HIGH WEIGHTING - Central Nervous System Flashcards
(370 cards)
1
Q
DEMENTIA
What are the aims of treatment for dementia?
A
- Promote independence
- Maintain function
- Manage symptoms of dementia
2
Q
DEMENTIA
(1) What non-drug treatment can be offered in dementia? (2) For which patient group does this apply?
A
(1) Structured group cognitive stimulation programme
(2) All types of mild-moderate dementia
3
Q
DEMENTIA
What should be considered regarding antimuscarinic drugs in patients with dementia?
A
Anticholinergic burden
4
Q
DEMENTIA
What should be considered regarding anticholinergic drugs in patients with dementia?
A
Anticholinergic burden
5
Q
DEMENTIA
Why is anticholinergic burden a point of consideration for dementia patients?
A
Can increase cognitive impairment
6
Q
DEMENTIA
Name some common drugs with anticholinergic effects.
A
- Amitriptyline
- Paroxetine
- Antihistamines
- Antipsychotics
- Urinary antispasmodics
7
Q
DEMENTIA
Give two examples of urinary antispasmodics.
A
- Tolterodine
- Solifenacin
8
Q
DEMENTIA
What are the first line treatment options for mild-moderate Alzheimer’s disease?
A
- Donepezil hydrochloride OR
- Galantamine OR
- Rivastigmine
9
Q
DEMENTIA
What is first line treatment for moderate Alzheimer’s disease when acetylcholinesterase inhibitors are contraindicated?
A
Memantine hydrochloride
10
Q
DEMENTIA
When is memantine hydrochloride considered suitable in treatment of Alzheimer’s disease?
A
(1) Severe Alzheimer’s disease OR
(2) Moderate Alzheimer’s disease
- When acetylcholinesterase inhibitors are contraindicated
11
Q
DEMENTIA
What is the first line treatment for severe Alzheimer’s disease?
A
Memantine hydrochloride
12
Q
DEMENTIA
When is donepezil hydrochloride indicated in Alzheimer’s disease?
A
Mild-moderate Alzheimer’s disease
13
Q
DEMENTIA
When can memantine hydrochloride be used as an additional therapy in Alzheimer’s disease?
A
Patients already receiving acetylcholinesterase inhibitor
IF they develop moderate/ severe Alzheimer’s disease
14
Q
DEMENTIA
What can be added for an Alzheimer’s patient who is already taking an acetylcholinesterase inhibitor that develops moderate/ severe Alzheimer’s disease?
A
Memantine hydrochloride
15
Q
DEMENTIA
Should acetyl cholinesterase inhibitors be discontinued in patients with moderate Alzheimer’s disease?
A
No
Can cause substantial worsening in cognitive function
16
Q
DEMENTIA
What is the first line treatment for mild-moderate dementia with Lewy bodies?
A
Donepezil hydrochloride/ rivastigmine
17
Q
DEMENTIA
When should galantamine be considered for dementia with Lewy bodies?
A
If BOTH donepezil hydrochloride and rivastigmine are not tolerated
18
Q
DEMENTIA
What is the first line treatment for severe dementia with Lewy bodies?
A
Donepezil hydrochloride/ rivastigmine
19
Q
DEMENTIA
When is memantine hydrochloride used in treatment of dementia with Lewy bodies?
A
Alternative when acetylcholinesterase inhibitors are contraindicated or not tolerated
20
Q
DEMENTIA
When should acetylcholinesterase inhibitors and memantine hydrochloride be considered in treatment of vascular dementia?
A
Suspected co-morbid Alzheimer’s OR
PD dementia OR
Dementia with Lewy bodies
21
Q
DEMENTIA
Can acetylcholinesterase inhibitors and memantine hydrochloride be used for treatment of frontotemporal dementia?
A
No
Not recommended
22
Q
DEMENTIA
Can acetylcholinesterase inhibitors and memantine hydrochloride be used for treatment of cognitive impairment caused by multiple sclerosis?
A
No
Not recommended
23
Q
DEMENTIA
Name some non-cognitive symptoms of dementias.
A
- Agitation
- Aggression
- Distress
- Psychosis
24
Q
DEMENTIA
For which symptoms should psychosocial and environmental interventions be used for in dementia treatment?
A
- Management of pain
- Management of delirium
- Reduce distress
25
***DEMENTIA***
When are antipsychotic drugs recommended for dementia patients?
- Risk of harming themselves/ others OR
- Experiencing agitations/ hallucinations/ delusions that are causing severe distress
26
***DEMENTIA***
Describe an MHRA warning for dementia regarding antipsychotic drug use.
Increased risk of stroke and small increased risk of death when antipsychotic drugs are used in elderly patients with dementia
27
***DEMENTIA***
Name some risk factors for cerebrovascular disease?
- Hypertension
- Atrial Fibrillation
- Diabetes
- Smoking
28
***DEMENTIA***
How often should antipsychotic drugs be reviewed in patients with dementia?
Every 6 weeks
Lowest effective dose should be maintained
29
***DEMENTIA***
What effect can antipsychotic drugs have on Parkinson's disease dementia or dementia with Lewy bodies?
Can worsen motor functions
Can cause severe antipsychotic sensitivity reactions
30
***DEMENTIA***
(1) What psychological treatments are available for depression and anxiety associated with dementia?
(2) For which patient group does this apply?
(1)
- CBT
- Multisensory stimulation
- Relaxation
- Animal-assisted therapies
(2) Mild-moderate depression/ anxiety associated with mild-moderate dementia
31
***DEMENTIA***
When should antidepressants be considered for depression/ anxiety associated with dementia?
ONLY for pre-existing severe mental health problems
32
***DEMENTIA***
How are sleep disturbances managed for patients with dementia?
Non-drug approaches
- Sleep hygiene education
- Daylight exposure
- Increased exercise/ activity
33
***DEMENTIA***
Name the centrally acting anticholinesterases.
- Donepezil hydrochloride
- Rivastigmine
- Galantamine
34
***DEMENTIA***
Name an NMDA receptor antagonist associated with treatment of dementias.
Memantine hydrochloride
35
***SLEEP DISORDERS***
What is an anxiolytic?
Sedative
Induces sleep when given at night
36
***SLEEP DISORDERS***
What is a hypnotic?
Sedative
Sedates during the day
37
***SLEEP DISORDERS***
Why should anxiolytics and hypnotics be reserved for short courses?
May lead to withdrawal
38
***SLEEP DISORDERS***
What are the most common type of hypnotics and anxiolytics used?
Benzodiazepines
39
***SLEEP DISORDERS***
Briefly describe the mechanism of action of benzodiazepines.
Act at benzodiazepine receptors associated with GABA reecotirs
40
***SLEEP DISORDERS***
(1) Are barbiturates and meprobamate recommended as hypnotics/ anxiolytics?
(2) Why?
(1) No
(2) More side-effects + interactions + more dangerous in overdose
41
***SLEEP DISORDERS***
What duration are benzodiazepines indicated for in short-term relief of anxiety that is severe, disabling, or causing unacceptable distress?
2-4 weeks ONLY
42
***SLEEP DISORDERS***
Should benzodiazepines be used for treatment of short-term mild anxiety?
No
Inappropriate use
43
***SLEEP DISORDERS***
When should benzodiazepines be used to treat insomnia?
- Severe OR
- Disabling OR
- Causing extreme distress
44
***SLEEP DISORDERS***
Why should withdrawal of a benzodiazepine be gradual?
May produce confusion/ toxic psychosis/ convulsions/ condition resembling delirium tremens
45
***SLEEP DISORDERS***
For how long after cessation of treatment can benzodiazepine withdrawal syndrome occur?
Up to 3 weeks
- After stopping a long-acting benzodiazepine
Up to 24 hours
- After stopping a short-acting benzodiazepine
46
***SLEEP DISORDERS***
How is benzodiazepine withdrawal syndrome characterised?
- Insomnia
- Anxiety
- Loss of appetite
- Loss of bodyweight
- Tremor
- Perspiration
- Tinnitus
- Perceptual disturbances
47
***SLEEP DISORDERS***
What are:
- Insomnia
- Anxiety
- Loss of appetite
- Loss of bodyweight
- Tremor
- Perspiration
- Tinnitus
- Perceptual disturbances
symptoms of?
Benzodiazepine withdrawal syndrome
48
***SLEEP DISORDERS***
How should benzodiazepine reduction rate be managed?
Flexible, at a rate that is tolerable for the patient
Should depend on initial dose/ duration of use/ clinical response
49
***SLEEP DISORDERS***
How long is it likely to take a patient who has used benzodiazepines for 2-4 weeks to taper off?
2-4 weeks
50
***SLEEP DISORDERS***
How long is it likely to take a patient who has used benzodiazepines long-term to taper off?
Period of several months or more
51
***SLEEP DISORDERS***
What is a suggested protocol for withdrawal of long-term benzodiazepine use?
(1) Transfer patient to diazepam, at equivalent daily dose, over about 1 week - preferably taken at night
(2) Reduce diazepam dose by 1-2mg every 2-4 weeks
(3) Reduce diazepam dose further, if necessary in smaller steps (e.g. 500micrograms)
(4) Then stop completely
52
***SLEEP DISORDERS***
What is the equivalent dose of 5mg of diazepam in:
(1) Chlordiazepoxide?
(2) Temazepam?
(3) Clobazam?
(4) Clonazepam?
(1) 12.5mg
(2) 10mg
(3) 10mg
(4) 250micrograms
53
***SLEEP DISORDERS***
The addition of which types of drugs should be AVOIDED when withdrawing from benzodiazepines?
- Beta-blockers
- Antidepressants
- Antipsychotics
54
***SLEEP DISORDERS***
What type of medication is preferable in treatment of sleep onset insomnia?
Short-acting hypnotics
55
***SLEEP DISORDERS***
Which type of medication is preferable for treatment of insomnia in elderly patients?
Short-acting hypnotics
56
***SLEEP DISORDERS***
Which type of medication is preferable for treatment of insomnia when sedation the following day is undesirable?
Short-acting hypnotics
57
***SLEEP DISORDERS***
Which type of medication is preferable for treatment of sleep maintenance insomnia?
Long-acting hypnotics
58
***SLEEP DISORDERS***
What may cause transient insomnia?
- Noise
- Jetlag
- Shift work
59
***SLEEP DISORDERS***
(1) Which type of medication is preferable for treatment of transient insomnia? (2) How many doses should be given?
(1) Rapidly-eliminated hypnotic
(2) Only 1-2 doses
60
***SLEEP DISORDERS***
What may cause short-term insomnia?
- Emotional problem OR
- Serious medical illness
61
***SLEEP DISORDERS***
What duration of hypnotic should be given for treatment of short-term insomnia?
Maximum THREE weeks
(Preferably only ONE week)
62
***SLEEP DISORDERS***
What type of medication is preferable for treatment of short-term insomnia?
Short-acting hypnotic
63
***SLEEP DISORDERS***
What are some common causes of chronic insomnia?
- Anxiety
- Depression
- Abuse of drugs/ alcohol
64
***SLEEP DISORDERS***
How long does tolerance to hypnotics take to develop?
3-14 days of continuous use
65
***SLEEP DISORDERS***
What is a major drawback of long-term use of hypnotics?
Withdrawal can cause:
- Rebound insomnia
- Withdrawal syndrome
66
***SLEEP DISORDERS***
(1) Which hypnotics should be avoided in the elderly? (2) Why?
(1)
- Benzodiazepines
- Z-drugs
(2) Elderly are at greater risk of becoming ataxic and confused
- Leads to increased falls/ injury
67
***SLEEP DISORDERS***
(1) Which hypnotic is preferable for use in dental patients? (2) Why?
(1) Temazepam
(2) Minimise residual effect on following day
68
***SLEEP DISORDERS***
Which benzodiazepines used as hypnotics tend to have a cumulative effect due to their prolonged action?
- Nitrazepam
- Flurazepam
69
***SLEEP DISORDERS***
Which benzodiazepines have little-to-no hangover effect?
- Temazepam
- Loprazolam
- Lormetazepam
70
***SLEEP DISORDERS***
(1) Which treatment is preferable for insomnia that is associated with daytime anxiety? (2) How should this be taken?
(1) Long-acting benzodiazepine anxiolytic
- e.g. diazepam
(2) Taken as a single dose at night
71
***SLEEP DISORDERS***
Name two Z-drugs.
- Zolpidem
- Zopiclone
72
***SLEEP DISORDERS***
What are some non-benzodiazepine hypnotics that act at the benzodiazepine receptors?
- Zopiclone
- Zolpidem
73
***SLEEP DISORDERS***
Describe the duration of action of the Z-drugs.
Short-acting
74
***SLEEP DISORDERS***
(1) For which patient group is clomethiazole potentially useful? (2) Why?
(1) Elderly
(2) No hangover effect
75
***SLEEP DISORDERS***
What is melatonin licensed for?
- Short-term treatment of insomnia in adults >55yrs
- Short-term treatment of jet-lag in adults
76
***SLEEP DISORDERS***
What effect may benzodiazepines have on psychological adjustment in bereavement?
May inhibit
77
***SLEEP DISORDERS***
Which patient groups have the highest likely dependency to anxiolytic benzodiazepines?
- History of alcohol/ drug abuse OR
- Marked personality disorders
78
***SLEEP DISORDERS***
What effect do beta-blockers have on psychological symptoms?
None
79
***SLEEP DISORDERS***
What effect do beta-blockers have on non-autonomic symptoms?
None
80
***SLEEP DISORDERS***
What effect do beta-blockers have on autonomic symptoms?
Reduction in symptom severity
81
***SLEEP DISORDERS***
Which anxiolytics are indicated for the short-term relief of severe anxiety?
- Diazepam
- Alprazolam
- Chlordiazepoxide
- Clobazam
- Lorazepam
- Oxazepam
82
***SLEEP DISORDERS***
(1) When are shorter-acting anxiolytics preferable for the short-term relief of severe anxiety? (2) What risk does this present?
(1) Hepatic impairment
(2) Increased risk of withdrawal symptoms
83
***SLEEP DISORDERS***
What can be used in panic disorders that are resistant to antidepressant therapy?
Benzodiazepines
84
***SLEEP DISORDERS***
When should IV use of lorazepam/ diazepam be used for the control of panic attacks?
When other administration routes have failed
85
***SLEEP DISORDERS***
What is the advantage of the IM route of benzodiazepines compared to oral route?
None
86
***SLEEP DISORDERS***
How long may response to treatment with buspirone take?
Up to TWO weeks
87
***SLEEP DISORDERS***
Describe the dependence and abuse potential of buspirone.
Low
88
***SLEEP DISORDERS***
How does meprobamate compare to benzodiazepines, as an anxiolytic?
Less effective + more hazardous in overdose
Can induce dependence
89
***SLEEP DISORDERS***
When are intermediate-acting barbiturates used for treatment of sleep disturbances?
Severe intractable insomnia in patients ALREADY taking barbiturates
90
***SLEEP DISORDERS***
In which patient group should barbiturates be avoided?
Elderly
91
***SLEEP DISORDERS***
Name some intermediate acting barbiturates.
- Amobarbital
- Butobarbital
- Secobarbital
92
***SLEEP DISORDERS***
What does increased hostility and aggression after barbiturates normally indicate?
Intoxication
93
***SLEEP DISORDERS***
Name some long-acting benzodiazepines.
- Diazepam
- Nitrazepam
- Flurazepam
94
***SLEEP DISORDERS***
Name some short-acting benzodiazepines.
- Loprazolam
- Lormetazepam
- Temazepam
95
***SLEEP DISORDERS***
Which type of benzodiazepines are used for sleep maintenance?
Long-acting
96
***SLEEP DISORDERS***
Which type of benzodiazepines are used for sleep onset?
Short-acting
97
***SLEEP DISORDERS***
How is benzodiazepine overdose treated?
Flumazenil
98
***SLEEP DISORDERS***
Which benzodiazepines have a legal driving limit?
- Clonazepam
- Oxazepam
- Lorazepam
- Diazepam
- Flunitrazepam
- Temazepam
99
***Epilepsy***
What is the first line treatment for focal seizures?
- Carbamazepine OR lamotrigine
100
***Epilepsy***
What is the second line treatment for focal seizures?
- Oxcarbazepine
- Levetiracetam
- Sodium valproate
101
***Epilepsy***
What are the different types of generalised seizures?
- Tonic clonic
- Absence
- Myoclonic
- Atonic
- Tonic
102
***Epilepsy***
What is the first line treatment for tonic clonic seizures?
Sodium valproate
103
***Epilepsy***
What is the second line treatment for tonic clonic seizures?
Lamotrigine
104
***Epilepsy***
What is the first line treatment for absence seizures?
Ethosuximide OR sodium valproate
105
***Epilepsy***
What is the second line treatment for absence seizures?
Lamotrigine
106
***Epilepsy***
What is the first line treatment for myoclonic seizures?
Sodium valproate
107
***Epilepsy***
What is the second line treatment for myoclonic seizures?
Topiramate OR levetiracetam (Keppra)
108
***Epilepsy***
What is the first line treatment for tonic seizures?
Sodium valproate
109
***Epilepsy***
What is the second line treatment for tonic seizures?
Lamotrigine
110
***Epilepsy***
What is the first line treatment for atonic seizures?
Sodium valproate
111
***Epilepsy***
What is the second line treatment for atonic seizures?
Lamotrigine
112
***Epilepsy***
For treatment of epilepsy, for which type(s) of generalised seizures is sodium valproate first line treatment?
- Tonic Clonic
- Tonic
- Atonic
- Myoclonic
- Absence
113
***Epilepsy***
For treatment of epilepsy, for which type(s) of generalised seizures is lamotrigine second line treatment?
- Tonic Clonic
- Tonic
- Atonic
- Absence
(All, except myoclonic)
114
***Epilepsy***
What is the treatment for status epilepticus seizures lasting longer than 5 minutes?
- IV lorazepam (repeated once after 10 minutes if seizures recur/ fail to respond)
OR
- IV diazepam
115
***Epilepsy***
What is the treatment for status epilepticus, if seizures fail to respond to treatment after 25 minutes?
- Phenytoin
- Fosphenytoin
- Phenobarbital
116
***Epilepsy***
What is the treatment for status epilepticus, if seizures fail to respond to treatment after 45 minutes?
- Thiopental
- Midazolam
- Propofol (anaesthetic)
117
***Epilepsy***
What is the treatment of status epilepticus, in the community or where resus is not available?
- Rectal diazepam
OR
- Buccal midazolam
118
***Epilepsy***
Which add-on drug can be used for treatment of status epilepticus if alcohol abuse is suspected?
Parenteral thiamine
119
***Epilepsy***
What is the add-on treatment of status epilepticus, if pyridoxine deficiency is suspected as the cause?
Pyridoxine
120
***Epilepsy***
What needs to be done if a driver experiences epilepsy while driving?
Stop driving immediately
DVLA must also be informed
121
***Epilepsy***
What are the driving rules for a patient with their first unprovoked/ single isolated seizure?
May resume provided they have been assessed by a specialist as fit to drive
122
***Epilepsy***
What are the driving rules for a patient with established epilepsy for personal vehicles?
- Must be seizure free for one year
OR
- A pattern of seizures established with no effect on consciousness for one year
- ALSO:
ø Must not have a history of unprovoked seizures
ø Additional criteria applies for large goods/ passenger-carrying
123
***Epilepsy***
What must be remembered regarding driving rules for a patient with established epilepsy for driving on large goods vehicles/ passenger-carrying drivers?
- Must be seizure free for one year
OR
- A pattern of seizures established with no effect on consciousness for one year
- ALSO:
ø Must not have a history of unprovoked seizures
ø Additional criteria applies for large goods/ passenger-carrying
124
***Epilepsy***
What are the driving rules for a patient with seizures while asleep?
Not permitted to drive for 1 year from date of seizure UNLESS:
- Hx of sleep seizures ONLY while asleep (established over 1 year)
- If previous seizures while awake but shown to only have sleep seizures over the past 3 years
125
***Epilepsy***
What are the driving rules for a patient with epilepsy who has had a medication change/ withdrawal?
- Should not drive for at least 6 months after last previous dose
- IF seizure occurs, license revoked for one year (reinstated after 6 months if treatment resumed AND no further seizures occurred)
126
***Epilepsy***
What is the risk vs benefit of epilepsy treatment in pregnancy?
Risk of harm to mother and foetus from convulsions outweighs risk of continued treatment
127
***Epilepsy***
Why is folic acid given in pregnancy?
Reduce risk of neural tube defects in first trimester
128
***Epilepsy***
At what stage of pregnancy can neural tube defects occur in the foetus without folic acid supplementation?
First trimester
129
***Epilepsy***
What injection is given at birth to reduce the risk of neonatal haemorrhage?
Vitamin K injection
130
***Epilepsy***
Why is a vitamin K injection given at birth?
To reduce risk of neonatal haemorrhage
131
***Epilepsy***
(1) Who is at most risk from sodium valproate treatment? (2) How is this prevented?
(1) Pregnancy/ foetus
(2) Pregnancy Prevention Programme
132
***Epilepsy***
What is the risk of using topiramate in pregnancy?
Risk of cleft palate development
133
***Epilepsy***
Which anti-epileptic medication cause the most risk in treatment of pregnant patients?
- Sodium valproate
- Topiramate
134
***Epilepsy***
What is the breastfeeding advice for patients on epilepsy treatment?
Encouraged to breastfeed, on single treatment
135
***Epilepsy***
Which anti-epileptics are highly present in breast milk?
- Primidone
- Ethosuximide
- Lamotrigine
- Zonisamide
136
***Epilepsy***
Which anti-epileptics have the highest risk of drowsiness in breastfeeding?
- Primidone
- Phenobarbital
- Benzodiazepines
137
***Epilepsy***
Which anti-epileptics can cause withdrawal effects if the mother suddenly stops breastfeeding?
- Phenobarbital
- Primidone
- Benzodiazepines
- Lamotrigine
138
***Epilepsy***
How should anti-epileptics be switched?
Cautiously
Only withdraw the first drug once new regimen has been established
Only withdraw ONE anti-epileptic at a time
139
***Epilepsy***
(1) What is an MHRA alert for anti-epileptic drugs? (2) How soon may these symptoms develop?
(1) Risk of suicidal thoughts and behaviours
(2) Symptoms may appear as early as one week after beginning treatment
140
***Epilepsy***
(1) What should be done if a patient has symptoms aligning with an MHRA warning for their anti-epileptic medication? (2) What are these symptoms?
(1) Seek medical advice
- Do NOT stop treatment, speak to HCP first
(2)
- Mood changes
- Distressing thoughts
- Suicidal ideation/ self-harm thoughts
141
***Epilepsy***
What is the advice on switching between different manufacturer's products for anti-epileptic medication?
ONLY APPLIES FOR TREATMENT OF EPILEPSY:
(1) If maintaining on a SPECIFIC brand, brand should be specified
(2) If maintaining on a GENERIC brand, name and name of manufacturer (MA holder) should be specified
142
***Epilepsy***
What should be done if a patient experiences any adverse effects to anti-epileptics?
Report on Yellow Card
143
***Epilepsy***
(1) If a prescribed anti-epileptic is not available, what may it be necessary to do? (2) Who needs to agree to this?
(1) Dispense a product from a different manufacturer to maintain continuity of treatment
(2) Must be agreed by prescriber AND patient (or carer)
144
***Epilepsy***
Which anti-epileptics can cause Anti-epileptic Hypersensitivity Syndrome?
- Carbemazepine
- Phenytoin
- Phenobarbital
- Primidone
- Lamotrigine
- Lacosamide
- Oxcarbazepine
- Rufinamide
145
***Epilepsy***
(1) What are some common symptoms of Anti-epileptic Hypersensitivity Syndrome? (2) What are some more severe symptoms? (3) How soon may the more severe symptoms develop?
(1)
- Fever
- Rash
- Lymphadenopathy
(2) Liver dysfunction, haematological abnormalities, renal impairment, pulmonary issues, vasculitis, multi-organ failure
(3) Usually start 1-8 weeks after exposure
146
***Epilepsy***
What should be done if a patient has suspected Anti-epileptic Hypersensitivity Syndrome?
Withdraw drug immediately
Do not re-expose
Seek specialist advice
147
***Epilepsy***
What is the therapeutic range of carbemazepine?
4-12mg/L
148
***Epilepsy***
What are some signs of carbamazepine toxicity?
- Hyponatraemia
- Ataxia (loss of control of body movements)
- Nystagmus (involuntary, repetitive movement of eyes)
- Drowsiness
- Blurred vision
- Arrhythmias
- GI disturbances
149
***Epilepsy***
Which drug is primidone converted into?
Phenobarbital
150
***Epilepsy***
What is the therapeutic range of phenytoin?
10-20mg/L
151
***Epilepsy***
What are signs of phenytoin toxicity?
- Confusion
- Hyperglycaemia
- Ataxia (loss of control of body movements)
- Nystagmus (involuntary, repetitive movement of eyes)
- Double vision
- Slurred speech
152
***Epilepsy***
What is a common side-effect of phenytoin?
Can cause gingival hyperplasia
153
***Epilepsy***
What is the pregnancy prevention programme (PPP) for?
Teratogenic medication
154
***Epilepsy***
If a teratogenic medication must be used during pregnancy, how should this be managed?
Lowest effective dose
Divided doses OR m/r tablets (to avoid peak plasma concentrations)
155
***Epilepsy***
What doses of sodium valproate are associated with teratogenicity?
>1g
156
***Epilepsy***
What is the MHRA advice for sodium valproate in pregnancy?
Contra-indicated for migraine prophylaxis AND BPD
Must only be considered for epilepsy if there are no suitable alternatives
157
***Epilepsy***
What are the monitoring requirements for sodium valproate?
- Liver function: Before AND during first 6 months
- FBC: To assess potential for bleeding, before starting AND before surgery
158
***Epilepsy***
Why is routine monitoring of plasma valproate concentrations not useful?
Plasma valproate concentrations are not a useful index of efficacy
159
***Epilepsy***
What are the cautions for sodium valproate use?
- Liver toxicity
- Pancreatitis (discontinue treatment)
- Vitamin D (supplementation required)
- SLE
160
***Epilepsy***
When does liver toxicity, due to sodium valproate, most frequently occur?
In first 6 months (especially in children under 3)
161
***Epilepsy***
If on sodium valproate treatment and raised liver tests are observed, what should be done?
Reassess clinically AND monitor liver function until returned to normal
Including prothrombin time
162
***Epilepsy***
If a patient is on sodium valproate and their prothrombin time is abnormal, what should be done?
Discontinue treatment
163
***Epilepsy***
When should immediate withdrawal of sodium valproate be considered?
- Persistent vomiting AND abdominal pain
- Jaundice
- Oedema
- Anorexia
- Malaise
- Drowsiness
- Loss of seizure control
- Pancreatitis
164
***Epilepsy***
If sodium valproate treatment is stopped, over what period of time should this be done?
Gradually over 4 weeks
165
***Epilepsy***
What are the cautionary labels for sodium valproate?
Label 8: Do not stop taking unless your doctor tells you to stop
Label 10: Read the additional information given with this medicine
Label 21: Take with or just after food, or a meal
166
***Epilepsy***
What is the prodrug of phenytoin?
Fosphenytoin
167
***Epilepsy***
How do the formulations of fosphenytoin compare to that of phenytoin?
Fosphenytoin: IM or IV
Phenytoin: IV only
168
***Epilepsy***
What is a benefit of fosphenytoin over phenytoin?
(1) Fewer injection site reactions
(2) Can be given more rapidly than phenytoin
169
***Epilepsy***
Why is carbemazepine not recommended in tonic, atonic, myoclonic, and absence seizures?
May exacerbate seizures
170
***Epilepsy***
In what types of seizure must carbemazepine only be recommended in?
(1) Tonic Clonic
(2) Focal
171
***Epilepsy***
Which anti-epileptics should be avoided in tonic, atonic, absence, and myoclonic seizures?
- Carbemazepine
- Oxcarbazepine
- Gabapentin
- Pregabalin
172
***Epilepsy***
(1) In which type of seizure is lamotrigine not recommended? (2) Why?
(1) Myoclonic
(2) Can exacerbate and cause serious rashes
173
***Epilepsy***
Is lamotrigine affected by enzyme inhibitors or inducers?
Both
174
***Epilepsy***
For which types of seizure is phenytoin not recommended?
(1) Absence
(2) Myoclonic
175
***Epilepsy***
Which anti-epileptics should be prescribed as brand-specific?
Category 1
- Carbemazepine
- Phenobarbital
- Phenytoin
- Primidone
176
***Epilepsy***
What are the category 1 anti-epileptics?
- Carbemazepine
- Phenobarbital
- Phenytoin
- Primidone
177
***Epilepsy***
What are the category 2 anti-epileptics?
- Clobazam
- Clonazepam
- Eslicarbazepine
- Oxcarbazepine
- Lamotrigine
- Perampanel
- Rufinamide
- Topiramate
- Sodium valproate
178
***Epilepsy***
What are the category 3 anti-epileptics?
- Brivaracetam
- Ethosuxamide
- Gabapentin
- Pregabalin
- Lacosamide
- Levetiracetam
- VIgabatrin
- Tiagabine
179
***Epilepsy***
Do category 2 anti-epileptics needs to be prescribed as brand-specific?
Base on clinical judgement AND consultation with patient
180
***Epilepsy***
Do category 3 anti-epileptics needs to be prescribed as brand-specific?
Usually not necessary as equivalence can be presumed
181
***Epilepsy***
For which anti-epileptic category can equivalence be presumed?
Category 3
182
***Epilepsy***
Which anti-epileptic(s) are enzyme inducers?
- Carbemazepine
- Phenytoin
- Phenobarbital
183
***Epilepsy***
Which anti-epileptic(s) are enzyme inhibitors?
Sodium valproate
184
***Epilepsy***
Which drugs can lower seizure threshold?
- Quinolones
- Tramadol
- Theophylline
185
***Epilepsy***
Which drug groups does carbemazepine interact with?
Drugs causing hyponatraemia:
- SSRIs
- Diuretics
186
***Epilepsy***
Which drug groups does phenytoin interact with?
Anti-folates:
- Methotrexate
- Trimethoprim
187
***Epilepsy***
What are some side-effects of carbemazepine, phenytoin, and sodium valproate?
- Depression & suicide
- Hepatotoxicity
- Hypersensitivity
- Blood dyscrasias
- Vitamin D deficiency
188
***Epilepsy***
What are some side-effects specific to carbemazepine?
- Hyponatraemia
- Oedema
189
***Epilepsy***
What are some side-effects specific to phenytoin?
- Coarsening appearance
- Facial hair
190
***Epilepsy***
What are some side-effects specific to sodium valproate?
- Pancreatitis
- Teratogenic effects
191
***Epilepsy***
Which anti-epileptics can cause hypersensitivity?
- Carbemazepine
- Phenytoin
- Phenobarbital
- Primidone
- Lamotrigine
192
***Epilepsy***
Which anti-epileptics can cause skin rash (Stevens-Johnson syndrome)?
- Lamotrigine most likely
- Phenytoin (discontinue use)
- Carbemazepine
- Phenobarbital
193
***Epilepsy***
Which anti-epileptics can cause blood dyscrasias?
C. VET. PLZ:
C: Carbemazepine
V: Valproate
E: Ethosuximide
T: Topiramate
P: Phenytoin
L: Lamotrigine
Z: Zonisamide
194
***Epilepsy***
Which anti-epileptics can cause eye disorders?
- Vigabatrin (reduced visual field)
- Topiramate (secondary glaucoma)
195
***Epilepsy***
Which anti-epileptics can cause encephalopathy?
Vigabatrin
196
***Epilepsy***
Which anti-epileptics can cause respiratory depression?
- Gabapentin
- Pregabalin
197
***Bipolar Disorder***
What is bipolar disorder?
Extreme fluctuation between manic phases and depressive phases
198
***Bipolar Disorder***
What is the treatment for acute bipolar disorder?
- Benzodiazepines
- Antipsychotics (normally quetiapine/ olanzapine/ risperidone)
- Lithium/ sodium valproate can be added in
199
***Bipolar Disorder***
What is the prophylactic treatment for bipolar disorder?
- Carbemazepine
- Sodium valproate
- Lithium
200
***Bipolar Disorder***
What is are the symptoms of lithium toxicity?
- Renal impairment (e.g. incontinence)
- Extrapyramidal side-effects (e.g. tremors)
- Visual disturbances (blurred vision)
- Nervous system disorder (confusion & restlessness)
- GI disorder (diarrhoea/ vomiting)
201
***Parkinson's disease***
Which hormone causes Parkinson's disease?
Low dopamine
202
***Parkinson's disease***
What is the aim of Parkinson's disease treatment?
To increase dopamine
203
***Parkinson's disease***
What is the treatment of Parkinson's disease for patients whose motor symptoms decrease their quality of life?
- Levodopa AND Carbidopa/ Benserazide
ø Co-carelopa
ø Co-beneldopa
204
***Parkinson's disease***
What is the treatment of Parkinson's disease for patients whose motor symptoms do not decrease their quality of life?
- Levodopa AND Carbidopa/ Benserazide
- Non-ergot derived dopamine receptor agonist
- Monoamine-oxidase-B inhibitors (MAO-B inhibitors)
205
***Parkinson's disease***
Which adjuvant to levodopa should be added on for patients who develop dyskinesia or motor fluctuations?
- Non-ergot derived dopamine receptor agonist
- MAO-B inhibitors
- COMT inhibitors
206
***Parkinson's disease***
What are the side-effects of levodopa?
- Impulse disorders
- Sudden onset of sleep
- Red urine
207
***Parkinson's disease***
How is sudden onset of sleep, in levodopa treatment, treated?
Modafinil
208
***Parkinson's disease***
What are some examples of non-ergot derived dopamine agonists?
- Rotigotine
- Pramipexole
- Ropinirole
209
***Parkinson's disease***
What are some side-effects of non-ergot derived dopamine agonists?
- Impulse disorders
- Sudden onset of sleep
- Hypotension
210
***Parkinson's disease***
How does the side-effect of impulse disorders from non-ergot derived dopamine agonists compare with that of levodopa?
Impulse disorders are worse in non-ergot derived dopamine agonists
211
***Parkinson's disease***
How should hypotension from non-ergot derived dopamine agonists be treated?
Midodrine
212
***Parkinson's disease***
What can happen if a MAO-B inhibitor is given with phenylephrine?
Can cause hypertensive crisis
213
***Parkinson's disease***
Which foods interact with MAO-B inhibitors?
Tyramine rich foods
- Marmite
- Yeast
- Tofu
- Salami
- Mature cheese
214
***Parkinson's disease***
Name some COMT inhibitors.
- Entacapone
- Tolcapone
214
***Parkinson's disease***
Name some COMT inhibitors.
- Entacapone
- Tolcapone
215
***Parkinson's disease***
What is a common discolouration caused by entacapone?
Red-brown urine
216
***Parkinson's disease***
What is the first line treatment for nocturnal akinesia?
Levodopa
OR
Oral dopamine receptor agonists
217
***Parkinson's disease***
What is the second line treatment for nocturnal akinesia?
Rotigotine patch
218
***Parkinson's disease***
Why is carbidopa/ benserazide given?
Prevent peripheral breakdown of levodopa before it crosses into brain
219
***Parkinson's disease***
What are some examples of impulse disorders?
- Pathological gambling
- Binge eating
- Hypersexuality
220
***Parkinson's disease***
What are some examples of MAO-B inhibitors?
- Rasagiline
- Selegiline
221
***Parkinson's disease***
What are some side-effects of COMT inhibitors?
- Entacapone: Red-brown urine
- Tolcapone: Hepatotoxicity
- Increases sympathetic side-effects: increase in CVD side-effects
222
***Parkinson's disease***
What are some side-effects of ergot derived dopamine receptor agonists?
- Pulmonary reactions: SOB, chest pain, cough
- Pericardial reactions: Chest pain
223
***Parkinson's disease***
What are some examples of ergot derived dopamine receptor agonists?
- Bromocriptine
- Cabergoline
224
***Psychosis & Schizophrenia***
What are the types of symptoms in schizophrenia?
- Positive symptoms
- Negative symptoms
225
***Psychosis & Schizophrenia***
What are some positive symptoms of schizophrenia?
- Delusions
- Disorganisation
- Hallucinations
226
***Psychosis & Schizophrenia***
What are some negative symptoms of schizophrenia?
- Social withdrawal
- Neglect
- Poor hygiene
227
***Psychosis & Schizophrenia***
Can an antipsychotic be used in a patient with Parkinson's disease?
No
Has the opposite effect
228
***Psychosis & Schizophrenia***
What are the types of antipsychotic drugs?
(1) 1st gen
- Phenothiazines (Group 1/2/3)
- Thioxanthenes
- Butyrophenones
(2) 2nd gen
229
***Psychosis & Schizophrenia***
How many groups of phenothiazines are there?
3 groups
230
***Psychosis & Schizophrenia***
(1) What are the groups of phenothiazines? (2) Describe their sedative effect. (3) Describe their extrapyramidal side-effects (EPSEs) significance.
Group 1: Most sedation. Moderate EPSEs.
Group 2: Moderate sedation. Least EPSEs.
Group 3: Moderate sedation. High EPSEs.
231
***Psychosis & Schizophrenia***
(1) What are some examples of thioxanthenes? (2) Describe the sedation and extra-pyramidal side-effects (EPSEs).
(1)
- Flupentixol
- Zuclopenthixol
(2) Moderate sedation & EPSEs
232
***Psychosis & Schizophrenia***
What are some examples of butyrophenones?
(1) Benperidol/ haloperidol
(2) Moderate sedations and high EPSEs
233
***Psychosis & Schizophrenia***
(1) What are some examples of butyrophenones? (2) Describe the sedation and extra-pyramidal side-effects (EPSEs).
(1) Benperidol/ haloperidol
(2) Moderate sedations and high EPSEs
234
***Psychosis & Schizophrenia***
What are some examples of group 1 phenothiazines?
- Chlorpromazine
- Levomepromazine
- Promazine
235
***Psychosis & Schizophrenia***
What are some examples of group 2 phenothiazines?
Pericyazine
236
***Psychosis & Schizophrenia***
What are some examples of group 3 phenothiazines?
- Fluphenazine
- Prochlorperazine
- Trifluoperazine
237
***Psychosis & Schizophrenia***
What are some examples of second generation anti-psychotics?
- Amisulpride
- Aripiprazole
- Clozapine
- Olanzapine
- Quetiapine
- Risperidone
238
***Psychosis & Schizophrenia***
Which second generation anti-psychotic has the least side-effects?
Aripiprazole
239
***Psychosis & Schizophrenia***
What are some anti-psychotic side-effects?
- EPSEs
- Hyperprolactinaemia
- Sexual dysfunction
- Cardiovascular side-effects
- Hypotension
- Hyperglycaemia
- Weight gain
- Neuroleptic malignant syndrome
240
***Psychosis & Schizophrenia***
In which group of antipsychotics are EPSEs most common?
Group 3 phenothiazines and butyrophenones
241
***Psychosis & Schizophrenia***
In which group of antipsychotics are EPSEs least common?
Second gen:
- Clozapine
- Olanzapine
- Quetiapine
- Aripiprazole
242
***Psychosis & Schizophrenia***
What does hyperprolactinaemia lead to?
- Sexual dysfunction
- Reduced bone density
- Menstrual disturbances
- Breast enlargement
- Galactorrhoea (milky nipple discharge, unrelated to breastfeeding)
- Increased risk of breast cancer
243
***Psychosis & Schizophrenia***
In which antipsychotic is hyperprolactinaemia least common?
Aripiprazole
244
***Psychosis & Schizophrenia***
In which antipsychotics is hyperprolactinaemia most common?
- First gen
- Risperidone
- Amisulpride
- Sulpride
245
***Psychosis & Schizophrenia***
In which antipsychotics is sexual dysfunction common?
All antipsychotics
246
***Psychosis & Schizophrenia***
Which antipsychotics have the highest prevalence for sexual dysfunction?
- Risperidone
- Haloperidol
- Olanzapine
247
***Psychosis & Schizophrenia***
Which antipsychotics have the lowest prevalence for sexual dysfunction?
- Aripiprazole
- Quetiapine
248
***Psychosis & Schizophrenia***
(1) Which cardiovascular side-effect is most common in antipsychotic treatment? (2) Which antipsychotic drugs cause this most?
(1) QT prolongation
(2)
- Pimozide
- Haloperidol
249
***Psychosis & Schizophrenia***
Which antipsychotics are most likely to cause hypotension?
- Clozapine
- Quetiapine
250
***Psychosis & Schizophrenia***
Which antipsychotics are most likely to cause hyperglycaemia?
- Clozapine
- Olanzapine
- Risperidone
- Quetiapine
251
***Psychosis & Schizophrenia***
Which antipsychotics are most likely to cause weight gain?
- Olanzapine
- Clozapine
252
***Psychosis & Schizophrenia***
(1) What should be done if a patient taking antipsychotics develops Neuroleptic Malignant Syndrome? (2) How should this be treated? (3) How long should this take to resolve?
(1) Stop treatment
(2) Treat with bromocriptin
(3) Should resolve in 5-7 days
253
***Psychosis & Schizophrenia***
What are the monitoring requirements for antipsychotics?
- Weight
- Fasting blood glucose + HbA1c + blood lipid concentrations
- ECG
- Blood pressure
- FBCs + U&Es + LFTs
254
***Psychosis & Schizophrenia***
How frequently should weight be monitored in antipsychotic treatment?
- Upon initiation
- Weekly for first 6 weeks
- At 12 weeks
- At 1 year
- Then yearly
255
***Psychosis & Schizophrenia***
What contraindications are there for clozapine?
- Seizures
- Uncontrolled diabetes
256
***Psychosis & Schizophrenia***
When is clozapine used?
Resistant schizophrenia
Only used when 2+ antipsychotics (inc. one 2nd gen) has been used for 6-8 weeks
257
***Psychosis & Schizophrenia***
(1) What are the monitoring requirements for clozapine? (2) How frequently should this be done?
(1) Leucocytes + differential blood counts
(2) Weekly for 18 weeks, THEN fortnightly til one year, THEN monthly
258
***Psychosis & Schizophrenia***
What are some side-effects of clozapine?
- Myocarditis & cardiomyopathy
- Agranulocytes + neutropenia
- GI disturbances
259
***Anxiety***
Which type of medication is used for the acute treatment of anxiety?
Benzodiazepines
260
***Anxiety***
What is the chronic treatment of anxiety?
- SSRI: Sertraline, citalopram, escitalopram, fluoxetine
- Propranolol (alleviates physical symptoms only)
261
***Anxiety***
How is an overdose of benzodiazepines?
Flumazenil
262
***Anxiety***
What can overdose of benzodiazepines lead to?
Can induce hepatic coma
263
***Anxiety***
What are some long-acting benzodiazepines?
- Diazepam
- Aprazolam
- Chlordiazepoxide
- Clobazam
264
***Anxiety***
What are some short-acting benzodiazepines?
- Lorazepam
- Oxazepam
265
***Anxiety***
When are short-acting benzodiazepines preferred?
- Hepatic impairment
- Elderly
266
***Anxiety***
Which type of benzodiazepines (long or short) have a greater risk of withdrawal symptoms?
Short-acting
Therefore only use for 2-4 weeks
267
***Anxiety***
Give some examples of waht can be used concomitantly with benzodiazepines to increase risk of sedation?
- Alcohol
- CNS depressants
- CYP enzyme inhibitors
268
***Anxiety***
Which benzodiazepines ahve a legal driving limit?
- Clonazepam
- Oxazepam
- Lorazepam
- Diazepam
- Flunitrazepam
- Temazepam
(COLD FT)
269
***Anxiety***
What are some symptoms of benzodiazepine withdrawal?
- Anxiety
- Sweating
- Weight loss
- Tremor
- Loss of appetite
270
***Anxiety***
How can benzodiazepine withdrawal be managed?
(1) Convert to once nightly dose of diazepam
(2) Reduce by 1-2mg every 2-4 weeks (1/10th on larger doses)
ø Only withdraw further if patient has overcome any withdrawal symptoms
(3) Reduce further (by 0.5mg at end
271
***Depression***
What is depression?
A reduction of serotonin, dopamine, or noradrenaline at the synaptic cleft
272
***Depression***
What is the first line treatment for mild depression?
CBT
273
***Depression***
When are antidepressants indicated in treatment of depression?
Moderate-severe
274
***Depression***
What may a patient on treatment of depression experience in the first 1-2 weeks of pharmacological treatment?
Worsening of symptoms
275
***Depression***
How long should antidepressants be taken for before they are deemed to be ineffective?
4 weeks
(6 weeks in elederly)
276
***Depression***
How long should antidepressants be taken, after remission?
For 6 months - 2 years in recurrent
(1 year in elderly)
277
***Depression***
What is the first line treatment of depression?
SSRI
278
***Depression***
What are the second line treatment options for depression?
- Increase dose
- Change SSRI
- MIrtazepine
- MAO-I
- TCA/ venlafaxine (if severe)
279
***Depression***
What is the third line treatment for depression?
Addition of another class, such as lithium/ other antipsychotics
280
***Depression***
What is the treatment for severe refractory depression?
Electroconvulsive therapy
281
***Depression***
What are the types of effects of serotonin syndrome?
(1) Cognitive effects
(2) Autonomic effects
(3) Neuromuscular excitation
282
***Depression***
What are some cognitive effects of serotonin syndrome?
- Headache
- Agitation
- Hypomania
- Coma
- Confusion
283
***Depression***
What are some autonomic effects of serotonin syndrome?
- Sweating
- Hyperthermia
- Nausea
- Diarrhoea
284
***Depression***
What are the symptoms of neuromuscular excitation in serotonin syndrome?
- Myoclonus
- Tremor
- Teeth grinding
285
***Depression***
Which drugs can cause serotonin syndrome?
- SSRIs/ TCA/ MAOi
- Triptans
- Tramadol
- Lithium
- Linezolid
- Bupropion
286
***Depression***
Name some common SSRIs.
- Fluoxetine
- Citalopram
- Escitalopram
- Sertraline
287
***Depression***
Which SSRI is considered safest in patients with a history of cardiac events?
Sertraline
288
***Depression***
What is the SSRI of choice in patients under 17 yeras old?
Fluoxetine
289
***Depression***
What are some side effects of SSRIs?
- GI disturbances
- Weight gain (appetite)
- Sexual dysfunction
- Risk of bleed
- Insomnia
- QT prolongation (citalopram/ escitalopram)
290
***Depression***
Which SSRIs can cause QT prolongation?
- Citalopram
- Escitalopram
291
***Depression***
What are some common interactions for SSRIs?
(1) CYP enzyme inhibitors
- avoid grapefruit juice (increases plasma concentration)
(2) CYP enzyme inducers
- reduces effectiveness
(3) Drugs that cause QT prolongation
- amiodarone/ stall/ quinolones
(4) Drugs that cause increased risk of bleeding
(5) Hyponatraemia
- carbemazepine/ diuretics
(6) Serotonin syndrome
292
***Depression***
(1) Which antidepressant is better for agitated and anxious patients for treatment of depression? (2) Why?
(1) TCAs
(2) Sedating
293
***Depression***
Which TCA antidepressants are sedating?
- Amitriptyline
- Clomipramine
- Dosulepin
- Trazodone
294
***Depression***
Which TCA antidepressants are non-sedating?
- Imipramine
- Lofepramine
- Nortriptyline
295
***Depression***
What are some common side-effects of TCA antidepressants?
- Cardiac events
- Anti-muscarinic
- Seizures
- Hypotension
- Hallucinations
296
***Depression***
What are some interactions of TCAs?
- CYP enzyme inhibitors (avoid grapefruit juice)
- CYP enzyme inducers (reduces effectiveness)
- Drugs that cause QT prolongation
- Anti-muscarinic drugs
- Anti-hypertensive drugs
- Serotonin syndrome
297
***Depression***
What are some examples of MAOis?
- Tranylcypromine
- Phenelzine
- Isocarboxazid
- Moclobemide
298
***Depression***
Which MAOis can cause hepatotoxicity?
- Phenelzine
- Isocarboxazid
299
***Depression***
Can tranylcypromine and clomipramine be given together?
No, fatal
300
***Depression***
Which antidepressants have a washout period?
MAOis
301
***Attention Deficit Hyperactivity Disorder***
(1) Which type of formulation is preferred for treatment of ADHD? (2) Why?
(1) M/R
(2) Better pharmacokinetic profile, convenience, and improved adherence
302
***Attention Deficit Hyperactivity Disorder***
Do M/R formulations for treatment of ADHD need to be brand specific?
Yes
303
***Attention Deficit Hyperactivity Disorder***
What is the first line treatment for ADHD?
Methylphenidate (5yrs<)
304
***Attention Deficit Hyperactivity Disorder***
What is the alternative treatment option for ADHD, if first line treatment is unsuccessful after 6 weeks?
Lisdexamfetamine
305
***Attention Deficit Hyperactivity Disorder***
For treatment of ADHD, if lisdexamfetamine was helping but longer duration could not be tolerated, what can be used instead?
Dexamfetamine
306
***Attention Deficit Hyperactivity Disorder***
What is the treatment of ADHD in patients who are intolerant of both methylphenidate and lisdexamfetamine?
Atomoxetine/ guanfacine
307
***Attention Deficit Hyperactivity Disorder***
What is the second line treatment for ADHD in adults?
Atomoxetine
308
***Attention Deficit Hyperactivity Disorder***
What are some side-effects/ cautions for atomoxetine?
- QT prolongation
- Hepatotoxicity
- Suicidal ideation
- Sexual dysfunction
309
***Attention Deficit Hyperactivity Disorder***
What schedule are methylphenidate and lisdexamfetamine?
Schedule 2
310
***Attention Deficit Hyperactivity Disorder***
What are the phases of overdose of amphetamines?
(1) Wakefulness, excessive activity, paranoia, hallucination, hypertension
(2) Exhaustion, convulsions, hyperthermia, coma
311
***Attention Deficit Hyperactivity Disorder***
How does methylphenidate work?
CNS Stimulant
312
***Attention Deficit Hyperactivity Disorder***
What schedule is methylphenidate?
Schedule 2
313
***Attention Deficit Hyperactivity Disorder***
(1) What monitoring requirements are there for methylphenidate? (2) How frequently?
(1)
- Pulse
- BP
- Psychiatric symptoms
- Weight loss
- Height
(2) At initiation and then 6 monthly
314
***Attention Deficit Hyperactivity Disorder***
What are some important side effects of methylphenidate?
- High BP
- Tachycardia
- Arrhythmias
- Behavioural changes
- Drowsiness
- Sleep disorders
- Weight loss
- Growth retardation
315
***Substance Dependence***
How should mild alcohol withdrawal be managed?
Usually do not need assistance
316
***Substance Dependence***
Where should moderate alcohol withdrawal be managed?here
Community
Unless at high risk of withdrawal seizures/ delirium tremens
317
***Substance Dependence***
Where should severe alcohol withdrawal be managed?
Inpatient setting
318
***Substance Dependence***
How should delirium in alcohol withdrawal be managed?
Lorazepam
319
***Substance Dependence***
How should Wernicke's encephalopathy in alcohol withdrawal be managed?
Thiamine (vit B1)
320
***Substance Dependence***
(1) How should alcohol dependence be managed? (2) How should withdrawal symptoms be managed?
(1) CBT/ acamprosate/ naltrexone
(2) Chlordiazepoxide/ diazepam (aslo can use carbemazepine/ clomethiazole)
321
***Substance Dependence***
(1) What is the first line treatment for nicotine dependence? (2) When should this be avoided?
(1) Varenicline
(2) CVD/ psychiatric illness/ epilepsy
322
***Substance Dependence***
(1) What is the second line treatment for nicotine dependence? (2) When should this be avoided?
(1) Bupropion
(2) Psychiatric illness, seizures, eating disorders, serotonin syndrome
323
***Substance Dependence***
What is the third line treatment for nicotine dependence?
NRT
324
***Substance Dependence***
Which script should opioid dependence treatment be prescribed on?
FP10MDA
325
***Substance Dependence***
In treatment of opioid dependence, how many missed doses are required for a patient to be referred back to a specialist?
3 or more missed doses
Re-titration needed
326
***Substance Dependence***
Should opioid dependence treatment be continued in pregnancy?
Yes
327
***Substance Dependence***
When should naloxone be presrcibed alongside opioid dependence treatment?
In high risk of overdose
328
***Substance Dependence***
Give pros and cons of buprenorphine vs methadone in opioid dependence treatment.
BUPRENORPHINE:
- less sedating than methadone
- milder withdrawal symptoms
- lower risk of overdose
METHADONE:
- Can be carefully titrated according to patient's need
- causes QT prolongation
329
***Migraines***
What symptoms often accompany migraines?
- Nausea + vomiting
- Photophobia
- Phonophobia
330
***Migraines***
(1) What are some visual symptoms of migraines? (2) What are some sensory symptoms of migraines?
(1) Zigzag/ flickering lights, spots/ lines
(2) Pins/ needles, numbness
331
***Migraines***
What is the lifestyle advice for a migraine?
- maintain hydration, sleep + exercise
- avoid chocolate + wine
- relax after stress
- create a headache diary (to help identify triggers)
332
***Migraines***
What is the acute treatment of migraines?
Ibuprofen/ aspirin/ 5HT-1 agonist (preferably sumatriptan)
333
***Migraines***
When should a -triptan be taken for a migraine?
At start of HEADACHE not at start of aura
334
***Migraines***
How frequently can a -triptan be administered for migraines?
Can repeated after 2hrs (4hrs for naratriptan)
335
***Migraines***
(1) When are triptans contraindicated? (2) Why?
(1) Heart disease
(2) Cause constriction of blood vessels
336
***Migraines***
(1) For a migraine, when first line treatment options are not suitable, what can be used instead? (2) Why?
(1) Soluble paracetamol
(2) Faster acting, as it is already broken down (can also use any liquid preparation)
337
***Migraines***
Which antiemetics are most suitable in treatment of migraines?
Metoclopramide/ prochlorperazine
338
***Migraines***
What is the first line treatment for migraine prophylaxis?
Propranolol
339
***Migraines***
What is the second line treatment for migraine prophylaxis?
Amitriptyline
340
***Migraines***
What else can be used for migraine prophylaxis, if first and second line treatment options are unsuitable?
Sodium valproate/ pizotifen/ Botox
341
***Migraines***
What are the different types of headache?
- cluster
- migraine
- tension
342
***Migraines***
What is the acute treatment of cluster headaches?
SC sumatriptan
343
***Migraines***
What is the prophylactic treatment of cluster headaches?
Verapamil/ lithium/ prednisolone/ ergotamine
344
***Migraines***
What is the treatment for trigeminal neuralgia?
Carbamazepine
(Or pregabalin/ gabapentin)
345
***Migraines***
What is the treatment for a tension headache?
Paracetamol/ ibuprofen
346
***Nausea & Vomiting***
Which antihistamines can be useful in prevention of nausea and vomiting?
Cyclising/ promethazine
347
***Nausea & Vomiting***
Which antiemetics are most appropriate in postoperative nausea and vomiting?
5HT-3 receptor antagonist (e.g. ondansetron) or dexamethasone
348
***Nausea & Vomiting***
Which antiemetics are most appropriate in preoperative nausea and vomiting?
Lorazepam (short-acting)
349
***Nausea & Vomiting***
Which antiemetics are most appropriate in motion sickness nausea and vomiting?
Hyoscine hydrobromide
350
***Nausea & Vomiting***
Which antiemetics are most appropriate in nausea and vomiting associated with a terminal illness?
Haloperidol/ levomepromazine
351
***Nausea & Vomiting***
Which antiemetics are most appropriate in nausea and vomiting in a patient with Parkinson’s disease?
Domperidone
352
***Pain Management***
What is the treatment for mild pain?
Non-opiates
Paracetamol/ NSAIDs/ aspirin
353
***Pain Management***
What is the treatment for mild-moderate pain?
Weak opiates (codeine/ dihydrocodeine)
Moderate - tramadol
354
***Pain Management***
What are some cautions with tramadol?
- lowers seizure threshold
- serotonin syndrome
- increased risk of bleed
- psychiatric disorders
355
***Pain Management***
What is the treatment for moderate-severe pain?
Strong opiates
Morphine/ oxycodone/ fentanyl/ methadone/ buprenorphine
356
***Pain Management***
What is the treatment for neuropathic pain?
- TCAs (amitriptyline/ nortriptyline)
- antiepileptics (gabapentin/ pregabalin)
- opiates (tramadol/ morphine/ oxycodone)
- topical localised (lidocaine/ capsaicin)
357
***Pain Management***
What are the main side effects of opiates?
- dry mouth
- constipation
- CNS depression
- nausea and vomiting
- hypotension
- miosis (pupil constriction)
358
***Pain Management***
What issues can prolonged opioid use contribute to?
- hypogonadism
- adrenal insufficiency
- hyperalgaesia (pain sensitivity)
359
***Pain Management***
What opioid dose can be used for breakthrough pain?
1/6th to 1/10th of total daily dose
Every 2-4 hours
360
***Pain Management***
What are the main contraindications for use of opioids?
- respiratory depression
- head injury
- paralytic ileus
361
***Pain Management***
What is the maximum dose that methadone should be decreased to when switching to buprenorphine?
30mg
362
***Pain Management***
Which is more potent, oxycodone or morphine?
Oxycodone
More appropriate in patients who can’t consume large quantities due to nausea
363
***Pain Management***
When should a fentanyl patch be removed if there are signs of toxicity?
Immmediately
364
***Pain Management***
What effect can temperature have on fentanyl patches?
Concentrations may increase if skin temperature increases
365
***Pain Management***
(1) In what age groups can codeine be used? (2) What about codeine linctus?
(1) >12yrs old - >18yrs old if tonsils removed due to sleep apnoea
(2) >18yrs old
366
***Pain Management***
Which ethnicity is known to be at increased risk of being ultra-rapid metabolisers of codeine?
Afro-Caribbean
367
***Pain Management***
(1) In which ethnicity should codeine be avoided/ used with caution? (2) Why?
(1) Afro-Caribbean
(2) Risk of toxicity if ultra-rapid metabolisers
368
***Pain Management***
Can codeine be used in breastfeeding patients?
No
Avoid
369
***Pain Management***
Which pathway do opioids act on?
Mu pathway
