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Neurology > Anti-convulsants > Flashcards

Anti-convulsants Flashcards

1
Q

Haematological SE of Carbamazepine?

A

General BM depression with agranulocytosis in the first months of treatment

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2
Q

A trial of what medication is recommended in Infantile spasms (or West syndrome)

A

High dose steroids (or ACTH in UK)

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3
Q

What particular anticonvulsant would you trial in infantile spasms known to be secondary to tuberous sclerosis?

A

Vigabatrin

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4
Q

What is an irreversible SE of Vigabatrin?

A

Loss of peripheral vision

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5
Q

First line management for childhood absence epilepsy?

A

Ethosuximide

Then Sodium Valproate

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6
Q

1st line anticonvulsant for temporal lobe epilepsy?

A

Carbamazepine

2nd line phenytoin

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7
Q

Which anticonvulsants act on GABA?

A

Benzodiazepines
Vigabatrin
Topiramate (?)

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8
Q

Which anticonvulsants act by inhibiting voltage gated sodium channels?

A 
CBZ
Phenytoin/Phenobarbitone
Valproate
Topiramate
lamotrigine (?)
Oxcarbazepine 
Zonisamide
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9
Q

What should Carbamazepine NOT be used for?

A

Generalised epilepsies

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10
Q

Does Carbamazepine inhibit or induce liver enzyme system CYP-450?

A

Induction

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11
Q

What should one take care with Carbamazepine in Asian populations?

A

SJS (HLA-B* 1502 in Asian population)

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12
Q

Does phenytoin induce or inhibit liver enzymes?

A

Phenytoin induces CYP-450 liver enzymes

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13
Q

Side effects of phenytoin?

A

Rash/SJS/Serum sickness
hirsutism/gum hypertrophy
Osteoporosis
Severe idiosyncratic reactions

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14
Q

Side effects of phenobarbitone?

A

Rash
Megaloblastic anaemia
Osteomalacia (increased Vit D breakdown)

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15
Q

Contra-indications for Sodium Valproate?

A

Liver disease
Mitochondrial disease
<2yrs
Undiagnosed intellectual disability

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16
Q

Side effects of Sodium Valproate?

A 
Dose related tremor/irritability/confusion
Hepatotoxicity
Weight gain
Alopecia
Pancreatitis
Thrombocytopenia
17
Q

Action of benzodiazepines?

A

Bind to GABA site (increase Cl influx)

18
Q

Why should Valproate and Lamotrigine be used very carefully together?

A

Valproate INHIBITS metabolism of lamotrigine and increases the half-life

19
Q

Most common side effect of Lamotrigine?

A

Rash (increase the dose very slowly to minimise the risk of rash development)

20
Q

Action of Vigabatrin?

A

Irreversible inhibitor of GABA transaminase

produces dose dependent increase in CSF GABA concentration

21
Q

Irreversible side effect of Vigabatrin?

A

Visual field constriction (retinal toxicity) and retinopathy (20% of patients have changes on review)

22
Q

Topiramate SE?

A

Weight Loss
Nephrolithiasis
Dose dependent cognitive side effects (10% have word finding difficulties)

23
Q

SE of Keppra?

A

Behavioural disorders
Psychosis
Sleep disturbance

24
Q

Cross reaction to Oxcarbazepine if allergy to Carbamazepine?

A

30% cross-reaction

25
Q

MOA of Ethosuximide (Zorontin)

A

Enhancement of non-GABA mediated inhibition

Blocks T-type Ca channels

26
Q

Which anti-convulsant medications induce hepatic enzymes?

A

Phenobarbitone
Phenytoin
Carbamazepine

27
Q

Which commonly used AED causes hepatic enzyme inhibition?

A

Sodium Valproate

28
Q

Which AEDs are considered effective for primary generalised epilepsies? (5)

A 
Sodium valproate
Topiramate
Lamotrigine
Keppra 
Zonisamide
29
Q

What are the typical dose related side effects of AEDs?

A 
Sedation
Headache
GI irritation
Unsteadiness (ataxia)
Dysarthria
Behavioural disturbance
30
Q

Define idiosyncratic

A

Unpredictable, potentially fatal drug reactions not related to dose

31
Q

What idiosyncratic reactions have been documented with phenytoin? (4)

A

hepatic dysfunction
movement disorder
SJS
fulminant hepatic failure

32
Q

What idiosyncratic reactions: carbamazepine (5)

A 
Leukopenia
Aplastic anaemia
Thrombocytopenia
Hepatic dysfunction
Rashes
33
Q

Idiosyncratic reactions: ethosuxamide (3)

A

Leukopenia
Pancytopenia
Rashes

34
Q

Idiosyncratic reactions: valproate (6)

A 
Fulminant hepatic failure
Hyperammonemia
Pancreatitis
Thrombocytopenia
Rash
Stupor

Neurology (11 decks)

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