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Pharmacy Pre-reg > CNS > Flashcards

CNS Flashcards

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1
Q

What type of seizures are Carbamazepine, Oxcarbazepine, Zonisamide indicated for

A

Focal 2nd line

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2
Q

What are the first line anti seizure medicines if you are a woman of childbearing age?

A

Lamotrigine / Levetiracetam

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3
Q

What is the most effective and 1st line anti seizure medicine

A

Sodium valproate

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4
Q

Absence seizure 1st line

A

Ethosuximide

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5
Q

What are the treatment options for non-self-terminating status epilepticus

A

IV Lorazepam 1st
Buccal Midazolam
Rectal Diazepam

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6
Q

A patient taking carbamazepine 200mg tablets 2BD is nil by mouth what options do you have

A

Rectal carbamazepine
Increase dose by 25% to 1000mg rectally so 1x 250mg suppository QDS

Not ideal
NG tube crush and disperse
IV Levetiracetam conversion

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7
Q

What anti seizure medicines must a patient be maintained on the same brand?

A

Carbamazepine, Phenytoin, Phenobarbital, Primidone

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8
Q

Medicines that Lower the seizure threshold

A

Tramadol, Theophylline, Quinolones, Bupropion, beta Lactams, Metronidazole, Isoniazid, SSRIs, TCAs, MAOis

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9
Q

Lamotrigine side effect

A

Steven Johnson’s Syndrome

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10
Q

Which antiepileptics cause respiratory depression

A

Gabapentinoids

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11
Q

Which antiepileptic can cause hyponatraemia and oedema

A

Carbamazepine

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12
Q

Which anti seizure medicines induce hepatic enzymes?

A

Phenytoin, Phenobarbital, Carbamazepine

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13
Q

Which anti seizure medicines inhibit hepatic enzymes

A

Sodium Valproate

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14
Q

Carbamazepine target level

A

4-12mg/L

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15
Q

Carbamazepine toxicity signs

A

Hyponatraemia
Ataxia (slow movements)
Nystagmus (eye drift)
Drowsiness
Blurred vision
Arrhythmias
Gastro disturbances

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16
Q

Phenytoin target level

A

10-20mg/L

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17
Q

Which drug has the same target level as phenytoin and what is the level range?

A

Theophylline
10-20mg/L

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18
Q

Phenytoin toxicity

A

Slurred speech
Nystagmus (eye drift)
Ataxia (slow movements)
Confusion
Hyperglycaemia
Double vision

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19
Q

How does epilepsy affect driving

A

Once seizing must stop driving and inform DVLA
If 1st unprovoked or a single isolated seizure can drive after 6 months of no seizures
In established epilepsy 1 year seizure free warrants driving
If medication stopped no driving for 6months

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20
Q

What injection is given to children of epileptics at birth and why?

A

Vitamin K
Reduce risk of neonatal haemorrhage

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21
Q

What supplement is given during the first trimester and why

A

Folic acid
Prevent neural tube defects

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22
Q

Which antiepileptics are teratogenic

A

Valproate (PPP), Topiramate (PPP), Carbamazepine, Phenobarbital, Zonisamide, Phenytoin

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23
Q

Which antiepileptics are most present in breastmilk

A

Primidone, Ethosuximide, Lamotrigine, Zonisamide

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24
Q

What are the MHRA warnings shared between all antiepileptics

A

Suicidal ideation and behaviour
Only specialists should switch between agents/ brands
All are potentially teratogenic

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25
Which anti seizure medicines require a pregnancy prevention plan
Valproate, Topiramate
26
Valproate MHRA alerts
PPP required 2 specialists must independently agree this is the only option to initiate Annual consent of teratogenic risk form for female patients Could affect male offspring Must issue an alert card Must prescribe and dispense full boxes only
27
Sodium valproate target level
50-100
28
Phenobarbital target level
15-40
29
When should levels be taken for antiepileptics
Pre dose trough
30
What is sodium valproate licensed to treat?
All forms of epilepsy, Mania, Migraine prophylaxis unlicensed
31
Valproate toxicity
N&V, Abdo pain, Anorexia, Jaundice, Oedema (
32
Which antiepileptics affect the eyes
Vigabatrin reduces visual field Topiramate causes glaucoma
33
How to treat an acute episode of mania
Stop antidepressant Start Olanzapine or quetiapine or haloperidol or risperidone If ineffective try another from above If ineffective add lithium If lithium not suitable use valproate
34
How are manic episodes prevented
1st Lithium 2nd valproate or carbamazepine
35
Lithium target levels
0.4-1
36
Lithium toxicity
They act drunk N&V, blurred vision, tremor, drowsiness, polyuria, confusion, arrhythmia, thirst, reflexes, coordination and speech loss,
37
When should lithium levels be measured
12h post dose weekly in week 1 Then 3 monthly for year 1 Then 6 monthly
38
Apart from toxicity what else can lithium cause
+/-Thyroid, nephrotoxic, Rhabdomyolysis, QT prolongation, intracranial HTN, teratogenic in 1st trimester
39
When in combination with which drugs will lithium cause hyponatraemia
SSRIs, Diuretics, Carbamazepine
40
What electrolytes does lithium disturb
Sodium and potassium both lowered
41
What should you counsel Parkinson’s patients on regarding their treatment
Impulse control disorders sudden onset sleep Levodopa red urine No tyramine foods if MAOBi
42
What antipsychotic is most associated with weight gain
Olanzapine and clozapine
43
Benefits of aripiprazole
Less extrapyramidal SEs Reduces prolactin in hyperprolactinaemia Less QT-prolongation Least hyperglycaemic and weight gaining
44
When is clozapine licensed
When 2 other antipsychotics fail
45
Clozapine MHRA warnings
Fatal faecal impaction/intestinal obstruction/paralytic ileus must be on laxatives aiming 2-3 soft stools a day. Level monitoring for agranulocytosis and toxicity especially if smoking is changed
46
When to take clozapine levels
Immediately pre-dose trough If OD dosing 10-12h post dose Weekly 1st 18w, q2w until 1st year done Monthly thereafter and 1m after cessation
47
When must clozapine be retitrated
After 2 missed doses/ coming to 3rd dose
48
Clozapine target levels
0.35-5
49
Which antiepileptic causes gingivinal hyperplasia
Phenytoin
50
High risk drugs that cause serotonin syndrome
Lithium, methadone, linezolid, Tramadol, fentanyl, Triptans, prams, SNRIs, MAOi, St. John’s wort, amphetamines
51
What drugs should be avoided in sciatica
paracetamol monotherapy ineffective must be combined. SSRI, SNRI, TCA, GABA, Antiepileptics
52
How is spasticity treated in multiple sclerosis?
Baclofen
53
How is fatigue managed in multiple sclerosis?
Amantadine
54
Drugs contraindicated in Myasthenia Gravis
Quinolones Beta blockers Aminoglycosides Tetracyclines Macrolides Antimilarials Neuro claps Clozapine Lithium Antipsychotics Phenytoin
55
Which antiemetics cause parkinsonisms
Metoclopramide Prochlorperazine
56
Sedating antihistamines
Hydroxyzine, Promethazine, Cinnarizine, Diphenhydramine, Cyclizine, Buclizine, Chlorphenamine
57
Non-sedating antihistamines
Acrivastine, Cetirizine, Desloratadine, Loratadine, Fexofenadine
58
How can hypersensitivity reactions and Steven Johnson Syndrome be avoided in Lamotrigine?
Slowly uptitrate to an effective dose
59
What analgesic option is least appropriate for a patient taking lithium
NSAIDs
60
Triptans Contraindications
Elderly HTN prev stroke/ MI/ TIA Vascular disease Cautioned if seizure history
61
If an epileptic patient has compliance issues which AEP is a good option
Phenytoin has a long half life
62
Thiazide like diuretics in renal impairment
Ineffective below 30mL/min
63
Loop diuretics in renal impairment
High doses cause tinnitus and deafness but can be used
64
Potassium sparing diuretics in renal impairment
Avoid in AKI and SEV impairment <30mL/min
65
Which medicine is best for sedation in Parkinson’s
Risperidone least associated with hallucinations but still sedating
66
Which antipsychotic is least associated with hallucinations
Risperidone
67
Methylphenidate review
Appetite HR BP Weight
68
Management of changing a gabapentinoid to another medicine compared to another gabapentinoid
Between no weaning required Addictive creating dependence
69
How do Carbamazepine and Bendeoflumethiazide interact
Hyponatraemia

Pharmacy Pre-reg (5 decks)

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