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BNF chapter summary - CNS
Central nervous system BNF chapter summary
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CHAPTER 4 – CENTRAL NERVOUS SYSTEM4.1 HYPNOTICS AND ANXIOLYTICS
Temazepam short acting, therefore good for dental
Short acting Benzodiazepines have greater risk withdrawal symptoms
Hepatic impairment use short acting e.g. Lorazepam
BNZ CONTRAINDICATED: Respiratory depression, pulmonary depression, myasthenia gravis
Paradoxical effects (hostility and aggression)
Diazepam had a long T½, so avoids sharp fluctuations in plasma levels, so less likely to get withdrawal with
late dose
When withdrawing from BDZs, convert dose to Diazepam dose and then withdraw patient slowly
Buspirone: 5HT1A antagonist, used for anxiety
4.2 DRUGS USED IN PSYCHOSES AND RELATED DISORDERS
4.2.1 Antipsychotic Drugs
Tranquillise without impairing consciousness
SIDE EFFECTS: EPSEs
Typical Antipsychotics (more EPSEs), Atypical are thought to be more safe
Clozapine
o SIDE EFFECTS: Myocarditis, cardiomyopathy, agranulocytosis (Blood tests required)
4.2.2 Antipsychotic Depot Injections
Given at intervals of 1-4 weeks.
4.2.3 Antimanic Drugs
Carbamazepine
o SIDE EFFECT: Blood dyscrasias
Valporic Acid
Lithium
o Toxicity d by Na+ depletion therefore avoid thiazides
o Must stick to the same brand
o Should avoid major dietary changes, esp with salt
o LONG TERM HAS BEEN ASSOCIATED WITH Thyroid disorders, mild cognitive and memory impairment
4.3 ANTIDEPRESSANT DRUGS
Choice of Antidepressant (AD)
o SSRIs are 1st choice in depression
Better tolerated and safe in OD
CAUTION IN ELDERLY: CSM: Hyponatreamia should report signs such as confusion,
drowsiness or convulsions
COUNSELLING: Cause insomnia so should take in the morning
SIDE EFFECT OF FLUOXETINE: EPSEs reported
o TCAs have similar efficacy to SSRIs, but are not as well tolerated due to S/E
Dangerous in OD Cardiotoxicity
o MAOIs – dangerous interactions with food (S&S = throbbing headache)
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