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Pharmocolgy > Anti-Epileptics > Flashcards

Anti-Epileptics Flashcards

1
Q

what is a seizure ?

A

a sudden irregular discharge of electrical activity in the brain
causing a physical manifestation such as sensory disturbance, unconsciousness
or convulsions

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2
Q

what is a convulsion ?

A

uncontrolled shaking movements of the body due to rapid

and repeated contraction and relaxation of muscles

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3
Q

what is an Aura ?

A

a perceptual disturbance experienced by some prior to a seizure,
e.g. strange light, unpleasant smell, confusing thoughts

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4
Q

what is Epilepsy ?

A

neurological disorder marked by sudden recurrent episodes of
sensory disturbance, LOC or convulsions, associated with abnormal electrical
activity in the brain

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5
Q

what is status epilepticus ?

A

epileptic seizures occurring continuously without

recovery of consciousness in between

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6
Q

what is the difference between partial and generalised seizures ?

A 
partial = in one part of the brain 
Generalised = electrical activity everywhere
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7
Q

what is difference between partial simple/ complex seizures ?

A 
simple = maintain consciousness 
complex = loss in consciouses
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8
Q

what is the most common effected lobe in epilepsy and how does it present/Caused ?

A

Temporal

Aura- auditory hallucinations and rush of memories
10-20 yrs olds , fever or early injury to the brain

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9
Q

what is seen in frontal lobe epilepsy ?

A

contralateral side affected

convulsions

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10
Q

what is the Tonic clonic seizure?

A

generalised -

muscles tense and then convulsions

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11
Q

What is a absence seizure ?

A

Daydreaming - may start a sentence and stop

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12
Q

what is a myoclonic seizure ?

A

short shock like muscle jerks

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13
Q

What is an Atonic seizure ?

Tonic?

A

Without tone - drops down

increased tone

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14
Q

how do you take a history for seizure ?

what specifically would you ask ?

A 
what happened:
before - PH, FH, Triggers , first sign
during- Description, Duration , ending 
after - headspace, tongue biting, incontience , neuro deficit 
take collateral histry
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15
Q

what is primary epilepsy ?

A

cause is idiopathic

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16
Q

what are vascular causes of epilepsy ?

A

stroke , TIA

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17
Q

what are Infective causes of epilepsy ?

A

Abscess , meningitis

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18
Q

What are Traumatic causes of epilepsy?

A

IC haemorrhage

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19
Q

What are Autoimmune causes of epilepsy?

A

SLE

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20
Q

What are Metabolic causes?

A

Hypoxia, electrolyte imbalance , Hypoglyceamia, thyroid

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21
Q

What are Iatrogenic causes ?

A

Drugs, alcohol with-drawl

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22
Q

What are neoplastic causes ?

A

SoLs

23
Q

what can EEG do ? also what can it cause ?

A

First unprovoked seizure = asses risk of recurrence

Photic stim and hyperventilation = induce a seizure

24
Q

what are don’t of a EEG?

A

If there’s high chance of syncope
Clinical presentation supports diagnosis of non-elieptic event
in isolation to make diagnosis

25
Q

what other EEGs can you do ?

A

repeat EEGs
sleep EEGs
Long term video or ambulatory

26
Q

What other investigations do for epilepsy ?

A

ECGs

MRI

27
Q

Name sodium channel blockers used as anti-epileptics

A

Carbamazepine, Lamotrigine, Phenytoin, sodium valproate (first line)

28
Q

name CCBs used in anti-elliptics

what type of seizures are they good for ?

A

Sodium Valproate, Ethosuximide

absence

29
Q

how do barbiturates and benzo work?

give one example of each

A

potentiates GABA so enhances the effect at the synaptic junction
Diazepam, Phenobarbital

30
Q

how does Vigabatrin work ?

A

inhibit GABA transminase in pre synaptic terminal leading to increase of GABA due to less breakdown

31
Q

how does Gabapentin work ?

A

increased ultalisation of glutamate which is precursor for GABA .

32
Q

how does Levetiracetam work?

A

binds to synaptic vesicles to inhibit pre synaptic Ca2+ activity stoping neurotransmitter release

33
Q

what are the principles of initiating anti-epileptics ?

A

start monothearpy and Triate up

34
Q

what anti-epileptics are CYP3A4 inducers ?

A

carbmazepine and pheytonin

increase COCP dosage

35
Q

what anti-epileptics are CYP3A4 inhibtors ?

A

sodium valproate

36
Q

what is first line in generalised or tonic / clonic seizures ?

A

Sodium valproate

37
Q

what are some ARDs of AED?

A 
Dizziness , fatigue , diplopia (all) 
irritability
weight loss / gain 
tics and insomnia 
language dysfunction
38
Q

how to change AEDs?

A

start initial dose and slowly titrate to middle dose whilst still on original and then slowly titrate down the first AED over 6 wks

39
Q

when should you stop AEDs?

what considerations should you think about ?

A

seizure free for 2 yrs

since childhood , polypharmcy , myoclonic/clonic , EEG abnormal, undelrying brain damage

40
Q

how long can patient not drive after stopping AEDs?
when is a patient with epilepsy allowed to drive again ?
what about 1 off seizure

A

6 months

1 yr free of seizure

6 mothns

41
Q

how to stop AEDs? why? what about polypahrmcy ?

A

Taper off
avoid withdrawl features= recurrent seizures and anxiety and restlessnes
take one drug off at a time and leave 1 moth gaps

42
Q

how would you taper off Na channel blockers ?

A

reduce dose 10% every 2-4 wks

43
Q

how would you taper off Ca channel blockers and Benzos?

A

10% reduction every 4-8 wks

44
Q

what can be used in pregnancy ? what cant ? why?

A

carbamzepine

sodium valproate = decrese in folate = neural tube defects

45
Q

what must you do on pregnant / child bearing women on sodium valproate ?

A

lowest dose possible , divide over day
specialist monitoring
folate supplements
contraception if not pregnant

46
Q

what are side effects of phenytonin ?

A

congnetinal malformations - cleft lip/ palate
heart defects
Nausea , CNS dysfunction , coma
due to

47
Q

what else is phenytonin used for ?

A

arrhythmias - cardiac depressant

48
Q

what is the pharmokinetics of phenytonin ?

what must you do ?

A 
narrow thearputic window 
non linear trend
monitor closely (3-4 days )
49
Q

what drugs do you use for partial seizures ?

A 
Lamotrigine
Topirmate (CCB)
Gabapentin 
Phenytonin 
Carbamazepine
50
Q

What drugs for general seizures ?

A

Phenobarbitol
Sodium valproate
Ethosuxamide
Diazepam (1st line for status epilepticus )

51
Q

what is Initial mangement of seizures ?

A

ABCDE
give benzo - Lorazepam or midazolam
If pre hospital - PR or Buccal
if hospital = IV access

52
Q

how to treat status elipticus ?

A

Benzo or phenytoin

53
Q

what too long considerations would you say to a patient in annual review ?

A

check compliance , seziure control
SUDEP in poorly controlled
increased risk of mental illness

Pharmocolgy (22 decks)

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