anti-epileptic drugs

Question 1

what are the 5 important AEDs to learn

Answer 1

phenytoin
valproate
carbamazepine
lamotrigine
levetiracetam

Question 2

what is first line drug for generalised tonic clonic seizures?

Answer 2

valproate or lamotrigine/levetiracetam in pregnacy-risk women

Question 3

what is first line drug for generalised absence seizures?

Answer 3

if ONLY absence - ethusuximide

or valproate, or lamotrigine if unsuitable

Question 4

carbamazepine can be used for myoclonic epilepsy - T or F

Answer 4

F

Question 5

what drug should be used for myoclonic epilepsy?

Answer 5

valproate or levetiracetam/topiramate

Question 6

what is the first line drug of choice in partial seizures?

Answer 6

carbamazepine or lamotrigine

Question 7

side effects of AEDs

Answer 7

rash/stevens johnson syndrome
teratogenicity
toxic effects - unsteadiness, blurred vision, tremor, confusion

Question 8

of the 5 important AEDs to learn, which ones are cyp450 inducers?

Answer 8

carbamazepine, ethoxusimide, phenytoin,

Question 9

of the 5 important AEDs to learn, which ones goes thru hepatic glucoronidation i.e. caution in hepatic failure

Answer 9

lamotrigine, valproate

Question 10

levetiracetam is excreted hepatically - T or F

Answer 10

F, it is renally excreted

Question 11

what does it mean if phenytoin is a highly protein bound drug?

Answer 11

means that if patient has hepatic failure, less albumin will be around, meaning more free active drug will be circulating

also measurement of phenytoin levels includes both PPB and free floating drugs, therefore albumin levels are key in determining therapeutic level

Question 12

valproate is an inducer or inhibitor of cyp450 ?

Answer 12

inhibitor

Question 13

what antipsychotic is good to use in someone with PD?

Answer 13

quetiapine

Question 14

what are some causes of drug induced parkinsonism

Answer 14

valproate
ccbs like nifidepine
fluoxetine
lithium

Question 15

what does it mean when carbamazepine is an autoinduer

Answer 15

means that drug will be metabolised faster, might need to give higher dose at initiation

Question 16

what AEDs cause cerebellar signs?

Answer 16

carbamazepine

Question 17

what ethnicity is prone to stevens johnson syndrome in using AEDs

Answer 17

han chinese and thai

Question 18

what should be noted when using AEDs with COCP?

Answer 18

most of them will require higher doses of COCP, when using with lamotrigine, must increase dose of lamotrigine

Question 19

how to manage status epilepticus?

Answer 19

in hospital - lorazepam 4mg IV, repeat once within 10-20 minutes

in community - rectal diazepam or buccal midazolam

2nd line - phenytoin infusion

3rd line - anaesthetist, ITU, phenobarbital

Question 20

what to monitor when using phenytoin infusions?

Answer 20

hypotension, arrythmias