Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

gphc chapter revision > Central Nervous System > Flashcards

Central Nervous System Flashcards

(70 cards)

Start Studying
1
Q

What are the main aims of dementia treatment?

A

Manage symptoms, as there is no cure. CBT can be used for mild to moderate dementia to help with cognitive symptoms.

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

What types of drugs are associated with increased anticholinergic burden in patients with cognitive impairment?

A

Drugs with antimuscarinic effects, such as amitriptyline, paroxetine, chlorphenamine, promethazine, olanzapine, quetiapine, solifenacin, and tolterodine.

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

What is the first line treatment for mild to moderate Alzheimer’s disease (AD)?

A

Monotherapy with donepezil, galantamine, or rivastigmine (all ACEIs). If ACEI is not tolerated/CI then use memantine for moderate AD.

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

When can memantine be added to Alzheimer’s Disease treatment?

A

If a patient is already receiving an Acetylcholinesterase inhibitor (donepizil or rivastigmine) and develops moderate to severe AD, memantine can be added.

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

Which ACEIs are used (unlicensed) to treat mild to moderate dementia with Lewy bodies?

A

Donepezil or rivastigmine.

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

What is the recommendation regarding antipsychotics (APs) for dementia patients?

A

APs should only be offered if patients are at risk of harming themselves or others, or distressed by hallucinations. Use at the lowest effective dose and review every six weeks due to MHRA warnings about increased stroke and death risk.

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

What non-drug treatment should be considered for depression and anxiety in patients with mild to moderate dementia?

A

Psychological treatments such as CBT.

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

When initiating AED treatment, what dosing strategy is recommended?

A

Start with a low dose and increase gradually, adjusting based on plasma drug half-life to encourage adherence.

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

What should be done if monotherapy with a first-line AED is unsuccessful?

A

Try monotherapy with an alternative AED.

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

What is the MHRA advice regarding AEDs and suicidal thoughts?

A

All AEDs may be associated with a small increased risk of suicidal thoughts and behavior. Patients and carers should seek medical advice if mood changes or suicidal thoughts occur, but do not stop or switch AEDs without advice.

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

What does Category One for AED switching risk include?

A

Carbamazepine, Phenobarbital, Phenytoin, Primidone - MAINTAIN ON SPECIFIC BRAND.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the main symptoms of antiepileptic hypersensitivity syndrome?

A

Symptoms start 1-8 weeks after exposure: fever, rash, lymphadenopathy (most common 3 symptoms). Other symptoms: liver dysfunction, haematological, renal, pulmonary abnormalities, vasculitis, multi-organ failure. Withdraw drug immediately and DO NOT re-expose.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Under what condition can AEDs be withdrawn?

A

If a patient has been seizure-free for 2 years.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What driving restrictions apply after a first unprovoked epileptic seizure?

A

Patients must not drive for 6 months; can then resume driving if they are fit to.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the general advice regarding AED use in pregnancy?

A

Increased risk of teratogenicity, especially in the first trimester and with multiple AEDs. Valproate is highly teratogenic and should only be used if PPP conditions are met and alternatives are ineffective or not tolerated. Lamotrigine and levetiracetam are safer options. 5mg folic acid is needed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What advice should be given to females who find out they are pregnant while on AEDs?

A

They should seek urgent medical help and should not stop their AEDs without discussing this with their doctors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Regarding breast feeding by women on AEDs, what toxicity symptoms of infants should be advised?

A

Advise on signs of toxicity in the infant. All infants should be monitored for sedation, feeding difficulties, adequate weight gain, and developmental milestones.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What 1st line drugs may be considered for Focal seizures with or without secondary generalisation?

A

lamotrigine or levetiracetam.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the first-line treatment for tonic-clonic seizures in men and women unable to have children?

A

Sodium valproate. Alternatives: lamotrigine or levetiracetam [unlicensed].

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What should be offered as 1st line treatment for myoclonic seizures in males/females who can’t have kids?

A

Offer sodium valproate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What additional treatment should be considered if monotherapy is unsuccessful for Dravet syndrome?

A

Clobazam, stiripentol, and sodium valproate and alternative to this- clobazam and cannabidiol.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How treat Convulsive epilepticus, seizure lasting for 5 or more mins?

A

Use BZDs, such as diazepam rectal solution OR midazolam oromucosal solution.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the treatment for brief febrile convulsions?

A

Need no specific treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

In BPD, what is the recommendation regarding antidepressants?

A

DO NOT give in patients with rapid cycling bipolar disorder, recent history of mania, hypomania or with mood fluctuations. Stop antidepressant if the patient develops mania or hypomania.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What drugs are used in the treatment of acute episodes of mania or hypomania?
Antipsychotic drugs such as haloperidol, olanzapine, quetiapine, risperidone.
26
How to discontinue Antipsychotics used to treat acute episodes of mania or hypomania?
To discontinue APs – reduce dose over 4 weeks.
27
What is the recommendation regarding valproic acid and valproate in BPD for pregnant women?
Must NOT be used in BPD in pregnant women.
28
When should ADHD treatment be started?
Treatment should be started in patients with ADHD whose symptoms are still causing significant impairment in at least one area of function, despite environmental modifications.
29
What are the treatment considerations for ADHD?
First line; Lisdexamfetamine or methylphenidate Trial for 6 weeks, switch to other treatment if no effect.
30
What is the definition of chronic depression?
Chronic depression – continually met criteria of major depressive episode for two years or have persistent subthreshold symptoms or persistent low mood.
31
What is NOT a recommendation when treating depression?
Withholding treatment for depression on the basis of patients suicide risk is not recommended.
32
With regards to children under 18 with depression, what SSRI is used?
Fluoxetine.
33
What's the 1st line therapy for moderate or severe depression?
Combo therapy with an antidepressant and individual CBT should be offered as 1st line; monotherapy with an antidepressant or a psychological treatment e.g. CBT may also be offered as 1st line.
34
What is the treatment approach for Psychosis/Schizophrenia?
Oral AP +-Psychological therapy = offered to schizophrenic. Start low and slowly titrate up, need to receive optimum AP dose for at 4-6 weeks before judging if it is ineffective.
35
Why should prescribing more than one AP at a time be avoided?
Except in exceptional circumstances e.g. clozapine augmentation or when changing medication during titration because of increases risk of adverse effects such as EPSE, QT prolongation, sudden cardiac death.
36
What do first generation AP drugs (typical) block and what are the effects?
Block D2 receptors in the brain cause EPSE and hyperprolactinemia.
37
When using APs for elderly patients with dementia, what should be considered?
AP should not be used in dementia unless pts at risk of harming someone, agitated, hallucinations causing distress; Use lowest effective dose; Review treatment regularly; every 6 weeks.
38
What should be done if parkinsonian symptoms are identified during AP treatment?
Review treatment and aim to reduce AP dose. Procyclidine for all ESPE except TD.
39
What is considered essential to provide for all children with spasticity?
Offer physio and occupational therapy.
40
What is the use of oral diazepam or oral baclofen in spasticity?
Used to treat discomfort, pain, muscle spasm and functional disability.
41
What drug can be considered for drooling in epilepsy + cerebral palsy related situations?
Managed with antimuscarinic drug such as PO or enteral glycopyrronium bromide [unlicensed under 3] or transdermal hyoscine hydrobromide [unlicensed].
42
What drugs are used to suppress chorea in Huntington’s disease?
Haloperidol [unlicensed], Olanzapine [unlicensed], Quetiapine [unlicensed].
43
For the Parkinson's motor symptom of rest tremor, what should be done?
If PD is diagnosed – need to tell DVLA. Incurable progressive condition so symptom control is all we can treat.
44
What's often used as first line treatment for motor symptoms affecting QoL of Parkinson's patients?
Levodopa combined with carbidopa or benserazide (co-careldopa or co-beneldopa).
45
What do we do if patients develop dyskinesia or motor fluctuations on optimal levodopa therapy?
Offer a choice of non-ergotic dopamine receptor agonist, MAO-B inhibitors, or COMT inhibitors (entacapone or tolcapone) as an addition.
46
What is the appropriate treatment if a Parkinson's patient is hallucinating but has no cognitive impairment?
Quetiapine [unlicensed] for hallucinations/delusions; Clozapine as alternative.
47
In advanced PD conditions, what may be offered?
Offer apomorphine hydrochloride as intermittent or continuous SC infusions. To control N+V associated with apomorphine, administer domperidone {unlicensed in <35kg] 2 days prior to apomorphine therapy and stop asap.
48
What is the action of domperidone?
Acts on CTZ. Less likely to cause central effects (e.g. sedation and dystonia) than metoclopramide and phenothiazines as doesn’t cross the BBB.
49
When is ondansetron used?
If moderate to severe N+V consider IV fluids. Regular antiemetics needed, IV fluid and electrolyte replacement and nutritional support.
50
When handling motion sickness, what should be given?
Antiemetics should be given to prevent motion sickness rather than after N+V develop. Hyoscine hydrobromide – licensed for prevention of motion sickness e.g. N+V, vertigo.
51
What pain should respond to analgesics?
Nociceptive pain.
52
What is chronic pain defined as?
Chronic pain - pain being present for more than 12 weeks (beyond the expected time of wound healing).
53
What are the types of chronic primary pain?
Types of chronic primary pain: fibromyalgia, primary headache, orofacial pain, primary visceral, primary musculoskeletal pain.
54
What does MHRA highlight regarding AEDs and neuropathic pain?
AEDs can be used for management of neuropathic pain, see however info on risk of suicidal thoughts and behaviour.
55
When should tramadol be prescribed?
Tramadol is prescribed when other treatments have been unsuccessful.
56
What is the aim for acute migraine treatment?
Treatment should be restricted to 2 days per week and patients should be advised of the risk of developing medication overuse headaches.
57
When should 5HT1's be taken?
At start of headache.
58
What drugs should we NOT prescribe for prophylaxis to menstrual migraine?
Women with menstrual related migraine who are using 5ht1 agonists for both perimenstrual prophylaxis and at other times of month should be warned about medication overuse headache.
59
What's the drug of choice for cluster headaches?
SC sumatriptan is drug of choice for cluster headaches.
60
What is the use of anxiolytics regarding acute conditions?
In most cases should be used short term to alleviate acute conditions.
61
How should short term users (2-4 weeks) taper off BZDs?
Short term users (2-4 weeks) can taper off within 2-4 weeks. Long term users need to withdraw over a few months.
62
If transient insomnia occurs, what type of hypnotic should be chosen?
Choose a hypnotic that is rapidly eliminated.
63
What is the recommendation regarding hypnotics?
Hypnotics should not be prescribed indiscriminately and routine prescribing is undesirable.
64
What associated risk with BZDs should be accounted for?
Prolonged action causes drowsiness the next day.
65
Are beta-adrenoreceptor blocking drugs okay to use for long term anxiety?
No, they don’t affect psychological symptoms of anxiety e.g. worry, fear.
66
What should be used to attenuate alcohol withdrawal symptoms?
Long acting BZD – chlordiazepoxide or diazepam is recommended to attenuate alcohol withdrawal symptoms.
67
In a BZD withdrawal when alcohol is also a dependence issue, what should be done?
Inpatient withdrawal regimens should last 2-3 weeks or longer, depending on severity of BZD dependence; When withdrawal is managed in the community, or where there is a high level of BZD dependence, both the regimen should last for a minimum of 3 weeks.
68
What are appropriate acute treatments for delirium tremors caused by alcohol?
First line: oral lorazepam; If symptoms persist, parenteral lorazepam [unlicensed] or haloperidol [unlicensed] as adjuvant therapy.
69
At which point in methadone usage do drug concentrations peak and require titration?
As a long half life, so plasma concentration progressively rise during initial treatment even on same daily dose – 3-10 days for concentration to reach Css.
70
What medication in substitute of opioids is safer for drivers?
Buprenorphine is less sedating than methadone - better for a driver.

gphc chapter revision (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions