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CNS > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What are the MHRA warnings for anti-epileptics

A
  1. Risk of suicidal thoughts
  2. Some anti-epileptics should not be switched between different manufacturers products.
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2
Q

What are the category 1 drugs?

A

Carbamazepine, Phenytoin, Primidone, Phenobarbital

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3
Q

What does category 1 mean

A

They need to be maintained on a specific manufacturers brand.

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4
Q

What is anti-epileptic hypersensitivity syndrome?

A

Rare and potentially fatal syndrome that is associated with some anti-epileptics

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5
Q

What drugs are associated with anti-epileptic hypersensitivity syndrome?

A

Carbamazepine, Phenytoin, Primidone, Phenobarbital, Laccosamide, Lamotrigine, Oxecarbazepine and Rufinamide (cat 1 and LLOR)

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6
Q

When do symptoms show of anti-epileptic hypersensitivity syndrome?

A

Usually start between week 1 and 8 of exposure and can be fever, rash and lymphadenopathy
Withdraw drug immediately, do not restart and seek expert advice immediately.

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7
Q

What are the main interactions associated with anti-epileptics?

A

Complex and may cause toxicity without added anti-epileptic effect
Caused by hepatic enzyme induction or inhibition, displacement from protein binding sites is not usually a problem.

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8
Q

How do you withdraw an anti-epileptic drug?

A

Avoid abrupt withdrawal especially in barbituates and benzodiazepines.
In the case of barbituates it can take months. (primidone, phenobarbital)

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9
Q

How long can you not drive for if you have one single isolated seizure?

A

6 months

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10
Q

How long must a patient be seizure free for or established pattern so they can drive again?

A

1 year

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11
Q

If the patient has had seizures whilst being awake but now only has them when they are asleep, how long must this happen for so they can drive again?

A

Establish the pattern for 3 years

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12
Q

How long can a patient not drive for if they have a medication change or withdrawal?

A

6 months

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13
Q

if a patient has a seizure whilst their medication has changed or withdrawn, how long must they go without driving?

A

1 year (if medication restarted and they remain seizure free it may be considered after 6 months)

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14
Q

What are the first and second line anti-epileptics for focual seizures?

A

First line: Lamotrigine or Levetiracetam
Second line: Carbamazepine, Oxcarbazepine, Zonisamide

Got to take 2 L’s to get you focused COZ

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15
Q

Whats the first and second line for tonic clonic seizures

A

1st: Sodium Valproate
2nd: Lamotrigine or Levetiracetam

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16
Q

Whats the first and second line for absence seizures

A

1st: Ethosuximide
2nd: Sodium Valproate

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17
Q

Whats the first and second line for absence and another seizure

A

1st: Sodium valproate
2nd: Lamotrigine or Levetiracetam

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18
Q

Whats the first and second line for myoclonic seizures

A

1st: sodium valproate
2nd: Levetiracetam

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19
Q

Whats the first and second line for Atonic seziures

A

1st: sodium valproate
2nd: Lamotrigine

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20
Q

Whats the first and second line for tonic seizures

A

1st: sodium valproate
2nd Lamotrigine

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21
Q

What other two anti-epileptics can be used in tonic seizures?

A

Carbamazepine and Vigabatrin

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22
Q

Whats the definition of Status epilepticus

A

A seizure lasting for longer than 5 minues

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23
Q

Whats the different treatment options for Status epilepticus depending on where you are?

A

In the community: Buccal Midazolam 10mg or Rectal diazepam 10-20mg
If resus facilities available: IV lorazepam 4mg

if the seizure doesn’t stop within 5-10 minutes then give another dose

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24
Q

What do you give if the status epilepticus seizure fails to respond after 2 benzodiazepine doses?

A

Give Levetiracetam, Phenytoin, Sodium valproate

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25
Q

What do you do if the status epilepticus fails to respond to the benzodiazepines and the anti-epileptics?

A

Give Phenobarbital or General anaesthesia

26
Q

What are the drug interactions for Carbemazepine?

A

Drugs that cause hepatotoxicity: Amiodarone, Itraconazole, Macrolides, Alcohol
It’s an enzyme inducer
Drugs that lower seizure threshold e.g. Tramadol, Theophylline, Quinolones
Drugs that cause hyponatraemia e.g. SSRI’s, diuretics
DOAC’s
Oral contraceptives

27
Q

What are the drug interactions for Phenytoin?

A

Drugs that cause hepatotoxicity: Amiodarone, Itraconazole, Macrolides, Alcohol
It’s an enzyme inducer
Drugs that lower seizure threshold e.g. Tramadol, Theophylline, Quinolones
Anti-folates e.g. Methotrexate, Trimethoprim

doac, carbamazepine, oral contraceptive pill, ulipristal.

28
Q

What are the drug interactions for Sodium Valproate ?

A

Drugs that cause hepatotoxicity: Amiodarone, Itraconazole, Macrolides, Alcohol
It’s an enzyme inhibitor
Drugs that lower seizure threshold e.g. Tramadol, Theophylline, Quinolones

29
Q

What effect does phenobarbital have on CYP enzymes?

A

It’s an inducer

30
Q

Side effects of Carbamzepine

A

Depression and suicide
Hepatotoxicity
Hypersensitivity
Blood dyscrasias
Vit D deficiency- bone pain
Hyponatraemia
Oedema

Nausea vomiting sedation dizziness and ataxia are dose related and are most common at the start of treatment
Hyponatraemia, eucopenia and thrombocytopenia are very common.
carbamazepine known to be an enzyme inducer and induces its down metabolism

31
Q

Side effects of Phenytoin

A

Depression and suicide
Hepatotoxicity
Hypersensitivity
Blood dyscrasias
Vit D deficiency- bone pain
Coarsening appearance and facial hair

Gingival hyperplasia, agranulocytosis, thrombocytopenia, altered taste

32
Q

Side effects for Sodium Valproate

A

Depression and suicide
Hepatotoxicity
Hypersensitivity
Blood dyscrasias
Vit D deficiency- bone pain
Pancreatities
Teratogenicity

33
Q

How long can a hypersensitivity reaction take to develop?

A

8 weeks

34
Q

What are the symptoms of a hypersensitivity reaction?

A

Abdominal pain
Jaundice
Dark urine
Rash

LIVER, RASH, FEVER, SOB then Multi organ failure

35
Q

What anti-epileptics cause hypersensitivity reactions

A

carbamzepine
phenobarbital
phenytoin
primidone
lamotrigine
Lacosamide
Rufinamide
Oxecarbazepine
CP3L2RO

36
Q

What anti-epileptics cause skin rash

A

Lamotrigine- steven johnson syndrom

37
Q

What anti-epileptics cause Bloody dyscrasias

A

Carbamazepine, Valproate, Ethosuximide, Topiramzte, Phenytoin, Lamotrigine, Zonisamide
C VET PLZ

38
Q

What anti-epileptics cause eye disorders

A

Vigabatrin (reduced visual field)
Topiramate (secondary glaucome)

39
Q

What anti-epileptics cause Encephalopathy

A

Vigabatrin

40
Q

What anti-epileptics cause respiratory depression

A

Gabapentin and Pregabalin

41
Q

What’s carbamazepine’s therapeutic range?

A

4-12 mg/L

42
Q

Whats the signs of carbamazepine toxicity?

A

HANDBAG
Hyponatraemia, Ataxia, nystagmus, Drowsiness, Blurred vision, Arrhythmias, GI disturbances

43
Q

Whats the therapeutic range of phenytoin?

A

10-20 mg/L

44
Q

Whats the signs of Phenytoin toxicity?

A

SNACHD
Slurred speech, Nystagmus, Ataxia, Confusion, Hyperglycaemia, Double vision

45
Q

Key points of anti-epileptics during pregnancy

A

The risks of harm to mother and baby from a convulsive seizure outweighs the risk of continued therapy.
Folic acid can reduce the risk of neural tube defects
Vit K injection administered at brith to minimise risk of neonatal haemorrhage
Most risk: Sodium valproate
Topiramate can cause cleft palate

46
Q

Key points of anti-epileptics and breastfeeding

A

Encouraged to breastfeed
High presence in milk: Primidone, Ethosuximide, Lamotrigine, Zonisamide
Risk of drowsiness: Primidone, Phenobarbital, Benzydiazepines
Withdrawal effects: Phenobarbital, primidone, Benzodiazepines and lamotrigine

47
Q

Enzyme inducing anti-epileptics:

A

Carbamazepine
Oxcarbazepine
Phenobarbital
Phenytoin/Fosphenytoin
Primidone
Topiramate

48
Q

Definition of an absence seizure

A

Abrupt loss of awareness for a short period

49
Q

Definition of a myoclonic seizure

A

Seizure involving a group of muscles causing jerking motions

50
Q

Definition of a tonic clonic seizure

A

Seizures involving stiffening (tonic) or sudden relaxation (atonic) of muscles

51
Q

Definition of focal seizures

A

Start in one part of the brain and affect the corresponding side of the body

52
Q

What are the MHRA warnings for carbamazepine?

A

Prescribe a specific brand
Risk of suicidal thoughts
Risk of congenital malformations in pregnancy
Risk of steven johnsons syndrome in presence of certain allele that can be found in chinese or thai origin - should always test patients from malaysia and phillipines.

53
Q

Key points of phenytoin

A

Narrow therapeutic index drug and follows non linear kinetics. Small change in dose can result in a large change in blood levels.
Drug monitoring in patients with epilepsy is not routinely performed.
Anti-folate

54
Q

What is the optimum plasma levels for phenobarbital?

A

15-40mg/L

55
Q

Patient and carer advice for phenobarbital?

A

28 days to collect prescription from the date prescribed
Consider vitamin D supplementation for immobilised patients or those who have inadequate sun exposure or dietary intake of calcium

56
Q

What is the % risk of someone on sodium valproate having teratogenicity?

A

30-40%

57
Q

What teratogenicity can topiramate cause?

A

Neurodevelopmental disabilities
Cleft lip

58
Q

What are the two benzodiazepines licensed in epilepsy?

A

Clonazepam and Clobazam

59
Q

What type of seizure can lamotrigine exacerbate?

A

Myoclonic

60
Q

What drugs exacerbate generalised seizures?

A

Carbamazepine, Pregabalin, Gabapentin

61
Q

What other indications is carbamazepine licensed for?

A

Trigeminal neuralgia
Bipolar if unresponsive to lithium
Diabetic neuropathy
Alcohol withdrawal

CNS (15 decks)

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