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
which drugs lower seizure threshold and interact with carbamazepine, phenytoin and sodium valproate?
tramadol
theophylline
quinolones
which hyponatraemic drugs interact with carbamazepine
SSRIs
Diuretics
which anti-folate drugs interact with phenytoin
Methotrexate
Trimethoprim
what are the s/e of carbamazepine, phenytoin and sodium valproate?
suicide
depression
hepatotoxicity
hypersensitivity
blood dyscrasia
vit D deficiency
what is s/e of carbamazepine?
hyponatraemia
what is s/e of phenytoin?
coarsening appearance + facial hair
what is s/e of sodium valproate?
pancreatitis
teratogenic
which antileptic drugs cause hypersensitivity as a s/e
CP3L
->carbamazepine, phenobarbital, phenytoin, primidone, lamotrigine
which antileptic drug cause skin rash as a s/e
lamotrigine -> steven-Johnson-syndrome
which antileptic drugs cause blood dyscrasia as a s/e
C.VET.PLZ
->carbamazepine, valproate, ethosuximide, topiramate, phenytoin, lamotrigine, zonisamide
which antileptic drug lowers visual field as a s/e
vigabatrin
which antileptic drug cause secondary glaucoma as a s/e
topiramate
which antileptic drug cause enecphalopathy as a s/e
vigabatrin
which antileptic drugs cause respiratory depression as a s/e
gabapentin
pregabalin
what is therapeutic range of carbamazepine
4-12mg/l
what is therapeutic range of phenytoin
10-20mg/l
what are the toxicity signs of carbamazepine
HANDBAG
-hyponatraemia
-ataxia
-nystagmus
-drowsiness
-blurred vision
-arrythmia
-GI disturbances
what are the toxicity signs of phenytoin?
SNACHD
-slurred speech
-nystagmus
-ataxia
-confusion
-hyperglycaemia
-double vision
if you drive and have a epileptic fit what do you do?
STOP driving and inform DVLA
How long do you have to wait to drive if you have had 1st unprovoked/single isolated seizure?
6 months
how long do you have to wait to drive if you have an established epilepsy
1 year
if pattern of seizures is established for 1yr then no impact on consciousness
how long do you have to wait to drive if there are medication changes or withdrawal?
- don’t drive for 6MT after last dose,
-if seizure occur then license removed for 1yr
->reinstated after 6MT if tx resumed + no seizure occur
what is the caution of epilepsy and pregnancy
risk of harm to mother + fetus from convulsive seizures outweighs risk of continued therapy
what is given in first trimester of pregnancy in epilepsy and why?
folic acid given to reduce risk of neural tube defects
which injection is administered during pregnancy with epilepsy and why?
vit K to reduce neonatal haemorrhage
which antiepileptic is most at risk in pregnancy?
Sodium valproate = PPI
what does topiramate cause in pregnancy
cleft palate in babies
