• Created by: AJ-A
  • Created on: 19-05-22 23:53
Cognitive symptoms of dementia
memory loss, difficulty thinking, language and orientation
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non-cognitive symptoms of dementia
psychiatric and behavioural problems (delusions, aggression)
difficulties with daily activities
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Some commonly prescribed drugs are associated with increased antimuscarinic (anticholinergic) burden, and therefore cognitive impairment; their use should be minimised. Drugs with antimuscarinic effects include…
some antidepressants (e.g. amitriptyline hydrochloride, paroxetine), antihistamines (e.g. chlorphenamine maleate, promethazine hydrochloride), antipsychotics (e.g. olanzapine, quetiapine), and urinary antispasmodics (e.g. solifenacin succinate, tolterodin
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first-line treatment options for mild-to-moderate Alzheimer’s disease
donepezil hydrochloride, galantamine, or rivastigmine (acetylcholinesterase inhibitors).
If acetylcholinesterase inhibitors are not tolerated or contra-indicated, memantine hydrochloride is a suitable alternative
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what is the drug of choice in patients with severe Alzheimer’s disease
Memantine hydrochloride
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what should be given to patients with mild-to-moderate or severe dementia with Lewy bodies
Donepezil hydrochloride [unlicensed indication] or rivastigmine [unlicensed indication]
galantamine [unlicensed indication] can be considered only if treatment with both donepezil hydrochloride or rivastigmine is not tolerated
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in patients with frontotemporal dementia or cognitive impairment caused by multiple sclerosis
Acetylcholinesterase inhibitors and memantine hydrochloride ARE or AREN'T recommended?
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Antipsychotic drugs should only be offered to patients with dementia when?
if they are either at risk of harming themselves or others, or experiencing agitation, hallucinations or delusions that are causing them severe distress
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which antiepileptic drugs do doctors advise to ensure that their patient is maintained on a specific manufacturer’s product.
Carbamazepine, phenobarbital, phenytoin, primidone
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Antiepileptic hypersensitivity syndrome is a rare but potentially fatal syndrome associated with some antiepileptic drugs such as
carbamazepine, phenobarbital, phenytoin, primidone, oxcarbazepine, lamotrigine, lacosamide and rufinamide
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first-line options for treating newly diagnosed focal seizures
Carbamazepine and lamotrigine
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Options for adjunctive treatment for focal seizures include
carbamazepine, lamotrigine, oxcarbazepine, levetiracetam, clobazam, gabapentin, sodium valproate, or topiramate.
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first-line treatment for newly diagnosed generalised tonic-clonic seizures except in female patients who are premenopausal
Sodium valproate
Lamotrigine is the alternative choice if sodium valproate is not suitable, but may exacerbate myoclonic seizures
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list four types of generalised seizures
Tonic-clonic / Absence seizures / myoclonic seizures / atonic and tonic seizures
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which drugs may also be considered in newly diagnosed and established tonic-clonic seizures, but may exacerbate myoclonic and absence seizures
Carbamazepine and oxcarbazepine
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what are drugs of choice in absence seizures and syndromes
Ethosuximide, or sodium valproate
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________ is a suitable alternative when ethosuximide and sodium valproate are unsuitable, ineffective or not tolerated
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Which drugs are not recommended in absence seizures or syndromes
Carbamazepine, oxcarbazepine, phenytoin, pregabalin, tiagabine, gabapentin, and vigabatrin
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What is the drug of choice in newly diagnosed myoclonic seizures
Sodium Valproate (except in female patients who are premenopausal)
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What are alternative options for myoclonic seizures if sodium valproate is unsuitable
topiramate and levetiracetam
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Which drugs are not recommended for the treatment of myoclonic seizures
Carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine and vigabatrin
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Which drugs are effective in treating the generalised tonic-clonic seizures that coexist with myoclonic seizures
Sodium valproate and levetiracetam
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_______ is the drug of choice for Atonic and tonic seizures
Sodium Valproate
lamotrigine can be added as adjunctive treatment
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If a tertiary epilepsy specialist is consulted in atonic and tonic seizures they may consider _____ & _______
rufinamide or topiramate
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epilepsy syndromes are...
specific types of epilepsy characterised according to features including seizure type, age of onset, and EEG characteristics
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First line treatment of Dravet syndrome
Sodium valproate (except in pregnancy or females of childbearing potential, see Valproate below) or topiramate [unlicensed]
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What are adjunctive treatment in children and adults if first-line treatment for dravet's syndrome are ineffective or not tolerated
Clobazam or stiripentol
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Which drugs should not be used in dravet's syndrome as they may exacerbate myoclonic seizures
Carbamazepine, gabapentin, lamotrigine, oxcarbazepine, phenytoin, pregabalin, tiagabine, and vigabatrin
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Valproate ______ plasma-lamotrigine concentration, whereas the enzyme-inducing antiepileptics ______ it
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Sodium valproate has widespread metabolic effects and require special monitoring of...
liver function tests and full blood count
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Which drug is used in treating epilepsy associated with menstruation
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Seizures lasting longer than 5 minutes should be treated urgently with
intravenous lorazepam
repeated once after 10 minutes if seizures recur or fail to respond
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If, after initial treatment with benzodiazepines, seizures recur or fail to respond 25 minutes after onset, ___________________ should be used
phenytoin sodium, fosphenytoin sodium, or phenobarbital sodium
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Treatment for ADHD
Methylphenidate 2nd line Lisdexamfetamine
alt. Atomoxetine
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_______has been associated with all types of antidepressants; however, it has been reported more frequently with SSRIs
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symptoms of serotonin syndrome fall into 3 main areas which are
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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First line Management of acute anxiety generally involves the use of
benzodiazepine or buspirone hydrochloride
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If drug treatment is needed for Patients with generalised anxiety disorder
an SSRI such as escitalopram, paroxetine, or sertraline [unlicensed]

Duloxetine and venlafaxine (serotonin and noradrenaline reuptake inhibitors (SNRIs)) are also recommended for the treatment of generalised anxiety disorder
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TCAs with sedative properties include
amitriptyline, trazodone, trimipramine, clomipramine, dosulepin, doxepin, mianserin,
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TCAs with less sedating properties include
imipramine hydrochloride, lofepramine, and nortriptyline.
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Which MAOi has a greater stimulant action than phenelzine or isocarboxazid and is more likely to cause a hypertensive crisis
tranylcypromine, whilst phenelzine and isocarboxazid are more likely to cause hepatotoxicity
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Other antidepressants should not be started for ______ after treatment with MAOIs has been stopped
2 weeks
3 weeks if starting clomipramine or imipramine
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a MAOI should not be started until
at least 2 weeks after a previous MAOI has been stopped (then started at a reduced dose)
at least 7–14 days after a tricyclic or related antidepressant (3 weeks in the case of clomipramine or imipramine) has been stopped
at least a week after an SSRI or r
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What are 'positive symptoms' of schizophrenia
hallucinations and delusions
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what are 'negative symptoms' of schizophrenia
emotional apathy and social withdrawal
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first-generation antipsychotic drugs (also known as typical or conventional) act predominantly by
blocking dopamine D2 receptors in the brain
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First-generation antipsychotics include
chlorpromazine, levomepromazine (other -zine's except cariprazine)
benperidol and haloperidol
flupentixol and zuclopenthixol
sulpiride and pimozide
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2nd generation antipsychotics include
amisulpride, aripiprazole, asenapine, cariprazine, clozapine, lurasidone, olanzapine, paliperidone, quetiapine, and risperidone
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Extrapyramidal symptoms are dose-related and are most likely to occur with
fluphenazine decanoate and trifluoperazine), the butyrophenones (benperidol and haloperidol)
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Extrapyramidal symptoms consist of
parkinsonian symptoms (including bradykinesia, tremor)
dystonia (uncontrolled muscle spasm in any part of the body)
akathisia (restlessness)
tardive dyskinesia (abnormal involuntary movements of lips, tongue, face, and jaw)
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Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because
dopamine inhibits prolactin release
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which drugs are most likely to cause symptomatic hyperprolactinaemia
amisulpride, sulpiride, risperidone and FGAs
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The clinical symptoms of hyperprolactinaemia include
sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, galactorrhoea (****** discharge), and a possible increased risk of breast cancer
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QT-interval prolongation is a particular concern with which antipsychotic?
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Antipsychotic drugs are associated with cardiovascular side-effects such as
tachycardia, arrhythmias, and hypotension
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True / False
first-generation antipsychotic drugs are less likely to cause diabetes than second-generation antipsychotic drugs
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Symptoms of Neuroleptic malignant syndrome include
hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with fever, tachycardia, labile blood pressure, and sweating
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Which drugs are used to treat Neuroleptic malignant syndrome
Bromocriptine and Dantrolene
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In early stages of Parkinson's disease, patients whose motor symptoms decrease their quality of life should be offered
levodopa combined with carbidopa (co-careldopa) or benserazide (co-beneldopa).

if it does not affect their quality of life, could be prescribed a choice of levodopa, non-ergot-derived dopamine-receptor agonists (pramipexole, ropinirole or rotigotine) or
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adverse reactions from antiparkinsonian drugs, include
psychotic symptoms, excessive sleepiness and sudden onset of sleep with dopamine-receptor agonists, and impulse control disorders
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what should be offered to patients with mild-to-moderate Parkinson's disease dementia and considered for patients with severe Parkinson's disease dementia
An acetylcholinesterase inhibitor
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Card 2


non-cognitive symptoms of dementia


psychiatric and behavioural problems (delusions, aggression)
difficulties with daily activities

Card 3


Some commonly prescribed drugs are associated with increased antimuscarinic (anticholinergic) burden, and therefore cognitive impairment; their use should be minimised. Drugs with antimuscarinic effects include…


Preview of the front of card 3

Card 4


first-line treatment options for mild-to-moderate Alzheimer’s disease


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Card 5


what is the drug of choice in patients with severe Alzheimer’s disease


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