epilepsy

Question 1

must Rx by brand

Answer 1

phenytoin
carbamazepine
phenobarbital

Question 2

use clinical judgement whether to Rx by brand or not

Answer 2

lamotrigine
topiramate
valproate
clobazam

Question 3

don’t need to Rx by brand

Answer 3

gabapentin
pregabalin
levetiracetam
lacosamide

Question 4

usual levels for phenytoin

Answer 4

10 - 20 mg/L

Question 5

Sx of phenytoin toxicity

Answer 5

ataxia (loss of co-ordination)
hyperglycaemia
nystagmus
pin point pupils
diplopia

Question 6

when would SJS/toxic epidermal necorsis usually occur

Answer 6

first 8 weeks of Tx (more common with LTG & LEV)

Question 7

fatigue, nausea, dark urine, rash & itching taking AEDs

Answer 7

• could be hepatotoxicity
• common with CBZ, PHY, VAL
• need LFTs, look at serum transaminases (mildly elevated usually)
• may need to stop Tx

Question 8

AEDs that have common s/e of hepatotoxicity

Answer 8

carbamazepine
phenytoin
valproate

Question 9

safest AEDs in pregnancy

Answer 9

lamotrigine

levetiracetam

Question 10

ciprofloxacin and epilepsy

Answer 10

• interaction with epilepsy
• reduces seizure threshold
• better choice = rifampicin (eg if for meningitis)

Question 11

1st line for meningitis prophylaxis

Answer 11

ciprofloxacin 500mg stat dose

Question 12

alternative for meningitis prophylaxis for epileptic patient (instead of ciprofloxacin 500mg stat dose)

Answer 12

rifampicin 600mg BD for 2 days

(caution with contraceptives)