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Pre-reg revision > Nervous system > Flashcards

Nervous system Flashcards

1
Q

What is a side effect associated with ALL epilepsy drugs?

A

Increased risk of suicidal thoughts and behaviours

Patients should seek medical advice if they develop mood changes/distressing thoughts etc

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2
Q

How long must established epileptic patients be seizure-free for before they can drive?

A

1 year

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3
Q

When are epilepsy sufferers banned from driving?

A
  • During medication changes
  • 6 months after last dose if stopping medication
  • 6 months if single isolate seizure/first unprovoked seizure
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4
Q

If an epileptic patient has a seizure due to withdrawal of treatment, how long are they banned from driving for?

A

1 year

Relicensing may be considered earlier if treatment is reinstated and no seizures for 6 months

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5
Q

For which type of seziure is sodium valproate NOT a recommended first line treatment?

A

Focal seizures

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6
Q

First line treatment for focal seizures?

A

Carbamazepine or lamotrigine

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7
Q

First line treatment for tonic-clonic seizures?

A

Sodium valproate/carbamazepine

- lamotigine if SV not appropriate

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8
Q

First line treatment for absence seizures?

A

Sodium valproate / ethosuximide

- alternative = lamotrigine

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9
Q

First line treatment for myoclonic seizures?

A

Sodium valproate

alternative - topiramate or levetiracetam

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10
Q

In which type of generalised seizure is lamotrigine not recommended as an alternative first line therapy to sodium valproate in pre-menopausal women?

A

Myclonic seizures

recommended alternatives are topiramate or levetiracetam

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11
Q

Which are category 1 anti-epileptics that should always be maintained on the same product/brand?

A

Phenytoin, carbamazepine, phenobarbital, primidone

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12
Q

Which anti-epileptic has the HIGHEST risk of teratogenicity?

A

Sodium valproate

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13
Q

Which anti-epileptic has a risk of causing cleft palate if it is used in the first trimester?

A

Topiramate

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14
Q

What supplements should pregnant women on anti-epileptics take to reduce the risk of neural tube defects?

A

Folic acid 5mg until week 12

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15
Q

What treatment should be given to neonates at birth if their mothers have been taking anti-epileptics in pregnancy?

A

Vitamin K to reduce risk of neonatal haemorrhage

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16
Q

How should anti-epileptics be withdrawn?

A
  • Gradually

- withdraw one anti-epileptic at a time

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17
Q

‘In the treatment of epilepsy monotherapy should be prescribed wherever possible, particularly in pregnancy or breastfeeding’
True or false?

A

TRUE

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18
Q

Can women taking anti-epileptics breast feed?

A

Yes if on monotherapy.

Monitor infants for sedation, feeding difficulties, weight gain and developmental milestones

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19
Q

Which anti-epileptics might affect foetal growth?

A

Topiramate and levetiracetam

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20
Q

Which anti-epileptics are associated with blood dyscrasias and require patients to report any bruising, bleeding or signs of infection?

A 
Carbamazepine
Valproate
Ethosuximide
Topiramate
Phenytoin
Lamotrigine
Zonisamide

C Vet Plz

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21
Q

Which anti-epileptic is an enzyme inducer that may reduce efficacy of hormonal contraception?

A

Carbamazepine

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22
Q

What is the maximum dose of Gabapentin when used to treat neuropathic pain?

A

3.6g /day

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23
Q

Which anti-epileptic is also effective in migraine prophylaxis?

A

Gabapentin (this is an unlicensed use)

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24
Q

Which anti-epileptic is associated with the risk of serious skin reactions including Steven-Johnson syndrome?

A

Lamotrigine
Most rashes occur within first 8 weeks
Higher risk if high initial dose, rapid dose increase or used with valproate

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25
Which anti-epileptic can be associated with severe respiratory depression even without opioids?
Gabapentin
26
Which anti-epileptics are enzyme inducers?
Carbamazepine, phenytoin + phenobarbital
27
What is the therapeutic range of phenytoin?
10-20 mg/L or 40-80 micromol/L
28
When should plasma levels of phenytoin be taken?
After 10 days (trough level - pre dose)
29
What are the signs of phenytoin toxicity?
Nystagmus (uncontrolled/involuntary eye movements), slurred speech, ataxia, confusion, hyperglycaemia
30
What is the risk if phenytoin is administered too quickly?
Risk of bradycardia and hypotension - C/I in heart block | Max infusion rate 50mg/min
31
Which anti-epileptic is also licensed for generalised anxiety disorder?
Pregabalin
32
What is the maximum dose of Pregabalin when used to treat neuropathic pain?
600mg / day
33
100mg phenytoin sodium is equivalent to how much phenytoin base?
92mg
34
Which anti-epileptic is an enzyme inhibitor?
Sodium valproate
35
What is the therapeutic range for carbamazepine?
4-12 mg/L
36
What are the signs of carbamazepine toxicity?
Vomiting, arrythmias, visual disturbances, incoordination, hyponatraemia, ataxia
37
What are the signs of anti-epileptic hypersensitivity syndrome?
Fever, rash, lympadenopathy - potentially fatal
38
What is a potential visual side effect of topiramate?
Acute myopia (short-sightedness) with secondary angle glaucoma - usually occurs after a month of treatment - seek specialist advice and discontinue as fast as possible if raised intra-ocular pressure
39
What is a potential visual side effect of vigabatrin?
Visual field defects - can persist despite discontinuation - new visual symptoms should be referred
40
Which anti-epileptic is associated with encephalopathic symptoms?
Vigabatrin | signs include sedation/stupor/confusion
41
MHRA advice with sodium valproate?
Contra-indicated in women and girls off child bearing potential unless conditions of the pregnancy prevention programme are met and only if other treatments are ineffective/not tolerated
42
What is the risk of teratogenicity with valproate?
``` Neurodevelopmental disorders (30-40%) Congenital malformations (11%) ```
43
Other than epilepsy, what is valproate licensed for?
Migraine prophylaxis and bipolar disorder
44
What should pharmacists dispensing valproate do?
- Provide a patient card every time it is dispensed - Remind patients of the risks in pregnancy and the need for annual specialist review - Dispense in whole packs where available, always give PIL and warning sticker on box
45
What would you advise a woman taking valproate who had an unplanned pregnancy?
See their prescriber urgently and not stop treatment in the mean time
46
Is sodium valproate a black triangle drug?
Yes
47
What are some serious side effects of valproate?
- liver toxicity - pancreatitis - blood dyscrasias
48
What are the non-cognitive symptoms of dementia?
- psychiatric/behavioural problems (aggression) | - difficulties with daily activities
49
What are the cognitive symptoms of dementia?
- memory loss - difficulty thinking - problems with language - problems with orientation
50
Which 3 acetylcholinesterase inhibitors are used to treat mild to moderate dementia due to Alzheimers disease?
- Donepezil - Rivastigmine - Galantamine
51
What are the side effects of rivastigmine?
- Hallucinations / sleep disorders | - GI disturbance (less likely with patch)
52
Which acetylcholinesterase inhibitor has a risk of neuroleptic malignancy syndrome?
Donepezil
53
Which drug is used to treat severe cognitive symptoms in dementia due to Alzheimers disease?
Memantine | Can also be used if acetlcholinesterases are C/I
54
'Memantine is cautioned in epilepsy' | True or false?
True - can cause seizures
55
What are cholinergic side effects?
``` Diarrhoea Urination Muscle weakness/cramps Bronchospasm Emesis Lacrimation (teary eyes) Sweating ```
56
Which type of drugs are likely to cause cholinergic side effects?
Acetylcholinesterase inhibitors Donepezil, rivastigmine, galantamine - usually dose related, start low and titrate slow
57
How should convulsive seizures lasting >5 mins be treated in the community? (medical emergency)
EITHER Diazepam rectal solution | OR midazolam oromucosal solution
58
Which antidepressants cause mydriasis?
Tricyclic antidepressants eg, amitripyline Mydriasis = dilation of the pupils
59
What schedule are most BZDs?
CD 4 part 1
60
Which BZDs are short acting?
Lorazepam + oxazepam
61
'BZDs can cause a paradoxical increase in hostility and aggression' True or false?
True - can be associated with behaviours such as talkativeness + excitement or aggression + antisocial behaviour
62
Signs of benzodiazepine overdose?
Ataxia, drowsiness, nystagmus, dysarthria, coma, respiratory depression
63
Why should BZDs be used with caution in renal impairment?
Chance of increased cerebral sensitivty to BZDs
64
How should BZDs be withdrawn?
1. Gradually convert to an equivalent diazepam dose ON 2. Reduce diazepam by 1-2mg/week 3. Reduce in smaller steps at the end of withdrawal
65
What is the therapeutic index of lithium?
0.4-1 mmol/L The lower end is suitable for prophylaxis/elderly The higher end is used for acute manic episodes
66
How should lithium levels be taken?
Take 12 hours after dose | Should be taken 1 week after initiation, after any dose changes and every 3 months for maintenance
67
What are the signs of lithium toxicity?
N - Nervous system disturbance (confusion, drowsiness, incoordination, restlessness) E - Extrapyrimidal symptoms (tremor, nystagmus, muscle weakness) R - Renal disturbance (polyuria. incontinence, hypernatraemia) V - Visual disturbance (blurred vision) G - GI effects (diarrhoea and vomiting)
68
Can lithium be used in pregnancy?
No, risk of teratogenicity including cardiac abnormalities in the first trimester
69
What monitoring is required for patients on lithium?
- Bodyweight/BMI (can increase weight) - eGFR (risk of renal impairment) - Electorlytes (hyponatraemia can increase levels) - FBC - TFTs (risk of impaired thyroid func)
70
What adverse effects are associated with long term lithium use?
Thyroid disorders and mild cognitive and memory impairment
71
Contraindication for lithium?
Dehydration/low sodium diet - can increase lithium levels
72
Can lithium be given to epileptics?
Cautioned - can lower seizure threshold
73
Which drugs interact with lithium?
ACEi - reduce Li excretion NSAIDs - reduce Li exretion Diuretics - can cause hyponatraemia Amiodarone - risk of arrythmias
74
Which SSRI is safe to use following MI/ in angina?
Sertraline
75
Why does St Johns Wort have many drug interactions?
It is an enzyme inducer | If patient stops taking this then the conc. of drugs can increase causing toxicity

Pre-reg revision (14 decks)

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