Q&A Flashcards by Unknown Unknown

Which drugs can increase cognitive impairment in dementia

antimuscarinic drugs- increase cognitive impairment
e.g. antidepressants/ antihistamines/ antipsychotic/ urinary spasmodics

How well did you know this?

Not at all

Perfectly

which drugs are 1st line in mild- moderate Alzheimers disease

Acetylcholinesterase inhibitors as monotherapy
donepezil/ galantamine/ rivastigmine

How well did you know this?

Not at all

Perfectly

what is first choice in severe Alzheimers (and second line in mild-moderate)

memantine

How well did you know this?

Not at all

Perfectly

In which types of dementia are acetylcholinesterase inhibitors not used

Vascular dementia/ frontotemporal dementia

How well did you know this?

Not at all

Perfectly

why should antipsychotics not be used in dementia if possible

increased risk of stroke, increased risk of death

How well did you know this?

Not at all

Perfectly

when can antipsychotic use in dementia be justified

if patient is at risk of harming self or others or agitation/ halucinations/ delusions are very distressing

How well did you know this?

Not at all

Perfectly

how often should antipsychotics be reviewed in dementia

every 6 weeks

How well did you know this?

Not at all

Perfectly

What are the STOPP criteria for acetylcholinesterase inhibitors

known history of bradycardia, heart block, recurrant unexplained syncope, concurrent use of drugs that promote bradycardia

How well did you know this?

Not at all

Perfectly

Galantamine in renal impairment

avoid if eGFR is less than 9

How well did you know this?

Not at all

Perfectly

what should you warn patients about with galantamine

look out for symptoms of severe cutaneous reactions

How well did you know this?

Not at all

Perfectly

why are rivastigmine patches used

Less likely to cause side effects

How well did you know this?

Not at all

Perfectly

How to apply and remove rivastigmine patches

Remove patch after 24 hours, avoid same area for 14 days

How well did you know this?

Not at all

Perfectly

what should be monitored with rivastigmine

body weight- can cause weight loss via appetite supression

How well did you know this?

Not at all

Perfectly

rivastigmine with prolonged diarrhoea or vomitting (dehydration)

withhold until resolution then reiterate if needed

How well did you know this?

Not at all

Perfectly

which patients can use memantine with caution

epileptic

How well did you know this?

Not at all

Perfectly

what class of drugs in memantine

glutamate receptor antagonist

How well did you know this?

Not at all

Perfectly

in which impaired states should memantine be avoided

severe hepatic impairment
renal impairment if eGFR is <5

How well did you know this?

Not at all

Perfectly

which anti epileptics can be taken once a day at bedtime

lamotrigine, perampanel, phenobarbital, phenytoin

How well did you know this?

Not at all

Perfectly

which anti epileptics should be prescribed by brand

carbamazepine, phenobarbital, phenytoin, primidone

How well did you know this?

Not at all

Perfectly

which anti epileptics do not have to be prescribed by brand

brivaracetam, ethosuximide, gabapentin, pregabalin, lacosamide, levetiracetam, tiagabine, vigabatrin

How well did you know this?

Not at all

Perfectly

what are the symptoms of anti epileptic hypersensitivity syndrome

fever, rash, lymphadenopathy
1-8 weeks since starting
withdraw immediately, do not re-expose

How well did you know this?

Not at all

Perfectly

How do you stop/ switch anti epileptics

Gradually as can precipitate rebound seizure if too sudden
One at a time

How well did you know this?

Not at all

Perfectly

How long from an isolated epileptic seizure til you can drive again if you are seizure free

6 months, then assessed by specialist as ‘fit to drive’ with no further risk

How well did you know this?

Not at all

Perfectly

Can patients with established epilepsy drive

Provided they are not a danger to the public, and are compliant with treatment and follow up
seizure free for at least 1 year with no history of unprovoked seizure

How well did you know this?

Not at all

Perfectly

Can patients drive if they have seizures while they are asleep?

Not permitted to drive from 1 year since date of seizure UNLESS - only ever had seizures while asleep over the course of at least 1 year - only had seizures while asleep for 3 years if they used to have seizures while awake

Can you drive if you have epilepsy and are trying out a different medicine?

No, you cannot drive for 6 months after last dose of old medication

Which are the safer anti epileptics for pregnant ladies

Lamotrigine or levotiracetam (mono therapy at lowest effective dose)

Important interaction to consider about antiepiletics and young women

OHC and anti epileptics interact to reduce both of their efficacy Many anti epileptics are teratogenic

What can be given to pregnant epileptic women to reduce the risk of neural tube defects

Folic acid

How can we reduce the risk of neonatal haemorrhage when a baby is born to an epileptic mother

Vitamin K injection at birth

Which anti epileptics can cause withdrawal in baby

benzodiazepines and phenobarbital

what should we monitor in breast fed babies born to epileptic others

sedation, feeding difficulties, adequate weight gain, developmental milestones serum drug concentration

What are the drugs of choice in focal seizures

Carbemazepine / lamotrigine

What are the drugs of choice in tonic clonic seizures

sodium valproate/ lamotrigine

what are the drugs of choice in absence seizures

ethosuximide/ sodium valproate

what is the drug of choice in myoclonic seizures

sodiu valproate/ topiramate/ levetiracetam

which types of seizures is carbamazepine (and oxcarbemazepine), pregabalin and gabapentin going to exacerbate

tonic, atonic, myoclonic, absence

lamotrigine exacerbates which seizure type

myoclonic

phenytoin exacerbates which seizure types

absence, myoclonic

what should be given instead of IV phenytoin

IV fosphenytoin

what should you give if seizure lasts longer than 5 mins and you have IV access

IV lorazepam- repeat once after 10 mins if still going Monitor for respiratory depression and hypotension

what should you give if seizure lasts longer than 5 mins and no IV access

diazepam rectal solution/ midazolam solution to buccal cavity

if seizure lasts longer than 25 mins

Contact ICU, you need fosphenytoin/ phenytoin/ phenobarbital

if seizure lasts longer than 45 mins

anaesthesia- thiopental/ midozolam/ propofol

Which supplement should you consider with carbemazepine, phenytoin, valproate, phenobarbital

consider vitamin D supplementation if immobilised/ inadequate exposure to sun or dietary calcium

which individuals have a higher risk of Steven Johnsons syndrome with carbamazepine/ phenytoin

Han chineese/ thai origin with HLA-B*1502 allele

what is the therapeutic range of carbamazepine

4-12 mg/L after one- two weeks

what should patients be vigilant for with carbamazepine

blood, liver, skin disorders seek attention if fever, rash, mouth ulcers, bruising, bleeding

what should patients be vigilant for with ethosuximide/ phenytoin

blood disorders- fever, mouth ulcers, bruising, bleeding check FBC

Which brand of gabapentin may cause high levels of excipients in low body weight patients

Rosemont brand solution high levels of propylene glycol, acesulfame K and saccharin sodium at high doses

Which patients may need to reduce their dose of gabapentin/ pregabalin due to risk of respiratory depression

compromised respiratory function; respiratory and neurological disease; renal impairment; use with other CNS depressants; elderly people

which schedule/ drug class is gabapentin/ pregabalin

3, class C

lifestyle advice for gabapentin/ pregabalin

drinking with this medication can be fatal

Signs of SJS with lamotrigine

first 8 weeks usually get a rash- could be hypersensitivity especially used alongside valproate

If you use lamotrigine in pregnancy

check plasma levels before, during and after pregnancy as plasma levels change

patients taking lamotrigine need to be alert to

signs of bone marrow failure- anaemia, bruising, infection

which conditions are worsened by lamotrigine

brugada syndrome, myoclonic seizure, parkinson's disease

How does levetiracetam affect ability to drive

increases sleepiness and other CNS effects

when would you need to talk to the doctor with levetiracetam

signs of depression/ suicide ideation worsening of seizure

when do you need to adjust dose of levetiracetam in terms of impairment

if severe hep impairment if CrCl is less than 60 (half maintenance dose) if eGFR is less than 80

what does phenytoin toxicity look like?

slurred speech, hyperglycaemia, confusion, eye movement, double vision, poor muscle control

what might happen if phenytoin is injected too fast?

atrial/ ventricular conduction depression, ventricular fibrillation, respiratory arrest, tonic seizure, bradycardia and hypotension

what is the target level of phenytoin for 3 months of age +

10-20mg/L unbound

what are the max daily doses of pregabalin in renal impairment

30-60= 300mg 15-30= 150mg less than 15= 75mg

important side effects to look out for with valproate include

hepatic dysfunction- withdraw immediately if persistent vomitting, abdominal pain, anorexia, jaundice, oedema, malaise, drowsiness, loss of seizure control. Check hepatic function in first 6 months pancreatitis

how to withdraw valproate

slowly, over at least 4 weeks

why do you need to stay hydrated with topiramate

risk of kidney stones and metabolic acidosis

topiramate- dose adjustment in impairment

half usual dose if creatinine clearance is less than 70

topiramate ocular effects

if raised intraoccqular pressure- discontinue and refer to ophthalmology

zonisamide is linked to hypersensitivity with

other anti epileptics and sulphonamides

how long should breast feeding be avoided after last dose of zonisamide

4 weeks

how long should effective contraception be used after last dose of zonisamide

1 month

zonisamide with impairment

slowly increase dose at 2 week intervals

target plasma conc of phenobarbital

15-40mg/L- but tolerance can occur

what is the antidote to midazolam

flumazenil

Q&A Flashcards

(76 cards)