anti epileptic drugs Flashcards

1
Q

sodium valporate

A
  1. increases GABA activity

2. first line for generalised seziures

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2
Q

Carbamazepine

A
  1. binds to sodium channels increasing their refractory period
  2. first line for partial seizures
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3
Q

Lamotrigine

A
  1. sodium channel blocker

2. used second line for a variety of partial and generalised seizures

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4
Q

phenytoin

A
  1. binds to sodium channels increasing their refractory periods
  2. no longer used first line due to side effect profile
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5
Q

Groups of patients to consider when prescribing anti epileptics

A
  1. patients who drive:
    - generally patients cannot drive for 6 months following a seizure.
    - For patients with established epilepsy they must be fit free for 12 months before being able to drive
  2. patients taking other medications: antiepileptics can induce/inhibit the P450 system resulting in varied metabolism of other medications, for example warfarin
  3. women wishing to get pregnant:
    - antiepileptics are generally teratogenic, particularly sodium valproate.
    - It is important that women take advice from a neurologist prior to becoming pregnant, to ensure they are on the most suitable antiepileptic medication.
    - Breast feeding is generally considered safe for mothers taking antiepileptics with the possible exception of the barbiturates
  4. women taking contraception: both the effect of the contraceptive on the effectiveness of the anti-epileptic medication and the effect of the anti-epileptic on the effectiveness of the contraceptive need to be considered
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6
Q

Carbamazepine is used for;

A
  1. partial seizures

2, neuropathic pain (e.g. trigeminal neuralgia, diabetic neuropathy)

  1. bipolar disorder
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7
Q

Adverse effects of Carbamazepine

A
  1. P450 enzyme inducer
  2. dizziness/drowsiness/headache
  3. visual disturbance
  4. leucopenia and agranulocytosis
  5. may exacerbate myoclonic/absence seizures
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8
Q

adverse effects of Phenytoin

( chronic)

A
  1. gingival hyperplasia - enlarged size of the gums, secondary to increased expression to platelet derived growth factor
  2. Hirsutism
  3. megaloblastic anaemia - secondary to altered folate metabolism
  4. enhanced vitamin D metabolism causing osteomalacia
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9
Q

adverse effects of Phenytoin

( teratogenic )

A
  1. assoc with cleft palate and congenital heart disease
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10
Q

adverse effects of Phenytoin

( idiosyncratic )

A
  1. Fever
  2. rashes, including severe reactions such as toxic epidermal necrolysis
  3. hepatitis
  4. Dupuytren’s contracture*
  5. aplastic anaemia
  6. drug-induced lupus
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