4.2 Epilepsy Flashcards
A patient who is a new mother comes into your pharmacy. Her 5-year-old daughter has been recently diagnosed with epilepsy and she would like to know what factors trigger epileptic seizures.
Which one of the following is NOT a trigger for an epilepsy seizure?
Select one:
A. Flashing lights
B. Having an illness causing a low body temperature
C. Lack of sleep
D. Not taking prescribed epilepsy medicines
E. Stress
Having a high temperature can be a cause of an epileptic seizure
Ref: Seizure triggers, https://www.epilepsy.org.uk/info/triggers, on lots of common epilepsy websites
The correct answer is: Having an illness causing a low body temperature
A 55-year-old male patient suffers from generalised seizures. He has been prescribed sodium valproate and also uses a salbutamol inhaler once or twice a year. Identify the parameter that should be measured before commencing treatment.
Select one:
A. Blood pressure
B. Chest X-ray
C. Electrocardiogram (ECG)
D. Fasting blood glucose
E. Heart rate
F. Plasma urea
G. Serum alanine transaminase (ALT) Correct
H. Urinalysis
Serum ALT – Sodium Valproate is associated with hepatotoxicity therefore liver function should be measured at baseline and at regular intervals throughout therapy.
The correct answer is: Serum alanine transaminase (ALT)
A 28-year-old lady receiving sodium valproate for the treatment of epilepsy.
- If the patient suffers a severe skin reaction in the first 8 weeks, the medicine should be stopped immediately.
- The patient should be advised that they require routine monitoring of the blood levels of the medicine.
- The patient should be asked to sign the back of the prescription form as confirmation of collection.
- The patient should be provided with a Patient Card.
- The patient should immediately report a sore throat to a healthcare professional.
- The patient should take the medicine once weekly.
- The patient should stop taking this medicine if they have a seizure and seek further medical advice.
- The same brand must always be supplied.
The patient should be provided with a Patient Card.
A 50-year-old male receiving primidone for the treatment of epilepsy.
- If the patient suffers a severe skin reaction in the first 8 weeks, the medicine should be stopped immediately.
- The patient should be advised that they require routine monitoring of blood levels of the medicine.
- The patient should be asked to sign the back of the prescription form as confirmation of collection.
- The patient should be provided with a Patient Card.
- The patient should immediately report a sore throat to a healthcare professional.
- The patient should take the medicine once weekly.
- The patient should stop taking this medicine if they have a seizure and seek further medical advice.
- The same brand must always be supplied.
The same brand must always be supplied.
A 45-year-old lady receiving lamotrigine for the treatment of epilepsy.
- If the patient suffers a severe skin reaction in the first 8 weeks, the medicine should be stopped immediately.
- The patient should be advised that they require routine monitoring of the blood levels of the medicine.
- The patient should be asked to sign the back of the prescription form as confirmation of collection.
- The patient should be provided with a Patient Card.
- The patient should immediately report a sore throat to a healthcare professional.
- The patient should take the medicine once weekly.
- The patient should stop taking this medicine if they have a seizure and seek further medical advice.
- The same brand must always be supplied.
If the patient suffers a severe skin reaction in the first 8 weeks, the medicine should be stopped immediately.
Serious skin reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis have developed (especially in children); most rashes occur in the first 8 weeks. Avoid abrupt withdrawal (taper off over 2 weeks or longer) unless serious skin reaction occurs.
A 21-year-old male receiving pregabalin for the treatment of epilepsy.
- If the patient suffers a severe skin reaction in the first 8 weeks, the medicine should be stopped immediately.
- The patient should be advised that they require routine monitoring of blood levels of the medicine.
- The patient should be asked to sign the back of the prescription form as confirmation of collection.
- The patient should be provided with a Patient Card.
- The patient should immediately report a sore throat to a healthcare professional.
- The patient should take the medicine once weekly.
- The patient should stop taking this medicine if they have a seizure and seek further medical advice.
- The same brand must always be supplied.
The patient should be asked to sign the back of the prescription form as confirmation of collection.
A 19-year-old female is taking zonisamide for epilepsy.
- Drowsiness may affect your driving. This effect is enhanced with alcohol consumption
- Take this medication at night
- Oral solution should be swallowed as a single 100 mL dose with plenty of water while sitting or standing upright
- Take this medication on an empty stomach
- Avoid factors that cause overheating or dehydration like exercise
- Report symptoms including sore throat, mouth ulcers, bruising, fever, tiredness or non-specific illnesses to your doctor immediately
- Report immediately if a skin rash develops or if any signs or symptoms of hypersensitivity develops
- Take this medication after food
Avoid factors which cause overheating or dehydration like exercise
You are dispensing a prescription for sodium valproate for Mrs DS who is 26 years old. When dispensing the prescription, you ask if she has signed a risk acknowledgement form, but she says that she hasn’t. What should you do?
https://www.gov.uk/drug-safety-update/valproate-medicines-are-you-in-acting-in-compliance-with-the-pregnancy-prevention-measures
Dispense the prescription, but advise the patient to see her GP as soon as possible.
Dispense the prescription without taking any further steps.
Do not dispense the prescription and advise the patient to see her GP as soon as possible.
Do not dispense the prescription and alert the GP that you have not dispensed it.
Do not dispense the prescription as this form should be signed before the prescription can be dispensed.
The correct answer was Dispense the prescription, but advise the patient to see her GP as soon as possible.
When dispensing sodium valproate pharmacists should check whether women are enrolled in the Pregnancy Prevention Programme and have signed a Risk Acknowledgement Form - if not, dispense the prescription and advise the patient to speak to her GP as soon as possible (including by contacting the GP directly if necessary) for a specialist referral.
Which of the following non-prescription topical preparations is to be used with caution in patients taking phenytoin?
HC45® hydrocortisone 1% cream
Clotrimazole 2% cream
Daktarin® oral gel
Zovirax® 5% cream
Benzoyl peroxide 4% cream
The correct answer was Daktarin® oral gel
Miconazole enhances anticonvulsant effect of phenytoin (plasma concentration enhanced) although with topical use, the risk is lower.
A man presents to your pharmacy complaining of a rash all over his body. He tells you that he started taking phenytoin 9 days ago. What recommendation(s) would you give to this patient?
Stop drug, urgent referral for medical attention
Refer to GP as dose of drug may need to be reduced
Refer to GP as dose of drug may need to be increased
Stop drug, refer to GP as the patient is experiencing an allergic reaction
Continue taking drug as this is a harmless adverse effect of the drug
The correct answer was Stop drug, urgent referral for medical attention
Patients or their carers should be told how to recognise signs of blood or skin disorders, and advised to seek immediate medical attention if symptoms such as fever, rash, mouth ulcers, bruising, or bleeding develop.
You are dispensing an antiepileptic drug for a patient with epilepsy.
For which of the following antiepileptic drugs should you consult the prescriber to establish if the same brand is to be dispensed each time?
Carbamazepine
Gabapentin
Lamotrigine
Levetiracetam
Vigabatrin
The correct answer was Lamotrigine
Carbemazepine is incorrect as patients should always be kept on the same brand of that.
Category Drugs More details on classification Advice for prescribing
Category 2
Clobazam, Clonazepam, Eslicarbazepine, Lamotrigine, Oxcarbazepine, Perampanel, Retigabine, Rufinamide, Topiramate, Valproate, Zonisamide
Drugs that do not fit into Category 1 or 3
Base the need for continued supply of a particular manufacturer’s product on clinical judgement and consultation with patient and/or carer, taking into account factors such as seizure frequency and treatment history. Take into account patient/carer-related factors such as their negative perceptions about alternative products and/or other issues related to the patient should also be taken into account.
A patient experiencing an epileptic seizure is brought into Accident and Emergency for treatment.
What is the most appropriate treatment for patients to be prescribed for treatment of status epilepticus should they experience this in their day-to-day life?
Clobazam tablets
Clonazepam tablets
Diazepam intravenously
Diazepam rectally
Midazolam buccally
The correct answer was Midazolam buccally
Diazepam IV would be unusual for epilepsy with rectal diazepam being preferred as it is a safer and rapidly acting option. However, in day-to-day life this may be difficult to administer. Midazolam buccal would be the drug of choice in practice as it is also well absorbed. It is placed between the gum and the teeth along the side of the tongue and may be split so that a dose is given into each cheek to avoid accidental swallowing.
Mr N is worried about the abdominal pain, nausea and vomiting he has recently been suffering from. You know he is usually prescribed sodium valproate for the management of his epilepsy.
What is the most appropriate advice you should give Mr N?
There is no connection between his medication and the symptoms he’s describing, you could suggest over the counter symptomatic relief
These are normal side effects of the medication, nothing to worry about
Seek immediate medical attention
Advise Mr N to go to his GP, as the dose of sodium valproate might need to be increased
Advice Mr N to go to his GP, as the dose of sodium valproate might need to be decreased
The correct answer was Seek immediate medical attention
Mr N should seek immediate medical attention, as the symptoms he describes may be indicative of sodium valproate-induced pancreatitis.
A 34-year-old woman has come in with her prescription for carbamazepine 200 mg three times daily. She asks you what the likely reason is for her maintenance dose to be higher than the dose she was started on, as her symptoms have not worsened since the start of treatment. What is the most appropriate explanation to give to this patient?
Carbamazepine itself increases how quickly the body processes it so the maintenance dose is higher than the initial dose
Carbamazepine is removed by the kidneys at a high rate and so the dose must be increased over time
Carbamazepine is removed by the liver at a high rate and so the dose must be increased over time
Disease progression is taking place despite no change in symptoms and so the dose has been increased
Drug tolerance may have developed and so the dose has been increased
You were correct.
The correct answer was Carbamazepine itself increases how quickly the body processes it so the maintenance dose is higher than the initial dose
Carbamazepine is an enzyme autoinducer and thus a lower loading dose is required. Carbamazepine induces its own metabolism and so the maintenance dose is higher than the initial doses
