Central Nervous System - Epilepsy Flashcards

1
Q

1st line tx of focal seizures

A

lamotrigine/levetiracetam

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2
Q

2nd line tx of focal seizures

A

carbamazepine, oxcarbazepine, zonisamide

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3
Q

what are the different types of generalised seizures

A

-tonic-clonic
-absence
-absence + other
-myoclonic
-atonic
-tonic

-for child-bearing age = 2nd line tx

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4
Q

tx of tonic-clonic seziures

A

1)sodium valproate
2)lamotrigine, levetiracetam

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5
Q

tx of absence seizures

A

1)ethosuximide
2)sodium valporate

only one with different tx

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6
Q

tx of absence + other type of seizures

A

1)sodium valproate
2) lamotrigine/ levetiracetam

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7
Q

myoclinic seziures tx

A

1)sodium valproate
2) levetriacetam

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8
Q

atonic seziures tx

A

1)sodium valproate
2)lamotrigine

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9
Q

tonic seizures tx

A

1)sodium valproate
2)lamotrigine

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10
Q

what is status epilepticus

A

-seizures that last longer than 5 mins

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11
Q

immediate status epilepticus tx

A
  • resuscitation and immediate emergency tx
    -if patient doesn’t have individualised tx give standard tx
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12
Q

what is standard status epilepticus tx

A
  • 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
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13
Q

category 1 of anti-epileptic drugs

specific brands only

A

CP3
->carbamazepine, phenobarbital, phenytoin, primidone

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14
Q

category 2 of anti-epileptic drugs

A
  • maintain specific brands based on clinical judgement + pt factors
    -C2PLOTZRV
    ->clobazam, clonazepam, perampanes, lamotrigine, oxcarbazepine, topiramate, zonisamide, rufinamide and valproate
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15
Q

category 3 of anti-epileptic drugs

A

-unnecessary to ensure - specific brands
- brivaracetam, ethosuximide, gabapentin, laxosamide, levetiracrtam, pregabalin, tigabine, vigabatrin

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16
Q

what drugs interaction with carbamazepine, phenytoin and sodium valproate?

A
  • 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
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17
Q

which drugs cause hepatoxicity and interact with carbamazepine, phenytoin and sodium valproate?

A

amiodarone
itraconazole
macrolides
alcohol

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18
Q

which drugs lower seizure threshold and interact with carbamazepine, phenytoin and sodium valproate?

A

tramadol
theophylline
quinolones

19
Q

which hyponatraemic drugs interact with carbamazepine

A

SSRIs
Diuretics

20
Q

which anti-folate drugs interact with phenytoin

A

Methotrexate
Trimethoprim

21
Q

what are the s/e of carbamazepine, phenytoin and sodium valproate?

A

suicide
depression
hepatotoxicity
hypersensitivity
blood dyscrasia
vit D deficiency

22
Q

what is s/e of carbamazepine?

A

hyponatraemia

23
Q

what is s/e of phenytoin?

A

coarsening appearance + facial hair

24
Q

what is s/e of sodium valproate?

A

pancreatitis
teratogenic

25
Q

which antileptic drugs cause hypersensitivity as a s/e

A

CP3L
->carbamazepine, phenobarbital, phenytoin, primidone, lamotrigine

26
Q

which antileptic drug cause skin rash as a s/e

A

lamotrigine -> steven-Johnson-syndrome

27
Q

which antileptic drugs cause blood dyscrasia as a s/e

A

C.VET.PLZ
->carbamazepine, valproate, ethosuximide, topiramate, phenytoin, lamotrigine, zonisamide

28
Q

which antileptic drug lowers visual field as a s/e

A

vigabatrin

29
Q

which antileptic drug cause secondary glaucoma as a s/e

A

topiramate

30
Q

which antileptic drug cause enecphalopathy as a s/e

A

vigabatrin

31
Q

which antileptic drugs cause respiratory depression as a s/e

A

gabapentin
pregabalin

32
Q

what is therapeutic range of carbamazepine

A

4-12mg/l

33
Q

what is therapeutic range of phenytoin

A

10-20mg/l

34
Q

what are the toxicity signs of carbamazepine

A

HANDBAG
-hyponatraemia
-ataxia
-nystagmus
-drowsiness
-blurred vision
-arrythmia
-GI disturbances

35
Q

what are the toxicity signs of phenytoin?

A

SNACHD
-slurred speech
-nystagmus
-ataxia
-confusion
-hyperglycaemia
-double vision

36
Q

if you drive and have a epileptic fit what do you do?

A

STOP driving and inform DVLA

37
Q

How long do you have to wait to drive if you have had 1st unprovoked/single isolated seizure?

A

6 months

38
Q

how long do you have to wait to drive if you have an established epilepsy

A

1 year
if pattern of seizures is established for 1yr then no impact on consciousness

39
Q

how long do you have to wait to drive if there are medication changes or withdrawal?

A
  • 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
40
Q

what is the caution of epilepsy and pregnancy

A

risk of harm to mother + fetus from convulsive seizures outweighs risk of continued therapy

41
Q

what is given in first trimester of pregnancy in epilepsy and why?

A

folic acid given to reduce risk of neural tube defects

42
Q

which injection is administered during pregnancy with epilepsy and why?

A

vit K to reduce neonatal haemorrhage

43
Q

which antiepileptic is most at risk in pregnancy?

A

Sodium valproate = PPI

44
Q

what does topiramate cause in pregnancy

A

cleft palate in babies