CNS

Question 1

Which 4 anti epileptic drugs present in high amount in breastfeed milk?

Answer 1

ZELP
Zonisamide 
Ethosuximide 
Lamotrigine
Primidone (metab to phenobarb

Question 2

How does pregnancy affect serum lamotrigine concentration

Answer 2

Pregnancy increases lamotrigine clearance therefore double or triple dosage is required

Question 3

How does pregnancy affect serum phenytoin level

Answer 3

Pregnancy reduces albumin level, phenytoin is a protein-bound drug. Therefore increased unbound active phenytoin -> toxicity

Question 4

Why and how folic acid 5 mg should be taken

Answer 4

It is taken by women at higher risk of child with neural tube defects including those taking antiepileptics
One daily before conception till week 12 of preg

Question 5

Treatment option for partial focal seizure

Answer 5

Lamotrigine / carbam

Or leve, valp, oxacarbazepine

Question 6

Treatment options forGeneralised tonic clonic seizure

Answer 6

Valporate / carbam

Lamo

Question 7

Treatment options for absence seizure

Answer 7

Ethosux/ valp

Lamo

Question 8

Treatment option for myoclonic seizure

Answer 8

Valp

Topiramate , leve

Question 9

Treatment options for atonic / tonic seizure

Answer 9

Valporate

Question 10

What are the effects of phenobarbital on babies

Answer 10

• (and lamo) accumulate due to slower metabolism in infant -> toxicity
• (andprimidone) inhibit suckling reflex
• (and BZ, primidone) risk of drowsiness
• risk of withdrawal symptoms

Question 11

What is the NHRA warning associated with antiepileptics

Answer 11

Increased suicidal behaviour within one week of starting > reports any mood changes