Epilepsy Flashcards
What is the 1st and 2nd line treatment for Tonic-Clonic seizures?
1st Line: Sodium Valproate
2nd Line: Lamotrigine / Levetiracetam
What are the 1st and 2nd line treatments for Focal Seizures?
1st Line: Lamotrigine or Levetiracetam
2nd Line: Carbmazepine, Oxcarbazepine, Zonisamide
What is the 1st and 2nd line treatment for Absence seizures on their own?
1st Line : Ethosuximide
2nd Line: Sodium Valproate
What is the 1st and 2nd line treatment for Absence seizures along side other types of seizures?
1st Line: Sodium Valproate
2nd Line: Lamotrigine/ Levetiracetam
What is the 1st and 2nd line treatment for Myoclonic seizures?
1st Line: Sodium Valproate
2nd Line: Levetiracetam
What are the 1st and 2nd line treatments for Atonic and Tonic seizures?
1st Line: Sodium Valproate
2nd Line: Lamotrigine
What are the contraception conditions for a male on Sodium Valproate?
Male patients who may father children should use effective contraception during valproate treatment and for at least 3 months after stopping.
What is the 1st Line treatment for Status Epilepticus?
If resuscitation facilities are available e.g hospital - IV Lorazepam
If not available e.g community - Buccal Midazolam or Rectal Diazepam
What are the conditions for Sodium Valpraote to be started in patients under 55?
Two specialists must independently consider and document that there is no other effective or tolerated treatment
If a patients Status Epilepticus seizure does not stop within 5-10mins of first dose of treatment what should be done?
Give second dose
If seizure fails to respond after 2 doses, second line options are:
Levetiracetam (FL), Phenytoin, Sodium Valproate
If seizure fails to respond try a different second line option.
If still not responding, third line options:
Phenobarbital or General Anaesthesia
What are Category 1 Anti-Epileptic Drugs and what do they mean?
Carbamazepine, Phenobarbital, Phenytoin, Primidone (CP3)
Patients must be maintained on a specific brand throughout treatment of these drugs.
What are interactions that occur with Carbamazepine, Phenytoin and Sodium Valproate?
Hepatoxicity with Amiodaron, Itraconazole, Macrolides and Alcohol
Carbamazepine, Phenytoin and Phenobarbital are CYP inducers.
Sodium Valproate - CYP inhibitor
Interact with drugs that lower seizure threshold: Tramadol, Theophylline, Quinolones
What specific interactions occur with Carbamazepine?
Hyponatraemia - SSRI, Diuretics
What specific interactions occur with Phenytoin?
Anti-folate reaction - Methotrexate, Trimethoprim
What side effects occur with Carbamazepine, Phenytoin and Sodium Valproate?
Depression + Suicide (behavioural changes)
Hepatoxicity
Hypersensitivity
Blood Dyscrasia
Vitamin D Deficiency (disguised as bone pain)
What are specific side effects that occur with Carbamazepine?
Hyponatraemia and Oedema
What are specific side effects that occur with Phenytoin?
Coarsening Appearance and Facial Hair
What are specific side effects that occur with Sodium Valproate?
Pancreatitis + Teratogenic effects
Which Anti-Epileptic drugs can cause Hypersensitivity as a side effect?
Carbamazepine. Phenobarbital, Phenytoin, Primidone, Lamotrigine (CP3L)
Which Anti-Epileptic drug can causes Stevens-Johnsons Syndrome as a side effect?
Lamotrigine
Which Anti-Epileptic drugs cause Blood Dyscrasia as a side effect?
Carbamazepine, Valproate, Ethosuximide, Topiramate, Phenytoin, Lamotrigine, Zonisamide (C.VET.PLZ)
Which Anti-Epileptic drugs can cause Eye Disorders as a side effect?
Vigabatrin - reduced visual field
Topiramate - secondary glaucoma
Which Anti-Epileptic drug can cause Encephalopathy as a side effect?
Vigabatrin
Which Anti-Epileptic drugs can cause Respiratory Depression as a side effect?
Gabapentin and Pregabalin
What is the therapeutic range for Carbamazepine and what are the signs of toxicity?
4-12mg/L
Hyponatraemia
Ataxia
Nystagmus
Drowsiness
Blurred Vision
Arrhythmias
Gastrointestinal Distrubances
(HANDBAG)
What is the therapeutic range for Phenytoin and what are the signs of toxicity?
10-20mg/L (same as theophylline)
Slurred Speech
Nystagmus
Ataxia
Confusion
Hyperglycaemia
Double Vision
(SNACHD)
How long must a person stop driving for if they have their first unprovoked or single isolated seizure?
6 Months
How long must a person stop driving for is they have established epilepsy (multiple seizures)?
Must have no seizures for 1 year before starting to drive again.
If a patients epilepsy medication has been changed or stopped how long can they not drive for?
6 months after change in dose or last dose
If a patient has a seizure after their anti-epileptic medication has been changed or stopped how long is their license revoked for?
License is revoked for 1 year.
If no seizures occur in 6 months then patient can start driving again.
If a pregant epileptic patient queries that they heard ant-epileptic drugs are not safe for the baby what advise should you provide?
The risk of harm to mother and fetus from convulsive seizures outweighs the risk of continued therapy. Therefore the patient should continue to take their anti-epileptic medication.
What medication is given to pregnant women to prevent neural tube defects caused by anti-epileptic drugs?
Folic Acid 5mg OD in first trimester
Why is a Vitamin K injection administered at birth to pregnant epileptic women?
Minimises the risk of neonatal haemorrhage
Other than Sodium Valproate, what other Anti-Epileptic medication is contraindicated in pregnancy and women of childbearing potential unless on pregnancy prevention programme?
Topiramate
What is the advice for patients taking Anti-Epileptic medication who are breastfeeding?
If only on one medication Encouraged to breastfeed
If on combination therapy or other risk factors present such as pre-mature birth: Seek advice before breastfeeding
Which Anti-Epileptic drugs have a high presence in breast milk?
Primidone, Lamotrigine, Ethosuximide and Zonisamide
(PELZ)
Which Anti-Epileptic drugs have a risk of drowsiness whilst breastfeeding?
Primidone, Phenobarbital and Benzodiazepines
Which Anti-Epileptic drugs have withdrawal effects (mother suddenly stops breast-feeding)?
Phenobarbital, Primidone, Benzodiazepines and Lamotrigine
