These are my notes for the Central Nervous System - the biggest topic to revise for the GPhC pre-registration exam.
These notes cover the follow subheadings:
- Dementia
- Dementia treatment
- Key points Anti-epileptic Drugs
- Epilepsy
- Epilepsy in Pregnancy
- Different types of s...
Stick to the same brand for CP3 drugs (carbamazepine, phenobarbital,
primidone & phenytoin)
Central Nervous System (CNS) 4
, All cause suicidal thoughts
All teratogenic - thus may have high dose folic acid used in pregnancy
Epilepsy
Treatment aims?
Prevent occurrence of seizures
How are doses adjusted? dosage frequency?
Adjust doses if necessary - start small dose & gradually increase until
seizure controlled
Keep dosage frequency as low as possible to encourage pt adherence
Choice of AE drug depends on what?
Several factors including:
Co-morbidity
Concomitant medication
Age
Sex (SV & PPP)
Epilepsy syndrome type
Which AE drugs have a long half life & can be given OD? (Memory trick)
LP3 (LONG PERIOD 3) (can be given OD at bedtime)
Lamotrigine
Perampanel
Phenobarbital
Phenytoin
How is monotherapy initiated? how to switch to another AE?
Monotherapy with 1st line AE
If this fails = monotherapy = 2nd drug
Cautiously change from on AE to another
Central Nervous System (CNS) 5
, Slowly withdraw first drug only when new regimen established (pt will
be on 1 drug; then 2 - then initial drug will be withdrawn slowly)
Avoid abrupt withdrawal = cause rebound seizures
What is the risk with combination therapy?
2 or more AE = may be necessary
Increases chances of side effects & interactions
What if combination therapy fails?
Revert to the regimen (mono or combo) that provided best balance between
tolerability & efficacy
Prescribe a single AE where possible
MHRA/CHM ADVICE? (switching)
Potential harm between switching patients stabilised on brands for epilepsy
to generic products
What AE drugs need to be maintained on a specific brand?
Only for epilepsy
Category 1 drugs - as they vary in bioavailability
Category 1 drugs? (memory trick)
CPR3 (also cause hypersensitivity syndrome)
Carbamazepine (tegretol, carbagen) (retard & IR)
Phenytoin (epanutin)
Phenobarbital
Primidone
Category 2 drugs? (memory trick)
Need for continuity depends on clinical judgement from prescriber/consultant &
consultation with patient/carer
L.C.C.T.V
Lamotrigine
Clobazam
Clonazepam
Central Nervous System (CNS) 6
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