CNS

Question 1

what are the cognitive symptoms of dementia?

Answer 1

• memory loss
• lack of concentration
• disorientated
• speech difficulty

Question 2

what are the non-cognitive symptoms?

Answer 2

• agitation, aggression, distress, psychosis
• depression & anxiety

Question 3

3 drugs to manage mild-moderate alzheimer’s

Answer 3

• donepezil
• galantamine
• rivastigmine

Question 4

cautions in donepezil

Answer 4

• cardiac conduction
• neuroleptic malignant syndrome
• EPS
• asthma & COPD

Question 5

cautions in galantamine

Answer 5

• avoid GI & urinary flow obstruction
• severe skin reactions

Question 6

cautions in rivastigmine

Answer 6

• stop if dehydrated from vomiting/diarrhea
• less side effects with transdermal
• monitor body weight

Question 7

1 drug to manage moderate-severe alzheimer’s

Answer 7

• memantine

Question 8

cautions in memantine

Answer 8

• epilepsy
• history of convulsions

Question 9

drugs to review with bad cognitive function

Answer 9

• antidepressants (amitriptyline & paroxetine)
• anti-histamines (chlorphenamine & promethazine)
• antipsychotics (olanzapine & quetiapine)
• urinary spasmodics (solifenacin & tolterodine)

Question 10

why review drugs cause bad cognitive function

Answer 10

• antimuscarinic burden
• bradycardia, bronchospasm, muscle weakness, diarrhoea

Question 11

management non-cognitive symptoms

Answer 11

• agitation, aggression, distress, psychosis (only if risk of harm & delusions)
• depression & anxiety (CBT, anti-depressants for pre-existing conditions)

Question 12

what is the risk of antipsychotic use in dementia?

Answer 12

• increased stroke
• lowest effective dose & shortest time
• review at least every 6 weeks

Question 13

symptoms of epilepsy

Answer 13

• uncontrollable jerking & shaking
• losing awareness
• tingling feeling in extremities
• collapsing
• becoming stiff

Question 14

treatment focal seizures without second generalisation

Answer 14

• lamotrigine/levetiracetam
• OR carbamazepine

Question 15

treatment generalised seizures

Answer 15

• sodium valproate

Question 16

immediate measures for epilepsy status?

Answer 16

• position to avoid injury
• support respiration
• maintain BP
• correct hypoglycaemia
• pyridoxine if deficiency

Question 17

measures for epilepsy status if alcohol abuse

Answer 17

• parenteral thiamine

Question 18

treatment if seizure longer than 5 minutes

Answer 18

• urgently Lorazepam IV

Question 19

final measures treatment epilepsy status

Answer 19

• diazepam rectal solutions
• midazolam oromucosal in buccal cavity

Question 20

epilepsy monotherapy and combination

Answer 20

• mono with 1st line then 2nd line
• combo with 2 or more drugs but increase risk AE and interactions

Question 21

category 1 drugs epilepsy

Answer 21

• carbamazepine
• phenobarbital
• phenytoin
• use same brand

Question 22

category 2 drugs epilepsy

Answer 22

• clobazam
• clonazepam
• lamotrigine
• sodium valproate
• brand based on patient & clinical judgement

Question 23

category 3 drugs epilepsy

Answer 23

• gabapentin
• levetiracetam
• vigabatrin
• no specific brand

Question 24

carbamazepine levels & monitoring

Answer 24

• 4-12mg/L (20-50 micromol/L) after 1-2 weeks
• HLA-B*1502 in Han Chinese/Thai (risk SJS)
• plasma concentration, renal & hepatic

Question 25

carbamazepine toxicity

Answer 25

- ataxia - drowsiness - headache - blurry vision - allergic skin reactions

Question 26

carbamazepine cautions & side-effects

Answer 26

- vitamin D supplementation for immobilised, low sun exposure/Ca2+ - withdraw if liver dysfunction/acute liver disease - signs of fever, rash, mouth ulcers, bruising and bleeding - anti-epileptic hypersensitivity syndrome

Question 27

cautions & side-effects anti-epileptics

Answer 27

- suicidal behaviour - cross-sensitivity oxcarbazepine, phenytoin, phenobarbital - visual disturbances (vigabatrin & topiramate) - serious skin reactions & toxic epidermal necrolysis in 1st 8 weeks (lamotrigine) - blood disorders (lamotrigine, phenytoin, carba, valproate) - severe resp. depression (gabapentin)

Question 28

phenytoin levels & dose equivalence,

Answer 28

- 10-20mg/L (40-80 micromol/L) - 100mg salt = 92mg base