CNS - Epilepsy Flashcards
Focal Seizures - First line
Levetiracetam or Lamotrigine
“Got to take 2 L’s to get u focused”
Focal seizures - second line
Carbamazepine, Oxcarbazepine, zonisamide
Generalised seizures types
Tonic clonic
Atonic
Tonic
Absence
Absence 2 (absence + other seizure type)
If under 55 years old generalised seizure excluding absence seizure treatment?
Lamotrigine or levetiracetam
Over 55 years old generalised seizure excluding absence treatment?
Sodium valproate
Second line: Levetiracetam or Lamotrigine
Absences alone seizure treatment
1st line: Ethosuximide
2nd line: Sodium Valproate
Sodium valproate & Pregnancy
Avoid - Teratogenic
Use PPP (Pregnancy prevention plan)
What is a Status Epilepticus?
Seizure lasting longer than 5mins
Status epilepticus treatment plan?
Resuscitation and immediate emergency treatment
Status Epilepticus - Resuscitation Facilities available treatment?
IV Lorazepam
Status Epilepticus - Carehome/Community treatment?
Buccal Midazolam
Or
Rectal Diazepam
How long after first dose of status epilepticus should second dose be given?
After 5-10mins and seizure hasn’t stopped
What if 2 benzodiazepines fail to help status epilepticus seizure?
Levetiracetam
Phenytoin
Sodium valproate
Give 1 if fails try another
If Levetiracetam, phenytoin, sodium valproate doesn’t work in status epilepticus?
Phenobarbital or General Anaesthesia
Category 1 Antiepileptic drugs?
Carbamazepine
Phenobarbital
Phenytoin
Primidone
Must MAINTAIN ON SPECIFIC BRAND!!!
Category 2 Anti epileptic drugs?
Clobazam, Clonazepam, Lamotrigine, oxcarbazepine, perampanel, Rufinamide, Topiramate, Valproate, Zonisamide
***Clinical judgment on brands
Category 3 antiepileptic drugs?
Ethosuximide, Gabapentin, Pregabalin, Brivaracetam, tiagabine, vigabatran, Levetiracetam, Lacosamide.
do not need to maintain brand
Which Anti-epileptic drugs can affect warfarin?
CYP INDUCERS:
Phenytoin, Phenobarbital & Carbamazepine
Will reduce warfarin levels
Which anti epileptic drugs are Hepatotoxic?
Carbamazepine, phenytoin, sodium valproate
Which drugs is a CYP inhibitor so will increase volume of other drugs in system?
Sodium valproate
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
