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Nervous System Flashcards

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1
Q

Is dementia non progressive and reversible?

A

Dementia is progressive and largely irreversible

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2
Q

Symptoms of dementia

A

Cognitive symptoms:

  1. Memory loss
  2. Difficulty thinking
  3. Language
  4. Orientation

No cognitive symptoms

  1. Psychiatric and behavioural problems
  2. Difficulties in daily activities
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3
Q

Is there treatment for vascular dementia

A

No

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4
Q

Treatment for mild to moderate dementia

A

Treatment usually includes acetylcholesterase inhibitors

  1. Donepezil ( can very rarely cause malignant syndrome)
  2. Rivastigmine (only one licensed for dementia in Parkinson’s)
  3. Galantamine ( can cause very serious skin reactions)
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5
Q

Treatment in severe dementia

A

Memantine. It can be used in moderate dementia where anticholinesterases are contraindicated. It can also manage non-cognitive symptoms

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6
Q

Cholinergic side effects

A

Diarrhoea
Urination
Muscle weakness, cramps, miosis
Bronchospasm

Bradycardia
Emesis
Lacrimation (teary eyes)
Salivation/Sweating

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7
Q

Management of non cognitive symptoms for dementia

A

If less severe then no drug treatment. Only aromatherapy or multi sensory stimulation. Antipsychotics should only be given if the patient is extremely distressed or there is an immediate risk of harm to others or themselves.

Extreme violence or aggression:

  1. Oral benzodiazepines or antipsychotic ( there is an increased risk of stroke or death when antipsychotics used in elderly patients with dementia).
  2. IM haloperidol, lorazepam, olanzapine
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8
Q

Difference between epileptic and non epileptic seizures

A

Epilepsy is a sudden surge of electrical activity in the brain.
Non-epileptic seizures can be of two types:
1. Organic ( e.g. hypoglycaemia or fever)
2. Psychogenic ( mental/ emotional processes)

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9
Q

How often are anti epileptics taken

A

Mostly taken twice a day except for:

  1. Lamotrigine
  2. Perampanel
  3. Phenytoin

This is because they have long half lives and are taken once daily at bedtime

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10
Q

Epilepsy treatment

A

Partial- 1st line lamtrogine/carbamazepine
Generalised seizures - tonic clonic - 1st line sodium valproate / carbamazepine. Alternative is lamotrigine
- absence seizures 1st line ethosuximide or sodium valproate - alternative is lamtorigine
- myoclonic - 1st line sodium valproate
- atonic 1st line is sodium valproate

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11
Q

Epilepsy treatment categories

A

Category one - have to be on the same brand. Carbamazepine, phenytoin, phenobarbital, primidone
Category two- based on clinical judgement and patient consultation - valproate, lamotrigine, clonazepam, topiramate
Category three- do not need maintain on same product- levetiricetam, gabapentin, pregabalin, ethosuximide,

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12
Q

Which antiepileptics can increase risk of birth defects

A
  1. Sodium valproate / valproic acid
  2. Phenytoin
  3. Phenobarbital
  4. Primidone
  5. Lamotrigine
  6. Carbamazepine
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13
Q

DVLA rules in regards to seizures

A
  1. Can only drive if they have been seizure free for 1 year
  2. Can only drive if they are getting only asleep seizures for at least 3 years
  3. If they do get a first seizure, can not drive for 6 months
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14
Q

What medication is given at bIRTH

A

Injection of vitamin k to reduce risk of neonatal haemorrhage particularly those that have been associated with anti epileptic medication

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15
Q

What to watch out for with carbamazepine

A

Blood disorders
Sore throat
Seizure
Unexplained bruising

Can show bone marrow suppression

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16
Q

Carbamazepine symptoms of toxicity

A

Blood disorders
Skin disorders
Drowsiness
Blurred vision

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17
Q

Which antiepileptic medication cause blood dyscrasias

A

C VET PLZ

Carbamazepine
Valproate
Ethosuximide
Topiramate

Phenytoin
Lamtorigine
Zonisamide

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18
Q

Can carbamazepine cause respiratory depression

A

Yes especially in patients with impaired lung function e.g. asthma, copd
Be careful with cnd depressants

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19
Q

What do Anti epileptic enzyme inducers interact with

A

Can interact with oral contraceptives and warfarin

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20
Q

Should phenytoin be used in absenses and myoclonic seizures

A

No. Phenytoin should be avoided as it can exacerbate these seizures

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21
Q

Signs of phenytoin toxicity

A 
Slurred speech
Nystagmus ( uncontrolled eye movement)
Ataxia ( lack of voluntary co-ordination of muscle movements)
Confusion
Hyperglycaemia
Diplopia (double vision)

Snached

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22
Q

Which medication are anti folates

A

Phenytoin, Trimethoprim and methotrexate

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23
Q

Which medication reduce the seizure threshold

A

Quinolones, tramadol, SSRI, and antipsychotics

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24
Q

MOA of carbamazepine

A

Inhibits sodium channels stabilising membrane potential

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25
Carbamazepine signs of toxicity
IHANDBAG ``` Inco-ordination Hyponatraemia Ataxia( lack of voluntary co-ordination of muscles) Nystamus ( uncontrolled repetitive eye movement) Drowsiness Blurred vision Arrythimas Gastro-intestinal disturbance ```
26
Sodium valproate MOA
Weak inhibitor of sodium chloride channels
27
Convulsive Status epileptics first line
IV Lorazepam is given first line
28
Non-convulsive status epileptics
if incomplete loss then restart usual oral antiepileptic | If complete loss then IV lorazepam
29
Treatment of status epilepticus in the community setting
Status epilepticus in the community setting is usually treated using either rectal diazepam solution or using midazolam oromucosal solution administered into the buccal cavity. This is repeated after 10-15 mins if necessary
30
Common medication to treat anxiety
Diazepam, lorazepam and propranolol
31
What to look out for with sodium valproate
Hepatotoxicty. Such as jaundice, abdominal pain
32
Do shorter acting BZD cause more withdrawal symptoms
Yes. E.G Lorazepam
33
Do beta blockers work on the psychological effects or the physical autonomic symptoms
Physical autonomic symptoms. Reducing heart palpitations, tremors
34
Is buspirone licenced for long or short term use
It is licensed for short term use in anxiety. However it can take up to 2 weeks to start working. If coming off of BZD, it must be tapered off.
35
Can BZD cause paradoxical effects
Yes they can. Things like aggression, talkativeness, excitement, antisocial acts
36
Which medication is given to reverse the effects of sedation in BZD
Flumazenil
37
Treatment for ADHD
1st line: methylphenidate CD2 2nd line: Lisdexamfetamine CD2 Alternative is atomoxetine
38
Methylphenidate CD2
Potent CNS stimulant
39
Dexamfetamine and lisdexamfetmine
Potent CNS stimulant
40
Atomoxetine
Noradrenaline reuptake inhibitor causes increased levels of noradrenaline at synaptic cleft. Counsel the patient to report suicideal thoughts, self harming behaviour
41
Can BZD be used in acute episodes of mania And hypo mania
Yes. Only short term use tho as it can cause dependence
42
2nd generation antipsychotics
Quetiapine Olanzapine Risperidone
43
Severe manic episodes
Lithium or valproic acid may be added
44
Signs of lithium toxicity
``` REVENGE Renal disturbances- polyuria, incontinence, hypernatraemia, Extrapyramidal symptoms: Visual disturbances Nervous system disturbances Gastro-intestinal effects ```
45
Counselling for lithium
Maintain constant, adequate salt and water intake Lithium treatment pack Avoid alcohol as lithium can cause drowsiness. OTC interactions: NSAIDS, analgesics, antacids Lithium is teratogenic, effective contraception is needed Lithium can lower seizure threshold
46
Lithium interactions
Increased risk of seizures QT interval prolongation Reduced renal excretion Hyponatraemia predisposes lithium toxicity Increased risk of extrapyramidal sympotoms Concomitant drugs that affect salt balance Increased risk of neurotoxicity Increased risk of serotonin syndrome
47
Major Classes of Antidepressants
MOA TCA (common Amitriptyline) SSRI (common Citalopram, fluoxetine, sertraline) Amitriptyline also used in neuropathic pain Fluoxetine only licensed in children Sertraline Safe to use after MI/unstable angina
48
First Line treatment of Antidepressants
SSRI Better tolerated, and safer in OD Less sedating Takes 2 weeks to work - may initially feel worse Wait at least 4 weeks, 6weeks in the elderly Continue to take for atleast 6 months after remission
49
Failure to respond to SSRI
Increase dose or choose a different SSRI or Mirtazepine Other choices lofepramine, metoclobramide
50
Side effects of SSRI
Hyponatraemia, suicidal ideation and behaviour | SSRI - syndrome ( neuromuscular hyperactivity, altered mental state, autonomic dysfunction)
51
Side effects of using SSRI
Gastro intestinal disturbances Appetite or weight disturbances Serotonin syndrome Hypersensitivity reactions Citalopram QT interval prolongation
52
Which juice is avoided with SSRI
Grapefruit juice
53
How often do u take TCA.
Once daily at night
54
TCA side effects
T - more toxic in overdose C- Cardiac side effects A- antimuscarinic side effects Seizure thresholds
55
MAOI can cause
Postural hypotension and hypertensive responses Should be discontinued in palpitations or frequent headaches occur. Avoid food containing tyramine Mature cheese, wine, herring,game,meat stocks
56
Antipsychotics drugs given in which route during an emergency
IM
57
First generation antipsychotics Cause what type of side effects
Extrapyramidal symptoms and hyper prolactin anemia. But they cause less metabolic side effects
58
Extrapyramidal side effects
Parkinsonism Dystopia Akathisia Tardive dyskinesia
59
Most antipsychotics cause hyperprolactinaemia apart from
Aripiprazole because it is a partial dopamine agonist
60
Weight gain is usually seen in which antipsychotics
Clozapine and olanzapine
61
What caution needs to be taken with chlorpromazine
Avoid direct contact with it. Avoid crushing and handle solutions with care
62
Aspirin adult dose and caution and advisory label
Adult dose is 300-900mg every 4-6 hours as required. A maximum of 4g per day. Taken with or just after food. Not for under 16 as it can cause Reyes
63
What cd class is morphine
Morphine is cd2 however, morphine sol 13mg/5ml or less is cd5
64
Break through pain and standard rescue dose
break through pain is a sudden flair up that breaks through regular doses of pain regulation. Standard rescue dose is usually 1/10th to 1/6th of regular 24 hour dose, repeated every 2-4 hours as required
65
Opioid effects
``` Dry moth Constipation Sedation Reduced concentration and confusion Euphoria, hallucinaitons ```
66
Opioid side effects
``` MIOSIS (PINPOINT PUPILS) OUT OF IT (SEDATION) RESPIRATORY DEPRESSION POSTURAL HYPOTENSIOLN HYPERALGESIA, HALLUCINATIONS INFREQUENCY (URINARY RETENTION, CONSTIPATION) NAUSEA AND VOMITING EUPHORIA ``` MORPHINE
67
Morphine dose for immediate and modified release
Dose is every 4 hours in immediate release and then 12-24 hours modified release
68
In palliative care do not adjust the dose of morphine by more than
1/2 to 1/3 of the total daily dose and the dose should be increased no frequently than 24 hours
69
What’s the relationship between parenteral dose and the oral dose of morphine
The parenteral dose of morphine is half the oral dose
70
The equivalent dose of diamorphine and morphine is
Diamorphine is 1/3 of oral morphine dose
71
Buprenorphine patch. How long does it act
72 hours, 96 hours, 7 day patch
72
How long does fentanyl patch act
72 hours
73
Codeine is contraindicated with which age group
Under 18 as they may metabolise it to morphine
74
First line migraine attack
Simple analgesic such as aspirin, paracetamol or NSAID. Soluble or dispersible formulation
75
Treatment of migraines
Take one dose of sumatriptan asap. If a second attack occurred a 2nd dose can be taken at least 2 hours after the first dose. They work by vasoconstriction of intracranial blood vessels.
76
Cluster headache choice of drug
Sumatriptan

Nervous System (1 decks)

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