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CNS Flashcards

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1
Q

What is first line in absent seizures?

A

Ethosuximde

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2
Q

What is the treatment for focal seizures?

A

2 Ls to get focussed : levetiracetam
Or lamotrigine

2nd line: carbamazepine, oxcarbazepine or zonisamide

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3
Q

assuming a man / woman is of child bearing potential, what drug are they given in tonic-clonic, myoclonic, tonic and atoning seizures ?

A

TC: lamotrigine / levetiracetam
Myoclinic : levetiracetam
Atomic: lamotrigine
Tonic: lamotrigine

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4
Q

What is status epilepticus?

A

A seizure >5 mins

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5
Q

What drugs are given for status epilepticus ?

A

IV Loraz if in hosp
Buccal Middaz / rectal Diaz if no resus facilities available

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6
Q

What is the treatment for status epileticus?

A

IV loraz / buccal Midaz / rectal Diaz

Then if no response in 5-10 mins : give second dose

If no response after 2 benzos: levetiracetam / phenytoin / sodium Valpro

Still no response : phenobarbital/ general anaesthetic

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7
Q

What are the 3 category 1 antiepileptics ?

A

3Ps C
Phenytoin
Primidone
Phenobarbital
Carbamazepine

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8
Q

What are category 3 antiepiletics ?

A

BELLT
birateracetem
Ethosuximide
levetiracetam
Lacosamide
Tiagabine
Vigabatrin

Pregablin
Gabapentin

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9
Q

What are category 2 anti epileptics?

A

Valproate
Lamotrigine
Oxcarbazepine
Clobazm
Clonazepam
Perampanel
Topiramate
Rufinamide

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10
Q

What drugs lower seizure threshold ?

A

Tramadol
Theophylline
Quinolones - floxacins
SSRIS

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11
Q

What anti epileptics is full pack dispensing required for

A

Sodium valpro

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12
Q

What are the side effects of valproate

A

VALPROATE
Vomitting / Vit D deficiency
Alopecia
Liver dysfunction+ toxicity
Pancreatitis
Reduced sodium
Oral disorders
Agranulocytosis
Teratogenic
Encephalopathy
Suicide

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13
Q

Which is the most teratogenic anti epileptic

A

Sodium valpro

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14
Q

How often is a PPP completed if on sodium valpro

A

Annually

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15
Q

what is the therapeutic range of carbamazepine

A

4-12mg/L

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16
Q

What is the therapeutic range of phenytoin

A

10/20mg/L

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17
Q

What are carbamazepine side effects

A

HANDBAG
Hyponatremia ,
Ataxia
Nystagmus
Drowsiness + depression + Vit D deficiency
Blurred vision + blood disorders
Arrhythmias
GI
Odesa

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18
Q

What are phenytoin side effects

A

SNACHED
Slurred speech
nystagmus
Ataxia
Confusion
Hyperglycaemia + hair (facial hair) +hepatotoxic
Double vision + depression

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19
Q

Which anti epileptic is most likely to cause encephalopathy?

A

Vigabatrin

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20
Q

Which anti epileptics are most likely to cause eye problems including glaucoma

A

Vigabatrin and topiramate

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21
Q

What should drivers do after a fit?

A

Stop driving- single incident = stop driving for 6 months

Established epilepsy = stop for 1 year

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22
Q

After a medication change how long should drivers wait?

A

6 months after last dose

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23
Q

What is the risk of topiramate in unborn babies?i

A

Cleft palate

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24
Q

Which antiepilepictis have a high presence in milk?

A

PELZ
Primidone
Ethosuximide
Lamotrigine
Benzos

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25
If on anti epileptics should a mother breast feed ?
Yes - encouraged to do so
26
Which antiepileptics have a suicide risk?
Carbamazepine , phenytoin and valproate
27
Which antiepileptics have a suicide risk?
Carbamazepine , phenytoin and valproate
28
What is monitored while on valproate ?
LFTs
29
In which antieplileltics should we look out for signs of blood disorders ?
Carbemaz Phenytoin Sodium valpro Topiramate Ethosuximide Lamotrigine Zonisamide
30
Which anti epileptic is most likely to cause Steven Johnson syndrome ?
Lamotrigine
31
What are some general side effects of anti epileptics
SLIM FAT CAT Suicidal thoughts Liver Impaired bone health Minor blood dysxasiaa Folate deficiency Acute psychotic (VTT) Teratogen Changes in weight Antiepileptics hypersensitivity syndrome Thrombocytopenia
32
Which antiepileptics can cause withdrawal in a baby who stops breastfeeding suddenly
Primidone Phenobarbital Benzos Lamotrigine
33
What foods can cause migraine
Chocolate and wine
34
What is an aura
Visual (zig zags, flashing lights etc) Sensory (pins and needles/numbnes)
35
How are Tristan’s taken for migraines?
Take as soon as HEADACHE part of migraine starts (not aura !!!!) If it helps a bit then can have another after 2 hours (4 hours for naratriptan)
36
When is naratriptan second dose given and under what condition?
After 4 hours and only if first one has helped at least a bit
37
Who should NOT have Triptans?
Uncontrolled hypertension !!!
38
What is a cluster headache
Intense unilateral pain 1 eye
39
What is trigeminal neuralgia and how is it treated ?
Shock like pain in jaw / teeth / gums - carbamazepine
40
What’s a tension headache and how is it treated?
tight band pain Paracetamol
41
What drug is used for migraine prophylaxis?
Propranolol
42
Why should levodopa not be stopped abruptly?
Risk of NMS and rhabdomyolysis
43
What are Levodopa side effects
Loss of appetite Euphoric mood Vomitting Orthostatus hypotension Daytime sleepiness Oral disorders Pathological gambling Addiction ++ red urine
44
What are the side effects of COMT inhibitors
Entaca = red brown urine Tolcapone: hepatotoxic
45
What are the side effects of cabergoline and brompcriptine?
CHEST
46
What should be done if someone has off periods on levodopa?
Switch to MR
47
What should be done if someone has off periods on levodopa?
Switch to MR
48
How is hypotension treated in Parkinson’s?
Midodrine
49
How is sudden onset of sleep treated in parkinsons
Modanifil
50
What OTC medicine do MAOB inhibitors interact with
Phenylephidrine
51
What are the 3 types of sleep disorders
Transient / short term / chronic
52
How long should Z drugs be taken for (maximum)
4 weeks
53
How soon does dependancy occur with Z drugs?
3-14 days
54
What are Benzo side effects
SLEEPY slurred speech Loss of memory Excitement Emotional blurring Physical dependence Yawning
55
What are Benzo side effects
SLEEPY slurred speech Loss of memory Excitement Emotional blurring Physical dependence Yawning
56
Which benzos are long acting?
Diazepam Nitrazepam Flurazepam
57
Which benzos are short acting and what Is the benefut / downfall?
Midazolam Lorazepam Temazepam Less hangiver effect but more chance of withdrawal
58
What is the dose of donperidone and metoclopramide ?
10mg TDS
59
What anti emetic is use post op?
Ondansetron and Dez
60
What is used for sickness in pregnancy
Diet / lifestyle Then promethazine
61
What is used for motion sickness
Hyoscone hydrobromode
62
How long can domperidone be used for and in what age group?
ONE week and 12+
63
What weight restriction does domperidone have?
35kg +
64
What age group can use Metoclopramide and how long for
18+ and 5days
65
What is the best pain relief for an asthmatic
Paracetamol - NOT NSAID
66
What bloods should be done for cloazapine
Leukocyte and neutrophils
67
What is the age restriction for sumatriptan?
18+
68
After fluoxetine is stopped how long should a patient wait before starting phenelzine?
5 weeks
69
What are the side effects of donepezil
NMS
70
what is the side effect of rivastigmine
GI
71
What is a side effect associated with galantamine
SJS
72
What drug class are midazolam and temazepam
Schedule 3
73
How long does a fentynal patch last?
72 hours / 3 days
74
When are ADHD meds prescribed by brand
When they are MR
75
What drug class is methylphenidate
Schedule 2
76
Who cannot have methylpehidate
Cardiomyopathy, CVD or hyperthyroid
77
What are methylphenidate side effects?
Low weight Low appetite Tachycardia Hypertension Abnormal behaviour
78
What is a sign of lisdexamfetimine toxicity
High then low Hallucinations, sxcited, paranoid, wakefulness THEN exhaustion, seizures, coma
79
What antidepressant is given in someone who has had a heart attack?
Sertraline
80
What antidepressant is given in someone who has had a heart attack?
Sertraline
81
What antidepressant is given in children (ie under 18)
Fluoxetine
82
At what point can you feel worse on antidepressants
1-2 weeks
83
At what point can you feel worse on antidepressants
1-2 weeks
84
How long should an antidepressant be trialled for
4 weeks, 6 in elderly
85
What is the worst TCA in an overdose
Dosulepin NEVER give amitriptyline and dosulepin together
86
What cannot be given OTC with MAOIS
Psuedoephifrine
87
Which benzos have a legal driving limit
COLD FT Clonazepam Oxazepamx Lorazepam Diazepam Flunitrazepam Temazepam

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