Epilepsy

Question 1

True or false: A single AED should be used whenever possible

Answer 1

TRUE - when monotherapy with one drug fails, try monotherapy with another

Question 2

How should you change from one AED to another?

Answer 2

Slow cross tapering

Slowly withdraw the first drug when the new regimen has been established

Question 3

Which AED need to always be prescribed by brand? ( 4 points)

Answer 3

Phenytoin
Carbamazepine
Phenobarbital
Primidone

Question 4

True or false: Levetiracetam and Gabapentinoids should be prescribed by brand

Answer 4

FALSE - it is not usually necessary to prescribe by brand unless it is the patient’s preference

Question 5

Which drugs cause anti-epileptic hypersensitivity syndrome? ( 4 points )

Answer 5

Carbamazepine
Phenytoin
Phenobarbital
Lamotrigine

Question 6

Symptoms of anti-epileptic hypersensitivity syndrome ? (5 points)

Answer 6

Fever 
Rash 
Lymphadenopathy 
Liver dysfunction
Haematological, renal and pulmonary abnormalities

Question 7

True or false: Sodium Valproate is an enzyme inducer

Answer 7

FALSE - valproate is an enzyme inhibitor

SICKFACES.COM

Question 8

Which AEDs are enzyme inducers? (3 points)

Answer 8

Carbamazepine
Phenytoin
Phenobarbital (and primidone which is metabolised to phenobarb)

Question 9

True or false: Patients with epilepsy must not drive

Answer 9

FALSE - They can drive but they must be seizure free for at least 1 year.

Question 10

How long must a driver stop driving if they have an unprovoked seizure of any type?

Answer 10

6 months

They must also notify the DVLA

Question 11

True or false: AEDs are not safe in breastfeeding

Answer 11

FALSE - breastfeeding can be encouraged in those on monotherapy.
Monitor babies for sedation, feeding difficulties and adequate weight gain.

Question 12

Topiramate is teratogenic. It increases the risk of _____

Answer 12

Cleft palate

Question 13

______ and ______ are the safer AEDs for use in pregnancy

Answer 13

Lamotrigine

Levetiracetam

Question 14

Which AEDs can be taken once daily due to their long half life ? (4 points)

Answer 14

Phenytoin
Perampanel
Phenobarbital
Lamotrigine

Think LP3 = long half life!

Question 15

When do symptoms of anti-epileptic hypersensitivity syndrome usually start after exposure?

Answer 15

Within 1-8 weeks

Question 16

Which vitamin should be given at birth to babies if mothers taking AEDs?

Answer 16

Vitamin K

To reduce the risk of neonatal haemorrhage associated with AEDs

Question 17

First line drugs for focal (partial) seizures ? (2)

Answer 17

Carbamazepine

Lamotrigine

Question 18

First line for tonic clonic seizures

Answer 18

Sodium valproate

Lamotrigine alternative e.g. in women of childbearing age

Question 19

First line for absence seizures ?

2

Answer 19

Ethosuxamide

Sodium valproate (lamotrigine alternative)

Question 20

Which AED is generally used as an alternative to sodium valproate where it is unsuitable ?

Answer 20

Lamotrigine

Question 21

Status epilepticus:

If seizures recur or don’t respond within 25 minutes despite treatment with lorazepam, which drug can be used

(2 options)

Answer 21

Phenytoin

Phenobarbital

Question 22

Which AED can cause vitamin d deficiency and rickets

Answer 22

Phenytoin

Question 23

Therapeutic level for carbamazepine?

Answer 23

4-12 mg/mL

Measure after 1-2 weeks

Question 24

Which AEDs may cause bone marrow suppression

2 points

Answer 24

Carbamazepine

Lamotrigine