NERVOUS SYSTEM

Question 1

Does PPP extend to Valporic acid too?

Answer 1

Yes

Question 2

Valproic acid - when to withdraw?

Answer 2

If patient experiences Sx of pancreatitis or hepatic dysfunction

Question 3

For BPD and migraine prophylaxsis (unlicensed)

Answer 3

MHRA advises that valproate must NOT be used
Can be used in epilepsy if there is no alternative

Question 4

Lithium concentrations should be taken after ____ hrs

Answer 4

12

Question 5

Patient and carer advice for Lithium

Answer 5

should report signs of Lithium Toxicity, Hypothyroidism, renal dysfunction (polyuria+ polydipsia) and intracranial HTN (persistent headache + visual disturbances)

Question 6

Anti-depressants should be continued for how long after remission

Answer 6

6 months (12 months in elderly) for depression
12 months for GAD
Those with Hx of recurrent depression = 2 years

Question 7

Hyponatraemia symptoms for Antidepressants

Answer 7

confusion, convulsions + drowsiness

Question 8

Second choices after SSRI not effective

Answer 8

increase dose or switch to different SSRI
Or mirtazapine
Third line: Lofepramine or moclobemide or robextine
TCA + Venlafaxine = severe depression
Irreversible MAOi = specialist initiation only

Question 9

Failure to respond to second antidepressant =

Answer 9

adding another anti-depressant of a different class or use of augmenting agent

Question 10

GAD SSRIs/ SNRIs

Answer 10

Paroxetine, Escitalopram or sertraline (unlicensed)
Duloxetine or Venlafaxine.

Question 11

More sedative TCAs ( better for anxious pts)

Answer 11

Amitriptyline, Clomipramine, Trazadone, Dosulepin

Question 12

Less sedative (better for depressed pts)

Answer 12

Imipramine and Lofepramine and nortriptyline

Question 13

Safest TCA

Answer 13

Lofepramine

Question 14

Highest anti-muscarinic SEs TCA wise

Answer 14

Imipramine

Question 15

The TCA(s) most likely to cause Hepatoxicity

Answer 15

Isocarboxazid + Phenelzine

Question 16

Monitoring requirements for Mianserin (TCA)

Answer 16

FBC every 4 weeks for 3 months. Monitor for Sx of blood disorders.

Question 17

TCA should be discontinued if the patient enters a _____ phase

Answer 17

manic

Question 18

Treatment cessation for anti-depressants

Answer 18

Withdrawal effects may occur within 5 days of stopping treatment with antidepressant drugs; they are usually mild and self-limiting, but in some cases may be severe. The risk of withdrawal symptoms is increased if the antidepressant is stopped suddenly after regular administration for 8 weeks or more. The dose should preferably be reduced gradually over about 4 weeks, or longer if withdrawal symptoms emerge (6 months in patients who have been on long-term maintenance treatment).

Question 19

Tryptophan red flag sx

Answer 19

If the patient experiences symptoms of eosinophilia myalgia syndrome (affects muscles, skin and lungs) – with hold tx until EMS excluded

Question 20

Vortioxetine reasons for discontinuation

Answer 20

Seizures (develop or there is an increase in seizure frequency)

Question 21

Benperidol

Answer 21

Control of deviant anti-social behaviour.

Question 22

When would an antipsychotic dose be deemed ineffective

Answer 22

After 4 to 6 weeks

Question 23

Aripiprazole increases prolactin levels in a ____ dependent manner

Answer 23

dose

Question 24

Risperidone, amisulpride, sulpiride and first gen anti-psychotics are more likely to cause

Answer 24

Hyperprolactinemia

Question 25

Aripiprazole, Clozapine and Quetiapine less likely to cause

Answer 25

Hyperprolactinemia

Question 26

Sx of hyperprolactaemia

Answer 26

Sexual dysfunction, menstrual irregularities, reduced bone mineral density , galactorrhoea and increased cancer risk

Question 27

Risperidone, Olanzapine and Haloperidol have the highest risk of

Answer 27

Sexual dysfunction

Question 28

Aripiprazole and Quetiapine have the lowest risk of

Answer 28

sexual dysfunction

Question 29

Postural hoTN is more likely with which antipsychotics

Answer 29

Clozapine and Quetiapine

Question 30

Antipsychotics which are least likely to cause diabetes

Answer 30

Aripiprazole and Amisulpiride (second gen) Haloperidol and Fluphenazine ( first gen)

Question 31

Highest risk of weight gain (antipsychotics wise)

Answer 31

Clozapine and Olanzapine

Question 32

Discontinuation of anti-psychotics following NMS should last at least

Answer 32

5 days

Question 33

Tx of NMS

Answer 33

Bromcriptine and dantrolene

Question 34

Contact sensitisation associated with which drug

Answer 34

chlorpromazine

Question 35

BP monitoring not mandatory for which antipsychotic

Answer 35

Sulpiride

Question 36

Cariprazine requirements for contraception

Answer 36

Highly effective contraception in women of CBP during tx and 10 weeks after last dose BArrier method + contraceptive.

Question 37

MHRA alert for ondansetron

Answer 37

Risk of cleft lip/ cleft palate in babies born to women who had ondansetron in the first trimester

Question 38

Hyoscine patch administation

Question 39

Tapentadol MHRA alert

Answer 39

Can induce seizures and therefore should be used with caution in patients with a Hx of epilepsy. Increase risk of SS with other serotonergic drugs

Question 40

Post op tramadol

Answer 40

Extreme caution in children. Life threatening events after tonsillectomy for obstructive sleep opnoea