Central Nervous System - Epilepsy Flashcards
1st line tx of focal seizures
lamotrigine/levetiracetam
2nd line tx of focal seizures
carbamazepine, oxcarbazepine, zonisamide
what are the different types of generalised seizures
-tonic-clonic
-absence
-absence + other
-myoclonic
-atonic
-tonic
-for child-bearing age = 2nd line tx
tx of tonic-clonic seziures
1)sodium valproate
2)lamotrigine, levetiracetam
tx of absence seizures
1)ethosuximide
2)sodium valporate
only one with different tx
tx of absence + other type of seizures
1)sodium valproate
2) lamotrigine/ levetiracetam
myoclinic seziures tx
1)sodium valproate
2) levetriacetam
atonic seziures tx
1)sodium valproate
2)lamotrigine
tonic seizures tx
1)sodium valproate
2)lamotrigine
what is status epilepticus
-seizures that last longer than 5 mins
immediate status epilepticus tx
- resuscitation and immediate emergency tx
-if patient doesn’t have individualised tx give standard tx
what is standard status epilepticus tx
- IV lorazepam (resuscitation if available)
- buccal midazolam/rectal diazepam (community)
- give second dose if seizure x stop within 5-10mins of 1st dose
- if seizure x respond after 2x benzodiazepine doses give levetiracetam, phenytoin, sodium valproate
- if seizure fails to respond try another 2nd line if still x respond give phenobarbital/general anaesthesia
category 1 of anti-epileptic drugs
specific brands only
CP3
->carbamazepine, phenobarbital, phenytoin, primidone
category 2 of anti-epileptic drugs
- maintain specific brands based on clinical judgement + pt factors
-C2PLOTZRV
->clobazam, clonazepam, perampanes, lamotrigine, oxcarbazepine, topiramate, zonisamide, rufinamide and valproate
category 3 of anti-epileptic drugs
-unnecessary to ensure - specific brands
- brivaracetam, ethosuximide, gabapentin, laxosamide, levetiracrtam, pregabalin, tigabine, vigabatrin
what drugs interaction with carbamazepine, phenytoin and sodium valproate?
- drugs that cause hepatoxicity
- CYP inducers - phenytoin, phenobarbital + carbamazepine
- CYP inhibitors - sodium valproate
- drugs that lower seizure threshold
- hyponatraemia drugs - carbamazepine
- anti-folate drugs - phenytoin
which drugs cause hepatoxicity and interact with carbamazepine, phenytoin and sodium valproate?
amiodarone
itraconazole
macrolides
alcohol