CNS Part 6 November 23

Question 1

Question

Answer 1

Answer

Question 2

300. What is motor neurone disease?

Answer 2

• A neurodegenerative disease that affects the brain and spinal cord.

Question 3

301. What drugs are used for muscular symptoms in MND?

Answer 3

• Quinine (unlicensed) as the 1st line treatment for muscle cramps.

Question 4

302. What drugs are used for saliva issues in MND?

Answer 4

• Antimuscarinic drugs (unlicensed).

Question 5

303. What drugs are used for respiratory symptoms in MND?

Answer 5

• Opioids (unlicensed) for breathlessness.

Question 6

304. What drugs are used for saliva associated with MND?

Answer 6

• Humidification (moisture), nebulizers, and carbocisteine.

Question 7

305. What drugs are used for amyotrophic lateral sclerosis?

Answer 7

• Riluzole is used as a treatment to extend life.

Question 8

306. What is Parkinson’s disease?

Answer 8

• A progressive neurodegenerative condition resulting from the death of dopamine cells in the brain’s substantia nigra.

Question 9

307. What are the non-motor symptoms associated with Parkinson’s?

Answer 9

• Dementia.

Question 10

308. What’s the DVLA advice for patients with Parkinson’s?

Answer 10

• Inform DVLA and car insurers once the diagnosis is confirmed.

Question 11

309. What are the main aims for managing Parkinson’s?

Answer 11

• Control symptoms.

Question 12

311. What are the non-drug treatments for Parkinson’s?

Answer 12

• Physiotherapy.

Question 13

312. Which antimuscarinic drugs are used for Parkinson’s?

Answer 13

• Procyclidine.

Question 14

313. Which dopaminergic drugs are used for Parkinson’s?

Answer 14

1. Catechol-o-methyltransferase (COMT) inhibitors:
2. Entacapone,
3. Opicapone,
4. Tolcapone.

Question 15

314. What’s used first line in the management of motor symptoms affecting quality of life in Parkinson’s?

Answer 15

1. Levodopa + carbidopa (co-careldopa)
2. or benserazide (co-beneldopa).

Question 16

315. What’s used in the management of motor symptoms that don’t adversely affect quality of life in Parkinson’s?

Answer 16

• Levodopa.

Question 17

316. If a patient needs to stop treatment for Parkinson’s, how is it done?

Answer 17

• Patients are not to stop drugs abruptly.

Question 18

317. What patient and care advice would you give to a patient taking antiparkinsonian drugs?

Answer 18

1. Inform them of the risks of adverse reactions,
2. including psychotic symptoms
3. and sudden onset of sleep with dopamine agonists.

Question 19

318. What drugs are used to treat dyskinesias associated with levodopa, 1st line?

Answer 19

• 1st line non-ergot dopamine receptor agonists as an adjunct to levodopa.

Question 20

318. What drugs are used to treat dyskinesias associated with levodopa, 2nd line?

Answer 20

• 2nd line ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, or pergolide)

used as an adjunct to levodopa if non-ergot is not adequate.

Question 21

319. What’s used in the management of excessive daytime sleepiness/sudden onset sleep associated with antiparkinsonian drugs, and what patient advice would you give?

Answer 21

• Modafinil.

Question 22

320. What’s used in the management of nocturnal akinesia associated with antiparkinsonian drugs?

Answer 22

Options include levodopa or oral dopamine receptor agonists as 1st line.

Question 23

321. What’s used for the postural hypotension associated with antiparkinsonian drugs, and what patient advice would you give?

Answer 23

Midodrine Hydrochloride (1st line).

Question 24

322. What’s used in the management of depression associated with Parkinson’s?

Answer 24

Standard antidepressant therapy, with 1st-line options being SSRIs.

Question 25

323. What’s used in the management of psychosis associated with Parkinson’s?

Answer 25

- Quetiapine (unlicensed) can be used to treat hallucinations and delusions.

Question 26

324. What’s used in the management of rapid eye movements associated with Parkinson’s?

Answer 26

- Clonazepam or melatonin.

Question 27

325. What’s used in the management of drooling associated with Parkinson’s?

Answer 27

- Glycopyrronium bromide (1st line).

Question 28

326. What’s used in the management of dementia associated with Parkinson’s?

Answer 28

- Cholinesterase inhibitors like Donepezil.

Question 29

327. What’s used in the management of advanced Parkinson’s?

Answer 29

- Apomorphine hydrochloride injections or infusions.

Question 30

328. What key disorder can patients get if they take dopaminergic drugs, and what can be done to prevent this?

Answer 30

- Impulse control disorders, 1. - such as compulsive gambling, 2. hypersexuality, 3. binge eating, 4. or obsessive shopping.

Question 31

329. What’s the main safety advice for antiparkinsonian drugs?

Answer 31

- Warn about impulse control disorders, which can develop on dopaminergic therapy, especially with levodopa and apomorphine.

Question 32

330. Which drugs should you always avoid when you have Parkinson’s?

Answer 32

-` Metoclopramide,` as it can exacerbate Parkinson’s symptoms and antagonize the effects of anti-Parkinson drugs.

Question 33

331. What’s the best drug to give a Parkinson patient if they have N&V?

Answer 33

- Domperidone.

Question 34

332. What are the main drug interactions of domperidone?

Answer 34

- Increases the risk of QT prolongation when given with apomorphine, which can cause serious arrhythmias. Start domperidone 2 days before apomorphine treatment and discontinue it as soon as possible.

Question 35

333. What should patients watch out for when taking tolcapone?

Answer 35

- Liver toxicity, characterized by symptoms such as anorexia, nausea, vomiting, fatigue, abdominal pain, dark urine, or pruritus.

Question 36

334. What are the 3 main side effects patients should be advised about when taking antiparkinsonian drugs?

Answer 36

- Sudden onset of sleep, especially with dopamine receptor agonists.

Question 37

336. When are antiemetics given?

Answer 37

- Only when the cause of vomiting is known, especially in children.

Question 38

337. When are antiemetics avoided or not necessary?

Answer 38

- Antiemetics should be avoided or considered unnecessary when the cause of vomiting is known, especially in children.

Question 39

338. Which antiemetic is the only one that can be used in patients with Parkinson’s?

Answer 39

- Domperidone to control N&V associated with apomorphine.

Question 40

339. What is the main MHRA warning for domperidone?

Answer 40

- Domperidone is no longer indicated for relief of N&V in children under 12 years old and weighing less than 35kg.

Question 41

340. Which antiemetics are used for chemotherapy-induced N&V and postoperative N&V?

Answer 41

- Dexamethasone (alone or with 5HT3 antagonist).

Question 42

341. Which antiemetics are used in the terminally ill?

Answer 42

- Levomepromazine.

Question 43

342. What are the steps for managing N&V associated with pregnancy?

Answer 43

1. Self-care.

Question 44

343. What is used for motion sickness?

Answer 44

- Antiemetics are used to prevent motion sickness, with hyoscine hydrobromide being a common choice.

Question 45

344. What drugs are used in Meniere's disease?

Answer 45

- Betahistine.

Question 46

345. What's the safety advice for metoclopramide?

Answer 46

- There is a risk of neurological adverse drug reactions.

Question 47

346. What's the MHRA safety advice for promethazine?

Answer 47

- Promethazine should not be given to children under 6 years old in OTC cough and cold medicines containing promethazine.