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CNS > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Which antiepileptic drugs can be given once daily at bedtime?

A

LPPP (LP3)

  1. Lamotrigine
  2. Perampanel
  3. Phenobarbital
  4. Phenytoin
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2
Q

What must be done when changing epileptic drugs?

A

Introduce the 2nd drug, so the patient is taking two drugs together.
Then slowly withdraw first drug only when new regimen has been established.

Avoid abrupt withdrawal. May cause rebound seizures.

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3
Q

Why is the use of 2 or more epileptic drugs avoided?

A

Using 2 or more epileptic drugs together will increase the chance of side effects and drug interactions.

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4
Q

What should be done is combination therapy is unsuccessful?

A

Revert back to the regimen (monotherapy or combination) that provided the best balance between tolerability and efficacy.

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5
Q

What are the MHRA / CHM advice for epileptic drugs?

A

There’s a potential harm in switching patients that are established on brands for epilepsy, to generic products.

Antiepileptic drugs are divided into 3 risk categories to help decide if continuity is essential or not.

And all antiepileptic drugs may be associated with a small increased risk of suicidal thoughts and behavior - symptoms can occur 1 week after starting medication - seek medical advice is any mood changes, distressing thoughts, feelings about suicide or self harm occurs.

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6
Q

What must be done for category 1 of epileptic drugs?

A

Maintain patients on specific brands (only when used for epilepsy and not other conditions) e.g. carbamazepine does not have to be prescribed by brand if it’s being used for prevention of Bipolar

Report yellow card drugs - report any suspected adverse reactions to antiepileptic drugs.

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7
Q

Why can’t you switch brands for some epileptic drugs?

A

Because different formulations of oral preparations may vary in bioavailability.

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8
Q

Which antiepileptic drugs need to be maintained on a specific brand (category 1)?

A

CP3

  • Carbamazepine (Tegretol, Carbagen (retard & IR)
  • Phenytoin (Epanutin)
  • Phenobarbital
  • Primidone
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9
Q

What must be noted for category 2 of epileptic drugs?

A

The need for continuity depends on clinical judgement & consultation with patient/carer.

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10
Q

Which drugs are category 2?

A
  • Lamotrigine
  • Topiramate
  • Valproate
  • Clobazam
  • Clonazepam
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11
Q

What must be done for category 3 of epileptic drugs?

A

No need for maintenance on specific brand, except concerns for patient anxiety, risk of confusion & dosing errors.

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12
Q

Examples of category 3 drugs?

A
  • Levetiracetam
  • Gabapentin
  • Pregabalin
  • Vigabatrine
  • Ethosuximide
  • Tiagabine
  • Brivaracetam
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13
Q

What is Antiepileptic hypersensitivity syndrome?

A

Side effects that occur with certain epileptic drugs, in the first few months.

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14
Q

Which drugs can cause Antiepileptic hypersensitivity syndrome?

A

Carbamazepine, Phenytoin, Primidone (CPr3) + rufinamide, lamotrigine, lacosamide.

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15
Q

What are the symptoms of Antiepileptic hypersensitivity syndrome?

A

Fever, rash, liver dysfunction, renal & pulmonary abnormalities & multi-organ failure.

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16
Q

What should be done if patient has Antiepileptic hypersensitivity syndrome?

A

Stop the drug immediately and refer to GP if any symptoms occur

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17
Q

Interactions for antiepileptic drugs

A

Learn enzyme inducers and enzyme inhibitors

18
Q

What are the rules Epilepsy?

A
  • Withdraw under specialist supervision
  • Do not withdraw abruptly as can cause severe rebound seizures
  • Reduce gradually over at least 2-3 months, by reducing daily dose by 10-25% at intervals for 1-2 weeks.
  • If using more than 1 drug, withdraw one drug at a time
19
Q

Which antiepileptic drugs are most likely to cause seizures?

A

Benzodiazepines & Barbiturates

20
Q

Which antiepileptic drug can take over 6 months to withdraw?

A

Benzodiazepines

21
Q

What is the DVLA driving advice for epileptic patients?

A

If a driver has a seizure of any type, stop driving immediately and inform DVLA

Patients with a first unprovoked epileptic seizures (no known cause) or a single isolated seizure, stop driving for 6 months

Patients with established epilepsy may driving if they are not a danger to the public and compliant with treatment and follow up.

To continue driving, patients must be seizure free for at least a year - and also NOT have a history of unprovoked seizures.

22
Q

What is the DVLA driving rules for epileptic patients, when changing medication and withdrawing?

A

Patients are not allowed to drive during medication changes or withdrawal of antiepileptic drugs and for 6 months after their last dose.

If a seizure occurs due to a change or withdrawal of antiepileptic drug, driving license is revoked for 1 year

23
Q

When is driving revoked for 6 months?

A
  • If 1st unprovoked seizures occur
  • If single isolated seizure occurs
  • If dose changes or medication occurs
24
Q

When is driving revoked for 1 year?

A

Seizure due to drug change or withdrawal

25
Q

When should driving be stopped immediately?

A

Any seizure, any type

26
Q

Is there a risk in pregnancy with epileptic drugs?

A

There’s an increased risk of teratogenicity with antiepileptic drugs especially during 1st trimester and particularly if patient takes 2 or more antiepileptic drugs.

27
Q

Which anti-epileptic drug has the highest risk in pregnancy and what risk?

A

Valproate is associated with the highest risk of serious developmental disorders (up to 30-40% risk) and congenital malformations.

So Valproate must not be used in pregnant women or females of childbearing age - unless PPP conditions are met or there’s no alternative.

28
Q

What must Pharmacist do when dispensing Valproate?

A
  • Ensure the medicine has a warning label.
  • Make sure patients have the valproate patient guide and have spoken to their GP or specialist to discuss their treatment and the need for contraception
  • Discuss risk of pregnancy each time it’s dispensed.
29
Q

What contraceptive methods should be used for patients taking antiepileptic drugs?

A

At least one highly effective method of contraception OR two complementary forms of contraception including a barrier method.

30
Q

Examples of highly effective contraceptions?

A
  • Copper intrauterine device
  • Levonorgestrel intrauterine system
  • Progestogen-only contraceptive implant
31
Q

Which drugs have an increased risk in Pregnancy?

A
  • Carbamazepine
  • Phenytoin
  • Phenobarbital
  • Primidone
  • Lamotrigine

Topiramate carries increased risk of congenital malformations (like cleft palate) if taken in 1st trimester.

32
Q

What should be advised to women wanting to get pregnant, before and after getting pregnant?

A

Advice folate supplementation before conception and throughout 1st trimester, to reduce risk of neural tube defects

33
Q

Which drugs should be adjusted during pregnancy?

A

Doses of:
- Phenytoin
- Carbamazepine
- Lamotrigine
should be adjusted during pregnancy

34
Q

Which drug requires special monitoring when pregnant?

A

Topiramate - monitor fetal growth with patients on this medication

35
Q

Can new-borns have withdrawal effects?

A

Yes, it especially occurs with benzodiazepines & phenobarbital

36
Q

What must be given to new borns?

A

They must be given routine injection of VIT K, to minimize risk of neonatal haemorrhage associated with antiepileptics

37
Q

Which antiepileptic patients need to be monitored?

A

Monitor all patients on antiepileptics

38
Q

Which therapy should be used for breastfeeding?

A

Monotherapy

39
Q

Which antiepileptic drug causes drowiness in breastfed babies?

A
  • Primidone
  • Phenobarbital
  • Benzodiazepines

There’s a caution required

40
Q

Can withdrawal effects occur with breastfed babies?

A

Yes, if mother suddenly stops breastfeeding

Particularly if she’s taking: Phenobarbital, Primidone or Lamotrigine

41
Q

What should be monitored in breastfed babies?

A

Monitor all infants for:
- Sedation
- Feeding difficulties
- Adequate weight gain
- Developmental milestone

CNS (14 decks)

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