Nevrous System Flashcards
Carbamazepine therapeutic range
10-20mg/L or 40-80 micromol/L
What types of seizures does carbamazepine exacerbate
Atonic, clonic and myoclonic
Signs of carbamazepine toxicity (I Handbag)
In coordination Hyponatraemia Ataxia Nystamus- uncontrolled eye movements Drowsiness Blurred vision and double vision Arrhythmias Gastrointestinal disturbance
Carbamazepine side effects
Leucopenia or thrombocytopenia
Hepatotoxicity
Hypersensitivity- anti epileptic syndrome
Rashes- Han Chinese and Thai patient are at increased risk of Steven Johnson syndrome
Hyponatraemia
How can you reduce some side effects of carbamazepine
Use MR preparations
Side effects: headache, ataxia, jazziness, nausea, vomiting, blurred vision, unsteadiness and allergic skin reactions
What drugs reduce seizure threshold with carbamazepine
Quinolones SSRIs antipsychotics, TCAs and related antidepressants
What drugs increase the risk of hepatotoxicity with carbamazepine
Tetracyclines sulphasalazine sodium valproate, methotrexate iron aside statins fluconazole and alcohol
Think what drugs affect the liver
What is the dose of citalopram in the elderly?
Max 20mg
What should you consider adding to citalopram
PPI as there is an increased risk of bleeding
When should a drug sample to check lithium is in range after initation
12 hours after first dose
Elderly patient comes in with a shaky tongue. What drug do you think it could be due to
Morphine
Furosemide
Haloperidol
Ramipril
Haleperiodol is a first gen antipsychotic
Thats are most likely to cause eps
Which medication is QT interval prolongation not a concern
Haloperidol Citalopram Alteplase Sotalol Amiodarone
Alteplase
Patient is due risperidone depot and has the following: muscle rigidity, tachycardia, sweating all day, times that they lose conciousness. What should you do?
Reduce dose
Stop medicine
Switch to oral
Continue but monitor
Stop
May have neuroleptic malignant syndrome which is fatal
May last 5-7 days after stopping oral but longer after stopping depot
Which of the following antipsychotic side effects are irreversible?
A. Tremors
B. Tardive dyskinesia
C. Dystonia
D. Akthsia
B. Tardive dyskinesia
A patient has been experiencing tremors, tongue wagging and a twitch in their check and they are on haloperidol? Which should you switch to?
Olanzapine, prochloperazine, flupentixol or citalopram
Olanzapine- 2nd gen are less likely to cause EPSEs
How often should FBCs be monitored for a patient taking quetiapine? 3 monthly 6 monthly Yearly At the start only
Yearly
Which of the following do not need to be monitored in patients taking antipyschotics? Blood pressure Lipids Weight ECG TSH
TSH
A patient is taking olanzapine which of the following medication is appropriate to prescribe the patient? Ciprofloxacin Ramipril Metoclopramide Domperidone Citalopram
Domperidone
Assess clinical need but SSRIs, metoclopramide and SSRIs interact
SSRIs- prolong QT
Metoclopramide- EPS
A patient is unhappy because they have being gaining weight they are taking the following…
Metformin
Glizide
Quetiapine
Metformin is weight neutral
A patient has been taking clozapine for 32 weeks how often are they going in clozapine monitoring?
2 weekly
Every week for 18 weeks, then fortnightly up to one year then monthly
A patient asks you for Senna as they have not open their bowels for 3 days. You ask and found out that they are on paracetamol, clozapine and cyclizine. What should you do?
Tell them to get medical attention asap as faecal impaction can be a fatal side effect from clozapine
A 82 year old is starting on olanzapine and the doctor wants some advise on the starting dose. Which one should it be? 5mg 10mg 15mg 20mg
5mg as elderly patients should be started on half or lower than the usual dose. 20mg is the max dose dose. 10mg is the typically starting dose.
Which of the following are most likely to cause hyperprolactinemia?
Amisulpride
Aripiprazole
Quetiapine
Amisulpride as does risperidone
Apripiprazole does not cause this side effect
Patient is experiencing nausea and vomiting and can not swallow. They can not have medicines rectally. What would you give?
Prochlorperazine can be given as a buccal tablet
