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Pre-Reg 22 - Nervous System > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Five types of epileptic seizures

A

1) Focal (partial) seizure with or without secondary generalisation
2) Tonic colonic seizures
3) Absence seizures
4) Myoclonic seizures.
5) Atonic seizures

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2
Q

Which antiepileptic can be given OD

A

Lamotrigine, perampanel, phenobarbital, and phenytoin,

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3
Q

Category one antiepileptic drugs

A
  • Carbamazepine
  • Phenytoin
  • Phenobarbital
  • Primidone
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4
Q

Category two antiepileptic drugs

A
  • Valproate
  • Lamotrigine
  • Clonazepam
  • Topiramate
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5
Q

Category two antiepileptic drugs

A
  • Levetiracetam
  • Gabapentin
  • Pregabalin
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6
Q

What symptoms occur in Antiepileptic hypersensitivity syndrome

A
  • fever, rash, and lymphadenopathy
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7
Q

Three things to consider when withdrawing antiepileptic drugs

A
  • Gradually reduce the dose under specialist supervision
  • Avoid abrupt withdrawal
  • Withdraw one epileptic at time
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8
Q

Epileptic patients can drive if…

A
  • Seizure free for one year
  • Seizure pattern has no affect on person
  • No history on unprovoked seizure
  • Seizures are due to prescribed change or withdrawal
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9
Q

Which antiepileptic medication belong to each risk group of pregnancy

  • Highest risk:
  • Increased risk
  • Cleft plate:
A
  • Highest risk: Valproate
  • Increased risk : Carbamazepine , Phenytoin , Phenobarbital , lamotrigine.
  • Cleft plate: Topimerate
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10
Q

Which Antiepileptic drug needs to be dose adjusted due to plasma concentration changes

A
  • Carbamazepine and Lamotrigine.
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11
Q

Which Antiepileptic drug needs you to monitor foetal growth

A
  • Topimerate and Levetiracetam
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12
Q

Which Antiepileptic drugs need to be referred to specialist family planning

A

All

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13
Q

What do you need to give to women who are pregnant, planning to become pregnant or just after pregnancy who also take antiepileptic medication:

A
  • Vitamin K

- Folic acid

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14
Q

Which medication causes withdrawal effects in newborn children

A

Benzodiazepines and phenobarbital.

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15
Q

What to monitor in antiepileptic drugs + breastfeeding

A

Monitor drowsiness , weight gain , feeding , adverse effects, development milestones

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16
Q

Which antiepileptic medication is present in high amounts in milk?

A

ZELP

Zosinammide, Ethosuximide , Lamotrigine , Primidone

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17
Q

Which antiepileptic accumulates due to slower metabolism in infants

A

Phenobarbital + lamotrigine

18
Q

Which antiepileptic inhibits sucking reflex

A

Phenobarbital / Primidone

19
Q

Which antiepileptic has an increased risk of drowsiness in babies

A

Benzo , Phenobarbital and Primidone

20
Q

Which antiepileptic should you avoid abrupt withdrawal or breast feeding?

A

ALL special phenobarbital/ primidone.

21
Q

What is the main side effect with antiepileptics?

A

1) Antiepileptics hypersensitivity syndrome.
o Rash , fever and systemic involvement
2) MHRA alert: Risk of suicidal behaviour and thoughts,
3) Skin rashes
a. SJS , toxic epidermal necrolysis
4) Blood dyscarasis
5) Eye problems
a. Espc . Vigabatrin
6) Encephalopathic symptoms
(loss of memory and concentration)
7) MHRA alert: risk of severe respiratory depression without opioid medication - Elderly renal impaired respiratory compromised are at higher risk

22
Q

What is the MOA of interaction with antiepileptics

A
  • Antiepileptics are enzyme inhibitors = Increased Cp
    o E.g Sodium valproate
  • Anti-epileptics enzyme inducers = decreased Cp
    o Carbamazepine / Phenytoin / Phenobarbital.
23
Q

Uses of Phenytoin

A

Focal seizures and tonic clonic seizures

24
Q

What does Phenytoin extubate

A

Absence and myoclonic seizures

25
Q

Phenytoin Therapeutic range

A

10-20mg/l or 40-80micmol/l

26
Q

Phenytoin Plasma therapeutic drug monitoring what do you need to measure

A

1) Non linear relationship between dose and Cp – small changes in dose can cause large changes in plasma concentration
2) Phenytoin is highly protein bound
- When protein binding I reduced measure the free plasma concentration
- Risk increased in young / elderly and liver impairment pts.

27
Q

Phenytoin Signs and symptoms of toxicity =

A 
SNATCHED 
S – Slurred speak 
N – Nystagmus (uncontrolled rapid eye movement) 
A – Ataxia 
C – Confusion 
H – Hyperglycaemia 
D – Diplopia , blurred vision
28
Q

Phenytoin - How to reduce risk factors

A

Maintain is same brand ,

Different routes have different bioavailability.

29
Q

How do you switch between different phenytoin products

A

100mg of Phenytoin = 92mg of phenytoin base.

30
Q

Side effects – Phenytoin (8)

A
  • Change in appearance
  • Blood dyscarasias
  • Hypertensive reaction
    o Antiepileptic hypersensitivity syndrome.
  • Rashes
  • Low vitamin D
  • Hepatotoxicity
  • Suicidal ideation
  • IV phenytoin: bradycardia + hypotentoion MHRA alert : risk of death with phenytoin injectable
31
Q

Drug interaction – Phenytoin (5)

A
  • Increased phenytoin toxicity with enzyme inhibitors
  • Reduced phenytoin concentration = enzyme inducers
  • Anticonvulsant effect antagonised.
  • Increased antifolate effect
32
Q

Carbamazepine - Uses

A

First line in social seizures , generalised tonic colonic seizures. .

33
Q

What does Carbamazepine extubates

A

atonic , colonic and ,myoclonic seizures.

34
Q

Therpeutic range of Carbamazepine

A

4-12 or 20-50 micrograms

- Measure after 1 to 2 weeks

35
Q

Signs and symptoms of toxicity of Carbamazepine

A 
I HANDBAG
I coordination 
H hyponatremia 
A Ataxia 
N Nystagmus 
D Drowsiness 
Blurred vison 
Arrythmias 
G I side effects
36
Q

Side effects of Carbamazepine

A 
Blood dyscrasias  
Hepatotoxicity 
Hypertensive  reaction 
Rashes 
Hyponatremia
This is more common with elderly patients at the start of treatment
37
Q

Drug interaction of Carbamazepine

A
  • Enzyme inhibitors = Increased carbamazepine concentration
  • Decreased carbamazepine concentration (enzyme inducers)
  • Anticonvulsants effect antagonised
  • Increased risk of hyponatremia
  • Increased risk of hepatotoxicty
  • Carbamazepine is an enzyme inducer , reduces concentration.
38
Q

How to reduce risk of side effect of Carbamazepine

A

MR preparations

39
Q

Sodium Valproate action for pharmacist

A

TBC

40
Q

What do in patient who are status epileptic

A
  • IV lorazepam

- AVOID IV diazepam as it can cause thrombophlebitis’s.

41
Q

What do in patients who are non -convulsive status epileptic

1) If pt has incomplete loss of awareness
2) If pt has complete loss of awareness)

A

(If pt has incomplete loss of awareness)
- Continue or restart usually oral antiepileptic drug

(if pt has complete loss of awareness)
- Treat the same as convulsive status epileptic.

42
Q

What to do in patients who have febrile convulsion in children

  • First line
  • If more than 5 minutes
A
  • Paracetamol (antipyretic)

- If >5 minutes treat the same as status epileptic

Pre-Reg 22 - Nervous System (5 decks)

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