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Pre Reg > Chapter 4 BNF (Epilepsy) > Flashcards

Chapter 4 BNF (Epilepsy) Flashcards

1
Q

What are examples of non epileptic seizures?

A

Organic eg hypoglycaemia

Psychogenic eg mental or emotional

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2
Q

Which antiepileptics are not given twice daily?

A

Barbiturates
Lamotrigine
Phenytoin

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3
Q

What’s first line and second line in partial focal seizures?

A

Carbamazepine or Lamotrigine

Oxcarbazepine sodium Valproate levetiracetam

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4
Q

What’s first line in Tonic Clonic seizures?

A

Lamotrigine or Sodium valproate

Carbamazepine

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5
Q

What’s first line in absence seizures?

A

Ethosuxamide or sodium Valproate

Lamotrigine

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6
Q

What’s first line in myoclonic?

A

Sodium Valproate

Topiramate or levitiracetam

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7
Q

What’s first line in tonic/atonic seizures?

A

Valproate

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8
Q

What’s the option if monotherapy with antiepileptics doesn’t work?

A

Dual therapy then triple therapy

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9
Q

What’s in category 2?

A

Lamotrigine
Valproate
Clonazepam
Topiramate

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10
Q

What’s the risk with quick withdrawal of antiepileptics?

A

Rebound seizures (withdraw one at a time)

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11
Q

How long must established epilepsy patients be seizure free before they can drive?

A

One year

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12
Q

How long must patients be awake seizure free (if experiencing sleep seizures) before being allowed to drive?

A

One year if no awake seizures

3 years if awake seizures

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13
Q

How long must someone wait to drive if they have an unprovoked seizure?

A

6 months

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14
Q

How long after being withdrawn from antiepileptics can patients drive?

A

6 months

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15
Q

Which antiepileptics must you monitor foetal growth with? Which causes a cleft palate?

A

Topiramate (cleft)

Levetiracetam

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16
Q

Should patients on one antiepileptic be encouraged to breastfeed?

A

Yes

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17
Q

When should patients on antiepileptics take folic acid?

A

Before pregnancy up to 12 weeks pregnant

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18
Q

Which antiepileptics are present in high amounts in breast milk?

A

Zosunamise
Ethosuxamide
Lamotrigine
Primidone

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19
Q

When is antiepileptic hypersensitivity most likely to occur?

A

1-8 weeks

20
Q

What’s the MHRA on antiepileptics?

A

Suicidal thoughts

21
Q

Which antiepileptics cause SJS?

A

Lamotrigine

22
Q

Which antiepileptic cause blood dyscrasias

A

C Vet plz

23
Q

Which antiepileptic causes eye problems?

A

Vagabatrin

Topiramate

24
Q

Which antiepileptic causes encephalopathy?

A

Vibagatrin

25
Q

Which antiepileptic has an MHRA for respiratory depression ?

A

Gabapentin

26
Q

Which antiepileptic is an enzyme inhibitor?

A

Sodium Valproate

27
Q

Which antiepileptics are enzyme inducers

A

Carbamazepine
Phenytoin
Phenobarbital

28
Q

What’s the target range for phenytoin?

A

10mg-20mg/L

6mg-15mg/L babies

29
Q

What are the side effects of phenytoin?

A

Change in appearance
Blood dyscrasias (anti folate)
Lower vit d
Hepatotoxicity

30
Q

What’s mg of phenytoin base is equivalent to 100mg phenytoin sodium

A

92mg

31
Q

How does phenytoin work?

A

Binds you’re sodium channels in their inactive sites

32
Q

What are the side effects of IV phenytoin?

A

Bradycardia, hypotension

33
Q

What mg of fosphenytoin is equivalent to 1mg phenytoin sodium ?

A

1.5mg

34
Q

What are the side effects of IV fosphenytoin?

A

Severe cardiac reactions

35
Q

How does phenytoin interact with other medication? (Enzyme inducers, inhibitors etc)

A

Enzyme inhibitors - increases phenytoin concentration

Enzyme inducers - reduce phenytoin concentration

Anticonvulsant effect antagonised - drugs that lower seizure threshold

Phenytoin is an inducer itself

36
Q

How does carbamazepine exert its effects?

A

Inhibits neuronal sodium channels

37
Q

What seizures are exacerbated by carbamazepine?

A

Myoclonic

Atonic

38
Q

What’s the desired concentration of carbamazepine?

A

4-12mg/L

39
Q

How does carbamazepine interact with other drugs?

A

Enzyme inhibitors

Enzyme inducers

Anticonvulsant effect antagonised

Hyponatraemia: SSRIs , diuretics, NSAIDs TCAs

Hepatotoxicity

40
Q

How does sodium valproate exert its effects?

A

Weak inhibitor of neuronal Sodium channels

41
Q

What are the side effects of sodium Valproate?

A

Blood dyscrasias
Hepatotoxicity
Pancreatitis

42
Q

How does sodium valproate interact with other drugs ?

A

Anticonvulsant effect antagonised

Hepatotoxicity

43
Q

How is convulsive status epilepticus treated?

A

IV lorazepam

Avoid diazepam

44
Q

How is non convulsive status epilepticus treated ?

A

Incomplete loss of awareness : oral antiepileptic

Complete loss of awareness: IV lorazepam

45
Q

How are convulsive or febrile seizures treated in community ?

A

Diazepam rectal solution

Midazolam oromucosal

Repeat once after 10-15 mins

46
Q

Which antiepileptics cause Steven Johnson Syndrome?

A

Ethosuxamide
Carbamazepine
Lamotrigine

(Ethan Carl Larry Stephen and Johnson )

Pre Reg (37 decks)

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