Epilepsy Flashcards
What is epilepsy?
Electrical imbalance that causes epileptic seizures
List drugs that are taken once daily(at bed time)
LP3
Lamotrigine
Phenytoin
Phenobarbital
Perampanel
Why are some drugs taken once daily?
They have longer action/ long half life
What is the criteria of category 1 drugs
Needs to be given on specific brands (only for epilepsy)
List drugs on Category 1
CP3
- carbamazepine (Tegretol, carbagen)
- phenytoin
- phenobarbital
- primidone
All cause hypersensitivity syndrome
What is category 2 drugs?
Need for continuity depends on patient and doctors
List drugs under category 2v
Sodium valproate
Lamotrigine
Clobazam
Clonazepam
Topiramate
What are category 3 drugs?
No need to maintain brands unless pt wants it for confusion, dosing error etc
List category 3 drugs?
Gabapentin
Pregabin
Levetiracetam
Tiagabine
Brivaracetam
Ethosuximide
Vigabatrine
List drugs that cause anti epileptic hypersensitivity syndrome
CP3
Lamotrigine
Lacosimide
Rufinamide
List symptoms of AE HS?
Fever
Rash
Liver dysfunction
Renal & pulmonary abnormalities
Multi organ failure
When do you monitor patient for HS and how long does symptoms start?
First 2 months of starting meds
1 to 8 weeks
What is the MHRA warning when taking AE drugs?
Suicidal thoughts and behavior within 1 week of starting
Benzodiazepines withdrawal period is how long?
6 months or longer
What are the DVLA rules?
-Stop driving immediately and inform dvla if driver has seizures
- if you have unprovoked (unknown) seizures or isolated one - stop driving for 6 months
-established seizures - can drive if there is no harm
- if there is a change of meds or withdrawal don’t drive for 6 months after last dose
- if seizure occurs during that change- hold license for 1 year
What happens when you take AE drugs during pregnancy?
Increased risk of teratogenicity especially during 1st trimester
Which drugs has the highest risk during pregnancy and what is the requirement?
Sodium valproate
Must not be used in women of childbearing unless they meet the PpP criteria and no other options
Which drug carries increased risk of congenital malformations and what does it cause?
Topiramate - causes Cleft Palate
Which vitamin should you give at birth yo minimize risk of neonatal haemorrhage?
Vitamin K
List drugs that causes drowsiness in breastfeeding?
Phenobarbital
Primidone
Benzodiazepines
Lamotrigine
What are the two types of seizures
Generalized and focal seizures
What is the first line treatment for all generalized seizure?
Sodium valproate
List the four types of generalized seizures?
Tonic clonic
Absence
Myoclonic
Atonic&tonic
List the drugs that can’t completely be used in the types of generalized seizures except Tonic-clonic seizure?
Carbamezapine
Vigabatrin
Exacerbates symptoms
What is the drugs used for absence seizure?
First line - Sodium valproate or ethosuximide
Alternative- Lamotrigine
(SEAL)
Describe absence seizure?
Mainly in Childress
Brief loss of consciousness, resolves in few seconds
No convulsions
Describe tonic clonic seizure
Body stiffens
Loss of consciousness
Body shakes (convulses)
Loss of bladder/bowel movement
Treatment of tonic clonic seizure
Sodium valproate or carbamazepine/lanotrigine
Describe myoclonic seizures?
Jerking
Muscle contraction - Arm/elbow
List the treatment for myoclonic?
(SALT)
Sodium valproate - first line
Levetiracetam, Topiramate- alternative
Describe tonic-atonic seizure
Brief loss of consciousness
Stiff
Fall to ground
Treatment for tonic-atonic?
(SLART)
Sodium valproate or Lamotrigine - first line
Rufinamide, Topiramate- alternative
List treatment of focal seizure?
Carbamazepine
Lamotrigine
(Cal)
Describe focal seizures
One part of brain
List the two types of focal seizures and explain them
Simple focal seizures- muscle jerk in one arm or leg, no loss of consciousness
Complex focal seizure- consciousness affected
What is status epilepticus?
Seizure that last more than 5 minutes or multiple seizure within 30 mins
What is the treatment of status epilepticus
Diazepam rectal solution
Or
Midazolam oromucosal soln
First seizure - impaired consciousness (Group 1- cars and motor cycles), how long should you avoid driving?
Do not drive for six months
Epileptic seizure - impaired consciousness (Group 1)?
Don’t drive for 1 year
No loss of consciousness seizure?
Seek DVLA advice
First seizure (group two-buses and lorries)
Don’t drive for 5 years
More than one seizure (group 2)
Don’t drive for 10 years
When do you withdraw med after pt is seizure free?
Min 2 years
