epilepsy Flashcards
Most common dosage regimen for antiepeleptics
BD
First line for partial focal seizures
Carbamazepine or Lamotrigine
First line for all generalised
NaValproate
Which seizures does carbamazepine worsen
Mylonic, atonic and clonic seizures
Alternative first line in absence
Ethosuximide
Alternative first line in tonic/clonic
Carbamazepine
What seizures does Phenytoin worsen
Absence and Mylonic
Category 1
CPPP
Category 2
NaVal
Lamotrigine
Topiramate
Clonazepam
Can anti-epileptics be withdrawn suddenly and why? Which AE needs to be withdrawn super carefully
NO
Rebound seizures
Barbiturates can take months to taper down
Driving and Epilepsy
Can drive car but not HGV etc
Drive: 1 yr seizure free Established seizure pattern No effect on consciousness No unprovoked Seizures due to provoked changes
Seizures whilst asleep:
can drive if no awake seizures- 1 yr since first sleep seizure
established pattern of sleep seizure for 3 years
Driving ban
during withdrawal or change
6 months isolated or unprovoked
6 months from last dose
Which AE is high risk teratogenic
NaVal
Which carry a high risk in birth other than NaVal
CPPPL
Which AE can increase cleft lip risk
Topiramate
Which anti epileptic is an enzyme inducer
Carbamazepine
Which AE plasma concs can vary during pregnancy
Phenytoin Carbamazepine and Lamotrigine
This means dose adjustments and also plasma concs can be checked to confirm compliance
What to do to reduce risks in pregnancy
5mg folic acid Vit K injection monitor foetal growth monitor withdrawal Notify Epilepsy pregnancy register
Breast feeding and pregnancy
Present in large amounts in milk:
ZELP- Zonisamide, Ethosixumide, Lamotrigine and Primidone
Excreted in milk:
Lamotrigine and Phenobarbital
Sucking affected:
Phenobarbital and primidone
AE side effects
Hypersensitivity- increased risk with CPPPL and cross sensitivity between AEs such as carbamazepine and phenytoin
Suicidal ideation
Skin rashes- worse with lamotrigine
eye problems and encephalopathic symptoms - Vigabatrin
Blood dyscrasias- C VET PLZ Carba Valproate Ethosuximide Topiramate Phenyotin Lamotrigine Zonisamide
Gabapentin MHRA warning
Respiratory depression
Phenytoin plasma concs
10-20mg/L
100mg pheny= 92mg base
works by prolonging the deactivation of neuronal Na channels
signs of toxicity (Phenytoin)
SNAtCHeD
Slurred speech Nystamus Ataxia Confusion Hyperglycaemia Dilopia
Side effects of phenytoin
CHanges in appearance- acne, gingival hyperplasia, hirustim
Blood dyscrasias
Skin rashes
Vit D
hepatotoxic
Suicide
IV phenytoin and fosphenytoin issues
Bradycardia and hypotemtsion- monitor BP and ECG
MHRA increased risk of death and harm
IV Fosphenytoin- Cardiovascular reactions e.g. arrhythmias and heart failure
1.5mg fosp= 1mg pheny
