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AKT > Neurological Problems > Flashcards

Neurological Problems Flashcards

1
Q

1st line pharmacological treatment for muscle cramps in patient with motor neurone disease?

A

quinine
(2nd line is baclofen)
(other options-tizanidine, gabapentin, dantrolene)

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2
Q

Pharmacological treatments for muscle stiffness/spasticity/hypertonia associated with motor neurone disease?

A

baclofen, tizanidine, gabapentin, dantrolene

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3
Q

1st line pharmacological tx for excessive salivation in pt with motor neurone disease and cognitive impairment?

A

glycopyrrolate (glycopyrronium) (anticholinergic)

if pt did not have cognitive impairment then hyoscine hydrobromide patch + amitriptyline OR atropine drops 0.5% SL, would be 1st line

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4
Q

Which investigation would be most useful to differentiate between a benign essential tremor and a tremor associated with Parkinson’s disease if unable to differentiate clinically?

A

SPECT-single photon emission CT

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5
Q

Only licensed drug treatment in UK for MND?

A

Riluzole-started at 50mg BD
this is a disease modifying drug and acts to inhibit the release of glutamate
only licensed for ALS

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6
Q

Blood test monitoring for Riluzole?

A

Monthly FBC and LFTs in first 3 months, then every 3 months for further 9 months, then annually

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7
Q

Which are the only treatments to improve prognosis in MND?

A

Riluzole and NIV

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8
Q

DVLA guidance for drivers of cars who have had a first unprovoked epileptic seizure or a single isolated seizure?

A

Must not drive for 6 months, risk of recurrence must be less than 20% or can’t drive for 1 year

(group 2 drivers-5 years-must be seizure free for 5 years with normal investigations and seizure risk less than 2% per year)

Must notify DVLA

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9
Q

How long must patients with established epilepsy be seizure free for to continue driving a car?

A 
1 year (can be on medication)
(or pattern of seizures established for 1 year where no effect on level of consciousness or ability to act)

(group 2 drivers-10 years-must be fit free without medication)

Must notify DVLA

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10
Q

How long must patients who drive cars not drive for if had a seizure while asleep?

A

1 year
unless hx or pattern of seizures occurring only ever while asleep has been established over course of at least 1 year from date of 1st sleep seizure or pattern established over 3 years if pt previously had seizures whilst awake

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11
Q

DVLA guidance for drivers with epilepsy with regards to medication changes or withdrawal?

A

for group 1 drivers, must not drive during changes or withdrawal and for 6 months after their last dose
if a seizure occurs during changes or withdrawal then licence will be revoked for 1 year.

n/a to group 2 drivers-unable to drive if on medication, must be seizure free for 10 years not medicated

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12
Q

Lamotrigine is 2nd line tx for generalised tonic-clonic seizures, but what type of seizures might it exacerbate?

A

myoclonic

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13
Q

What type of seizures is ethosuximide a 1st line tx option for?

A

absence seizures (type of generalised)

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14
Q

Which drug has a specific role in treating epilepsy associated with menstruation?

A

Acetazolamide (carbonic anhydrase inhibitor)

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15
Q

Which is the most common atypical parkinsonian syndrome?

A

PSP-progressive supranuclear palsy

*vertical gaze palsy (downward), frequent falls especially backward, subtle personality changes

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16
Q

3 commonest presentations of multisystem atrophy (MSA)?

A
  • urogenital dysfunction-ED, incontinence
  • postural hypotension
  • ataxia
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17
Q

Non-motor sx associated with essential tremor?

A

cognitive decline

mental health problems

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18
Q

Pharmacological tx of essential tremor?

A

if functional disability can treat with a beta blocker (propranolol, atenolol)
or primidone

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19
Q

Why should a throat swab be considered with abrupt onset tics in a child or adolescent patient?

A

to check for streptococcus-look for PANDAS-paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections

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20
Q

Most helpful intervention for mild tics?

A

habit reversal training

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21
Q

What drugs can be offered as an adjunct to levodopa to patients with PD who have developed dyskinesia or motor fluctuations despite optimal dose of levodopa therapy?

A

dopamine agonists
MAO-B inhibitors
COMT inhibitors

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22
Q

Examples of non-ergot derived dopamine agonists?

A

ropinirole
rotigotine
pramipexole

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23
Q

Examples of ergot derived dopamine agonists?

A

bromocriptine
cabergoline
pergolide

*rarely used now due to risk of fibrotic reactions

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24
Q

Examples of MAO-B inhibtors?

A

Rasagiline

Selegiline

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25
Q

Examples of COMT inhibitors?

A

Entacapone
Opicapone
Tolcapone

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26
Q

Indications for antimuscarinic drugs in parkinsonism?

A

for drug-induced parkinsonism

example-procyclidine, can be given for side effects induced by anti-psychotics, BUT has no improvement on tardive dyskinesia

Antimuscarinics should NOT be used in PD

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27
Q

Management of impulse control disorders in patients with PD?

A

if on dopamine agonist then gradually reduce the dose

if modifying dopaminergic therapy is not effective offer specialist CBT targeted at impulse control

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28
Q

Pharmacological tx of excessive daytime sleepiness in PD?

A

consider modafinil if a detailed sleep hx has excluded reversible pharmacological and physical causes

note NOT to be given to pregnant women or those planning to become pregnant-risk of congenital malformations

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29
Q

1st line pharmacological tx of postural hypotension in patients with PD?

A

midodrine

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30
Q

Pharmacological tx of hallucinations and delusions in patients with PD?

A

consider quetiapine if no cognitive impairment

if standard tx not effective consider clozapine-note need to register with patient monitoring service

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31
Q

Treatment of mild-moderate PD dementia?

A

offer an acetylcholinesterase inhibitor e.g. donepezil, galantamine, rivastigmine-rivastgimine capsules only current option with UK marketing authorisation

consider memantine only if above not tolerated or CI

32
Q

Acute tx of migraine?

A

PO triptan and PO NSAID OR
PO triptan and PO paracetamol
if aged 12-17, consider nasal triptan in preference to PO

if cannot tolerate PO or nasal preps
offer non-oral metoclopramide or prochlorperazine AND
consider adding a non-oral NSAID or triptan

33
Q

Prophylactic tx of migraine?

A

Offer topiramate or propranolol-should consider preventative tx if 2 or more migraines/month
Note teratogenecity of topiramate and can reduce effectiveness of contraceptives
If both of the above ineffective (sx not relieved after 2 months)/not tolerated consider a course of acupuncture
Can also consider amitriptyline
R/v the need for continuing prophylaxis after 6 months of treatment
Riboflavin may be effective in some people

for menstrual migraine prophylaxis note can use frovatriptan although not licensed for this use, frovatriptan or zolmitriptan can be given on days the migraine is expected if standard acute tx not effective

34
Q

Acute tx of cluster headache?

A

off O2-100% flow rate at least 12L/min NRM+reservoir bag, and/or SC or nasal triptan

arrange provision for home and ambulatory oxygen

35
Q

Minimum duration recommended for keeping a headache diary in evaluation of a primary headache?

A

8 weeks

36
Q

Prophylactic treatment for chronic tension type headache (headache on 15 or more days/month for more than 3 months)?

A

acupuncture-consider a course of up to 10 sessions of acupuncture over 5-8 weeks

37
Q

Prophylactic tx of cluster headaches?

A

consider verapamil during a bout of cluster headache

(consider if frequent attacks, last over 3 weeks or cannot be treated effectively)

very common side effect=constipation

38
Q

Which Abx can lower seizure threshold in epilepsy?

A

quinolones-ciprofloxacin, levofloxacin

39
Q

Driving advice if single episode of syncope, explained and treated e.g. cardiovascular?

A

1 month off driving for group 1, 3 months for group 2

if unexplained, then 6 months off if group 1, 12 months off if group 2
2 or more epsiodes-12 months off

40
Q

Time off driving a car if multiple TIAs over short time period?

A

3 months

must inform the DVLA

41
Q

Time frame of referral for patient with syncope and suspected underlying CVS cause?

A

urgent referral for CVS assessment to be reviewed and prioritised within 24 hours

42
Q

If suspected epilepsy as cause of blackout how should pt be referred by primary care?

A

person should be referred for neurological assessment by an epilepsy specialist within 2 weeks

43
Q

What referral might be considered if patient experiencing recurrent blackouts with suspected vasovagal syncope affecting their QOL or representing high risk of injury?

A

referral for tilt table test

44
Q

Most common type of cerebral palsy?

A

spastic diplegia

45
Q

Most severe form of cerebral palsy, often associated with generalised tonic-clonic seziures?

A

spastic quadriplegia

46
Q

When can AEDs be considered to start to be withdrawn?

A

if seizure free for at least 2 years

47
Q

Most common cause of epilepsy related death in young adults with uncontrolled epilepsy?

A

SUDEP-sudden unexpected death in epilepsy

significant RF=nocturnal seizures

48
Q

Definition of remission in epilepsy?

A

5 years seizure free either on or off drug treatment (approx 70% of children and adults with epilepsy)

resolved if seizure free for the past 10 years and at least the past 5 years without AED treatment

49
Q

Baseline tests arranged by GP for adults with suspected epilepsy?

A
  • ECG

- Bloods-FBC, U+Es, LFTs, glucose and calcium

50
Q

1st line tx in the community for a patient having a tonic-clonic seizure lasting for more than 5 mins or who have had more than 3 seizure in 1 hour?

A

buccal midazolam
if not available or preferred can use rectal diazepam
IV lorazepam if IV access already established and resuscitation facilities available

51
Q

Anti epileptic drugs which increase risk of osteoporosis?

A 
sodium valproate
carbamazepine
phenobarbitol
phenytoin
primidone
52
Q

DVLA guidance for patients with dissociative seziures?

A

group 1-must inform DVLA and not drive, licensing may be reconsidered after 3 months seizure free

group 2-must inform the DVLA and not drive, licensing may be reconsidered once controlled for 3 months and no significant mental health issues

53
Q

Contraceptive advice for women taking lamotrigine for epilepsy?

A

oestrogen containing contraceptives e.g. COCP can reduce effectiveness of lamotrigine and therefore increase risk of seizures, progestogen only contraceptives can be used without restriction

54
Q

For which drugs used in epilepsy should patient be kept on a specific manufacturer’s product?

A

carbamazepine
phenytoin
phenobarbital
primidone

55
Q

Features of antiepileptic hypersensitivity syndrome?

A

fever
rash
lymphadenopathy
liver, haematological, renal and pulmonary abnormalities, vasculitis, multi organ failure

56
Q

During pregnancy, women on which anti epileptic drugs should have fetal growth monitored?

A

topiramate

levitiracetam (keppra)

57
Q

1st line tx monotherapy for focal seizures?

A

carbamazepine or lamotrigine

gabapentin and pregabalin can be used as adjuncts

58
Q

1st line tx for generalised tonic-clonic seziures?

A

sodium valproate

lamotrigine if valproate not suitable but may exacerbate myoclonic seizures

59
Q

1st line tx for absence seziures?

A

ethosuximide or sodium valproate

lamotrigine is an alternative

60
Q

1st line tx for myoclonic seziures?

A

sodium valproate

if unsuitable, topiramate or levetiracetam

61
Q

Adjunctive treatment in atonic and tonic seizures?

A

lamotrigine added to sodium valproate

62
Q

Dexamethasone loading dose if suspect metastatic spinal cord compression?

A

16mg

63
Q

Drug tx for MS related fatigue?

A

amantadine (weak dopamine agonist), not licensed for fatigue in MS
also used in parkinsons disease

CI in epilepsy and hx of gastric ulceration

64
Q

DVLA guidance on time off driving post stroke?

A

group 1-1 month

group 2-1 year

65
Q

DVLA guidance re refraining from driving after a significant head injury?

A

6-12 months

66
Q

NICE guidance on CT head for head injury in a person on anticoagulants?

A

if no other indications for a CT head but on anticoagulants then should have CT head within 8 hours of the injury, and a provisional written radiology report should be available within 1hour of the scan.

67
Q

DVLA restrictions if 1st unprovoked seizure for a group 1 driver and high risk (20% or higher) of recurrence?

A

must not drive for 1 year

AND must notify DVLA

68
Q

DVLA guidance if simple faint?

A

group 1-no restrictions

group 2-must inform the DVLA and must stop driving

69
Q

3 most common comorbid conditions associated with restless legs syndrome?

A
  • pregnancy-most commonly in 3rd trimester, drug tx not recommended
  • iron deficiency
  • stage 5 CKD

serum ferritin should be measured in all people with suspected RLS

70
Q

Drugs that can precipitate or exacerbate sx of restless legs?

A 
antidepressants
antipsychotics
lithium
antiepileptics
antihistamines
beta blockers
dopamine blockers e.g. metoclopramide

excessive intake of caffeine, alcohol or chocolate

71
Q

Consideration of drug tx for restless legs?

A

if moderate or severe sx
1st line: non ergot derived dopamine agonists e.g. ropinirole, pramiprexole, rotigotine -can be given as transdermal patch if significant daytime sx
OR
pregabalin or gabapentin (off label)-preferred if hx of severe sleep disturbance, anxiety, RLS associated pain, hx of impulse control disorders

weak opioid e.g. codeine is an alternative part. if painful symptoms

72
Q

Supplement that should be taken regularly for patients with PD?

A

Vitamin D

73
Q

DVLA guidance for patients with PD?

A

must notify DVLA
may be able to drive as long as condition doesn’t impair driving, group 1 subject to medical reports and group 2 subject to medical reports and assessment

74
Q

Dietary advice for improvement of motor sx in PD for pt on levodopa experiencing motor fluctuations?

A

protein redistribution diet-most protein eaten in final main meal of the day, on advice of dietician

75
Q

Examples of parkinsons disease specific physiotherapy?

A
  • The Alexander technique

- Treadmill training

76
Q

Adjuvant treatments in PD?

A
  • COMT inhibitors-given with levodopa to improve motor fluctuations
  • amantadine-aid dyskinesia
  • SC apomorphine (dopamine agonist)
  • deep brain stimulation to subthalamic nucelus-pt must be fit, responsive to levodopa and not have any comorbid mental health conditions
77
Q

Management of severe N+V in PD not associated with medication?

A

low dose domperidone

AKT (25 decks)

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