Chapter 4: Nervous system Flashcards
(27 cards)
Which one of the following medicines does NOT affect the monoamine oxidase enzyme family?
Selegiline
Linezolid
Moclobemide
Phenelzine
Clonidine
Clonidine
A 29-year-old woman was started on fluoxetine two weeks ago for depression. At her follow up appointment with her GP, she reports that she has felt more anxious since starting the medication and that her mood has not improved. The GP has called you for advice on the management of this case.
Which one of the following is the most appropriate course of action in relation to the patient’s fluoxetine therapy?
Select one:
A. Continue fluoxetine and review with the GP again in 3 months
B. Continue fluoxetine for another 2 weeks and reassess whether there has been any improvement Correct
C. Gradually reduce the dose of fluoxetine with the aim of ceasing over the next 2-4 weeks
D. Stop fluoxetine and start a different class of antidepressant
E. Stop fluoxetine and start a different class of antidepressant after 2 weeks
Treatment should be continued for at least 4 weeks (6 weeks in the elderly) before considering whether to switch antidepressant due to lack of efficacy. In cases of partial response, continue for a further 2–4 weeks (elderly patients may take longer to respond).
Ref: https://bnf.nice.org.uk/treatment-summary/antidepressant-drugs.html
The correct answer is: Continue fluoxetine for another 2 weeks and reassess whether there has been any improvement
A 45-year-old male patient has schizophrenia and has been prescribed olanzapine to prevent the recurrence of his bipolar disorder. He has no other significant past medical history. Identify the parameters that must be reviewed and recorded before commencing treatment.
Select one:
A. Blood pressure
B. Chest X-ray
C. Electrocardiogram (ECG)
D. Fasting blood glucose Correct
E. Heart rate
F. Plasma urea
G. Serum alanine transaminase (ALT)
H. Urinalysis
Fasting blood glucose – patients taking antipsychotics, particularly olanzapine are susceptible to hyperglycaemia and diabetes therefore fasting BG must be tested at baseline and at regular intervals thereafter.
The correct answer is: Fasting blood glucose
A 45-year-old woman takes methadone 1 mg/mL oral solution 65 mg daily for opioid addiction. She has been prescribed domperidone 10 mg, three times a day by her GP.
Select one:
A. Bradycardia
B. Hypertensive crisis
C. Increased eGFR
D. Increased risk of bleeding
E. QT interval prolongation
F. Reduced eGFR
G. Tachycardia
H. Toxicity of either or both drugs
Domperidone increases the risk of QT-prolongation when given with methadone. Manufacturer advises avoid.
https://bnf.nice.org.uk/interaction/methadone.html
The correct answer is: QT interval prolongation
A 68-year-old man, who is taking citalopram for depression, presents with drowsiness, confusion, and convulsions.
Select one:
A. Hypercalcaemia
B. Hyperkalaemia
C. Hypermagnesaemia
D. Hypernatraemia
E. Hypoglycaemia
F. Hypokalaemia
G. Hypomagnesaemia
H. Hyponatraemia Correct
Hyponatraemia
A 64-year-old man is prescribed alprazolam 500 mcg three times daily. He has consumed 5 mg today.
Acetylcysteine
Aspirin
Digoxin-specific antibody
European viper snake venom antiserum
Flumazenil
Methaemoglobinaemia
Naloxone hydrochloride
Protamine sulfate
Flumazenil
This drug may exacerbate oedema and because of this is cautioned for use in congestive heart failure.
Trihexyphenidyl
Procyclidine hydrochloride
Orphenadrine hydrochloride
Tolcapone
Amantadine hydrochloride
Selegiline hydrochloride
Entacapone
Rasagiline
Amantadine hydrochloride
Amantadine is cautioned in congestive heart failure as it may exacerbate oedema.
References: BNF, Nervous system, Parkinson’s disease and related disorders
This drug may colour the urine reddish-brown.
Trihexyphenidyl
Procyclidine hydrochloride
Orphenadrine hydrochloride
Tolcapone
Amantadine hydrochloride
Selegiline hydrochloride
Entacapone
Rasagiline
Entacapone
Entacapone may colour the urine reddish-brown.
A 32-year-old male who has been prescribed lamotrigine for the first time.
- Take this medication on an empty stomach
- Take this medication after food
- You may experience sudden onset of sleep. Please exercise caution when performing skilled tasks
- Report any signs of visual impairment immediately to your prescriber
- Your medication may colour your urine blue. This is harmless
- Do not take this medication at the same time as antacids
- Immediately report any signs or symptoms of anaemia, bruising or infection to your doctor
- Take this medication at night
Immediately report any signs or symptoms of anaemia, bruising or infection to your doctor
Anaemia, bruising or infection are signs of bone marrow suppression.
Miss T is a 22-year-old female who regularly comes to your pharmacy to collect her prescription for fluoxetine. Today she presents you her prescription with a new additional drug, phenelzine.
Which one of the following is the best course of action to take?
Dispense both medications and advise Miss T to take phenelzine after food
Dispense both medications and advise Miss T to avoid eating foods rich in tyramine
Dispense both medications and advise Miss T to take both of them on an empty stomach
Dispense both medications and advise Miss T to take them at least 4 hours apart
Do not dispense her medication and contact her prescriber to advise him of the serious adverse effects associated with this combination of drugs.
Do not dispense her medication and contact her prescriber to advise him of the serious adverse effects associated with this combination of drugs.
The combination of these two drugs may result in central serotonin syndrome which is characterised by changes in mental status, agitation, diaphoresis, tachycardia and death.
Miss J is a 23-year-old female who has multiple sclerosis. She comes into your pharmacy on Saturday evening looking very concerned. After taking her into the consultation room, she tells you that she is beginning to see objects other people can’t see and that she is sweating profusely. She tells you that she stayed over at her sister’s house in Cornwall over the past 3 days and that she only took her glyceryl trinitrate spray with her.
Given that Miss J takes the following medicines: Glyceryl trinitrate 400 microgram sublingual spray prn, Verapamil 120 mg t.d.s, Baclofen 20 mg t.d.s, Loperamide m.d.u, and that there are no other signs or symptoms, which one of the following is the most likely cause of her symptoms?
A mosquito bite
Travel sickness
Food poisoning
Sudden withdrawal of baclofen
Sudden withdrawal of verapamil
Sudden withdrawal of baclofen
Serious life-threatening side-effects such as hallucinations and fever result from sudden withdrawal of baclofen therapy. Patients must be warned not to suddenly stop taking this medication.
You receive a prescription for haloperidol 500 mcg tablets for one of your patients. Your PMR system flags that haloperidol is contraindicated for this patient.
Which one of the following medical conditions would mean that haloperidol is contraindicated for this patient?
Diabetes
Depression
Parkinson’s disease
Schizophrenia
Tuberculosis
Parkinson’s disease
The symptoms of Parkinson’s may be precipitated by haloperidol.
Ms AL suffers from depression and has been taking phenelzine 15 mg three times daily for the last 6 months. As she is not responding to treatment her doctor has decided to change her to fluoxetine capsules.
How soon after stopping the phenelzine can Mrs AL start taking the fluoxetine?
Immediately
1 week
2 weeks
3 weeks
4 weeks
The correct answer was 2 weeks
You receive a prescription for phenytoin injection 250 mg/5 mL, 100 mg three times daily for one of your patients. The trainee dispensing technician comments that she has never seen phenytoin prescribed in injection form before and asks you why this is.
What is the best explanation to give her?
Injectable phenytoin decreases adherence
Injectable phenytoin increases the risk of adverse events
Injectable phenytoin is more error-prone with a risk of death
Injectable phenytoin provides a slower response
Injectable phenytoin reduces efficacy
Injectable phenytoin is more error-prone with a risk of death
Although the other points may be factually correct, in a practice the reason for phenytoin not being prescribed as an injection is primarily that it is more error-prone than in oral form and this can lead to an increased risk of patient deaths.
You have a patient ask you about purchasing sumatriptan for migraines.
Which of the following medicines is known to interact with sumatriptan?
Aspirin
Ibuprofen
Mefenamic acid
Paracetamol
Tramadol
The correct answer was Tramadol
Both sumatriptan and tramadol can increase the risk of serotonin syndrome.
A 27-year-old pregnant woman comes into the pharmacy to purchase some nicotine replacement therapy (NRT) to help her to quit smoking. She is otherwise healthy, with no other medical conditions, and she is not taking any other medication. She is, however, suffering from pregnancy-related nausea and vomiting.
Which one of the following is the most suitable formulation of NRT for this patient?
Nicotine gum
Nicotine lozenge
Nicotine mouth spray
Nicotine nasal spray
Nicotine patch
The correct answer was Nicotine patch
Normally intermittent therapy recommended for pregnant women e.g gum, lozenge etc, but with morning sickness a patch is more appropriate - taken off before bed and put on first thing in morning.
Ensuring appropriate GP referral will help safeguard patients.
Which of the following should result in referral to the patient’s GP?
A 15-year-old patient who is complaining of constipation
A 46-year-lady complaining of cystitis like symptoms
A patient aged 68 complained of a migraine-like symptoms for the first time
A 7-year-old child who is congested
A 12-year-old boy who has pyrexia
The correct answer was A patient aged 68 complaining of a migraine like symptoms for the first time
Any patient over the age of 60 years experiencing a first time migraine should be referred to their GP.
Mrs WB is a 77-year-old woman, who is admitted to hospital for the treatment of hallucinations. Her past medical history is multiple sclerosis. Her doctor decides to prescribe haloperidol. During treatment, Mrs WB complains of feeling unwell and you are asked if this could be due to the haloperidol.
Which ONE of the following symptoms suffered by Mrs WB is most likely to be caused by haloperidol?
The SPC is provided here: https://www.medicines.org.uk/emc/product/4521/smpc
Sweating
Dizziness
Diarrhoea
Dyspnoea
Fatigue
The correct answer was Dizziness
Dizziness is listed as a common adverse drug reaction of the nervous system for haloperidol.
Which ONE of the following is likely to require dose adjustment due to a drug interaction if the patient starts or stops smoking?
Salbutamol
Salmeterol
Ipratropium
Tiotropium
Theophylline
The correct answer was Theophylline
Smokers may require higher doses of theophylline as it is cleared quicker in these patients. Those who stop smoking will need to have their dose adjusted, as they will no longer require the higher doses as in smokers.
Some medicines are subject to additional monitoring requirements co-ordinated by the manufacturer. Which of the following medicines is subject to such a programme?
Clozapine
Fluoxetine
Olanzapine
Quetiapine
Sertraline
The correct answer was Clozapine
The use of Clozaril (clozapine) is restricted to patients who are registered with the Clozaril Patient Monitoring Service. The UK Clozaril Patient Monitoring Service (CPMS) was developed in order to manage the risk of agranulocytosis associated with clozapine. Similar schemes are run by generic makers of the medicine.
There are several reasons for withdrawing glucocorticoids slowly.
Which option, when stopped suddenly, is the most likely to cause withdrawal symptoms?
40 mg prednisolone daily for 5 days
25 mg prednisolone daily for 14 days
10 mg prednisolone daily for 21 days
20 mg prednisolone daily for 10 days
50 mg prednisolone daily for 10 days
The correct answer was 50 mg prednisolone daily for 10 days
Gradual withdrawal should be considered for patients receiving more than 40 mg prednisolone (or equivalent) daily for more than 1 week.
Ms G is a 78-year-old female who is a regular customer at your pharmacy. She has recently been initiated on Flupentixol. Which of the following risks are NOT associated with the use of antipsychotics in elderly patients?
Hypothermia
Hyperthermia
Hypoglycaemia
Postural hypotension
Stroke
The correct answer was Hypoglycaemia
Hyperglycaemia (NOT hypoglycaemia) and sometimes diabetes is a risk with all antipsychotics.
Which of the following can be a side-effect of mirtazapine?
The SPC is provided here: https://www.medicines.org.uk/emc/product/535
Hypokalaemia
Hyponatraemia
Hypocalcaemia
Hypomagnesaemia
Hypophosphataemia
The correct answer was Hyponatraemia
A 45-year-old patient, who works on the night shift, is prescribed a 10-day supply of temazepam 10 mg when required to help sleep.
Which counselling point is the most appropriate for this patient for to get the best effect from their medicine?
Do not take with food
Do not use for more than 3 weeks
Take at night
Take 30-60 minutes before you want to sleep
This medicine may make you drowsy
The correct answer was Take 30-60 minutes before you want to sleep
‘Do not take with food’ is irrelevant. ‘Do not use for more than 3 weeks’ is less important as the patient only has a 10 day supply. ‘Take at night’ is not appropriate as this is when the patient will need to be alert during the night to be able to work. ‘Take 30-60 minutes before you want to sleep’ is the most relevant as this information will best match their need. ‘This medicine may make you drowsy’ is less important as the indication is to help sleep.
