Anti-epileptic medication Flashcards
What factors are considered when prescribing ant-epileptic medication?
type of seizure
age
sex
co-morbidities
how often is it given for adults and for children?
usually twice a day
children: given higher doses or more frequent doses as their metabolism is more rapid.
Which AED have a long half-life? How often are they given?
Lamotrigine
phenytoin
phenobarital
given ONCE AT NIGHT
Which three categories are anti-epileptic medication placed into?
Category 1: Patient must stick to the same brand:
- carbamazepine
- phenytoin
- phenobabital
Category 2:
- lamotrigine
- valproate
- zonisamide
Category 3: doesn’t matter what brand
- levetiracetam
- gabapentin
- pregabalin
What should pts avoid doing?
avoid abrupt withdrawal
Can the categories be used with one another?
yes, but monotherapy is preferred.
What are the rules and regulations of patients on AED?
- Must only drive if only seizure free for one year
- if pts are experiencing seizures, it should only be sleep seizures not wake seizures for 3 years
- if pt does get a seizure (if single episode or first episode) cannot drive for 6 months
if pt is pregnant is there a risk of teratogenicity when taking AED?
Yes especially in the 1st trimester or pts taking two or more AED.
valproate has the highest risk
Why are routine injections of vitamin K given at birth?
to minimise the risk of neonatal haemorrhage particularly in those who have been associated with anti-epileptic medication
For any newly diagnosed tonic-clonic seizure, what is first line?
Sodium valproate
For a generalised tonic-clonic seizure, what is first line?
Sodium valproate
Carbamazepine
For an absence seizure, what is first line?
Sodium valproate or
ethosuximide
For a focal seizure, what is first line?
Lamotrigine
but for newly diagnosed, its carbamazepine
For a person with atonic/tonic seizure what is first line?
Sodium valproate
For pregnancy, if a pt has been diagnosed with epilepsy, what is first line?
Oxycarbazepine
For pregnancy, if pt has been diagnosed with general tonic clonic seizures, what is first line?
lamotrigine
Whats the therapeutic range of carbamazepine?
4-12mg/L
Patients on carbamazepine may experience blood disorders, what are the signs of these symptoms?
Blood disorders - so sore throat, fever, unexplained bruising - may have bone marrow suppression - make sure patient is aware
What are the toxicity S/E of carbamazepine?
- blood disorders
- skin disorders
anti-epileptic hypersensitivity disorders - hepatic disorders
- blurred vision
- drowsiness
- hyponatraemia
What is the route of elimination of carbamazepine?
hepatic
What category is carbamazepine in? Whats the most important factor about this category?
Category 1. patient must stick to the same brand.
What can lamotrigine cause?
Bone Marrow Supression
Both laMotrigine and cabarbaMazepine cause bone Marrow supression
What is status epilepticus?
a pt starts to have a seizure one after the other without regaining consciousness in between them
What do you do if a patient experiences status epilepticus?
put pt in recovery position
given oxygen
hyperglycaemia must be corrected (if they do have it)
if its due to alcohol intake - give thiamine
if they are pyridoxine deficient - give pyridoxine
if a pt does get a seizure for more than FIVE minutes, what is given to the patient?
- IV lorazepam
If unable to resuscitate the patient what would you give?
diazepam rectal solution or midazolam oromucosal solution via buccal cavity?
if seizure lasts for more than 25 minutes, what would you give?
phenytoin or phenobarbital
if seizure lasts for more than 45 minutes what would you give?
anaesthesia with thiopental, midazolam
if patients have febrile convulsions, what would you give?
paracetamol
