Epilepsy

Question 1

What is first line treatment for focal seizures?

Answer 1

lamotrigine or levetiracetam
got to take 2 L’s to get focused

Question 2

what is the second line treatment for focal seizures?

Answer 2

carbamazepine, oxcarazepine, zonisamide

Question 3

what is the first line treatment for generalised seizures? tonic-clonic, absence (with other seizures too), myoclonic, atonic, tonic

Answer 3

sodium valoporate

Question 4

what is first line treatment for generalised seizures for absence alone)?

Answer 4

ethosuximide

Question 5

who shouldn’t be started on sodium valproate?

Answer 5

anyone women of child bearing age or men under 55 without the guidance of 2 specialist when nothing else has worked

Question 6

what is second line treatment for generalised seizures? tonic-clonic, absence (with other seizures too), myoclonic, atonic, tonic

Answer 6

lamotrigine or levetiracetam

Question 7

what’s status epileptics?

Answer 7

a seizure lasting longer than 5mins

Question 8

what is the treatment for status epileptics?

Answer 8

provide resuscitation and immediate emergency treatment
-some patients have individualised emergency management plan that is available
-some don’t

Question 9

what is the treatment for status epileptics?

Answer 9

-seizures lasting longer than 5mins: IV lorazepam (if resuscitation facilities are available ) or buccal midazolam or renal diazepam (if in community)

Question 10

what happened if seizure doesn’t stop within 5-10mins of first dose?

Answer 10

give second dose
if seizure fails to respond after 2 benzodiazepine doses: levetiracetam, phenytoin, sodium valproate

Question 11

what happens if seizure fails to respond after this too?

Answer 11

phenobarbital or general anesthesia

Question 12

what does the different categories of anti-epileptic drugs describe?

Answer 12

the level of accuracy that you have to dispense the drugs at

Question 13

what is category 1of anti-epileptic drugs?

Answer 13

-ensure maintained on specific brands for carbamazepine, phenobarbital, phenytoin, primidone

Question 14

what is category 2 of anti-epileptic drugs?

Answer 14

maintaining specific brand based on clinical judgement with patients factors considered
-clobazem, clonazepam, lamotrigine, oxcarbazepine, perampanel, rufinammide, topiramate, valproate, zonisamide

Question 15

what is a category 3 anti-epileptic drugs?

Answer 15

-no need to maintain specific brand
-brivaracetam, ethosuximide, gabapentin, lacosamide, levetiracetam, pregabalin, tiagabine, vigabatrin

Question 16

what are some of the high risk anti-epileptic drugs?

Answer 16

carbamazepine, phenytoin, sodium valproate

Question 17

what are the main information to know for carbamazepine, phenytoin and sodium valproate?

Answer 17

-all hepatotoxic
-all work on the CYP enzyme: ~inducer =phenytoin, phenobarbital and carbamazepine (induces the CYP enzyme to work more
~inhibitor= sodium valproate
- drugs that lower seizure threshold= tramadol, theophylline, quinolones

Question 18

what affectes does carbamazepine have on other drugs?

Answer 18

can cause hyponatraemia (like SSRIs, dietetics), oedema

Question 19

what type of reaction does phenytoin cause?

Answer 19

anti-folate (like methotrexate, trimethoprim)

Question 20

what are some side effects of carbamazepine ?

Answer 20

hyponatraemia and odema

Question 20

what are the main side effects of carbamazepine, phenytoin and sodium valproate?

Answer 20

-depression+suicide
-hepatoxicty
-hypersensitivity
-blood dyscrasia
-vitamin D deficiency (presented as bone pain)

Question 21

what are some side effects of phenytoin?

Answer 21

coarsening appearance and facial hair

Question 22

what are some side effects of sodium valporate?

Answer 22

pancreatitis and teratogenic

Question 23

what anti-epileptic drugs can cause hypersensitivity?

Answer 23

-carbamazepine, phenobarbital, phenytoin, primidone, lamotrigine

Question 24

what anti-epileptic drugs can cause skin rashes?

Answer 24

-lamotrigine can cause stevens-johnson syndrome

Question 25

what anti-epileptic drugs can cause blood dyscrasia?

Answer 25

carbamazepine, valoporate, ethosuximide, topiramate, phenytoin, lamotrigine, zonisamide (C.VET,PLZ)

Question 26

what anti-epileptic drugs can cause eye disorders?

Answer 26

vigabatrin (reduced visual field). topiramate (secondary glaucoma)

Question 27

what anti-epileptic drugs can cause encephalopathy?

Answer 27

vigabatrin

Question 28

what anti-epileptic drugs can cause respiratory depression ?

Answer 28

gabapentin, pregabalin

Question 29

what is the therapeutic range and what are the signs of toxicity for carbamazepine?

Answer 29

-range= 4-12mg/L SOT -Hyponatraemia -Ataxia -Nystagmus -Drowsiness -Blurred vision -Arrhythmias -Gastroinestinal disturbance

Question 30

what is the therapeutic range and what are the signs of toxicity for phenytoin?

Answer 30

range: 10-120mg/L SOT -Slurred speech Nystagmus Ataxia Confusion Hyperglycaemia Double vision

Question 31

what are the rules of driving and epilepsy?

Answer 31

-must stop driving and immediately let DVLA know -first unprovoked /single isolated stop driving for 6months -established epilepsy stop for 1 year to be fit free -medication change/withdrawal: should not drive for 6 months after last dose, seizure occurs due to change: licence revoked for 1 year, reinstated for after 6 months if treatment resumes and no further seizures occurs

Question 32

what is the risk of epilepsy and pregnancy?

Answer 32

-risk of harm to mother and foetus from convulsive seizures outweighs the risk of continues therapy -folic acid given reduce the risk of neural tube defects in first trimester -vit K injection given at birth to minis risk of neonatal haemorrhage -most risk drug : sodium valproate (PPP) -topirmate can cause cleft palates

Question 33

what is the information for breast feeding and epilepsy?

Answer 33

-encouraged to breastfeed ( unless on combination therapy/risk factors like premature birth should seek advice) -high presence in milk: Primidone, ethosuximide, lamotrigine, zonisamide -risk of drownsiness: Primidone, phenobarbital, and benzodiazepines -withdrawal effects if mother stops breast feeding with : Primidone, phenobarbital, lamotrigine and benzodiazepines