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Nervous System > Anti-Epileptics and Seizures > Flashcards

Anti-Epileptics and Seizures Flashcards

1
Q

Which anti-epileptics have a long half-life and can be taken OD at night?

A

Lamotrigine
Perampanel
Phenobarbital
Phenytoin

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2
Q

What are the MHRA warnings for anti-epileptic drugs?

A
  • risk of suicidal thoughts and behaviours (symptoms may occur as early as 1 week after starting treatment)
  • advice on switching between different manufacturer’s products
  • teratogenicity: valportate must not be used in females of child-bearing age unless conditions of the PPP are met and alternative treatments contraindicated or not appropriate
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3
Q

What anti-epileptic drugs are category 1 and should be prescribed and maintained on a specific brand?

A

Carbamazepine
Phenobarbital
Phenytoin
Primidone

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4
Q

What anti-epileptic drugs are category 2 and prescribing by brand is based on clinical judgment and the patient?

A

Clobazam
Clonazepam
Lamotrigine
Topiramate
Valporate

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5
Q

Which drugs is anti-epileptic hypersensitivity syndrome associated with?

A

Carbamazepine
Lacosamide
Lamotrigine
Oxcarbazepine
Phenobarbital
Primidone
Rufinamide

Symptoms start between 1-8 weeks of exposure

Withdraw drug immediately - do not re-expose

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6
Q

What are the symptoms of hypersensitivity syndrome?

A

common: fever, rash and lymphadenopathy

other systemic signs: liver dysfunction, haematological, renal and pulmonary abnormalities, vasculitis and multi-organ failure

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7
Q

Which anti-epileptics can precipitate severe rebound seizures if stopped abruptly?

A

Barbiturates
Benzodiiazepines

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8
Q

How do you withdraw anti-epileptic medication?

A

Patient should be seizure for 2 years at least
Assessment to determine seizure recurrence should be carried out
Withdrawal should do done over a minimum of 3 months

If a seizure occurs during this process - the last dose reduction should be reversed and clinicians must seek advise from epilepsy specialist

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9
Q

How long must patients who have had an unprovoked or single isolated seizure not drive for?

A

6 months

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10
Q

How long must patients with established epilepsy not drive for?

A

Must be seizure free for at least 1 year or have a pattern of seizures established for one year where there is no influence on their level of consciousness or their ability to act

They must also have no history of unprovoked seizures

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11
Q

What are the exemptions for people who have seizures while asleep?

A

They must not drive for a year from last date of seizure unless:
- a history or pattern of sleep seizure’s occurring ONLY ever while asleep has been established over the course of at least one year from the date of the first sleep seizure
- an established pattern of purely asleep seizures can be demonstrated over the course of 3 years if the patient has previously had seizures whilst awake (or awake and asleep)

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12
Q

What should patients take if on anti-epileptics and becomes pregnant?

A

Folate especially during the first trimester is recommended

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13
Q

How do you minimise the risk of neonatal haemorrhage associated with anti-epileptics?

A

Routine injection of vitamin K

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14
Q

Who should pregnant females with epilepsy be encourages to notify?

A

Epilepsy and Pregnancy Register

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15
Q

Which anti-epileptics are readily transferred into breast-milk causing high infant serum-drug concentrations?

A

ethosuximide
Lamotrigine
primidone
zonisamide

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16
Q

Which anti-epileptics slow metabolism in infants causing it to accumulate?

A

Phenobarbital
Lamotrigine

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17
Q

Which anti-epileptics have established risk of drowsiness in breast-fed babies?

A

Primidone
Phenobarbital
Benzodiazepines

18
Q

Which anti-epileptics may cause withdrawal effect if mother suddenly stops breast-feeding?

A

Phenobarbital
Primidone
Lamotrigine

19
Q

How do you treat focal seizures with or without secondary generalisation?

A

1st line: monotherapy with lamotrigine or levetiracetam

2nd line: monotherapy with carbamazepine, oxcarbazepine or zonisamide

3rd line: lacosamide

Conjunctive therapy:
1st line: carbamazepine, lacosamide, lamotrigine, levetiracetam, oxcarbazepine, topiramate

2nd line: brivaracetam, cenobamate, eslicarbazepine, perampanel, pregabalin, sodium valporate (in males and females unable to have children)

3rd line: phenobarbital, phenytoin, tiagabine, vigabatrin

20
Q

How do you treat tonic-clonic generalised seizures?

A

Males or females unable to have children:
1st line: sodium valporate
2nd line: lamotrigine or levetiracetam

Females who are able to have children:
1st line: lamotrigine or levetiracetam

Adjunctive treatment
1st line: clobazam, lamotrigine, levetiracetam, perampanel, sodium valporate (men and females unable to have children), or topiramate

2nd line: brivaracetam, lacosamide, phenobarbital, primidone, zonisamide

21
Q

How do you treat generalised myoclonic seizures?

A

1st line: sodium valporate
2nd line: levetiracetam (1st line if females of childbearing age) monotherapy or adjunctive

22
Q

How do you treat generalised atonic or tonic seizures?

A

Usually seen in childhood

1st line: sodium valproate
2nd line: lamotrigine monotherapy or adjunctive (1st line in females of childbearing age)

23
Q

Which type of epilepsy is associated with cerebral damage or learning difficulties?

A

Atonic or tonic seizures

24
Q

How do you treat Dravet’s syndrome?

A

1st line: sodium valporate in all patients (ensure PPP)

If monotherapy fails, consider triple therapy: Sodium valporate + clobazam + stiripentol

Cannibidiol with clobazam may be considered as 2nd line in certain patients

25
Q

How do you treat lennox gastaut syndrome?

A

1st line: sodium valporate in all patients (PPP)

2nd line: lamotrigine monotherapy or adjunctive therapy

3rd line: adjunctive therapy with cannabidiol + clobazam

26
Q

What is considered as a repeated or cluster seizure?

A

3 or more self-terminating seizures in 24 hours

27
Q

What is considered as a prolonged convulsive seizure?

A

A seizure that continued for 2 minutes longer than the usual patients seizure

28
Q

What is considered as convulsive status epilepticus?

A

A seizure that lasts for 5 minutes or more - medical emergency

29
Q

How are repeated/ cluster seizures or prolonged seizures treated?

A

1st line: individualised emergency management plan
2nd line: benzodiazepine e.g. clobazam or midazolam urgently considered

30
Q

How do you treat convulsive status epilepticus?

A
  • position to avoid injury
  • support respiratory : provision or oxygen, maintaining BP and correction of any hypoglycaemia
  • consider parenteral thiamine if alcohol abuse suspected
  1. patients individualised emergency plan
  2. urgent buccal midazolam or rectal diazepam if in community
    - if resuscitation resources available then IV lorazepam

Call emergency services and if 1st dose doesnt work, provide a 2nd dose after 5-10 minutes

No response to 2 doses of benzodiazepines: levetiracetam, phenytoin or sodium valporate

3rd line: phenobarbital or general anaesthesia

31
Q

How do you treat convulsive status epilepticus if caused by pyridoxine deficiency (vitamin B6)?

A

Pyridoxine hydrochloride

32
Q

How do you treat non-convulsive status epilepticus?

A

Depends of severity of condition

If incomplete loss of awareness = usual antiepileptic therapy should be continued or restarted

Fail to respond/ lack of awareness = treat the same way as convulsive status epilepticus

33
Q

Which antiepileptic drugs do MRHA suggest vitamin D supplementation in immobilised patients or those lacking exposure to sunlight or dietary intake of calcium?

A

Carbamazepine and phenytoin

34
Q

What are the cautions for carbamazepine?

A

Blood, hepatic of skin disorders
HLA allele

35
Q

What is the optimum plasma concentration response range for carbamazepine?

A

4-12mg/L OR
20-50micromol/L
Measured after 1-2 weeks

36
Q

What additional MHRA warnings doses gabapentin have?

A

Risk of respiratory depression
Risk of abuse and dependence: now sch 3

37
Q

What is a serious side effect of lamotrigine?

A

Serious skin reactions - Stevens-Johnson syndrome and toxic epidermal necrolysis have developed (especially in children)
Most rashes occur within 8 weeks

Factors associated with this: rapid dose increase, use with valporate and initial high dose

38
Q

What is the additional MHRA warning for pregabalin?

A

Respiratory depression

39
Q

What is the additional MHRA warning for phenytoin?

A

risk of death and severe harm from error with injectable phenytoin

40
Q

What is the additional MHRA warning for topiramate?

A

Start of safety review triggered by a study reporting an increased risk of neurodevelopmental disabilities (e.g. autism) in children with prenatal exposure

Nervous System (14 decks)

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