Anti-epileptics

Question 1

Which anti-epileptics must be always prescribed by brand?

Answer 1

CPPP - Carbamazepine, Phenytoin, Phenobarbital, Primidone

Question 2

Name main drugs associated with antiepileptic hypersensitivity syndrome (6)

Answer 2

Lamotrigine, Carbamazepine, Lacosamide, PPP

Question 3

Is abrupt withdrawal of anti-epileptics recommended?

Answer 3

No - risk of severe rebound seizures

Question 4

First-line for focal seizures

Answer 4

Carbamazepine and Lamotrigine

Question 5

First Line for tonic-clonic seizures

Answer 5

Sodium valproate, Lamotrigine first line in pre-menopausal women

Question 6

First line for absence seizures

Answer 6

Ethosuximide and Valproate (Lamotrigine if unsuitable)

Question 7

First line for myoclonic seizures

Answer 7

Valproate (topiramate and levetiracetam if unsuitable)

Question 8

What type of seizures can Lamotrigine exacerbate?

Answer 8

Myoclonic seizures

Question 9

What anti-epileptic increases plasma concentration of Lamotrigine?

Answer 9

Valproate

Question 10

What to monitor on Valproate

Answer 10

LFTs, FBC

Question 11

Why not give IV diazepam for status epilepticus?

Answer 11

High risk of thrombophlebitis

Question 12

What to monitor for Carbamazepine?

Answer 12

LFTs, FBC (WBC), U&E, skin reactions, signs of infection

Question 13

MHRA warnings for Gabapentin?

Answer 13

Risk of severe respiratory depression, Schedule change

Question 14

CD class of Gabapentin and Pregabalin?

Answer 14

CD 3, exempt from safe custody

Question 15

Symptoms of antiepileptic hypersensitivity syndrome

Answer 15

Fever, lymphadenopathy, rash

Question 16

When can you drive if you have epilepsy?

Answer 16

If you are seizure-free for at least a year and no unprovoked seizures

Question 17

Which anti-epileptic plasma levels are affected in pregnancy

Answer 17

Phenytoin, Carbamazepine and Lamotrigine

Question 18

Target plasma concentration for Carbamazepine and when to take it

Answer 18

4-12 mg/L

measured after 1-2 weeks

Question 19

What type of PK does phenytoin have and what does it mean clinically?

Answer 19

Non-linear PK - even a small change in dose may have a huge effect

Question 20

Target levels for phenytoin

Answer 20

10-20 mg/L

Question 21

Side-effects of phenytoin

Answer 21

Rash (discontinue), arrhythmias, necrosis extravasation, electrolyte disturbances

Question 22

Side-effect of Topiramate to look out for

Answer 22

Acute myopia and glaucoma

Question 23

Status epilepticus management

Answer 23

Oxygen

Buccal midazolam or rectal diazepam

If seizures >5min - IV lorazepam

If seizure >25min - phenytoin or phenobarbital

Question 24

Apart from liver dysfunction and blood disorders, what else can Valproate cause

Answer 24

Pancreatitis