Nervous System

Question 1

First Line treatment for acute migraine

Answer 1

Monotherapy with either aspirin, ibuprofen or a 5HT1-receptor agonist (‘triptans’).

Question 2

What treatment options would be recommended if a patient does not respond to monotherapy

Answer 2

Sumatriptan and naproxen (unlicensed indication)

Question 3

Antiemetics suggested in relieving N+V symptoms in migraines

Answer 3

Metoclopramide or prochlorperazine (unlicensed use)

Question 4

Precautions/important safety aspects with metoclopramide

Answer 4

• Should not be used regularly due to risk of EPSEs.. caution in parkinsons
• Should only be prescribed for short term use (up to 5 days)
• Usual recommended dose of 10mg up to tds.
• also caution in bradycardia, cardiac conduction disturbances.

Question 5

What treatments can be used in prophylaxis of migraines

Answer 5

Propranolol is recommended first line 80-240mg in divided doses. (works by blocking receptors in blood vessels which causes vessels to relax and improve blood flow.

Where propranolol in unsuitable other beta blockers can be considered such as metoprolol and atenolol.

If a betablocker is unsuitable in patients with episodic or chronic migraines - topiramate can be given (not in females of childbearing age).

Tricyclics can also be used in episodic or chrinic migraines

Question 6

What antiepileptic meditations are in cat 1

Answer 6

Carbamazepine
Phenobarbital
Phenytoin
Primidone

Maintained on specific brand.

Question 7

What antiepileptics are in category 2

Answer 7

Clobazam,
clonazepam,
eslicarbazepine acetate,
lamotrigine,
oxcarbazepine,
perampanel,
rufinamide,
topiramate,
valproate,
zonisamide

continued supply of a particular manufacturer’s product should be based on clinical judgement

Question 8

What are the symptoms of Antiepileptic hypersensitivity syndrome

Answer 8

fever
rash
lymphadenopathy (enlarges lymphnodes)
other: liver dysfunction, renal and pulmonary abnormalities

Question 9

Criteria for antiepileptic withdrawal

Answer 9

• Seizure free for at least 2 years
• Only one drug withdrawn at a time
• dose reduction over three months
• barbiturates and benzodiazepines may need reducing over a longer period of time

Question 10

when clozapine is initiated, how often are clozapine levels taken?

Answer 10

weekly for the first 18 weeks, then fortnightly for up to a year then monthly after that

Question 11

What are the main side effects/adverse effects of clozapine?

Answer 11

-Neutropenia/agranulocytosis
-reduced gastrointestinal motility
- weight gain
- hypersalivation

others:
- myocarditis
- sedation
- nocturnal enuresis (contraction in bladder)

Question 12

what are non motor symptoms of Parkinson’s?

Answer 12

• Daytime sleepiness and sudden onset of sleep
• Nocturnal akinesia (difficulty moving/turning in bed)
• Postural hypotension
• Depression
• Psychotic symptoms
• Rapid eye movements sleep behavior
• parkinsons dementia
• drooling of saliva

Question 13

What is the function oof carpidopa in co-careldopa

Answer 13

increases bioavailability of levodopa preventing it from breaking down before reaching CNS

Question 14

contraindications for levodopa preparations

Answer 14

Angle-closure glaucoma; suspicious undiagnosed skin lesions or history of skin melanoma (risk of activation)

Question 15

common side effects of levodopa preparations

Answer 15

Anxiety; appetite decreased; arrhythmia; depression; diarrhoea; hallucination; movement disorders; nausea; parkinsonism; postural hypotension; sleep disorder; taste altered; vomiting

Question 16

MHRA/CHM alert: There is a risk of…… with aripiprazole

Answer 16

Gambling