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GPhC Exam > CNS: Epilepsy > Flashcards

CNS: Epilepsy Flashcards

1
Q

What is epilepsy?

A

A condition caused by a sudden surge of electrical activity of neurons, causing seizures

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2
Q

What is the first line treatment for all generalized seizures?

A

Sodium valproate

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3
Q

What is the most important factor to consider when choosing an appropriate antiepileptic?

A

The presenting epilepsy syndrome (or the seizure type if syndrome is unclear)

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4
Q

What influences the dosage frequency of most antiepileptics?

A

The plasma-drug half-life

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5
Q

What four antiepileptics have long half-lives, and therefore can be given once a day (at bedtime)?

A

Lamotrigine
Phenobarbital
Phenytoin
Perampanel

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6
Q

What are the two main types of seizure? How are they determined (2)?

A

Focal - affects one part of the brain

Generalised - affects both sides/multiple parts of the brain; symptoms affect whole body

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7
Q

What are four main types of generalised seizures?

A

Tonic-clonic
Absence
Myoclonic
Atonic and tonic

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8
Q

What are three main characteristics for tonic-clonic seizures?

A

Body stiffens
Followed by convulsions
Loss of bladder/bowel control

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9
Q

What can be used for tonic-clonic seizures when sodium valproate is inappropriate?

A

Lamotrigine

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10
Q

What type of seizure can lamotrigine exacerbate?

A

Myoclonic

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11
Q

What are three characteristics of an absence seizure?

A

Brief loss of consciousness
No convulsions
Common in children

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12
Q

What are the preferred drugs for monotherapy in absence seizures? (3)

A

Sodium valproate OR ethosuximide, alternatively lamotrigine

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13
Q

What are two characteristics of a myoclonic seizure?

A

Brief/short

Shock-like muscle jerks

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14
Q

What are the preferred drugs for monotherapy in myoclonic seizures? (3)

A

Sodium valproate

Alternatively, levetiracetam or topiramate

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15
Q

What are two characteristics of atonic/tonic seizures?

A

Brief loss of consciousness

Body sometimes falls to the ground as muscles are too weak to support it

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16
Q

What are the preferred drugs for monotherapy in atonic/tonic seizures? (3)

A 
Sodium valproate (lamotrigine can be used as adjunct therapy)
Alternatively, rufinamide or topiramate
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17
Q

What are the preferred drugs for monotherapy of focal seizures?
Remember: fo-CA-L

A

Carbamazepine or lamotrigine

Alternatively, levetiracetam, oxcarbazepine or sodium valproate

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18
Q

What did the MHRA conclude about switching between brands for antiepileptics?

A

Some antiepileptics need to be prescribed by brand as switching can cause loss of seizure control

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19
Q

What are four examples of category 1 antiepileptics?

A

Carbamazepine
Phenobarbital
Phenytoin
Primidone

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20
Q

What are four examples of category 2 antiepileptics?

A

Topiramate
Lamotrigine
Sodium valproate
Clonazepam

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21
Q

What are four examples of category 3 antiepileptics?

A

Levetiracetam
Gabapentin
Pregabalin
Ethosuximide

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22
Q

How should antiepileptics be withdrawn/switched? (3)

A

Slowly/gradually
One at a time
Under specialist supervision

23
Q

What should a driver do if they get a seizure?

A

Stop driving and tell the DVLA ASAP

24
Q

How long before someone who has had their first seizure can drive again?

A

6 months

25
Q

What two criteria need to be met before patients with established epilepsy can drive?

A

Seizure free for a year

No history of unprovoked seizures

26
Q

How long do patients who have had a seizure while asleep have to wait before driving again? What are the two exclusion criteria?

A

1 year, unless:
an pattern of no seizures while awake for a year after the first sleep seizure has been established;
there haven’t been any seizures while awake for three years (if they previously had seizures while awake)

27
Q

How long do patients who have recently changed/withdrawn their antiepileptics wait before driving again?

A

6 months

28
Q

When can sodium valproate be used in females? (2)

A

They satisfy the criteria for the Pregnancy Prevention Programme
There are no other appropriate alternatives

29
Q

What two antiepileptics are safe in pregnancy?

A

Levetiracetam

Lamotrigine

30
Q

What is a side effect of topiramate in pregnancy?

A

The baby may develop a cleft palate

31
Q

What should be given to babies shortly after birth if their mum was on antiepileptics? Why?

A

Vitamin K, to reduce the likelihood of neonatal hemorrhage

32
Q

What should happen if a lady on antiepileptics becomes pregnant unexpectedly?

A

No changes to their meds should be made (the risk of seizures > the risk of continued therapy)

33
Q

If a patient on antiepileptics is planning to get pregnant, what supplement should she be offered?

A

Folic acid

34
Q

What two antiepileptics are more likely to cause withdrawal symptoms in newborns?

A

Benzodiazepines and phenobarbital

35
Q

What three antiepileptics are associated with risk of drowsiness in breast-fed babies?

A

Primidone
Phenobarbital
Benzodiazepines

36
Q

What should infants be monitored for if their mother is on antiepileptics? (4)

A

Sedation
Weight gain
Developmental milestones
Feeding difficulties

37
Q

Which antiepileptic can reduce the efficacy of hormonal contraception?

A

Carbamazepine

38
Q

What are three common symptoms of antiepileptic hypersensitivity syndrome?

A

Rash
Fever
Lymphadenopathy

39
Q

What drugs are associated with antiepileptic hypersensitivity syndrome? (5)

A 
Carbamazepine
Phenytoin
Phenobarbital
Primidone
Lamotrigine
40
Q

When is antiepileptic hypersensitivity syndrome most likely to occur? What should happen if it’s suspected?

A

Within the first 8 weeks of treatment; discontinue drug immediately

41
Q

What did the MHRA concluded about all antiepileptics? What should patients do if they experience it?

A

There is a small risk of suicidal ideation - patients should report any changes in mood or distressing thoughts

42
Q

Which antiepileptic is most likely to cause serious skin reactions (e.g. SJS, toxic epidermal necrolysis)? What can increase the risk of developing this?

A

Lamotrigine; concomitant use with sodium valproate

43
Q

What drugs are most likely to cause blood dyscrasias?

Remember: C VET PLZ

A 
Carbamazepine
Sodium valproate
Ethosuximide
Topiramate
Phenytoin
Lamotrigine
Zonisamide
44
Q

Which antiepileptics are most likely to cause visual issues? (2)

A

Vigabatrin

Topiramate

45
Q

Which antiepileptic is most likely to cause encephalopathic symptoms? What should be done if the patient experiences them?

A

Vigabatrin - reduce dose or withdraw

46
Q

What did the MHRA conclude about gabapentin? Which groups of patients are more prone to experiencing it? (4)

A 
Can cause severe respiratory depression - esp. if patients 
have existing respiratory issues;
are old;
have renal impairment; or 
are on other CNS depressants
47
Q

Which antiepileptics are enzyme inducers, and can decrease the plasma conc. of other drugs? (3)

A

Carbamazepine
Phenytoin
Phenobarbital

48
Q

Which antiepileptic is an enzyme inhibitor, and can increase the plasma conc. of other drugs?

A

Sodium valproate

49
Q

What is status epilepticus?

A

A medical emergency where seizures last for more than 30 mins, or there are several seizures without regained consciousness in-between

50
Q

What should be administered if a patient experiences convulsive status epilepticus?

A

IV lorazepam

51
Q

What should be administered if a patient experiences non-convulsive status epilepticus, with signs of awareness?

A

Their usual antiepileptic drug

52
Q

What should be administered if a patient experiences non-convulsive status epilepticus, with loss of awareness OR failure to respond to their normal antiepileptic?

A

IV lorazepam

53
Q

What should be administered if a patient experiences febrile convulsions for less than 5 mins?

A

An antipyretic i.e. paracetamol

54
Q

What should be administered if a patient experiences febrile convulsions for longer than 5 mins?

A

IV lorazepam

GPhC Exam (10 decks)

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