CNS - Epilepsy Flashcards by Deroy —

Focal Seizures - First line

Levetiracetam or Lamotrigine

“Got to take 2 L’s to get u focused”

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Focal seizures - second line

Carbamazepine, Oxcarbazepine, zonisamide

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Generalised seizures types

Tonic clonic
Atonic
Tonic

Absence
Absence 2 (absence + other seizure type)

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If under 55 years old generalised seizure excluding absence seizure treatment?

Lamotrigine or levetiracetam

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Over 55 years old generalised seizure excluding absence treatment?

Sodium valproate

Second line: Levetiracetam or Lamotrigine

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Absences alone seizure treatment

1st line: Ethosuximide

2nd line: Sodium Valproate

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Sodium valproate & Pregnancy

Avoid - Teratogenic

Use PPP (Pregnancy prevention plan)

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What is a Status Epilepticus?

Seizure lasting longer than 5mins

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Status epilepticus treatment plan?

Resuscitation and immediate emergency treatment

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Status Epilepticus - Resuscitation Facilities available treatment?

IV Lorazepam

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Status Epilepticus - Carehome/Community treatment?

Buccal Midazolam

Rectal Diazepam

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How long after first dose of status epilepticus should second dose be given?

After 5-10mins and seizure hasn’t stopped

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What if 2 benzodiazepines fail to help status epilepticus seizure?

Levetiracetam
Phenytoin
Sodium valproate

Give 1 if fails try another

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If Levetiracetam, phenytoin, sodium valproate doesn’t work in status epilepticus?

Phenobarbital or General Anaesthesia

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Category 1 Antiepileptic drugs?

Carbamazepine
Phenobarbital
Phenytoin
Primidone

Must MAINTAIN ON SPECIFIC BRAND!!!

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Category 2 Anti epileptic drugs?

Clobazam, Clonazepam, Lamotrigine, oxcarbazepine, perampanel, Rufinamide, Topiramate, Valproate, Zonisamide

***Clinical judgment on brands

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Category 3 antiepileptic drugs?

Ethosuximide, Gabapentin, Pregabalin, Brivaracetam, tiagabine, vigabatran, Levetiracetam, Lacosamide.

do not need to maintain brand

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Which Anti-epileptic drugs can affect warfarin?

CYP INDUCERS:
Phenytoin, Phenobarbital & Carbamazepine

Will reduce warfarin levels

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Which anti epileptic drugs are Hepatotoxic?

Carbamazepine, phenytoin, sodium valproate

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Which drugs is a CYP inhibitor so will increase volume of other drugs in system?

Sodium valproate

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Which drugs lower seizure thresholds?

Tramadol

Theophyliline

Quinolones

Which antiepileptic causes Hyponatraemia?

Carbamazepine (SSRI + diuretics also cause Hyponatraemia)

Which Anti-epileptic drug causes anti folate reactions ?

Phenytoin (also caused by Methotrexate, Trimethoprim)

Anti folate reaction -> Blood Dyscrasia

What 3 Antiepileptic Drugs have severe side effects? What are the side effects?

Carbamazepine
Phenytoin
Sodium valproate

Depression
Hepatotoxicity
Blood Dyscrasia —-> Anti folate reaction
Vit d deficiency——> BONEPAIN

Which anti-epileptic causes facial hair and coarsening appearance?

Phenytoin

Which anti epileptic can cause pancreatitis?

Sodium valproate

Which Anti-epileptic causes Steven’s-Johnson syndrome?

Lamotrigine

Which antiepileptic causes hypersensitivity?

Carbamazepine Phenobarbital Phenytoin Primidone Lamotrigine (CP3L)

Which anti epileptic causes blood Dyscrasia ?

Carbamazepine Valproate Ethosuximide Topiramate Phenytoin Lamotrigine Zonisamide (C.VET.PLZ)

Which anti epileptics cause eye disorders?

Vigabatrin (Reduced visual field) Topiramate (Secondary Glaucoma)

Which Anti-epileptic causes Encephalopathy?

Vigabatrin

Which Anti epileptic cause Respiratory Depression

Gabapentin or Pregabalin

Carbamazepine therapeutic range?

4–12 mg/L Think carb is 4 Rest is 12

Carbamazepine Toxicity Signs?

Hyponatraemia Ataxia (Loss of full control body move) Nystagmus (involuntary eye movement) Drowsiness Blurred vision Arrhythmias Gastrointestinal Disturbances

Phenytoin therapeutic range?

10-20mg/l Same as Theophylline PHEN = TEN

Phenytoin toxicity signs?

Slurred speech Nystagmus Ataxia Confusion Hyperglycaemia Double Vision ***SNACHD***

Epileptic fit - can I still drive?

Stop immediately inform DVLA

Driving rules: First unprovoked one or single isolated fit?

Stop driving for 6 months If there are no more in those 6months Good to drive

Driving rules - If you have continuous seizures but no impact on consciousness, what should you do?

Wait 1 year to be fit free to start driving again

Driving rules - med change or weaning off med

Should not drive 6 months after last dose Eg: carbamazepine 400mg to 200mg

Driving rule - If you have seizure as a result of dose reduction

License revoked for 1 year ***HOWEVER If dose is increased back up and don’t have seizure for another 6 months u can drive —- do not need to wait the year

Epilepsy in pregnancy

Epilepsy risk of harm to foetus/mother is lower than the harm it will cause to stop meds

Epilepsy - Neural tube defect treatment?

Folic acid 5mg

Epilepsy in pregnancy at birth injection? And why?

Vitamin K (Phyteniadone) injected Given to reduce risk of neonatal haemorrhage

Which anti epileptic can cause cleft plate in pregnancy?

Topiramate Use PPP (Pregnancy Prevention Programme)

When should epilepsy breastfeeding need specialist advice?

Only when you have combo therapy or risk factors such as premature birth Not if on one med for epilepsy-continue as normal

Which anti-epileptic drug is highly present in breast milk?

Primidone Lamotrigine Ethosuximide Zonisamide ***PLEZ***

Which anti-epileptic poses a risk of drowsiness?

Primidone Phenobarbital Benzodiazepines ***PPB***

What happens if you stop breast feeding with phenobarbital, Primidone, benzodiazepines & Lamotrigine?

Withdrawal effect

Which antiepileptics are contraindicated in childbearing potential & pregnancy?

Sodium valproate & Topiramate