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CNS treatment summary > RV > Flashcards

RV Flashcards

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1
Q

What condition can beta blockers like propranolol mask

A

Hypoglycaemia

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2
Q

Side effects of pramipexole

A
  • Hypotension
  • Binge eating
  • Sudden onset of sleep
  • Compulsive gambling
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3
Q

Which vitamin supplement should be prescribed for wenicke encephalopathy

A

Thiamine

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4
Q

Patient on diazepam is showing increased talkativeness, emotional release, excitement and excessive movement

A

Signs of BDZ - Flumazenil

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5
Q

Clozapine blood monitoring

A
  • Weekly for 18 weeks
  • Every 2 weeks til 1 year
  • Then every 4 weeks
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6
Q

Which of the following would be safest to sell co-codamol

a. 13 year old
b. 17 year old who had tonsils removed due to sleep apnoea
c. 43 year old man from uganda
d. breast feeding mother
e. 31 year old man wanting two packets

A

A

  • Unable to sell for 18 year old who had tonsils removed for sleep apnoea
  • Uganda would be rapid metabolisers (afro-caribean)
  • Toxicity in BF
  • Can only sell one pack oTC
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7
Q

Antipsychotics with highest risk of weight gain

A

Clozapine and olanzapine

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8
Q

Remission and depression

A

Patients should continue their medications for a period after remission for depression. This is usually 6 months in most patients, 1 year in elderly and 2 years in patients with recurrent remission

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9
Q

Patient with a headache and sudden pain alongside a stiff neck, sensitivity to light and double vision

A

Subaranchoid haemorrhage

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10
Q

Failure to respond to initial treatment with SSRI

A

May require a dose increase or switching to different SSRI/SNRI

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11
Q

Common side effects of TCA

A
  • dry mouth
  • Thirst
  • Pupil dilation
  • Increased intraocular pressure
  • urinary retnetion
  • Constipation
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12
Q

21 year old female with myoclonic seizures

A

Leviracetam

SV x tetragoneic
Myoclonic would be exacerbated by lamotrigine

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13
Q

Which drugs are associated with high risk of falls and injures

A

Z hypnotics and BDZ are most associated with high risk of falls and injuries, even more so than anti-hypertensives, diuretics and alpha blockers

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14
Q

mONITORING Requirements of antipsychotics

A
  • Body weight
  • U+E
  • FBC
  • Blood lipids
  • Pulse
  • Blood glucose levels
  • BP
  • ECG
  • Prolactin level
  • LFT
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15
Q

Minimum age to use domperidone

A

12

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16
Q

Patient taking tranylcypromine (MAO- inhibitor) for 4 months. What is the washout period between ending the MAO and initiating imipramine

A

Antidepressants should not be started for 2 weeks after MAO-I treatment. Allow for 3 weeks to washout if switching to clomipramine or imipramine

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17
Q

OTC product to avoid on lithium

A

NSAIDS- Increases toxicity risk of lithium

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18
Q

What is apomorphine

A

Consultant led potent dopamine receptor agonists which can be helpful in dealing with off episodes with levodopa treatment. It is administered parenterally by sc injection or infusion

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19
Q

First line in focal

A

1st- Lamotrigine and levetiracetam
2nd- Carbamazepine, oxcarbazepine and zonisamide

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20
Q

Heartburn while on citalopram

A

Refer- SSRI can cause gi bleeding which may present as heartburn. Refer to GP

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21
Q

Treatment for PD postural hypotension

A

Midodrine

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22
Q

Foods to avoid while on MAO

A
  • Mature cheese
  • Salami
  • Pickled herring
  • Marmite
  • Fermented soya bean extract
  • Lager, wine some beers
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23
Q

Which AED are associated with high infant serum concentration when BF

A
  • Zonisamide
  • Ethosuximide
  • Lamotrigine
  • Primidone
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24
Q

Bromocriptine when to refer to GP

A

Has been associated with pulmonary, retroperitoneal and pericardial fibrotic reactions

Monitor for dysponea, peristent cough, chest pain, cardiac failure and abdominal pain/tenderness

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25
Which abx to avoid with methadone patients
Clarith - QT prolongation and can increase the conc of methadone
26
Side effects of morphine
- Dry mouth - N+V - Hypotension - Urinary retetnion - pupil constriction
27
Drugs than cause Serotonin syndrome
- SSRI - TCA - Triptans - Tramadol - Lithium
28
Tramadol side effects
- Reduced seizure threshold - Increased bleeding risk - Psych disorders - Serotonin syndrome
29
Short acting BDZ
Loprazolam Lormetazepam Oxazepam Temazepam Shorter time of action and have less hangover
30
Signs of phenytoin toxicity
- Slurred speech - Nystagmus - Ataxia - Resp depression - Double vision
31
HTN X triptan
avoid
32
What deficiency can carbamazepine, phenytoin and SV cause
Vitamin D
32
AED if >55 and having obscene seizures with tonic clonic
SV
33
Which BDZ have a legal driving limit
Clonazepam Oxazepam Lorazepam Diazepam Flunitrazepam Temazepam COLD FT
34
Can you take sertraline at night?
Avoid as can cause insomnia
35
Less sedating TCA
Imipramine Lofepramine Nortriptylien
36
What to prescribe PD who motor symptoms are not affecting QOL
Levodopa OR non Ergot DA or MAO-B or COMT inhibitor
37
Seizure (lasting 10 mins) not halting after given IV lorazepam what to do
Repeat once after 10 minutes if seizures recur or fail to respond.
38
Nausea and diarrhoea while on rivastigimine
Stop treatment, treat the dehydration before reinitating, amend the dose if needed. transdermal less likely to cause issues
39
Once stable after initiating a patient on lithium how long should the monitoring intervals be
Performed weekly after initiation and after each dose change until stable, then every 3 months for 1 year then 6 monthly thereafter
40
Which anti-emetic to avoid in lithium patients
Domperidone due to the QT
41
Which AED would cause withdrawal effects in the infant if a mother suddenly stops breast feeding
Phenobarbital Primidone Lamotirigne
42
Amfetamine overdose symptoms
- Wakefulness - Excessive activity - Paranoia - Hallucinations - Hypertension
43
43
methadone or buprenorphine, which is less sedative
Buprenorphine
44
Severe vomiting in pregnancy
Short term treatment with promethazine
45
Wanting to increase morphine dose what is the rule
Increments should not exceed one third to one half of the total daily dose
46
Carbamazepine, phenytoin, SV general side effects
Depression Suicidal thoughts Hepatotoxicity Hypersensitivity Blood dysrasias Vitamin D deficiency
47
Carbmazepine toxicity
Blurred vision Allergic skin reactions Dizziness Headache Ataxia N+V Drowsiness BADHAND
48
DVLA and just finished carbamazepine
Patients should not drive during med changes and withdrawal. Must be at least 6 MONTHS since last dose
49
Alcohol withdrawal symptoms medication
A long acting BDZ like chlordiazepoxide or diazepam
50
cluster headache
- begin quickly without warning - Pain is severe and is often unilateral - Often felt around the eye - Last between 15 mins and 3 hours - Can occur multiple times in a day
51
Max emergency supply of diazepam
5 days
52
Aripiprazole and prolactin
Reduces prolactin conc in a dose dependent manner because it is a dopamine partial agonist
53
If needing first gen in Parkinsons
Phenothiazines. Group 1( chlorpromazine, levomepromazine and promazine) have moderate EPSE Group 2 ( pericycazine) has the lowest risk of EPSE Group 3 (fluphenazine, prochlorperazine and trifluoperazine) have the strongest EPSE
54
Fluoxetine, paroxetine X tamoxifen
Reduces the efficacy of tamoxifen
55
MAO inhibitors and pseudoephedrine
Predicted to increased risk of HTN crisis
56
N+V and anxiety before surgery
Lorazepam is used in the case of anticipatory nausea and vomiting related with anxiety
57
Anti-emetic to avoid with macrolides
Domperidone as both cause QT interval
58
Tramadol in epilepsy
Avoid- As can reduce the seizure threshold
59
Lithium x triptan
Serotonin syndrome
60
TCA X amiodarone
QT prolongation
61
Which AED does trimethoprim interact with
Phenytoin- Concomitant use of these medications will increase the anti folate activity leading to blood disorders
62
For patients who have had a first unprovoked epileptic seizure or a single isolated seizure how long to wait to drive
6 months
63
Minimum age for metoclorpanide treatment
18
64
Maximum age for sumatriptan use OTC
65 licensed for 18-65

CNS treatment summary (15 decks)

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