Drugs

Question 1

Barbiturates

Answer 1

1. Phenobarbital - long half-life = ON, tonic-clonic and focal, sedative effect, re-bound seizures and withdrawal problems
2. Primidone - converted into phenobarbital, low initial dose
3. Thiopental

Question 2

Benzodiazepines

Answer 2

1. Clobazem - adj for generalised tonic-clonic and refractory focal seizures
2. Clonazepam - specialist, refractory absence and myoclonic seizures, sedative effects
3. Lorazepam - IV
4. Midazolam - convulsive status epilepticus, oromucosal
5. Brivaracetam - partial onset seizures

Question 3

Brivaracetam

Answer 3

Adj therapy in treatment of partial-onset seizures w/wo 2* generalisation

Question 4

Carbamazepine

Answer 4

Simple and complex focal seizures 
1st line for generalised tonic-clonic 
Used as adj for focal 
Start at low dose and build up slowly 
May exacerbate tonic, atonic, myoclonic and absence seizures

Question 5

Gabapentin, Pregablin

Answer 5

focal seizures with/without secondary generalization
NOT for tonic, atonic, absence, myoclonic seizures
Neuropathic pain treatment
Pregabalin = generalised anxiety disorder

Question 6

Lamotrigine

Answer 6

long half-life = ON
1st line for focal seizures and 1/2 generalised tonic-clonic seizures
Licensed for typical absence seizures in children
Unlicensed use in adults if 1st line unsuccessful
Adj for atonic or tonic seizures if 1st line fail
Exacerbates myoclonic seizures
Rashes in children - dose adjustments

Increased conc with valproate (enzyme inhibitor)
Decreased conc with (enzyme inducers)

Question 7

Levetiracetam

Answer 7

Focal seizures with/without 2* generalisation
Adj treatment for myoclonic seizures in pts with juvenile myoclonic epilepsy and 1* generalised tonic-clonic seizures
Mono/combo treatment for myoclonic seizures
Specialist for absence seizures

Question 8

Perampanel

Answer 8

long half-life = ON

Question 9

Phenytoin

Answer 9

long half-life = ON

Fosphenytoin is the phenytoin prodrug

Question 10

Sodium Valproate

Answer 10

Teratogenic

Question 11

Topiramate

Answer 11

Alone or adj for generalised tonic-clonic or focal seizures w/wo 2* generalisation
Adj for Lennox-Gastaut syndrome for absence, tonic, atonic seizures under specialist (unlicensed)
Considered for myoclonic seizures (unlicensed)

Question 12

Ethosuximide

Answer 12

1st line for ABSENCE seizures
Adj therapy too
Licensed for myoclonic seizures too

Question 13

Rufinamide

Answer 13

Adj treatment of seizures in Lennox-Gastaut syndrome

3* specialist for treatment of refractory tonic or atonic seizures (unlicensed)

Question 14

Perampanel

Answer 14

long half-life = ON

Question 15

Tiagabine

Question 16

Vigabatrin

Question 17

Side effects of antiepileptics

Answer 17

1. Anti-epileptic hypersensitivity syndrome
2. Risk of suicidal behaviours or thoughts
3. Skin rash = lamotrigine, valproate
4. Blood dyscrasias = C Vet Plz
5. Eye problems = Vigabatrin, Topiramate
6. Encephalopathic symptoms = Vigabatrin
7. Respiratory depression = Gabapentin

Question 18

Interactions

Answer 18

1. Anti-epileptic enzyme inhibitors = increase plasma conc

2. Anti-epileptic enzyme inducers = decrease plasama conc

Question 19

Anti-epileptic syndrome

Question 20

Blood Dysrasias

Question 21

Skin rashes

Question 22

HIGH RISK DRUGS

Answer 22

1. Sodium Valproate
2. Carbamazepine
3. Phenytoin

Question 23

Zonisamide

Answer 23

Monotherapy for focal seizures w/wo 2* generalisation in adults with newly diagnosed epilepsy
Adj therapy for refractory focal seizures w/wo 2* generalisation in adults and children >6 years
Specialist treatment for refractory absence seizures and myoclonic seizures (unlicensed)