neuro my notes Flashcards
1
Q
treatment of dementia:
mild/moderate
severe
non cognitive symptoms?
A
mild/ mod: NMDA antag
severe memantine
NC: APs (risk of stroke and death) = must assess CV risk
benzos if aggression/ agitation
2
Q
risk of NMDA antags
A
galant: SJS
Donepezil: neuroleptic malignant syndrome
rivastigmine: GI disturbances
3
Q
cholinergic SEs?
A
DUMBBELS
4
Q
Avoid Antimuscarinics with what drugs
A
AP
AD
AH
Urinary spasmodics e.g. solifenicin, tolterodine
5
Q
severe HS reactions with AEs occur in the first _____ w
A
8 weeks
6
Q
which AEs are OD dosing and why
A
phenobarbital, phenytoin, lamotrigine as long half life
7
Q
drugs which are barbituates?
A
phenobarbital
primidone
thiopental
8
Q
treatment of seizures?
A
all first line generalized: valproate except absence (ethuxamide)
pre menopausal first line: all generalised first line is lamotrigine (absence is still ethuxamide)
9
Q
which AEs do you not need to maintain on same brand
A
gaba
pregab
ethosuxamide
levetiracetam
10
Q
metoclopramide prokinetic effect does what
A
increases of absorption of oral analgesia
11
Q
albumin AEs
A
phenytoin, carbamazepine, lamo
12
Q
present in milk?
A
ZELP
13
Q
which AEs accumlate in the infant
which decrease sucking reflex
A
accumlate: phenobarb and lamo
decrease sucking reflex: phenobarb/ prim
14
Q
HS with which AEs
A
CPPPL
15
Q
blood dyscrisis with which AEs?
A
C VET PLZ
16
Q
which aes effect eyes
A
vigabatrin
topirimate (acute myopathy)
17
Q
which seizures do you not use carba in
A
atonic tonic myoclonic and absence
18
Q
which drugs can you not use for the following:atonic tonic myoclonic and absence
A
carbamazepine
gabapentin
pregabalin
19
Q
what seizure should you avoid lamo in and why
A
myoclonic
rashes
20
Q
which seizures should you avoid phenytoin in?
A
absence and myoclonic
21
Q
side efffects phenytoin?
A
toxicity: SNAtCHeD
change in appearance hypersensitivity SJS hepatotox vitamin D def blood dyscriasis suicidal ideation
22
Q
phenytoin interactions
A
Methotrex, trimeth (increased AF effect)
enzyme inhibs/ inducers
anticonvulsant effect antagonism
drugs metabolised by CYP as it is an enzyme inducer
23
Q
drugs which cause convulsions?
A
quinolones
tramadol
mefloquine
SSRIs, AP, TCAs
24
Q
Carbamazepine levels: when do you measure
A
4-12mg/L
measure after 1-2 weeks
25
carbamazepine side effects and toxicity
I HANDBAG
```
hypersensitivity
hepatotox
blood dyscriasis
SJS
hyponat= WATER INTOXICATION
```
26
carbamazepine interactions?
enzyme inhibs/ inducers
AC effects antagonised
hyponatraemia: aldosterone antagonists, SSRI, TCAs, diuretics, NSAIDs
hepatotox
is an enzyme inducer so anything metabolised by these
27
valproate side effects
hepatotox
pancreatitis
blood dyscriasis
interactions same as carba
28
formulation of lorazepam for status epilepticus
when do you give?
when would you repeat?
IV
after 5 minutes
repeat after 10 minutes
29
what to give if still seizing after 25 minutes of benzo
phenytoin
30
in community what would you give for seizure?
diazepam rectal or midazolam oral
31
short acting benzos
CLOT
32
benzodiazapine OD
flubendazole
33
withdrawing benzos?
1-2 mg every 2-4 weeks of diazepine at night
| 500mcg at end
34
methyphenidate whats it for and whats its class
lisdexamphetamine- used when?
CD Sch 2
first line in adhd
lisdex: if methylphen hasnt worked after 6 weeks- its also CD Sch 2
atomox used when stimulant effects arent tolerated
35
monitoring with ADHD drugs?
weight/ height of children
tik development
sexual dysfunction
monitor for misuse as study or weight loss drug
switch to non-stimulant
monitor 6 monthly
36
ADHD drugs increase what levels
dexam, lisdexam, methylpen: na and d
atomox: na
37
side effects of atomox
```
hepatotox
suicidal ideation
QTP
na increase= sympathomimetic effects: dry mouth, hyperten, constipation
monitor 6m and at dose changes
```
38
APs used in bipolar
QORH
Add on li, valproate
39
withdrawal of antimanic drugs in bipolar?
4 weeks if continuing other drugs
| 3 months if nothing else
40
how long to continue therapy after last manic episode in rapid cycling
rapid cycling: 2 years
41
predisposing to LI tox:
hyponat
| but li causes hypernat
42
side effects with li
TFT, renal imp, benign intracranial hypertension- report headaches and vision changes
QTP and lowers seizure threshold
43
lithium counselling
report signs of benign intracranial HTN
maintain hydration and salt intake
avoid alc
44
lithium interactions
EP- AP, Metoclop, PD
decreased renal excretion: ACEI/ARB, NSAIDs
QTP
seizure risk increased
salt balance (alginates)
neurotoxic
SEROTONIN SYNDROME: 5HT ag, SSRI, Granisetron, MAOI, Tramadol
45
venlafaxine MHRA
Increased risk of post partum haemorrhage
46
the efficacy between TCAs and SSRIs is the same, what makes SSRIs the preffered choice?
SSRIs safer in OD
| TCAs are more: AM, sedating and cardiotoxic
47
when to r/v MAOIs?
after 2 weeks
48
TCA cautioned in overdose?
doselupin
49
examples of TCAs
amitryp
doseulpin OD caution
imipramide (most AM)
lofepramie (hepatotox)
50
which TCA is the most AM
imipramide
51
which TCA is safest in OD
Lofepramine
52
which TCA is hepatotox
lofepramine
53
MAOIs example
phenelzine- most hepatotox
isocarboxazid- most hepatotox
tranylcypromine- more risk of AH crisis
reversible: moclobenide
54
review SSRIs how often
how long to wait before deeming ineffective
continue for how long after remission
1-2 weekly at start as can cause suicidal ideation as body decreases s
wait 4 weeks (6w in elderly) before saying its ineffective
```
6 month (12m in elderly, GAD)
2 years in recurrent
```
55
ADs cause what electrolyte imbalance
hyponatraemia- esp SSRI
56
Serotonin syndrome?
1. autonomic dysfunction: libaile BP, hyperthermia, tachy, sweating etc (dysreg between para and sym ns)
2. neuromuscular hyperactivity
3. altered mental state
57
MAOI washout
2 weeks except moclobemide
58
SSRI washout
1 week (2w sertraline, fluox 5w)
59
TCA washout
1-2 weeks (3 weeks for imipramine or clomipramine)
60
high risk of withdrawal
paroxetine and velnafaxine as short half lives
61
max dose citalapram in elderly and hepatic impairment
20mg
normally 40mg
62
what does TCAs do to BP
hypotension as D blockaid
63
when is loferamide preferred
less dangerous in OD and has less side effects
but hepatotoxic
64
how long do MAOIs take to work
3 weeks for a response then continue for another 1-2 weeks for maximum response
65
which MAOI is most stimulant and can cause hypertensive crisis most
tranylcopromine
66
which generation are better for negative symptoms of PD
second generation
67
which APs do you need to monitor concentrations for as per MHRA?
CLOZAPINE, ARIPIRAZOLE, OLANZ, QUETIAPINE, RISP
68
would you commonly see 2 AP drugs being used at the same time
only in exceptional circumstances e.g. titrating
69
which AP doesnt increase prolactin levels?
aripirazole as partial agonist
70
which APs have lowest risk of sexual dysfunction
aripip, quetiapine
71
which AP has high risk of cardiac side effects
pimozide
72
QTP is least common with which APs?
aripip, clozapine, flupentixol, risp, sulpride
73
which generation is more likely to cause postural hypotension
second gernation
74
which APs cause the least hyperglycaemia?
haloperidol, fluphentixol
75
what to do if neuroleptic malignant syndrome occurs with APs?
hold for 5 days
76
FIRST GENERATION APs 4 categories:
1. phenothiazines: e.g chlorpromazine
2. butyrophenones: haloperidol- most EPS
3. thioxantheses: -pentixol
4. others e.g. pimozine, sulpiride
77
which APs are hepatotoxic
phenothiazines
78
which generation causes EPS and which causes metabolic SEs
1st: EPS
2nd: metabolic
79
when would you rx clozapine
resistant schizo when tried more than 2 drugs including 2nd gen for 6-8 weeks
80
when would you retitrate clozapine
two or more missed doses
81
clozapine side effects
MAG: myocarditis- STOP if tachy in first 2 m
Agranulocytosis: FBC every 8 weeks then 2 weekly for a year then monthly
GI obstruction- do NOT give constipating meds
82
which APs have the highest risk of EP symptoms
group 1 phenothiazines and haloperidol
83
how could you treat EPS
antimuscarinics
84
which generation has highest risk of hyperprolactinaemia
first generation
85
hyperglycaemia most common with which APs?
CiROQ
86
treating neuroleptic malignant syndrome caused by APs?
bromocriptine/ dantrolene- dopamine receptor agonist
87
APs monitor?
FBC
LFT
Electrolytes
lipids- 3m then yearly
88
ergot dopamine agonists examples
bromocrip
cabergoline
pergolide
89
non ergot agonists?
pramipex
ropinirole
rotigotine
90
MAOBs for PD?
Selegeline, rasageline
91
what does amantadine and apomorphine treat
PD- weak DRA
92
COMT Inhibitor examples
entacapone (colours urine), tolcapone (hepatotox)
93
apomorphine for PD side effects- how to overcome this?
nausea and vomiting give with domperidone prophylaxis 2 days before
94
CAUTION of using domperidone 2 days before apopmorphine to decrease nausea and vomiting?
both cause QTP- risk benefit
95
what would you use to treat advanced PD
Apomorphinee SC/ IV
96
what to give to treat the non cognitive symptoms of PD:
1. day time sleepiness
3. postural hypotension
4. psychotic symptoms
5. REM
6. Salivation
1. modafanil
3. midodrine or fludrocortisone
4. dont treat unless not tolerated- quetiapine
5. clonazepam or melatonin
6. glycopyronium or botox
97
what do you use to treat PDD
Rivastigmine
98
treatment of PD?
+ affecting QOL: levodopa
- affecting QOL: any choice but ldopa best
99
ergot derived DRAs side effects?
impulse conrol disorders
sleepiness and onset of sleep
psychotic symptoms
hypotension
100
counselling with MAOIBs for PD
driving as metabolised to amphetamine
Do not purchase any sympathomimetics OTC= hypertensive crisis.
e.g. nasal decongestants: pseudoeph, phenylephedrine, zylometazoline
101
when are COMT inhibitors used? examples of these?
entacapone, tolcapone
used for end dose flucutations
102
counselling with COMT inhibitors?
entacapone: red urine
tolcapone: hepatotox
