Epilepsy Flashcards
Learn about anti epileptic drugs
What is the aim of anti epileptic treatment?
To prevent the occurrence of seizures
What are the difference epilepsy?
Generalised seizures
- tonic clonic
- Absence seizures
- Myoclonic seizures
- Atonic and tonic seizures
Focal aware or Focal impaired awareness seizures with or without generalisation
Unknown
Name the category 1 antiepiletics (4)
Carbmazepine
Phenobarbital
Phenytoin
Primidone
Name the category 2 antiepileptics (10)
Clobazam Clonazepam Eslicarbazepine acetate Lamotrigine Oxcarbazepine Perampanel Rufinamide Topiramate Valporate Zonisamide
What is meant by a category 1 antiepileptic
These must be supplied by brand only
What is meant by a category 2 antiepileptic
The supply of a particular brand should be based on clinical judgment
What is a category 3 antiepileptic
It’s unnecessary to prescribe by brand
What are the steps of management of epilepsy ?
. Monotherapy with first line
. Minotherapy with second line
. Monotherspy with a second drug (after checking the diagnosis)
. Use two (or more) antiepileptics
What serious side affect is associated with carbamazepine, lacosamide, lamotrigine, oxcarbazepine, phenobarbital, phenytoin, primidone and rufinamide?
Antiepileptic hypersensitivity syndrome if it has happened with one of these cross sensitivity can occur
When does a hypersensitivity reaction occur?
1 -8 weeks of exposure
What are the symptoms of hypersensitivity?
Fever Rash Lymphadenopathy Liver dysfunction Haemological, renal and pulmonary abnormalities Vasculitis Muti-organ failure
Which antiepileptics are associated with a small increase risk of suicidal thoughts and behaviour?
All
How soon can suicidal thoughts and behaviours start?
1 week after starting
When must a person stop driving after having a seizure?
Immediately
A patient who has had their first unprovoked seizure or a single seizure how long must they not drive for ?
6 months
A patient with a established epilepsy how long must they be seizure free for till they can drive again?
1 year old with no history of unprovoked seizures
How long does the DVLA recommend to wait till driving when changed or withdrawal antiepileptics?
6 months from the last dose
What antiepileptics are recommended for focal seizures with or without secondary generalisation?
1st line
Carbamazipine
Lamotrigine
2nd line
Oxcarbazepine
Sodium valproate
Levetiracetam
What antiepileptics are used for absence seizures?
1st line
Ethosuximide
Sodium valproate (best if there is a high risk of generalised seizures)
2nd line
Lamotrigine
What antiepileptics are recommended for myoclonic seizures?
1st line
Sodium valproate
2nd line
Topiramate
Levetiracetam
What antiepileptics are recommended for atonic and tonic seizure
Sodium valproate however antiepileptics respond poorly to antiepileptics
What are the side effects of carbamazepine? (5)
GI upset Neurological effects (dizziness and ataxia) Oedema Hyponaturaemia Hypersensitivity reaction
What warnings are there with carbamazepine? (3)
Pregnancy
Prior antiepileptic hypersensitivity syndrome
Prescribed in caution hepatic, renal and cardiac disease
What is the monitoring requirement for carbamazepine?
Plasma concentration for optimum response (4-12 mg/L) after 1-2 weeks but not routinely recommended
What supplement is needed for immobilised for long periods of time when on carbamazepine?
Vitamin D
What interactions occur with carbamazepine?
Reducing the plasma concentration on…
Warfarin
Oestrogen
Progesterone
It’s increased by
Macrolides
Lamotrigine
Drugs that lower seizure threshold
What are the main side effects of Lamotrigine? (7)
Headaches Drowsiness Irritability Blurred vision Dizziness GI symptoms Hypersensitivity reaction
What are the predicable (dose related) side effect for carbamazepine? (6)
Diplopia, Drowsiness, Headache, Nausea, Orofacial dyskinesia, Arrhythmias
What are unpredicable (non dose) related sode effect for carbamazepine? (6)
Photosensitivity Steven Johnson syndrome Agranulocytosis, Aplastic anemia, Hepatotoxicity, Teratogenicity
What are the main interactions with Lamotrigine?
These reduce levels Carbamazepine Phenytoin Oestrogen Rifampicin Protease inhibitor
These increase levels
Valproate
What are the predicable (dose related) side effect for Lamotrigine? (6)
Headaches, Drowsiness, Diplopia, Ataxia, Tremor, Insomnia,
What are non predicable (non dose related) side effect for Lamotrigine? (7)
Rash, Liver failure, Steven-johnson syndrome, Aplastic, Anaemia, Toxic epidermal necrolysis, Panctopenia
What are the predicable (dose related) side effects phenytoin? (7)
Ataxia, Nystagmus, Drowsiness, Diplopia, Asterixis, Orofacial dykinesia, Folate deficiency
What are non predicable (non dose relates) side effects phenytoin? (8)
Blood dyscrasis, Rash, Dupuytren contracture, Hepatotoxicity, Gingival hyperplasia, Acne, Coase facies, Hirsutism,
What are the warnings with carbamazepine? (5)
. Women planning pregnancy . Antiepileptic hypersensitivity syndrome . Hepatic disease . Renal disease . Cardiac disease
What antiepileptic is the clear first line choice for trigeminal neuralgia ?
Carbamazepine
What antiepileptic is used for bipolar?
Lamotrigine
What major interactions does levetiracetam have?
MTX - It’s clearance is reduced
