epilepsy

Question 1

Most common dosage regimen for antiepeleptics

Answer 1

BD

Question 2

First line for partial focal seizures

Answer 2

Carbamazepine or Lamotrigine

Question 3

First line for all generalised

Answer 3

NaValproate

Question 4

Which seizures does carbamazepine worsen

Answer 4

Mylonic, atonic and clonic seizures

Question 5

Alternative first line in absence

Answer 5

Ethosuximide

Question 6

Alternative first line in tonic/clonic

Answer 6

Carbamazepine

Question 7

What seizures does Phenytoin worsen

Answer 7

Absence and Mylonic

Question 8

Category 1

Answer 8

CPPP

Question 9

Category 2

Answer 9

NaVal
Lamotrigine
Topiramate
Clonazepam

Question 10

Can anti-epileptics be withdrawn suddenly and why? Which AE needs to be withdrawn super carefully

Answer 10

NO
Rebound seizures
Barbiturates can take months to taper down

Question 11

Driving and Epilepsy

Answer 11

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

Question 12

Which AE is high risk teratogenic

Answer 12

NaVal

Question 13

Which carry a high risk in birth other than NaVal

Answer 13

CPPPL

Question 14

Which AE can increase cleft lip risk

Answer 14

Topiramate

Question 15

Which anti epileptic is an enzyme inducer

Answer 15

Carbamazepine

Question 16

Which AE plasma concs can vary during pregnancy

Answer 16

Phenytoin Carbamazepine and Lamotrigine

This means dose adjustments and also plasma concs can be checked to confirm compliance

Question 17

What to do to reduce risks in pregnancy

Answer 17

5mg folic acid 
Vit K injection 
monitor foetal growth 
monitor withdrawal 
Notify Epilepsy pregnancy register

Question 18

Breast feeding and pregnancy

Answer 18

Present in large amounts in milk:
ZELP- Zonisamide, Ethosixumide, Lamotrigine and Primidone

Excreted in milk:
Lamotrigine and Phenobarbital

Sucking affected:
Phenobarbital and primidone

Question 19

AE side effects

Answer 19

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

Question 20

Gabapentin MHRA warning

Answer 20

Respiratory depression

Question 21

Phenytoin plasma concs

Answer 21

10-20mg/L

100mg pheny= 92mg base

works by prolonging the deactivation of neuronal Na channels

Question 22

signs of toxicity (Phenytoin)

Answer 22

SNAtCHeD

Slurred speech
Nystamus 
Ataxia 
Confusion 
Hyperglycaemia 
Dilopia

Question 23

Side effects of phenytoin

Answer 23

CHanges in appearance- acne, gingival hyperplasia, hirustim

Blood dyscrasias

Skin rashes

Vit D

hepatotoxic

Suicide

Question 24

IV phenytoin and fosphenytoin issues

Answer 24

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

Question 25

Carbamazepine therapeutic conc

Answer 25

4-12mg/L

works by inhibiting Na channels, stabilises membranve

Question 26

carbamazepine toxicity

Answer 26

Incoordination 
Hyponatraemia 
Ataxia
Nystamus 
Drowsiness
Blurred vision
Arrythmias
GI effects

Question 27

carbamazepine SE

Answer 27

Blood dycrasias 
GI distrubances 
Hypersensitivity 
Hepatotoxic 
Rashes 

USe MR preps to reduce risk