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CNS - HIGH WEIGHTED > CNS - EPILEPSY/SEIZURES > Flashcards

CNS - EPILEPSY/SEIZURES Flashcards

1
Q

Most anti-epileptic drugs are given BD except which ones and why?

A
  • Phenobarbital, Lamotrigine, Phenytoin

- They all have long half lives

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2
Q

What are focal seizures?

A
  • Seizures where a small part of the brain is affected
  • Simple partial seizures = where you remain fully conscious throughout
  • Complex partial seizures = Lose awareness and can’t remember what happened after seizure passed
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3
Q

What categories of seizures fall under generalised seizures?

A
  • Absence seizures = patient looks blank
  • Myoclonic seizures = arms, legs, or upper body jerk or twitch
  • Clonic seizures = similar twitching to myoclonic seizures but jerks last longer. consciousness may occur
  • Atonic seizures = all muscles suddenly relax, can result in a fall
  • Tonic seizures = all muscles suddenly stiffen, can result in a fall
  • Tonic-clonic seizures = 2 stages. Body initially becomes stiff and then arms and legs begin twitching
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4
Q

What is the treatment for Focal seizures with/without secondary generalisation?

A
  • 1st line = Lamotrigine or Carbamazepine

- OR: Levitiracetam, Valporate, Oxcarbazepine

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5
Q

What is the treatment for tonic-clonic seizures?

A
  • 1st line = Valporate or Carbamazepine

- OR: Lamotrigine

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6
Q

What is the treatment for absence seizures?

A
  • 1st line = Valporate (if high risk of generalised tonic/clonic seizures) OR Ethosuximide
  • OR: Lamotrigine
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7
Q

What is the treatment for myoclonic seizures?

A
  • 1st Line = Valporate

- OR - Topiramate, Levetiracetam

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8
Q

What is the treatment for Atonic/Tonic seizures?

A

1st Line = Valporate

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9
Q

Which drugs are category 1 drugs?

A
  • Carbamazepine, Phenytoin, Phenobarbital, Primidone

- Rx should contain brand name OR generic name + manufacturer

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10
Q

Which drugs are category 2 drugs?

A

Valporate, Lamotrigine, Clonazepam, Topiramate

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11
Q

Which drugs are category 3 drugs?

A

Levetiracetam, Gabapentin, Pregablin, Ethosuximide

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12
Q

What can happen if you withdraw anti-epileptics abruptly?

A

can precipitate rebound seizures

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13
Q

How would you withdraw anti-epileptics if the pt was on combination therapy?

A

You would withdraw them one at a time

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14
Q

How long must a patient be seizure-free for in order to drive?

A

1 YEAR

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15
Q

If a patient’s dose is changed, how long do they have to wait until they can drive?

A

6 months with no further seizures

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16
Q

What are the exceptions to driving if a patient has a history of SLEEP seizures?

A
  • Allowed to drive if they have had no awake seizures for 1 year from first sleep seizure
  • Allowed to drive if there is an established pattern of sleep seizures for 3 years if they have had previous awake seizures
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17
Q

When would patients with epilepsy be on a driving ban?

A
  • During medication changes or withdrawal
  • 6 months after last dose
  • 6 months for first unprovoked epileptic seizure or single isolated seizure (5 year ban for large goods or passenger carrying vehicles)
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18
Q

Which anti-epileptic holds the highest risk of causing teratogenicity?

A

Valporate

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19
Q

Which anti-epileptic in particular needs to be dose adjusted due to the reduced albumin levels is pregnancy?

A

Phenytoin - dose tends to be reduced

20
Q

With which 2 anti-epileptics is it important to monitor foetal growth?

A
  • Topiramate

- Levetiracetam

21
Q

What can be taken to reduce neural tube defect in pregnancy?

A
  • Folic acid

- Take before conception and until week 12 of pregnancy

22
Q

What can minimise the risk of neonatal haemorrohage?

A

vit k injection

23
Q

Women are encouraged to breastfeed if they are on monotherapy. What should be monitored in the infant if this is happening?

A
  • weight gain
  • feeding difficulties
  • drowsiness
24
Q

Which anti-epileptics can be present in high amounts in breast milk?

A
  • Zosinamide
  • Ethosuxamide
  • Lamotrigine
  • Primidone
25
Q

Which anti-epileptics can inhibit the sucking reflex? (identified with ADR ‘diffculty feeding)

A
  • Phenobarbital

- Primidone

26
Q

What are the main side effects of anti-epileptics?

A
  • Hypersensitivity - Rash, fever etc. Associated with carbamazepine, phenytoin, phenobarbital, primidone, and lamotrigine.
  • Suicidal behaviour and thoughts - can occur within 1 week of starting.
  • Skin rashes
  • Blood dyscrasias (C VET PLZ) - Carbamazepine, Valporate, Ethosuximide, Topiramate, Phenytoin, Lamotrigine, Zonisamide
  • Eye problems - vibagatrin (visual field defects), topiramate (secondary angle-closure glaucoma)
  • Encephalopathic symptoms - sedation, stupor (drunk person symptoms), confusion
27
Q

What interacts with anti-epileptics?

A
  • Inhibitors - increase cp

- Inducers - decrease cp. carbamazepine, phenytoin and phenobarbital are inducers

28
Q

What is the theraputic index at which phenyotin works?

A

10-20mg/L or 40-80 mmol/L

29
Q

Due to phenytoin being a highly protein bound drug, patient groups with lower albumin levels will experience early signs of toxicity for example:

A
  • pregnant patients
  • children
  • elderly
  • renal impairment
30
Q

What are the symptoms of phenytoin toxicity?

A

SNACHD

  • Slurred speech
  • Nystagmus (uncontrolled eye movement)
  • Ataxia
  • Confusion
  • Hyperglycaemia
  • Double vision, blurred vision
31
Q

What are the side effects of phenytoin?

A
  • change in appearance = acne, coarsening facial features, enlarged gums
  • blood dyscrasias = fever, sore throat, mouth ulcers, unexplained bruising
  • hypersensitivity reactions = fever, rash, swollen lymph nodes
  • rashes
  • low vitamin d = osteomalacia and rickets
  • hepatotoxicity
  • suicidal ideation
32
Q

What can happen if IV phenytoin is administered too quickly?

A

CVD/CNS depression

33
Q

How much fosphenytoin is equivalent to 1mg of phenytoin?

A

1.5mg

34
Q

What interacts with phenytoin?

A
  • Inhibitors + trimethoprim = increase cp
  • Inducers = reduce conc
  • Quinolones, tramadol, mefloquine, SSRIs, antipsychotics, TCA = antagonises anticonvulsant effect
  • Mtx, trimethoprim = increased risk of blood dyscrasias
  • Phenytoin is an inducer = decreases cp of other key drugs
35
Q

What is the therapeutic index of carbamazepine?

A

4-12 mg/L or 20-50 mmol/L

36
Q

What are the toxicity symptoms of carbamazepine?

A

HANDIBAG - dose related. adjusting dose may help these side effects

  • Hyponatraemia
  • Ataxia
  • Nystagmus (uncontrolled eye movements)
  • Drowsiness
  • Inco-ordination
  • Blurred and double vision
  • Arrhythmias
  • GI disturbance
37
Q

What are the side effects of carbamazepine?

A
  • blood dyscrasias
  • hepatotoxicity
  • hypersensitivity syndrome
  • rashes
  • hyponatraemia
38
Q

How can you reduce the risk of side effects of carbamazepine?

A

change to a modified release preparation

39
Q

What are the interactions for carbamazepine?

A
  • Inhibitors = increase cp
  • Inducers = decrease cp
  • Quinolones, tramadol, mefloquine, SSRIs, antipsychotics, TCA = antagonises anticonvulsant effect
  • drugs that induce hyponatraemia
  • hepatotoxic drugs
  • inducer itself
40
Q

What are the side effects of valproate?

A
  • Hepatotoxicity
  • Blood dyscrasias
  • pancreatitis - abdominal pain
41
Q

What interacts with valproate?

A
  • Quinolones, mefloquine, SSRI, antipsychotic, TCA = anticonvulsant effect antagonised
  • Hepatotoxic drugs
  • Valproate is an inhibitor = increase conc of phenobarbital and lamotrigine
42
Q

What is status epilepticus?

A

One fit after another without regaining consciousness

43
Q

How do you treat convulsive status epilepticus?

A
  • IV lorazepam

- AVOID DIAZEPAM = causes thrombophlebitis (inflammation of vein)

44
Q

How do you treat non-convulsive status epilepticus?

A
  • If incomplete loss of awareness = continue or restart usual oral antiepileptic
  • If complete loss of awareness & failure to respond to oral antiepileptic drug = IV lorazepam
45
Q

What are febrile convulsions?

A

Fits that occur when a child has a fever

46
Q

How do you treat febrile convulsions?

A
  • Paracetamol

- if fit lasts >5 minutes, treat with diazepam rectal solution or midazolam oromucosal solution

CNS - HIGH WEIGHTED (12 decks)

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