Epilepsy Flashcards
What is first line treatment for focal seizures?
lamotrigine or levetiracetam
got to take 2 L’s to get focused
what is the second line treatment for focal seizures?
carbamazepine, oxcarazepine, zonisamide
what is the first line treatment for generalised seizures? tonic-clonic, absence (with other seizures too), myoclonic, atonic, tonic
sodium valoporate
what is first line treatment for generalised seizures for absence alone)?
ethosuximide
who shouldn’t be started on sodium valproate?
anyone women of child bearing age or men under 55 without the guidance of 2 specialist when nothing else has worked
what is second line treatment for generalised seizures? tonic-clonic, absence (with other seizures too), myoclonic, atonic, tonic
lamotrigine or levetiracetam
what’s status epileptics?
a seizure lasting longer than 5mins
what is the treatment for status epileptics?
provide resuscitation and immediate emergency treatment
-some patients have individualised emergency management plan that is available
-some don’t
what is the treatment for status epileptics?
-seizures lasting longer than 5mins: IV lorazepam (if resuscitation facilities are available ) or buccal midazolam or renal diazepam (if in community)
what happened if seizure doesn’t stop within 5-10mins of first dose?
give second dose
if seizure fails to respond after 2 benzodiazepine doses: levetiracetam, phenytoin, sodium valproate
what happens if seizure fails to respond after this too?
phenobarbital or general anesthesia
what does the different categories of anti-epileptic drugs describe?
the level of accuracy that you have to dispense the drugs at
what is category 1of anti-epileptic drugs?
-ensure maintained on specific brands for carbamazepine, phenobarbital, phenytoin, primidone
what is category 2 of anti-epileptic drugs?
maintaining specific brand based on clinical judgement with patients factors considered
-clobazem, clonazepam, lamotrigine, oxcarbazepine, perampanel, rufinammide, topiramate, valproate, zonisamide
what is a category 3 anti-epileptic drugs?
-no need to maintain specific brand
-brivaracetam, ethosuximide, gabapentin, lacosamide, levetiracetam, pregabalin, tiagabine, vigabatrin
what are some of the high risk anti-epileptic drugs?
carbamazepine, phenytoin, sodium valproate
what are the main information to know for carbamazepine, phenytoin and sodium valproate?
-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
what affectes does carbamazepine have on other drugs?
can cause hyponatraemia (like SSRIs, dietetics), oedema
what type of reaction does phenytoin cause?
anti-folate (like methotrexate, trimethoprim)
what are some side effects of carbamazepine ?
hyponatraemia and odema
what are the main side effects of carbamazepine, phenytoin and sodium valproate?
-depression+suicide
-hepatoxicty
-hypersensitivity
-blood dyscrasia
-vitamin D deficiency (presented as bone pain)
what are some side effects of phenytoin?
coarsening appearance and facial hair
what are some side effects of sodium valporate?
pancreatitis and teratogenic
what anti-epileptic drugs can cause hypersensitivity?
-carbamazepine, phenobarbital, phenytoin, primidone, lamotrigine
what anti-epileptic drugs can cause skin rashes?
-lamotrigine can cause stevens-johnson syndrome
what anti-epileptic drugs can cause blood dyscrasia?
carbamazepine, valoporate, ethosuximide, topiramate, phenytoin, lamotrigine, zonisamide (C.VET,PLZ)
what anti-epileptic drugs can cause eye disorders?
vigabatrin (reduced visual field). topiramate (secondary glaucoma)
what anti-epileptic drugs can cause encephalopathy?
vigabatrin
what anti-epileptic drugs can cause respiratory depression ?
gabapentin, pregabalin
what is the therapeutic range and what are the signs of toxicity for carbamazepine?
-range= 4-12mg/L
SOT
-Hyponatraemia
-Ataxia
-Nystagmus
-Drowsiness
-Blurred vision
-Arrhythmias
-Gastroinestinal disturbance
what is the therapeutic range and what are the signs of toxicity for phenytoin?
range: 10-120mg/L
SOT
-Slurred speech
Nystagmus
Ataxia
Confusion
Hyperglycaemia
Double vision
what are the rules of driving and epilepsy?
-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
what is the risk of epilepsy and pregnancy?
-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
what is the information for breast feeding and epilepsy?
-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
