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PR - CNS > EPILEPSY > Flashcards

EPILEPSY Flashcards

1
Q

What is epilepsy?

A

Common condition that affects the brain and causes frequent seizures

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2
Q

What are the types of seizures?

A
  1. Focal
  2. Generalised
  3. Status epilepticus
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3
Q

What is a FOCAL seizure?

A
  • Affects one hemisphere
  • Can become generalised
  • Patient aware they are having a seizure
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4
Q

What is a GENERALISED seizure?

A
  • Can affect both hemispheres
  • Typically associated with impaired awareness (unconscious, pt may not know they’ve had a seizure)
    o Tonic clonic
    o Absence
    o Atonic
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5
Q

What is the FIRST line treatment for FOCAL seizures?

A

Lamotrigine
Levetiracetam

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6
Q

What is the SECOND line treatment for FOCAL seizures?

A

Carbamazepine
Oxcarbazepine
Zonisamide

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7
Q

What is the treatment for TONIC CLONIC seizures?

A
  1. SV
  2. L/L
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8
Q

What is the treatment for ABSENCE seizures?

A
  1. E
  2. SV
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9
Q

What is the treatment for ABSENCE + OTHER seizures?

A
  1. SV
  2. L/L
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10
Q

What is the treatment for MYOCLONIC seizures?

A
  1. SV
  2. Levetiracetam
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11
Q

What is the treatment for ATONIC/TONIC seizures?

A
  1. SV
  2. Lamotrigine
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12
Q

Should women take first or second line?

A
  • Women to take second-line option if at child bearing potential age – currently or in the future.
  • Except for in absence
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13
Q

What is SUDEP?

A

Sudden Unexpected Death in Epilepsy (SUDEP)
* Rare
* Person dies during or following seizure

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14
Q

What are the risk factors for SUDEP?

A
  • Uncontrolled/poorly controlled seizures
  • Frequent seizures
  • Nocturnal seizures
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15
Q

What is the non-pharmacological treatment for management of seizures?

A
  • Write seizure in a seizure diary: date, time, brought on by any certain activity, day time, night time
  • Protect from injury
  • Do not restrain them or put anything in their mouth
  • Check airways and place in recovery position
  • Observe until recovered
  • Examine for injuries
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16
Q

What is status epilepticus?

A

Seizure last more than 5 mins/ recurrent seizure with no recovery

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17
Q

FIRST line treatment of SE in community

A

Buccal midazolam or
PR diazepam

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18
Q

FIRST line treatment of SE in hospital

A

IV lorazepam

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19
Q

What do we give if there is no response within 5-10 mins of first line treatment for SE?

A

NO RESPONSE within 5-10mins of 1st dose = 2nd DOSE

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20
Q

SECOND line treatment of SE

A

LEVETIRACETAM, PHENYTOIN, SV
- If no response, try a different 2nd line
- If still no response = phenobarbital or
general anaesthesia

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21
Q

When would you call an ambulance for SE?

A
  • Call ambulance for urgent hospital admission if seizures DO NOT respond promptly to treatment
  • Call an ambulance for urgent hospital admission if seizures DO respond to treatment but:
    a. Seizures were prolonged or recurrent before treatment
    b. High risk of recurrence
    c. Difficulties monitoring persons conditions
    d. First seizure
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22
Q

Category 1 AEDs

A
  • Carbamazepine
  • Phenobarbital
  • Phenytoin
  • Primidone
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23
Q

Category 2 AEDs

A
  • Clobazam
  • Clonazepam
  • Lamotrigine
  • Oxcarbazepine
  • Perampanel
  • Rufinamide
  • Topiramate
  • Valproate
  • Zonisamide
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24
Q

Category 3 AEDs

A
  • Brivaracetam
  • Leveiracetam
  • Ethosuximide
  • Gabapentin
  • Lacosamide
  • Pregabalin
  • Tiagabine
  • Vigabatrin
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25
Q

Which drugs interact with AEDs to cause hepatotoxicity?

A
  • amiodarone
  • itraconazole
  • macrolides (mycins)
  • alcohol
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26
Q

Which AEDs are CYP enzymes INDUCERS?

A
  • carbamazepine
  • phenytoin
  • phenobarbital
27
Q

Phenytoin as an enzyme inducer

A

Reduces conc of
- hormonal concentreptive/ HRT
- warfarin
- levothyroxine

Causes increased antifolaxe effect with methotrexate and trimethoprim

28
Q

Which drugs interact with AEDs to lower seizure threshold?

A

o Tramadol
o Theophylline
o Quinolones

29
Q

What are the SFx of Carbamazepine?

A
  • Oedema
  • Hyponatraemia
30
Q

What drugs should you avoid with carbamazepine?

A

Hyponatraemic drugs
- SSRIS
- Diuretics

31
Q

What are the SFx of Phenytoin?

A
  • Antifolate reaction
  • Coarsening appearance e.g. gingivitis + facial hair
32
Q

What drugs should you avoid with Phenytoin?

A

Anti-folates
- methotrexate
- trimethoprim

can lead to blood dyscrasias

33
Q

What is blood dyscrasia

A

An imbalance of the four bodily fluids - blood, bile, lymph, phlegm

34
Q

AEDs SFx general

A
  • Depression + suicide
  • Hepatotoxicity
  • Hypersensitivity: CPPPLamo
  • Blood dyscrasia: C,V,E,T,Phen,Lamo,Z (C VET PLZ)
  • Vit d def
  • Skin rash e.g. stevens-johnsons syndrome: lamotrigine
  • Eye disorder
    o Vigabatrin (reduces visual field)
    o Topiramate (secondary glaucoma)
  • Encephalopathy: Vigabatrin
  • Respiratory depression: Gabapentin, pregabalin
35
Q

What is the therapeutic range for carbamazepine?

A

4-12mg/L

36
Q

What is the therapeutic range for Phenytoin?

A

10-20mg/L

37
Q

What are the signs of toxicity of carbamazepine?

A

Hyponatraemia
Ataxia
Nystagmus
Drowsiness
Blurred vision
Arrythmias
Gastrointestinal disturbances

38
Q

What are the signs of toxicity of Phenytoin?

A

Slurred speech
Nystagmus
Ataxia
Confusion
Hyperglycaemia
Double vision

39
Q

What AEDs cause blood dyscrasia?

A

Carbamazepine
Valproate
Ethosuxidimide
Topiramate
Phenytoin
Lamotrigine
Zonisamide

C VET PLZ

40
Q

Which AED reduces visual field?

A

Vigabatrin

41
Q

Which AED causes encephalopathy?

A

Vigabatrin

42
Q

Which AED can cause secondary glaucoma

A

topiramate

43
Q

Which AEDS can cause respiratory depression

A

Gabapentin
Pregabalin

44
Q

When would you consider Vit D supplementation in epileptic patients

A
  • In those who are immobilised for long period of time
  • Inadequate sun exposure or dietary intake of Ca
45
Q

Monitoring for AEDs

A
  • Test for HLA-B* 1502 allele in individuals of Han Chinese or Thai origin - Risk of SIS
  • Plasma conc
  • Renal
  • Hepatic
46
Q

What is the dose equivalence between phenytoin sodium and the phenytoin base

A

100mg of phenytoin sodium is approx equivalent in therapeutic effect to 92mg phenytoin base

47
Q

Driving with epilepsy: 1st unprovoked/ single isolated

A
  • Driver must stop immediately and inform the DVLA
  • must not drive for 6 months
48
Q

Driving with epilepsy: established epilepsy

A

o 1 year (or pattern of seizures established for 1 year with no impact on consciousness)

49
Q

Driving with epilepsy: seizure while asleep

A

o Not permitted to drive for 1 yr

50
Q

Driving with epilepsy: med change withdrawal

A

o Should not drive for 6 months after last dose
o Seizure occurs: license revoke for 1 year, reinstated after 6 months if treatment resumed and no further seizures occurred

51
Q

Teratogenicity and sodium valproate

A
  • Increased risk of teratogenicity associated with the use of AEDs
    o Valproate highly teratogenic
    o Congenital malformations and neurodevelopmental disorders
52
Q

What are safer alternative to sodium valproate

A

lamotrigine
levetiracetam

53
Q

What is the risk to babies of topiramate

A

cleft palate

54
Q

Folic acid in pregnancy

A

reduces the risk of neural tube defects in 1st trimester

55
Q

Vitamin K injection in pregnancy

A

administered at birth to minimises risk of neonatal haemorrhage
o Phytomenadione

56
Q

What should infants be monitored for

A

o Sedation
o feeding difficulties
o adequate weight gain
o developmental milestones

57
Q

BREASTFEEDING: high presence in breast milk

A

Primidone, Etho, Lamo, Z (PELZ)

58
Q

BREASTFEEDING: Risk of drowsiness

A

Primidone, Phenobarbital, Benzodiazepines

59
Q

BREASTFEEDING: Withdrawal effects

A

Phenobarbital, Primidone, Benzodiazepines, Lamotrigine

60
Q

AEDS and suicidal thoughts and behaviour

A
  • Symptoms may occur as early as 1 week after starting treatment.
  • Patients advised to seek medical advice of any mood changes, distressing thoughts, or feelings about suicide or self-harming develop
60
Q

Antiepileptic hypersensitivity syndrome

A

Rare
* Potentially fatal syndrome associated with:
o carbamazepine lacosamide, lamotrigine, oxcarbazepine, phenobarbital, phenytoin, primidone, and rufinamide

61
Q

When do symptoms of Antiepileptic hypersensitivity syndrome begin to present?

A

Symptoms start between 1 and 8 weeks of exposure

62
Q

What are the symptoms of Antiepileptic hypersensitivity syndrome

A

fever, rash, and lymphadenopathy
* If signs hypersensitivity syndrome occur, the drug should be withdrawn.

PR - CNS (61 decks)

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