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Central Nervous System > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is the 1st and 2nd line treatment for Tonic-Clonic seizures?

A

1st Line: Sodium Valproate

2nd Line: Lamotrigine / Levetiracetam

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2
Q

What are the 1st and 2nd line treatments for Focal Seizures?

A

1st Line: Lamotrigine or Levetiracetam

2nd Line: Carbmazepine, Oxcarbazepine, Zonisamide

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3
Q

What is the 1st and 2nd line treatment for Absence seizures on their own?

A

1st Line : Ethosuximide

2nd Line: Sodium Valproate

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4
Q

What is the 1st and 2nd line treatment for Absence seizures along side other types of seizures?

A

1st Line: Sodium Valproate

2nd Line: Lamotrigine/ Levetiracetam

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5
Q

What is the 1st and 2nd line treatment for Myoclonic seizures?

A

1st Line: Sodium Valproate

2nd Line: Levetiracetam

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6
Q

What are the 1st and 2nd line treatments for Atonic and Tonic seizures?

A

1st Line: Sodium Valproate

2nd Line: Lamotrigine

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7
Q

What are the contraception conditions for a male on Sodium Valproate?

A

Male patients who may father children should use effective contraception during valproate treatment and for at least 3 months after stopping.

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8
Q

What is the 1st Line treatment for Status Epilepticus?

A

If resuscitation facilities are available e.g hospital - IV Lorazepam

If not available e.g community - Buccal Midazolam or Rectal Diazepam

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9
Q

What are the conditions for Sodium Valpraote to be started in patients under 55?

A

Two specialists must independently consider and document that there is no other effective or tolerated treatment

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10
Q

If a patients Status Epilepticus seizure does not stop within 5-10mins of first dose of treatment what should be done?

A

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

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11
Q

What are Category 1 Anti-Epileptic Drugs and what do they mean?

A

Carbamazepine, Phenobarbital, Phenytoin, Primidone (CP3)

Patients must be maintained on a specific brand throughout treatment of these drugs.

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12
Q

What are interactions that occur with Carbamazepine, Phenytoin and Sodium Valproate?

A

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

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13
Q

What specific interactions occur with Carbamazepine?

A

Hyponatraemia - SSRI, Diuretics

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14
Q

What specific interactions occur with Phenytoin?

A

Anti-folate reaction - Methotrexate, Trimethoprim

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15
Q

What side effects occur with Carbamazepine, Phenytoin and Sodium Valproate?

A

Depression + Suicide (behavioural changes)
Hepatoxicity
Hypersensitivity
Blood Dyscrasia
Vitamin D Deficiency (disguised as bone pain)

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16
Q

What are specific side effects that occur with Carbamazepine?

A

Hyponatraemia and Oedema

17
Q

What are specific side effects that occur with Phenytoin?

A

Coarsening Appearance and Facial Hair

18
Q

What are specific side effects that occur with Sodium Valproate?

A

Pancreatitis + Teratogenic effects

19
Q

Which Anti-Epileptic drugs can cause Hypersensitivity as a side effect?

A

Carbamazepine. Phenobarbital, Phenytoin, Primidone, Lamotrigine (CP3L)

20
Q

Which Anti-Epileptic drug can causes Stevens-Johnsons Syndrome as a side effect?

A

Lamotrigine

21
Q

Which Anti-Epileptic drugs cause Blood Dyscrasia as a side effect?

A

Carbamazepine, Valproate, Ethosuximide, Topiramate, Phenytoin, Lamotrigine, Zonisamide (C.VET.PLZ)

22
Q

Which Anti-Epileptic drugs can cause Eye Disorders as a side effect?

A

Vigabatrin - reduced visual field
Topiramate - secondary glaucoma

23
Q

Which Anti-Epileptic drug can cause Encephalopathy as a side effect?

A

Vigabatrin

24
Q

Which Anti-Epileptic drugs can cause Respiratory Depression as a side effect?

A

Gabapentin and Pregabalin

25
Q
A
26
Q

What is the therapeutic range for Carbamazepine and what are the signs of toxicity?

A

4-12mg/L

Hyponatraemia
Ataxia
Nystagmus
Drowsiness
Blurred Vision
Arrhythmias
Gastrointestinal Distrubances

(HANDBAG)

27
Q

What is the therapeutic range for Phenytoin and what are the signs of toxicity?

A

10-20mg/L (same as theophylline)

Slurred Speech
Nystagmus
Ataxia
Confusion
Hyperglycaemia
Double Vision

(SNACHD)

28
Q

How long must a person stop driving for if they have their first unprovoked or single isolated seizure?

A

6 Months

29
Q

How long must a person stop driving for is they have established epilepsy (multiple seizures)?

A

Must have no seizures for 1 year before starting to drive again.

30
Q

If a patients epilepsy medication has been changed or stopped how long can they not drive for?

A

6 months after change in dose or last dose

31
Q

If a patient has a seizure after their anti-epileptic medication has been changed or stopped how long is their license revoked for?

A

License is revoked for 1 year.
If no seizures occur in 6 months then patient can start driving again.

32
Q

If a pregant epileptic patient queries that they heard ant-epileptic drugs are not safe for the baby what advise should you provide?

A

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.

33
Q

What medication is given to pregnant women to prevent neural tube defects caused by anti-epileptic drugs?

A

Folic Acid 5mg OD in first trimester

34
Q

Why is a Vitamin K injection administered at birth to pregnant epileptic women?

A

Minimises the risk of neonatal haemorrhage

35
Q

Other than Sodium Valproate, what other Anti-Epileptic medication is contraindicated in pregnancy and women of childbearing potential unless on pregnancy prevention programme?

A

Topiramate

36
Q

What is the advice for patients taking Anti-Epileptic medication who are breastfeeding?

A

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

37
Q

Which Anti-Epileptic drugs have a high presence in breast milk?

A

Primidone, Lamotrigine, Ethosuximide and Zonisamide
(PELZ)

38
Q

Which Anti-Epileptic drugs have a risk of drowsiness whilst breastfeeding?

A

Primidone, Phenobarbital and Benzodiazepines

39
Q

Which Anti-Epileptic drugs have withdrawal effects (mother suddenly stops breast-feeding)?

A

Phenobarbital, Primidone, Benzodiazepines and Lamotrigine

Central Nervous System (8 decks)

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