Parkinson’s disease?

A

Midodrine

53
Q

What can be used for advanced Parkinson’s disease (can cause nausea therefore is given with domperidone)?

A

Apomorphine (injection or infusion)

However - risk of QT prolongation with domperidone therefore ECG monitoring required

54
Q

For bus, coach and lorry drivers, how long following a 1 off seizure can they reapply for a licence?

A

5 years (and taking no epilepsy medications)

55
Q

For bus, coach or lorry drivers, how long following multiple seizures can they reapply for a licence?

A

10 years (not taking epilepsy medication)

56
Q

For normal drivers, how long following your 1st seizure can you reapply for a licence?

A

6 months (providing medical advisors happy)

57
Q

How long is your driving licence taken away when you have a seizure?

A

12 months

6 months if the seizure was due to a change in epilepsy medication and you have returned to previous regime / dose

58
Q

Which SSRI has the shortest half life?

A

Paroxetine (stop slowly over several weeks)

59
Q

Which SSRI causes the worst GI side effects?

A

Sertraline

60
Q

Which SSRIs have the highest incidence of side effects? (3)

A

Fluoxetine, fluvoxamine, and Paroxetine

61
Q

What are the most common side effects of mirtazepine? (2)

A

Sedation and weight gain

62
Q

What are the most common side effects of SSRIs?

A

Nausea and sexual dysfunction

63
Q

How long should you take an antidepressant for?

A

6 months following 1st bout

1-2 years following relapse

3-5 years if multiple relapses

64
Q

What is the drug treatment for GAD?

A

SSRI
Different SSRI/SNRI
Pregabalin

Continue for 1 year

65
Q

What is the drug treatment for PTSD?

A

Venlafaxine (off label) or SSRI (sertraline or Paroxetine licenced)

Consider antipsychotics e.g. risperidone

Continue for 12 months

66
Q

What is the drug treatment for panic disorder?

A

SSRI

imipramine or clomipramine (TCA)

Continue for 6 months

67
Q

What is the drug treatment for social anxiety disorder?

A

SSRI (escitalopram or sertraline)
Different SSRI (fluvoxamine) or SNRI
MAOI (phenelyzine or moclobemide)

Continue for 6 months

68
Q

What should be used to treat insomnia if over 55 years?

A

MR melatonin for maximum of 13 weeks

69
Q

Which benzodiazepines are best for insomnia?

A

Nitrazepam and temazepam

70
Q

What are the main side effects of 1st generation (typical) antipsychotics? (5)

A

EPS
QT prolongation (particularly haloperidol)
Elevated prolactin
Sexual dysfunction
Blood dycrasias

71
Q

What generation is chlorpromazine?

A

1st

72
Q

What generation is amisulpride?

A

2nd

73
Q

What generation is pimozine?

A

1st

74
Q

What generation is prochlorperizine?

A

1st

75
Q

What is the mechanism of action for 1st generation antipsychotics?

A

Unselective D2 antagonists (hence EPS)

76
Q

What are the main side effects of 2nd generation antipsychotics? (3)

A

Weight gain
Postural hypotension (clozapine and quetiapine)
Blood dyscrasias

77
Q

Which 2nd generation antipsychotics are least likely to cause weight gain?

A

Aripiprazole, amisulpride, lurisonide

78
Q

Which antipsychotics are least likely to cause hyperprolactinaemia ?

A

Quetiapine and Aripiprazole

79
Q

What is the difference between depot and long acting injections

A

Depot = oil base
Long-acting = modified to be insoluble and therefore release slowly

80
Q

Which antipsychotics are available as depot/long-acting injections?

A

Depot: haloperidol, flupentixol, zuclopenthixol

Long-acting: Aripiprazole, paliperidone, olanzepine, risperidone

81
Q

What does HDAT mean?

A

High dose: over 100% of max. BNF dose

82
Q

When should clozapine be offered?

A

Treatment failure of 2 antipsychotics (1 has to have been a 2nd generation)

83
Q

What monitoring is required for clozapine

A

FBC:
Weekly for 18 weeks
Then twice a week from 18-52 weeks
Then once ever 4 weeks from 52 weeks

84
Q

What does a red result mean when monitoring clozapine?

A

STOP and monitor daily until green

85
Q

What does amber mean when monitoring clozapine?

A

Monitor twice a week

86
Q

What are the common side effects with clozapine and how are they treated?

A

Constipation - laxatives (obvs)
Hypersalivation - antimuscarinic e.g. Hyoscine hydro bromide

Can also reduce seizure threshold - may require prophylactic carbamazepine at high doses

87
Q

How does smoking affect clozapine levels?

A

Reduces them via enzyme induction

Pre Reg 2023 Nafisa (24 decks)

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