Misc Healthcare Topics
Chapter 4: Nervous System
Compiled By Masterpiecesolutions
Edition: 2025/26
, Medical & Nursing | Misc Healthcare Topics I of XXVIII pages
1. What kind of drugs should be minimised in patients with cognitive impairment, such as dementia?
Antimuscarinicse.g. amitriptyline, paroxetine, solifenacin, antipsychotics
Can result in cognitive impariment
2. What is first line treatment options for patients with mild to moderate Alzheimers?
Monotherapy with one of the following Ach inhibitors:
DonezipilRivastigmineGalantamine
Drug treatment should only be initiated under a specialist (however can then be managed in primary care)
3. What is first line for patients with severe Alzheimers in someone who is not on any medication for the
Memantine
4. If a patient is on an Ach inhibitor for their mild/moderate Alzheimers, however their condition gets more
Consider adding memantine. In this case, it can be initiated in primary care without the advice from a
5. In patients with moderate Alzheimers, what is the risk of stopping Ach inhibitor treatment?
Can cause a substantial worsening in cognitive function
6. What is the MHRA warning regarding prescribing antipsychotics in elderly patients with dementia?
Increased risk of stroke and a small increased risk of death
If needed, use the lowest effective dose and for the shortest timeReview every 6 weeks
7. What is the risk of prescribing antipsychotics in patients with Lewy body/Parkinsons Disease dementia?
Antipsychotic drugs can worsen the motor features of the condition, and in some cases cause severe
8. What patient advice is needed for galantamine?
Risk of serious skin reaction including Stevens-Johnson
Stop taking if reaction occurs
9. What is the MHRA advice surrounding switching between different manufacturers products in epilepsy?
Antiepileptic drugs have been divided into three risk-based categories to help healthcare professionals decide
Category 1:Carbamazepine, phenobarbital, phenytoin, primidone. For these drugs, doctors are advised to
Category 2Clobazam, clonazepam, eslicarbazepine acetate, lamotrigine, oxcarbazepine, perampanel,
topiramate, valproate, zonisamide. For these drugs, the need for continued supply of a particular
product should be based on clinical judgement and consultation with the patient and/or carer taking into
Category 3Brivaracetam, ethosuximide, gabapentin, lacosamide, levetiracetam, pregabalin, tiagabine,
For these drugs, it is usually unnecessary to ensure that patients are maintained on a specific manufacturers
10. What is antiepileptic hypersensitivity syndrome?
Rare but potentially fatal syndrome associated with some antiepileptic drugs
The symptoms usually start between 1 and 8 weeks of exposure; fever, rash, and lymphadenopathy are most
11. What is the MHRA advice regarding antiepileptic drugs and psychological side effects?
Associated with a small increased risk of suicidal thoughts and behaviour (can occur as early as one week after
Seek medical advice if they develop mood changes
12. True or false:
Misc Healthcare Topics 2025/26 Edition
, Medical & Nursing | Misc Healthcare Topics II of XXVIII pages
Routine injection of vitamin K at birth minimises the risk of neonatal haemorrhage associated with
True
13. What is 1st line for newly diagnosed focal seizures?
Carbamazepine or Lamotrigine
14. What is 1st line for tonic-clonic seizures?
What would be an alternative if this is unsuitable? What is the problem with this?
Sodium valproate
Lamotrigine, carbamazepine is an alternative however may exacerbate myoclonic seizures
15. What is 1st line for absence seizures?
What would be an alternative?
Ethosuximide or sodium valproate
Lamtorogine is an alternative
16. What is 1st line for myoclonic seizures?
What would be alternative options?
Sodium valproate
Topiramate or levetiracetam
17. Atonic and clonic seizures are usually seen in which patient group?
What is the drug of choice for this?
Childhood or associated with cerebral damage or mental retardation
Sodium valproate Lamotrigine can be added
18. Which benzodiazepines can be used in epilepsy management (not status epilepticus)?
Clobazam
Clonazepam
19. Seizures lasting longer than 5 minutes should be treated with what benzodiazepine?
What should you monitor?
IV lorazepam - can repeat once after 10 minutes if response fails
Monitor for hypotension and respiratory depression
20. IV diazepam is effective in seizures but carries a high risk of what?
Thrombophlebitis
21. True or false:
Diazepam IM or suppositories should be used for status epilepticus
False- absorption is too slow
22. If after initial treatment of IV lorazepam and there is no response after 25 mins, what should be used?
Phenytoin/phenobarbital/fosphenytoin
If this does not work- anaesthesia
23. Do brief febrile convulsions need any treatment?
Misc Healthcare Topics 2025/26 Edition
Chapter 4: Nervous System
Compiled By Masterpiecesolutions
Edition: 2025/26
, Medical & Nursing | Misc Healthcare Topics I of XXVIII pages
1. What kind of drugs should be minimised in patients with cognitive impairment, such as dementia?
Antimuscarinicse.g. amitriptyline, paroxetine, solifenacin, antipsychotics
Can result in cognitive impariment
2. What is first line treatment options for patients with mild to moderate Alzheimers?
Monotherapy with one of the following Ach inhibitors:
DonezipilRivastigmineGalantamine
Drug treatment should only be initiated under a specialist (however can then be managed in primary care)
3. What is first line for patients with severe Alzheimers in someone who is not on any medication for the
Memantine
4. If a patient is on an Ach inhibitor for their mild/moderate Alzheimers, however their condition gets more
Consider adding memantine. In this case, it can be initiated in primary care without the advice from a
5. In patients with moderate Alzheimers, what is the risk of stopping Ach inhibitor treatment?
Can cause a substantial worsening in cognitive function
6. What is the MHRA warning regarding prescribing antipsychotics in elderly patients with dementia?
Increased risk of stroke and a small increased risk of death
If needed, use the lowest effective dose and for the shortest timeReview every 6 weeks
7. What is the risk of prescribing antipsychotics in patients with Lewy body/Parkinsons Disease dementia?
Antipsychotic drugs can worsen the motor features of the condition, and in some cases cause severe
8. What patient advice is needed for galantamine?
Risk of serious skin reaction including Stevens-Johnson
Stop taking if reaction occurs
9. What is the MHRA advice surrounding switching between different manufacturers products in epilepsy?
Antiepileptic drugs have been divided into three risk-based categories to help healthcare professionals decide
Category 1:Carbamazepine, phenobarbital, phenytoin, primidone. For these drugs, doctors are advised to
Category 2Clobazam, clonazepam, eslicarbazepine acetate, lamotrigine, oxcarbazepine, perampanel,
topiramate, valproate, zonisamide. For these drugs, the need for continued supply of a particular
product should be based on clinical judgement and consultation with the patient and/or carer taking into
Category 3Brivaracetam, ethosuximide, gabapentin, lacosamide, levetiracetam, pregabalin, tiagabine,
For these drugs, it is usually unnecessary to ensure that patients are maintained on a specific manufacturers
10. What is antiepileptic hypersensitivity syndrome?
Rare but potentially fatal syndrome associated with some antiepileptic drugs
The symptoms usually start between 1 and 8 weeks of exposure; fever, rash, and lymphadenopathy are most
11. What is the MHRA advice regarding antiepileptic drugs and psychological side effects?
Associated with a small increased risk of suicidal thoughts and behaviour (can occur as early as one week after
Seek medical advice if they develop mood changes
12. True or false:
Misc Healthcare Topics 2025/26 Edition
, Medical & Nursing | Misc Healthcare Topics II of XXVIII pages
Routine injection of vitamin K at birth minimises the risk of neonatal haemorrhage associated with
True
13. What is 1st line for newly diagnosed focal seizures?
Carbamazepine or Lamotrigine
14. What is 1st line for tonic-clonic seizures?
What would be an alternative if this is unsuitable? What is the problem with this?
Sodium valproate
Lamotrigine, carbamazepine is an alternative however may exacerbate myoclonic seizures
15. What is 1st line for absence seizures?
What would be an alternative?
Ethosuximide or sodium valproate
Lamtorogine is an alternative
16. What is 1st line for myoclonic seizures?
What would be alternative options?
Sodium valproate
Topiramate or levetiracetam
17. Atonic and clonic seizures are usually seen in which patient group?
What is the drug of choice for this?
Childhood or associated with cerebral damage or mental retardation
Sodium valproate Lamotrigine can be added
18. Which benzodiazepines can be used in epilepsy management (not status epilepticus)?
Clobazam
Clonazepam
19. Seizures lasting longer than 5 minutes should be treated with what benzodiazepine?
What should you monitor?
IV lorazepam - can repeat once after 10 minutes if response fails
Monitor for hypotension and respiratory depression
20. IV diazepam is effective in seizures but carries a high risk of what?
Thrombophlebitis
21. True or false:
Diazepam IM or suppositories should be used for status epilepticus
False- absorption is too slow
22. If after initial treatment of IV lorazepam and there is no response after 25 mins, what should be used?
Phenytoin/phenobarbital/fosphenytoin
If this does not work- anaesthesia
23. Do brief febrile convulsions need any treatment?
Misc Healthcare Topics 2025/26 Edition
