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Top 100 drugs > Anti-epileptics > Flashcards

Anti-epileptics Flashcards

1
Q

Valproate - indications ?

A
  1. epilepsy - first line for prophylaxis of tonic clonic seizures, absence, focal and myoclonic
  2. some Status epilepticus - those not responding to benzos
  3. Bipolar - acute treatment of manic and prophylaxis against recurrence
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2
Q

valproate - MOA?

A

Weakly inhibits neuronal sodium channels, stabilising resting membrane potentials and reducing neuron excitation.
+ increases GABA

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3
Q

valproate SE

A

GI upset
neuro and psych: ataxia, tremor and behaviour change
thrombocytiopenia
deranged lfts
hair loss
BMF, Pancreatitis, antiepileptic hypersensitivity syndrome
Teratogenic

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4
Q

Valproate warnings

A

not for women of child bearing age esp not in 1st trimester

avoid in hepatic impairment and reduce dose in severe renal impairment

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5
Q

valproate interactions

A
  • inhibits cyp450

- increases plasma conc of lamotrigine and cyp450 drugs e.g. warfarin

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6
Q

valproate starting dose for epilepsy

A

600mg

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7
Q

valproate starting dose for bipolar

A

750mg 1-3 divided doses . maintain at 1-2g

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8
Q

what advice can you give to patients on valproate to avoid upset tummy

A

take with food

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9
Q

DVLA advice on valproate

A

Advise patients not to drive unless they have been seizure-free for 12 months, and for 6 months after changing or stopping treatment.

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10
Q

Carbemazepine indications

A
  1. epilepsy - prophylaxis for tonic clonic and focal

2. trigeminal neuralgia

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11
Q

MOA of carbemazapine

A

inhibit neuronal sodium channels -

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12
Q

SE of Carbemazapine

A

Gi upset
neurological effects - ataxia and dizzy

odoema

hyponatraemia

hypersensitvity - rash

antiepileptic hypersensitivity syndrome - 2 months of treatment - SJS and pyrexia

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13
Q

what are the teratogenic effects of carbamezapine

A

neural tube defects, cardiac and urinary tract problems and cleft palate

if must take during pregnancy - high dose folic acid.

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14
Q

what situations should you prescribe carbamezapine with caution

A

hepatic, renal or cardiac disease

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15
Q

important interactions of carbemazapine

A

cyp 450 inducer. do not give with cyp450 inhibiters e.g. macrolides

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16
Q

what two routes can you prescribe carbamezapine

A

PO

PR

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17
Q

how should you stop carbamezapine

A

taper slowly

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18
Q

gabapentin and pregabalin indications

A
  • add on for focal epilepsies if others have failed
  • neuropathic pain including painful diabetic neuropathy
  • an option for generalised anxiety disorder
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19
Q

MOA of gabapentin and pregabalin

A

bind with pre-synaptic voltage sensitive calcium channels. stopping release of excitatory NTs = reduced neuronal excitability. similar structure to GABA.

same effect in peripheral nerves so reduces pain

20
Q

main side effects of gabapentin and pregabalin

A
  • drowsy
  • ataxia
  • dizziness
    improve after first few weeks of treatment
21
Q

When should the dose of gabapentin and pregabalin be reduced

A

when there is renal impairment

22
Q

what other drugs should you be careful prescribing gabapentin and pregabalin in

A

benzodiazepines due to overload of sedation

23
Q

what affect does gabapentin have on urine dip

A

Protein +ve. send protein creatinine ratio instead

24
Q

Lamotrigine indications

A
  1. seizure prophylaxis in epilepsy. esp in focal, tonic clonic and absence
  2. bipolar depression
25
Q

MOA of Lamotrigine

A
  • reduces na influx into neuron.

- inhibits post synaptic glutamate receptor - helps depression

26
Q

lamotrigine SE

A

Headache, drowsy, irritable, blurred vision, dizzy, GI symptoms

severe - skin rash, hypersensitivity

27
Q

when should you avoid prescribing lamotrigine

A

if patients have hypersensitivity to other antiepileptic drugs

28
Q

when should dose of lamotrigine be adjusted

A

moderate or severe hepatic impairment

29
Q

can you use lamotrigine in pregnancy

A

yes - plasma concentration measurement should be considered as metabolism changes

30
Q

Lamotrigine interactions

A
  • as it is metabolised by glucoronidation - CARBAMEZAPINE, PHENYTOIN, OESTROGENS, RIFAMPICIN AND PROTEASE INHIBITORS. = conc reduces
  • glucorinidation inhibited by valproate so rise in levels.
31
Q

levetiracetam (keppra) indications

A
  1. seizure prophylaxis in epilepsy. - focal 1nd line or add on for myoclonic and tonic clonic
  2. for refractory cases of status epilepticus
32
Q

moa of keppra

A

synaptic vesicle protein 2a (SV2A) - glycoprotein in excitatory and inhibitory synapses . keppra interferes with vesicles function = modulates neuronal excitability.

33
Q

SE keppra

A

usually none

  • drowsiness
  • weakness
  • dizzy
  • headache
  • rare - mood disturbance and psychiatric issues. suicidal ideation and serious hyepersensitivity
34
Q

when is dose reduction of keppra needed

A

renal impairment

35
Q

can you give keppra in pregnancy

A

yes

36
Q

can and should keppra be given IV

A

Yes it can be given however is more expensive. also it has good bioavailability so oral and iv dose remains same

37
Q

indications for benzos

A
  1. Status epilepticus and seizures
  2. alcohol wihdrawal reaction
  3. sedation for intervention
  4. short term anxiety or insomnia treatment
38
Q

MOA of benzos

A

facilitate enhanced binding of GABA to GABAaR. = depress synapses

39
Q

SE of benzos

A

drowy
sedation
coma
in overdose - loss of airway reflexes = airway obstruction and death

dependancy if ltm
abrupt cessation = withdrawal reaction

40
Q

benzos - when do you adjust dose

A

elderly - giv elower dose

41
Q

who do you avoid giving benzos

A
  • respiratory impaired patients
    NM disease patients
  • liver failure - can cause hepatic encephalopathy - is must then use lorazepam
42
Q

what drugs to benzos interact with

A
  • additive to sedating drugs e.g. opioids including alcoho and opioids. mostly depend on CYP450 so dont use with CYP-i.
43
Q

which are the longer acting benzos

A

lorazepam, diazepam

44
Q

what benzo is used for alcohol withdrawal

A

chlordiazepoxide

2nd = Di or lor

45
Q

what benzo is used for sedation

A

midazolam - short half life

46
Q

what benzo is used for anxiety and insomnia

A
  • temazepam - no longer than 2/52
47
Q

OD of benzo? what drug?

A

flumenazil. not in mixed OD

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