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Pharmacy Pre-reg > CNS > Flashcards

CNS Flashcards

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
Q

Which anti seizure medicines require a pregnancy prevention plan

A

Valproate, Topiramate

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26
Q

Valproate MHRA alerts

A

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

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27
Q

Sodium valproate target level

A

50-100

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28
Q

Phenobarbital target level

A

15-40

29
Q

When should levels be taken for antiepileptics

A

Pre dose trough

30
Q

What is sodium valproate licensed to treat?

A

All forms of epilepsy, Mania,

Migraine prophylaxis unlicensed

31
Q

Valproate toxicity

A

N&V, Abdo pain, Anorexia, Jaundice, Oedema (<Na+), Drowsiness, Seizures, Suicidal

32
Q

Which antiepileptics affect the eyes

A

Vigabatrin reduces visual field
Topiramate causes glaucoma

33
Q

How to treat an acute episode of mania

A

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
Q

How are manic episodes prevented

A

1st Lithium
2nd valproate or carbamazepine

35
Q

Lithium target levels

A

0.4-1

36
Q

Lithium toxicity

A

They act drunk
N&V, blurred vision, tremor, drowsiness, polyuria, confusion, arrhythmia, thirst, reflexes, coordination and speech loss,

37
Q

When should lithium levels be measured

A

12h post dose weekly in week 1
Then 3 monthly for year 1
Then 6 monthly

38
Q

Apart from toxicity what else can lithium cause

A

+/-Thyroid, nephrotoxic, Rhabdomyolysis, QT prolongation, intracranial HTN, teratogenic in 1st trimester

39
Q

When in combination with which drugs will lithium cause hyponatraemia

A

SSRIs, Diuretics, Carbamazepine

40
Q

What electrolytes does lithium disturb

A

Sodium and potassium both lowered

41
Q

What should you counsel Parkinson’s patients on regarding their treatment

A

Impulse control disorders
sudden onset sleep
Levodopa red urine
No tyramine foods if MAOBi

42
Q

What antipsychotic is most associated with weight gain

A

Olanzapine and clozapine

43
Q

Benefits of aripiprazole

A

Less extrapyramidal SEs
Reduces prolactin in hyperprolactinaemia
Less QT-prolongation
Least hyperglycaemic and weight gaining

44
Q

When is clozapine licensed

A

When 2 other antipsychotics fail

45
Q

Clozapine MHRA warnings

A

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
Q

When to take clozapine levels

A

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
Q

When must clozapine be retitrated

A

After 2 missed doses/ coming to 3rd dose

48
Q

Clozapine target levels

A

0.35-5

49
Q

Which antiepileptic causes gingivinal hyperplasia

A

Phenytoin

50
Q

High risk drugs that cause serotonin syndrome

A

Lithium, methadone, linezolid, Tramadol, fentanyl, Triptans, prams, SNRIs, MAOi, St. John’s wort, amphetamines

51
Q

What drugs should be avoided in sciatica

A

paracetamol monotherapy ineffective must be combined.
SSRI, SNRI, TCA, GABA, Antiepileptics

52
Q

How is spasticity treated in multiple sclerosis?

A

Baclofen

53
Q

How is fatigue managed in multiple sclerosis?

A

Amantadine

54
Q

Drugs contraindicated in Myasthenia Gravis

A

Quinolones
Beta blockers
Aminoglycosides
Tetracyclines
Macrolides
Antimilarials
Neuro claps

Clozapine
Lithium
Antipsychotics
Phenytoin

55
Q

Which antiemetics cause parkinsonisms

A

Metoclopramide
Prochlorperazine

56
Q

Sedating antihistamines

A

Hydroxyzine, Promethazine, Cinnarizine, Diphenhydramine, Cyclizine, Buclizine, Chlorphenamine

57
Q

Non-sedating antihistamines

A

Acrivastine, Cetirizine, Desloratadine, Loratadine, Fexofenadine

58
Q

How can hypersensitivity reactions and Steven Johnson Syndrome be avoided in Lamotrigine?

A

Slowly uptitrate to an effective dose

59
Q

What analgesic option is least appropriate for a patient taking lithium

A

NSAIDs

60
Q

Triptans Contraindications

A

Elderly
HTN
prev stroke/ MI/ TIA
Vascular disease

Cautioned if seizure history

61
Q

If an epileptic patient has compliance issues which AEP is a good option

A

Phenytoin has a long half life

62
Q

Thiazide like diuretics in renal impairment

A

Ineffective below 30mL/min

63
Q

Loop diuretics in renal impairment

A

High doses cause tinnitus and deafness but can be used

64
Q

Potassium sparing diuretics in renal impairment

A

Avoid in AKI and SEV impairment <30mL/min

65
Q

Which medicine is best for sedation in Parkinson’s

A

Risperidone least associated with hallucinations but still sedating

66
Q

Which antipsychotic is least associated with hallucinations

A

Risperidone

67
Q

Methylphenidate review

A

Appetite
HR
BP
Weight

68
Q

Management of changing a gabapentinoid to another medicine compared to another gabapentinoid

A

Between no weaning required
Addictive creating dependence

69
Q

How do Carbamazepine and Bendeoflumethiazide interact

A

Hyponatraemia

Pharmacy Pre-reg (5 decks)

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