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203 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What is the most common form of dementia? |
Alzheimer’s disease |
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What is the treatment for mild - moderate dementia ? |
Donepezil, galantamine, rivastigmine (acetlycholineaterase inhibitors) If these not tolerated 2nd line memanatine |
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What is the drug of choice for severe Alzheimer’s |
Memantine |
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What Is the treatment for non Alzheimer’s dementia? |
Donepezil or rivastigmine can be given for mild to moderate dementia with Lewy bodies |
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How often should antipsychotics be reviewed? |
Every 6 weeks |
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What is the initial dose of donepezil hydrochloride given for dementia in Alzheimer’s disease |
Initially 5mg once daily for one month and then increased up to 10mg daily |
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What serious side effect is caused from lamotrigine ? |
Serious skin reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis have developed (especially in children); most rashes occur in the first 8 weeks. Rash is sometimes associated with hypersensitivity syndrome and is more common in patients with history of allergy or rash from other antiepileptic drugs. Consider withdrawal if rash or signs of hypersensitivity syndrome develop. Factors associated with increased risk of serious skin reactions include concomitant use of valproate, initial lamotrigine dosing higher than recommended, and more rapid dose escalation than recommended. |
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What are the directions for administration for rivastigmine?how often should the patch be changed |
Manufacturer advises apply patches to clean, dry, non-hairy, non-irritated skin on back, upper arm, or chest, removing after 24 hours and siting a replacement patch on a different area (avoid using the same area for 14 days). |
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When switching from oral rivastigmine to transdermal patches what is the dose equivalent of 3-6mg daily orally in patches? |
When switching from oral to transdermal therapy, patients taking 3–6 mg by mouth daily should initially switch to 4.6 mg/24 hours patch Patients taking 9 mg by mouth daily should switch to 9.5 mg/24 hours patch if oral dose stable and well tolerated; if oral dose not stable or well tolerated. patients should switch to 4.6 mg/24 hours patch, then titrate as above. Patients taking 12 mg by mouth daily should switch to 9.5 mg/24 hours patch. The first patch should be applied on the day following the last oral dose |
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Memantine shound be used in caution in which patients |
Epileptics / history of convulsions dose initially 5 my once daily increased in steps of 5mg every week maintenance dose is 20mg |
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Which anti epileptics have long half lives ? And can be given once daily dosage |
Lamotrigine/ perampanel/ phenobarbital/ phenytoin long half lives once daily at night |
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Which drugs are in category 1 and need to be maintained on a specific brand? |
Phenobarbital/ phenytoin/ primidone Carbamazepine |
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Which drugs are in category 1 and need to be maintained on a specific brand? |
Phenobarbital/ phenytoin/ primidone |
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Gabapentin pregabalin and levetiracetam are in which category of epileptics ? |
Category 3 |
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What is the anti epileptic syndrome and which drugs carry the risk of this and list symptoms |
Rare but potentially fatal syndrome associated with some anti epileptics such as carbamazepine / phenobarbital / phenytoin primidone lamotrigine rufiniamide oxcabazepine Symptoms usually start between 1 and 8 weeks of exposure fever rash and lymphadenopathy if these occur withdraw drug immediately |
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What is the MHRA warning alert relating to anti epileptics drugs |
They all are associated with an increased risk of suicidal thoughts and behaviour seek medical help if mood changes occur or feeling of suicide or depression occur |
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Patients who have had first unprovoked seizure or a single isolated seizure must not drive for how long ? |
Must not drive for 6 months if a driver has a seizure if anytime just inform dvla and stop driving |
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When can epileptic patients start Driving again? |
They must be seizure free for at least one year or have a pattern of seizures established for one year that doesn’t influence their level of consciousness or the ability to act and must not have a history of unprovoked seizures |
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Which anti epileptic is associated with the highest risk of serious developmental disorders and by how much? |
Sodium valproate 30-40% risk |
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Why can’t topiramate be used in pregnancy ? |
Increased risk of congenital malformations including cleft palate / hypospadias |
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What can be given at birth to neonates to minimise the risk of neonatal haemorrhage associated with anti epileptics |
Routine injection of vitamin K |
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Which anti epileptics are transferred readily into the breast milk |
Lamotrigine / primidone/ zonisamide / ethosuxamide |
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Which 3 antiepiletics may cause withdrawal effects in infants of mother suddenly stop breastfeeding and cause drowsiness |
Phenobarbital primidone lamotrigine |
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What is the 1st line treatment for tonic clinic seizures ? |
Sodium valproate |
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Sodium valproate is 1st line treatment in all seizures except for which one? |
Apart from focal seizures where the OST line is either carbamazepine or lamotrigine the other seizures sodium valproate can be used 1st line |
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What caution is required in use of lamotrigine in children? |
Can chase serious rashes especially in children |
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What is acetazolamide used for? |
Can treat epilepsy associated with menstruation it is a carbonic anhydrase inhibitor |
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How is status epilepticus treated? |
- positioning patient to avoid injury - giving oxygen maintaining BP - correction of hypoglycaemia - parental thiamine is alcohol abuse is suspected - pyridoxine is given if status epilepticus is caused by pyridoxine deficiency - seizures lasting longer than 5 mins give iv lorazepam repeated once after 10 mins - if resuscitation facilities are not available diazepam can be given as a rectal solution or midozalam oromusocal solution can be given into the buccal activity If after initial treatment seizures re occur phenytoin or phenobarbital of fosphenotoin can be given if these measures fail to control symptoms 45 mins after give thiopental sodium midozalam or propofol |
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How are febrile convulsions treated |
Paracetamol can be given to reduce fever and prevent further convulsions |
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What caution is required with carbamazepine? |
Vitamin d supplementation in patients who are immobilised for long period or who have no sun exposure or dietary intake of calcium
Different formulations of oral preparations may vary in bioavailability. Patients being treated for epilepsy should be maintained on a specific manufacturer's product. |
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What side effects are associated with dosing of carbamazepine |
Some side-effects (such as headache, ataxia, drowsiness, nausea, vomiting, blurring of vision, dizziness and allergic skin reactions) are dose-related, and may be dose-limiting. These side-effects are more common at the start of treatment and in the elderly. |
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What is the plasma concentration of carbamazepine for optimal response ? |
Plasma concentration for optimum response 4–12 mg/litre (20–50 micromol/litre) measured after 1–2 weeks.
Manufacturer recommends blood counts and hepatic and renal function tests |
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How long over should the dose of carbamazepine be reduced over ? |
4 weeks |
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What is the patients and carer advice relating to carbamazepine? |
Patients or their carers should be told how to recognise signs of blood, liver, or skin disorders, and advised to seek immediate medical attention if symptoms such as fever, rash, mouth ulcers, bruising, or bleeding develop. |
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What is the safety information relating to gabapentin ? |
Associated with a rare risk of respiratory depression Schedule 3 drug Risk of interaction between gabapentin and alcohol and other medicines that cause CNS depression |
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When is donepezil given? |
At night initially 5mg for one month and then increased to 10mg daily |
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What is the MHRA warning alert for gabapentin and pregabalin? |
Severe risk of respiratory depression fatal interaction between gabapentin and alcohol and opioids as all these together increase the risk or cns depression |
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What is the serious side effect of lamotrigine list carer advice that should be given to the patient ? And how long should it be tapered of over ? |
Serious skin reactions including Steven Johnson syndrome toxic epidermal necrosis most rashes occur in the 1st 8 weeks avoid abrupt withdraw tapper of over 2 weeks or longer warn patient to report ain’t if hypersensitivity syndrome or have signs of anemia bruising |
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What are the signs of phenytoin toxicity ? |
Slurred speech ataxia confusion hyperglycaemia nystagmus (eye movement ) |
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With sodium valproate what supplementation should be given? For patients who are immobilised for long periods of time? |
Vitamin D deficiency |
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How long should the dose of sodium valproate be tapered or over what monitoring is done for this drug ? And why is the plasma valproate concentration not taken for sodium valproate and when should a patient discontinue this drug hint what does it cause what symptoms do they need to look out for |
Plasma valproate concentration is not a useful index of efficacy therefore routine monitoring is not helpful so just monitor liver function before and then every 6 months measure FBC reduce dose over 4 weeks can cause pancreatitis so discontinue if this does happen! Symptoms of hepatic dysfunction vomiting abdominal pain anorexia jaundice drowsiness oedema |
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How can episenta (valproate) capsules be taken? And how long does the liquid last |
Manufacturer advises granules may be mixed with soft food or drink that is cold or at room temperature, and swallowed immediately without chewing.
Manufacturer advises may be diluted, preferably in Syrup BP; use within 14 days. |
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What is a serious side effect of topiramate |
Can cause eye inflammation has been associated with acute myopia with secondary angle closure glaucoma starts within 1 month of treatment |
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What is the optimum response for plasma phenobarbital concentration ? |
15-40mg/ L |
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How do you reduce someone of benzodiazepines to prevent withdrawal symptoms ? |
Transfer patient stepwise, one dose at a time over about a week, to an equivalent daily dose of diazepam preferably taken at night. Reduce diazepam dose, usually by 1–2 mg every 2– 4 weeks (in patients taking high doses of benzodiazepines, initially it may be appropriate to reduce the dose by up to one-tenth every 1–2 weeks). If uncomfortable withdrawal symptoms occur, maintain this dose until symptoms lessen. Reduce diazepam dose further, if necessary in smaller steps; steps of 500 micrograms may be appropriate towards the end of withdrawal. Then stop completely. |
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What is the safety information relating to benzodiazepines ? |
When co prescribed with opioids can cause cns depressant effects |
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What is the safety information relating to benzodiazepines ? |
When co prescribed with opioids can cause cns depressant effects |
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What is the problem with co prescribing benzodiazepine with methadone? |
Respiratory depressant effect or methadone is delayed patients should be monitored for 2 weeks after initiating |
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What are the signs and symptoms of benzodiazepines toxicity /overdose |
Drowsiness ataxia dysarthria nystagmus depression coma |
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Which benzodiazepines is used for treatment of alcohol withdrawal in moderate dependance? |
Chlordiazepoxide hydrochloride |
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Which benzodiazepines are used in dental treatment ? |
Tempazem/ diazepam |
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Which benzodiazepines are short acting |
Temazepam loprazelam lormetazepam |
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Which benzodiazepines are short acting withdrawal phenomena is more common with the short acting benzodiazepines |
Temazepam loprazelam lormetazepam |
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Which benzodiazepines are long acting |
Nitrazepam / flurazepam |
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What is the first line treatment options for ADHD check hint |
1st line you can use either lisdexamfetamine or methylphenidate if one doesn’t work after 6 weeks switch to the other one if patient is on lisdexamfetamine can’t be tolerated due to it prolonged course of action then give methylphenidate If these are not tolerated give atmoxetine |
If patient develops new or worsening seizure stop and revise drug treatment monitor patients for the development of tics |
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What is the monitoring for atometine and methylphenidate |
Monitor for appearance or worsening of anxiety, depression or tics.
Pulse, blood pressure, psychiatric symptoms, appetite, weight and height should be recorded at initiation of therapy, following each dose adjustment, and at least every 6 months thereafter. |
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Which drug for adhd must be prescribed by brand? |
Methylphenidate |
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Which drugs are useful in the treatment in acute episodes of mania and hypo mania |
Olanzapine/ quetiapine / risperidone |
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How long does it take for the full prophylactic effect of lithium to work ? |
6-12 months after initiation |
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Lithium what are the long term cautions of its use ? |
Long term use is associated with thyroid disorders and mild cognitive impairment monitor thyroid function every 6 months |
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Lithium what are the long term cautions of its use ? |
Long term use is associated with thyroid disorders and mild cognitive impairment monitor thyroid function every 6 months |
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What are the signs of lithium toxicity overdose |
Signs of intoxication require withdrawal of treatment and include increasing gastro-intestinal disturbances (vomiting, diarrhoea), visual disturbances, polyuria, muscle weakness, fine tremor increasing to coarse tremor, CNS disturbances (confusion and drowsiness increasing to lack of coordination, restlessness, stupor); abnormal reflexes, myoclonus, incontinence, hypernatraemia. With severe overdosage seizures, cardiac arrhythmias (including sino-atrial block, bradycardia and first-degree heart block), blood pressure changes, circulatory failure, renal failure, coma and sudden death reported. |
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Lithium what are the long term cautions of its use ? |
Long term use is associated with thyroid disorders and mild cognitive impairment monitor thyroid function every 6 months |
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What are the signs of lithium toxicity overdose |
Signs of intoxication require withdrawal of treatment and include increasing gastro-intestinal disturbances (vomiting, diarrhoea), visual disturbances, polyuria, muscle weakness, fine tremor increasing to coarse tremor, CNS disturbances (confusion and drowsiness increasing to lack of coordination, restlessness, stupor); abnormal reflexes, myoclonus, incontinence, hypernatraemia. With severe overdosage seizures, cardiac arrhythmias (including sino-atrial block, bradycardia and first-degree heart block), blood pressure changes, circulatory failure, renal failure, coma and sudden death reported. |
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What are the main interactions with lithium? |
Nsaids / diuretics |
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Lithium is a narrow therapeutic index drug what should the concentration be to avoid toxicity and when should it be measured ? |
Samples should be taken 12 hours after dose ideal level 0.4-1mmol/L doses for acute episode of mania target level of 0.8-1mmol and this target is also for patients who have relapsed above 2mmol is dangerous and can cause over dose |
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Lithium is a narrow therapeutic index drug what should the concentration be to avoid toxicity and when should it be measured ? |
Samples should be taken 12 hours after dose ideal level 0.4-1mmol/L doses for acute episode of mania target level of 0.8-1mmol and this target is also for patients who have relapsed above 2mmol is dangerous and can cause over dose |
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How often is lithium testing done |
Routine serum-lithium monitoring should be performed weekly after initiation and after each dose change until concentrations are stable, then every 3 months for the first year, and every 6 months thereafter. |
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Lithium is a narrow therapeutic index drug what should the concentration be to avoid toxicity and when should it be measured ? |
Samples should be taken 12 hours after dose ideal level 0.4-1mmol/L doses for acute episode of mania target level of 0.8-1mmol and this target is also for patients who have relapsed above 2mmol is dangerous and can cause over dose |
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How often is lithium testing done |
Routine serum-lithium monitoring should be performed weekly after initiation and after each dose change until concentrations are stable, then every 3 months for the first year, and every 6 months thereafter. |
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What is assessed before initiating treatment of lithium |
Manufacturer advises to assess renal, cardiac, and thyroid function before treatment initiation. An ECG is recommended in patients with cardiovascular disease or risk factors for it. Body-weight or BMI, serum electrolytes, and a full blood count should also be measured before treatment initiation.
Monitor body-weight or BMI, serum electrolytes, eGFR, and thyroid function every 6 months during treatment, and more often if there is evidence of impaired renal or thyroid function, or raised calcium levels. Manufacturer also advises to monitor cardiac function regularly. |
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Lithium is a narrow therapeutic index drug what should the concentration be to avoid toxicity and when should it be measured ? |
Samples should be taken 12 hours after dose ideal level 0.4-1mmol/L doses for acute episode of mania target level of 0.8-1mmol and this target is also for patients who have relapsed above 2mmol is dangerous and can cause over dose |
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How often is lithium testing done |
Routine serum-lithium monitoring should be performed weekly after initiation and after each dose change until concentrations are stable, then every 3 months for the first year, and every 6 months thereafter. |
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What is assessed before initiating treatment of lithium |
Manufacturer advises to assess renal, cardiac, and thyroid function before treatment initiation. An ECG is recommended in patients with cardiovascular disease or risk factors for it. Body-weight or BMI, serum electrolytes, and a full blood count should also be measured before treatment initiation.
Monitor body-weight or BMI, serum electrolytes, eGFR, and thyroid function every 6 months during treatment, and more often if there is evidence of impaired renal or thyroid function, or raised calcium levels. Manufacturer also advises to monitor cardiac function regularly. |
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What is the patient and carer advice for lithium prescribing |
Brand specific don’t change
Patients should be advised to report signs and symptoms of lithium toxicity, hypothyroidism, renal dysfunction (including polyuria and polydipsia), and benign intracranial hypertension (persistent headache and visual disturbance).
Maintain adequate fluid intake and avoid dietary changes which reduce or increase sodium intake. |
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Which class of antidepressant are safest for patients who have unstable angina or MI |
SSRI’s - sertaline |
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How often should patients on antidepressant be reviewed ? |
Every 1-2 weeks at the start of antidepressant treatment treatment should be continued for 4 weeks and 6 weeks in elderly before deciding if it’s effective or not |
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Patients with a history of recurrent depression should receive maintenance treatment for how long |
2 years |
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What electrolyte imbalance do antidepressant effect |
They cause hyponotraemia especially in elderly more common with ssri’s |
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List the symptoms of seretonin syndrome |
The characteristic symptoms of serotonin syndrome fall into 3 main areas, although features from each group may not be seen in all patients—neuromuscular hyperactivity (such as tremor, hyperreflexia, clonus, myoclonus, rigidity), autonomic dysfunction (tachycardia, blood pressure changes, hyperthermia, diaphoresis, shivering, diarrhoea), and altered mental state (agitation, confusion, mania). |
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If ssri doesn’t work what should be done |
Try alternative ssri if that still don’t work then switch to mirtazipine |
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What is the 1st line and 2nd line treatment for panic disorders ocd and phobic state |
1st line - ssri clopiramine/ imipramine |
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Which antipsychotic is licensed for treatment of social anxiety disorder |
Meclobemide |
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Which TCA are sedating |
Amitriptaline, clomipramine, dosulepin, doxepin, mianserin, trazadone and trimipramine |
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Which 2 antidepressant should not used in the treatment of depression |
Dosulepin and amitriptaline due to over dose risk |
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When should TCA’s be taken |
Usually taken at night |
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Are tca recommended in children |
No studies have shown they are not effective |
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How long after stopping ssri can a maoi be started |
One week but for fluoxetine 5 weeks |
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How long after stop maoi can anther antidepressant be started |
2 weeks but for clopiramine or imipramine it’s 3 weeks |
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Why needs monitoring for maoi |
Monitor BP risk of postural hypotension and hypertensive response discontinue if palpations occur |
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What patient and carer advice is given maoi |
Patients should be advised to eat only fresh foods and avoid food that is suspected of being stale or ‘going off’. This is especially important with meat, fish, poultry or offal; game should be avoided. The danger of interaction persists for up to 2 weeks after treatment with MAOIs is discontinued.
Patients should also be advised to avoid alcoholic drinks or de-alcoholised (low alcohol) drinks. |
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Which maoi is reversible ? |
Moclobemide |
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What is the patient and carer advice regarding mirtazipine |
Report signs fever sore throat stomatitis or sign of infection blood count should before performed and drug stopped immediately |
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Which drug is used control deviant antisocial sexual behaviour |
Benperidol |
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Which antipsychotics are 1st generation |
Phenothiazine derivatives 3 categories phenothiazine derivatives (chlorpromazine hydrochloride, fluphenazine decanoate, levomepromazine, pericyazine, prochlorperazine, promazine hydrochloride, and trifluoperazine), butyrophenones (benperidol and haloperidol), tthioxanthenes (flupentixol and zuclopenthixol) diphenylbutylpiperidines (pimozide) and the substituted benzamides (sulpiride). |
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Antipsychotics cause hyperprolactinaemia which one doesn’t |
Ariprazole reduces prolactin concentration |
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Antipsychotics cause hyperprolactinaemia which one doesn’t |
Ariprazole reduces prolactin concentration |
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What are the signs of hyperprolactinaemia |
Decreases libido Sexual dysfunction , reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea |
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Name 6 side effects of antipsychotics |
Hyperprolactinaemia (except ariprazole) Sexual dysfunction (most common with haloperidol and risperidone) Qt interval prolongation especially pimozide and haloperidol Hyperglycaemia / weight gain diabetes most common with olanzapine clozapine quetiapine and risperidone all antipsychotic cause weight gain Hypotension interference with temperature regulation can lead to dangerous falls and hypothermia Blood discrasias perform blood count if unexpected fever occurs Neuroleptic malignant syndrome can lead to sweating increase in BP tachycardia muscle rigidity hyperthermia urinary continence if this occurs stop the antipsychotic |
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Which 4 antipsychotics cause postural hypotension? |
Clozapine / chlorpromazine/ lurasidone/ quetiapine |
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Which drugs are less likely to cause extrapyramidal side effects ? See hint |
Ariprazole / clozapine / olanzapine and quetiapine |
Second generation antipsychotic cause less extrapyramidal side effects |
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Which antipsychotic are less likely to cause sexual dysfunction |
Ariprazole and quetiapine |
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When is clozapine used in schizophrenia |
When 2+ antipsychotics have been used for 6-8 weeks and not effective |
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What monitoring is required for all antipsychotics? |
Fbc / urea/ electrolytes / LFT / at start and then annually Blood lipids / weight at the beginning then every 3 months and then yearly ECG before starting may be required BP before treatment |
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What monitoring is required for all antipsychotics? |
Fbc / urea/ electrolytes / LFT / at start and then annually Blood lipids / weight at the beginning then every 3 months and then yearly ECG before starting may be required BP before treatment Monitor prolactin concentration at start of therapy, 6 months and then yearly |
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Which 2 antipsychotics are used for intractable hiccup |
Chlorpromazine and haloperidol |
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How long after withdrawal of an antipsychotic should the patient be monitored for signs of relapse |
2 years |
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What is the MHRA warning alert relating to clozapine ? |
Impairment of intestinal peristalsis if constipation occurs before next dose seek medical attention |
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One of the cautions of clozapine is agranulocytosis how often should leukocyte and differential blood counts be monitored ? |
Neutropenia and potentially fatal agranulocytosis reported. Leucocyte and differential blood counts must be normal before starting; monitor counts every week for 18 weeks then at least every 2 weeks and if clozapine continued and blood count stable after 1 year at least every 4 weeks (and 4 weeks after discontinuation); if leucocyte count below 3000 /mm3 or if absolute neutrophil count below 1500 /mm3 discontinue permanently and refer to haematologist. |
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Clozapine should be avoided with which drugs |
Drugs that can cause constipation for example antimuscarinics Propiverine. ... Darifenacin. ... oxybutynin Solifenacin. ...tolteridone Trospium. ... Fesoterodine. |
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Which antipsychotic may require a dosage adjustment if smoking is stopped or started during drug treatment |
Olanzapine |
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What is 1st line 2nd line 3rd line treatment options for the treatment of muscular symptoms in cerebral palsy |
1st line - quinine unlicensed 2nd line - baclofen 3rd line -tizanidine / Dantrolene sodium / gabapentin |
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If motor symptoms do affect quality of life in Parkinsonism what should be offered ? |
Levodopa combined with cocareldopa |
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If motor symptoms do affect quality of life in Parkinsonism what should be offered ? |
Levodopa combined with cocareldopa |
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In patients whose Parkinsonism doesn’t affect quality of life what drugs can be given |
Levodopa / ropinerole / rotigotine/ rasagiline / selegeline |
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Which drug is given in Parkinsonism to control excessive daytime sleepiness |
Modafanil (review treatment every 12 months) |
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What is used to treat postural hypotension in Parkinsonism disease ? |
Midodirine 1st line 2nd fludcortisone |
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What is used to treat rapid eye movement in P.D. |
Clonazepam / melatonin |
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What is 1st line and 2nd line treatment for drooling if saliva in P.D. |
Glycopronium bromide 1st line 2nd botulinum toxin type A |
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What is the treatment for dementia in P.D. |
1st line - acetylcholinesterase inhibitors for example rivastigmine / galantamine ect 2nd line - memantine |
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What is the interaction beetween domperidone and apomorphine |
QT PROLONGATION |
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Which antiemetic can be used in Parkinsonism disease |
Domperidone (35kg+) max 7 days 10mg TDS (12+) |
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Apomorphine is used for advanced Parkinsonism disease but can cause nausea so what is given to prevent this and how long |
Domperidone start 2 days before apomorphine therapy and then stop ASAP to reduce risk of arythmias caused by QT prolongation |
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Levodopa- carbidopa intestinal gel is used for the treatment of advanced Parkinsonism disease with severe motor fluctuations and hyperkinesia or dyskinesia gel is administered with a portable pump given when |
Directly into the duodenum or upper jejunem |
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When transferring patients from levodopa/ dopa decarboxlase preparation to another how long before hand should it be discontinued |
12 hours before when switching from mr to dispersible reduce dose by 30% |
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Why should anti Parkinsonism drugs not be stopped abruptly |
Risk of neuroleptic malignant syndrome |
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How does bromocriptine work? |
Inhibits release of prolactin so can be used for prevention of lactation |
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What is the important safety information relating to brimocriptine |
Bromocriptine has been associated with pulmonary, retroperitoneal, and pericardial fibrotic reactions.
Manufacturer advises exclude cardiac valvulopathy with echocardiography before starting treatment with these ergot derivatives for Parkinson's disease or chronic endocrine disorders (excludes suppression of lactation); it may also be appropriate to measure the erythrocyte sedimentation rate and serum creatinine and to obtain a chest X-ray. Patients should be monitored for dyspnoea, persistent cough, chest pain, cardiac failure, and abdominal pain or tenderness |
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What is the dispensing and prescribing advice relating to canergoline? |
Dispense in original container contains a desiccant |
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How often should rotigotine patches be changed? |
Manufacturer advises apply patch to clean, dry, intact, healthy and non-irritated skin on torso, thigh, hip, shoulder or upper arm by pressing the patch firmly against the skin for about 30 seconds. Patches should be removed after 24 hours and the replacement patch applied on a different area (avoid using the same area for 14 days |
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When phenothiazine is the most sedating ? |
Chlorpromazine hydrochloride |
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Haloperidol and levomepromazine are indicated for which kind of nausea |
Nausea / vomiting in terminal illness |
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Haloperidol and levomepromazine are indicated for which kind of nausea |
Nausea / vomiting in terminal illness |
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Which anti emetic would be most suitable for nausea associated with gastroduodenal, hepatic and Billary disease |
Metoclopramide |
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Which antiemetic is suitable for relief of nausea and vomiting associated with cytotoxics and post operative nausea and vomiting |
Granisetron / ondansetron |
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Which antiemetic is given for relief of nausea and vomiting associated with pregnancy |
Promethazine short term use Alternatives are prochloperazine or metoclopramide |
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Which antiemetic is given for nausea and vomiting for motion sickness |
Hyoscine HYDRObromide |
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What is the MHRA warning alert for metoclopramide ? |
Max duration of treatment 5 days have to be 18+ 10mg TDS max 500mcg per kg only use for post operative or chemotherapy induced nausea and vomiting IV doses should be administered as a slow bolus over 3 mins Due to the risk of neurological effects Such as extrapyramidal disorders or tardive dyskinesia |
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If acute dystonic reactions occur with metoclopramide what can be given |
Injection of procyclidine |
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Hypscine hydrobromide patches are recommend for motion sickness how often should these be used again |
Apply one patch behind the ear 5-6 hours before journey then apply one patch after 72 hours if required remove old patch and site replacement patch behind the other ear |
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Chronic pain is classed as pain how long |
12 weeks |
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Which opioid can precipitate seizures due to accumulation of a neurotoxic metabolite |
Pethidine |
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Which nsaids are useful for dental pain? |
Ibuprofen / diclofenac sodium / aspirin |
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What is given for pain relief for dysmenorrhea associated with ovulatory cycles |
Oral contraceptive can be hard to manage pain paracetamol or nsaid can help to antiplasmodics can be used |
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Why is caffeine contained in analgesic preparations ? |
Can enhance the analgesic effect but may cause headache |
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Why are the effects of buprenorphine only partially reversed by naloxone hydrochloride? |
Buprenorphine has both agonist and antagonist properties |
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Why is diamorphine preferred in palitative care ? |
Cause less nausea and hypotension then morphine it has greater solubility so allows effective doses to be injected in smaller volumes |
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Which opioid should be avoided after MI as it may increase pulmonary and aortic BP as well as cardiac work |
Petazocine |
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What is pethidine used for ? |
Less constipating then morphine used for analgesia in labour |
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When can methadone be switched to buprenorphine suitably ? |
Dose of methadone should be reduced to a maximum 30 mg daily before starting buprenorphine therapy |
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What is the pre treatment screening for buprenorphine patches ? |
Viral hepatitis |
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How are sublingual tablets given? |
Manufacturer advises oral lyophilisates should be placed on the tongue and allowed to dissolve. Patients should be advised not to swallow for 2 minutes and not to consume food or drink for at least 5 minutes after administration. |
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Which buprenorphine patches should be changed every 72 hours ? |
Hapoctasin/ prenotrix/ |
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Which preparations should be applied every 96 hours |
Bupeaze buplast relevtec transtec |
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Which preparations should be applied every 96 hours |
Bupeaze buplast relevtec transtec |
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Which preparations should be applied every 7 days |
Butrans/ Butec/ reletrans/!sevodyne / bupramyl / panitaz |
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What age do you have to be over for codeine and what is the recommended maximum dose for between 12-18 |
12+ max dose between 12-18 should not exceed 240mg dose can be taken up to four times a day with intervals of no less than 6 hours limit duration to 3 days |
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What age do you have to be over for codeine and what is the recommended maximum dose for between 12-18 |
12+ max dose between 12-18 should not exceed 240mg dose can be taken up to four times a day with intervals of no less than 6 hours limit duration to 3 days |
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Which age range is codeine contraindicated in people who undergo removal of tonsils or adenoids for treatment of obstructive sleep opnea |
Contraindicated under 18 if they have had any of the above done |
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Which 3 groups of people is codeine contraindicated in ? |
Children younger than 12 Breastfeeding mothers Patients of any age that are ultra rapid metabolisers of cyp2d6 Also not recommended for children 12-18 who have breathing problems |
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How long does it take for the plasma fentanyl concentration to decrease by 50% |
17 hours |
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How long after breastfeeding should fentanyl buccal patches be avoided and how long after patches ? |
Avoid during treatment and for 5 days after last administration With patches avoid during treatment and for 72 hours of removal of the patch |
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How are fentanyl buccal tablets given |
For buccal films, moisten mouth, place film on inner lining of cheek (pink side to cheek), hold for at least 5 seconds until it sticks, and leave to dissolve (15–30 minutes); if more than 1 film required do not overlap, but use another area of the mouth. Avoid liquids for 5 minutes after application; avoid food until the film has dissolved.
With buccal use:
Patients should be advised to place the lozenge in the mouth against the cheek and move it around the mouth using the applicator; each lozenge should be sucked over a 15 minute period. In patients with a dry mouth, water may be used to moisten the buccal mucosa. Patients with diabetes should be advised each lozenge contains approximately 2 g glucose. |
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What is the patients and carer advice for fentanyl patches |
Patches should be removed immediately if any breathing difficulties marked drowsiness confusion dizziness impaired speech occur and see medical attention |
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Which mr preparations of morphine are 12 hourly |
Filnarnine/ MST continus / morphgesic / zomorph |
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Which mr preparations of morphine are 12 hourly |
Filnarnine/ MST continus / morphgesic / zomorph |
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Which mr morphine preparation is given 24 hourly |
MXL |
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When does morphine oral solution become a controlled drug |
Above 13mg per 5ml the solution become a schedule 2 controlled drug |
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What is the MHRA warning alert relating to tapentadol? |
Can induce seizures use in caution in patients with a history or seizures or epilepsy seizure risk can be increased when taking other drugs that lower desire threshold e.g SSRI’s TCA antipsychotics |
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What is the treatment for cluster headaches ? |
Analgesics don’t work sumatriptan is given sc or nasal spray can be used alternatively oxygen can be given at a rate of 10-15litres/ MIn for 10-20 mins prophylaxis is recommended if acute attacks are frequent last over 3 weeks |
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What is pizotifen indicated for and when should it be taken |
Prophylaxis of headache should be taken at night |
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What are the typical signs and symptoms of migraine headache |
Common in women recurrent attacks last about 4-72 hours unilateral pulsating can be aggravated by routine physical activity |
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What is a migraine headache |
Headache which last 15 days per month and has characteristic of migraine headache for at least 8 days per month for 3 months |
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What is the 1st line and 2nd line treatment for chronic migraine |
Propanolol 1st line Other BB can be used if this is not suitable metoprolol atenolol nadalol timolol If Bb are not suitable topiramate can be used |
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How long should prophylaxis be used in headache before classed as ineffective |
3 months at the maximum dose before deciding if it’s ineffective or not a good response to treatment is defined as 50% reduction in severity and frequency of migraine attacks |
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How should migraleve tablets be taken? |
Initially 2 tablets, (pink tablets) to be taken at onset of attack or if it is imminent, followed by 2 tablets every 4 hours if required, (yellow tablets) to be taken following initial dose; maximum 2 pink and 6 yellow tablets in 24 hours. |
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What are the side effects of triptans |
Discontinue if symptoms of heat heaviness pressure or tightness including throat and chest occur contraindicated in hypertension MI heart disease previous transitient ischaemic attack |
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List caution with capsasin and carer advice |
Avoid contact with broken skin; avoid contact with inflamed skin Avoid contact with eyes; avoid hot shower or bath just before or after application (burning sensation enhanced); avoid inhalation of vapours; not to be used under tight bandages
Wash hands immediately after use (or wash hands 30 minutes after application if hands treated).
With transdermal use:
Nitrile gloves to be worn while handling patches and cleaning treatment areas (latex gloves do not provide adequate protection). |
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Which benzodiazepines can be used for anxious patients who are having dental treatment |
Temazepam diazepam |
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Which benzodiazepines can be used for anxious patients who are having dental treatment |
Temazepam diazepam |
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Why should benzodiazepines be avoided in the elderly and zopiclone |
Cause falls in the elderly |
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Which benzodiazepines have long action |
Nitrazepam and flurazepam diazepam alprozalam chlordiazepoxide clobazam |
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Which 3 benzodiazepines are short acting Withdrawal phenomena more common with short acting benzodiazepines |
Temazepam lorazepam loprazolam |
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What is melatonin licensed for |
In 55* for short term treatment of insomnia for jet lag in adults |
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Why should food be avoided with immediate release melatonin |
Food when taken with immediate release melatonin may increase the bioavailability of melatonin Manufacturers advise that modified-release tablets should be taken with or after food. Licensed immediate-release formulations should be taken on an empty stomach, 2 hours before or 2 hours after food—intake with carbohydrate-rich meals may impair blood glucose control. |
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How long does complete withdrawal of opioids take |
4 weeks - in inpatient or residential setting 12 weeks - in community setting |
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How long after the last heroin dose can methadone be given and how long does it take for plasma concentrations to reach steady state in patients who are on a stable dose |
8 hours after the last heroin dose Take 3-10 days |
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Why is buprenorhine more suitable than methadone and preferred by patients |
Buprenorphine is less sedating than methadone so preferred in patients who work and drive hi |
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Why should withdrawal of methadone in pregnant women be avoided during the first trimester |
Increased risk of spontaneous miscarriage |
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What are the signs and symptoms of neonate opioid withdrawal when a child is born they should be monitored for signs of respiratory depression can be delayed up to 14 days |
High pitched cry rapid breathing hungry but in effective suckling excessive wakefulness convulsions hypertonicity |
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What is lofexidine used for ? |
Can alleviate the physical symptoms of opioid withdrawal |
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How long after the last heroin dose can methadone be given and how long does it take for plasma concentrations to reach steady state in patients who are on a stable dose |
8 hours after the last heroin dose Take 3-10 days |
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Why is buprenorhine more suitable than methadone and preferred by patients |
Buprenorphine is less sedating than methadone so preferred in patients who work and drive hi |
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Why should withdrawal of methadone in pregnant women be avoided during the first trimester |
Increased risk of spontaneous miscarriage |
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What are the signs and symptoms of neonate opioid withdrawal when a child is born they should be monitored for signs of respiratory depression can be delayed up to 14 days |
High pitched cry rapid breathing hungry but in effective suckling excessive wakefulness convulsions hypertonicity |
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What is lofexidine used for ? |
Can alleviate the physical symptoms of opioid withdrawal |
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Which drug is used for alcohol withdrawal but can only be used in an inpatient setting and should not be given to a patient if they continue to drink alcohol at the same time as taking this medication |
Clomethiazole - taking alcohol with this drug can lead to fatal respiratory depression should only be given in an inpatient setting where the patient has no access to alcohol |
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What is used to treat alcohol withdrawal |
Benzodiazepines or carbamazepine can be used if alcohol withdrawal seizures occur then give a fast acting benzodiazepines such as loazepam |
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Patients who are alcohol dependant are at high risk of developing what and what is given to reduce the risk |
High risk of developing wernicks encephalopathy patients who are at High risk are those who are malnourished or liver disease parental thiamine is given followed by oral thiamine |
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What is disulfiram used for and what is the patient and carer advice relating to this drug |
Used in the adjunct in the treatment of alcohol dependence
Manufacturer advises patients and their carers should be counselled on the disulfiram-alcohol reaction—reactions may occur following exposure to small amounts of alcohol found in perfume, aerosol sprays, or low alcohol and "non-alcohol" beers and wines; symptoms may be severe and life-threatening and can include nausea, flushing, palpitations, arrhythmias, hypotension, respiratory depression, and coma.
Patients and their carers should be counselled on the signs of hepatotoxicity—patients should discontinue treatment and seek immediate medical attention if they feel unwell or symptoms such as fever or jaundice develop. |
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Which drug treatment is suitable for smoking cessation in pregnant women |
NRT |
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Bupropion is used as a treatment option for smoking cessation what monitoring is required for this drug and what it the carer advice given to patients |
Monitor bP before and during treatment Manufacturer advises patients and carers should be instructed to report any clinical worsening of depression, suicidal behaviour or thoughts and unusual changes in behaviour. |
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What should be avoided when taking noticine replacement therapy (food wise ) |
Acidic beverages such as cofee or fruit juice as it may decrease the absorption of nicotine through the buccal mucosa and should be avoided for 15 mins before the use of oral nicotine replacement therapy |
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