Epilepsy

Question 1

First line treatment for status epilepticus?

Answer 1

Benzodiazepine- midazolam

Question 2

Which drug classes are capable of lowering the seizure threshold?

Answer 2

Antidepressants, antihistamines, antivirals, antipsychotics, etc

Question 3

Is prophylactic treatment following a traumatic brain injury or in brain tumours recommended?

Answer 3

No

Question 4

Carbamazepine, lamotrigine and levetiracetam are first line treatment options for which type of epilepsy?

Answer 4

Focal onset

Question 5

First line treatment option for generalised onset seizures?

Answer 5

Valproate or levetiractam

Question 6

Drug used mostly for absence seizures?

Answer 6

Ethosuximide

Question 7

Name 2-3 potential ADRs of valproate

Answer 7

Vomiting / nausea 
Increased appetite 
Tremor 
Rash 
Liver toxicity

Question 8

The metabolism of valproate is increased by which other 2 AEDs?

Answer 8

Phenytoin ams carbamazepine

Question 9

Which AED is associated with a severe rash linked to Han Chinese alleles? Rash = SJS or TENS

Answer 9

Carbamazepine - should test for allele before starting treatment

Question 10

Low vitamin D, sedation and increased cholesterol are potential ADRs of which AED?

Answer 10

Carbamazepine

Question 11

Why does carbamazepine take longer to reach steady state? (2-4 weeks)

Answer 11

Because it is an auto-inducer (induces it’s own metabolism).

Dose is slowly increased to allow for the enzyme induction

Question 12

Why is therapeutic drug monitoring required with phenytoin?

Answer 12

Phenytoin binds to plasma proteins. If patient has reduced albumin or reduced renal function, levels of free phenytoin may be wrong and the dose will need to be changed

Question 13

Unlike many other drugs, the PK of phenytoin is not — meaning, —

Answer 13

It is not linear.

Means that a small increase in dose can cause a large change in phenytoin levels

Question 14

Phenytoin interacts with which 2 common drugs?

Answer 14

Oral contraceptive pill

Alcohol

Question 15

Which AED is considered the ‘new phenytoin’

Answer 15

Lamotrigine

Question 16

Which drug is used for mono therapy in focal seizures but as an adjuvant in generalised seizures?

Answer 16

Levetiracetam

Question 17

Some AEDs induce hepatic enzymes which increases metabolism of the oral contraceptive pill. How can this be addressed?

Answer 17

Take 2 active pills instead of one each day

Switch to depot or IUD

Question 18

Which AED should be avoided in pregnancy

Answer 18

Valproate