Epilepsy Flashcards
Name the 4 antiepileptics that can be given once daily at night due to their long half-lives
Parampanel, Lamotrigine, Phenobarbital, Phenytoin
Which risk category does gabapentin fall into in terms of keeping with the same manufacturer when supplying antiepileptics?
Category 3- Not necessary to provide same manufacturer
Which risk category does lamotrigine fall into in terms of keeping with the same manufacturer when supplying antiepileptics?
Category 2
Which risk category does sodium valproate fall into in terms of keeping with the same manufacturer when supplying antiepileptics?
Category 2- Based on clinical judgement and patient circumstances
Which risk catergory does carbamazepine, phenobarbital, phenytoin, and primidone fall into in terms of keeping with the same manufacturer when supplying antiepileptics?
Category 1- Manufacturer must be kept the same when supplying
When are symptoms likley to develop in antiepilepsy hypersensitivity syndrome?
Between 1-8 weeks after exposure to drug
Name the symptoms of antiepilepsy hypersensitivity syndrome
Rash, fever, and lymphadenopathy most likley to occur, but multi-organ failure can occur when serious
How is antiepilepsy hypersensitivity syndrome treated?
Withdrawal of causative drug and no further re-occurence to drug
When can withdrawal of antiepileptics be considered?
If seizure free after 2 years
How are antiepileptics withdrawn?
Withdrawn over 3 months (benzodiazepines and barbiturates longer).
If on multiple epileptics, should be withdrawn one at a time.
Which classes of antiepileptics are associated with severe rebound seizures?
Barbiturates and benzodiazepines
How long does the DVLA recommend not driving for after an unprovoked epileptic seizure or a single isolated seizure?
6 months
What criteria do people with epilepsy have to meet to be permitted to drive?
- seizure free for 1+ years OR
- confirmed history of seizures that do not effect level of conciousness/ ability to act.
- Must not have history of unprovoked seizures.
How long is a person not permitted to drive for following a withdrawal of epilepsy treatment?
6 months after their last dose
Which trimester is the highest risk of teratogenicity when using anti-epileptics?
first trimester
Which 4 antiepileptics demonstrate the highest risk of major congenital abnormalities in the foetus?
Carbamazepine, phenytoin, topiramate, and phenobarbital
Why is folic acid recommended in the 1st trimester for a pregnant patient taking antiepileptics?
To prevent neural tube defects
Which 2 antiepileptics are particularly affected by physiological changes during pregnancy and post-partum?
Lamotrigine + phenytoin
What assessment must a pregnanct patient have if experiencing seizures in the seconf trimester?
eclampsia assessment
Which therapy reduces the risk of neonatal haemorrhage associated with antiepileptic use?
Vitamin K given at birth
Which type of seizure may lamotrigine exacerbate?
myoclonic seizure
First line therapy for focal seizures
Levetiracetam/ Lamotrigine
First line therapy for in pregnancy for epilepsy
Lamotrigine
Second-line therapy for focal seizures
carbamazepine, oxcarbamazepine, zonisamide
Third-line therapy for focal seziures
Lacosamide
Fourth line therapy for focal seizures
Adjunctive treatment with 1st, 2nd, and 3rd line agents + topiramate
First line therapy for generalised tonic-clonic seizure
Sodium valproate if unable to have children
Second-line therapy for generalised tonic-clonic seizure
Lamotrigine/Levetiracetam
Third-line therapy for generalised tonic-clonic seizure
Adjunctive therapy with 1st, 2nd, 3rd line options + perampanel, clobazam, topiramate.
First-line therapy for absence seizures
ethosuximide
Second-line therapy for absence seizures
sodium valproate if unable to have children- as monotherapy or adjunct
First-line therapy for myoclonic seizures
sodium valproate
Third-line therapy for absence seizures
Levetiracetam or Lamotrigine as monotherapy or adjunct
Second-line therapy for myoclonic seizures
Levetiracetam
Why is lamotrigine not used in myoclonic seizures?
Can exacerbate the seizure
First-line therapy for atonic or clonic seizures
sodium valproate
Second-line therapy for atonic or clonic seizures
Lamotrigine
What is first line therapy in epilepsy syndromes such as dravet and lennox-gastaut syndrome?
Sodium valproate irrespective of being female- due to seriousness of conditions
How are febrile convulsions treated?
Anti-pyretics used to bring temp down
Treated as status epilepticus if lasts 5+ minutes
What is 1st line therapy in status epilepticus if patient does not have an emergency management plan in place?
buccal midazolam or rectal diazepam.
Lorazepam if IV access and resuscitation equipment available (can give a second dose in 5-10 mins if no response)
Second line options in status epilepticus?
phenytoin, levetriacetam, sodium valproate, phenobarbital
Third-line option in status epilepticus?
general anaesthesia
What is the definition of prolonged convulsive seizure?
seizure lasting 2+ minutes more than a patient’s normal seizure
What is the definition of repeated/ cluster seizures?
3+ seizures in 24 hours
What condition is oral phenytoin contraindicated in?
Acute porphyrias
What conditions is IV phenytoin contrainidicated in?
2nd/3rd degree heart block, stokes-adams syndromes, sino-atrial block, and sinus bradycardia
What monitoring is needed when giving IV phenytoin?
ECG and BP monitoring
How long a gap should there be between phenytoin and enteral feeds?
2 hours either side of dose
What common side effects are associated with phenytoin?
vitamin d deficiency and electrolyte disturbances
Why should IM phenytoin not be given?
Slow and erratic absorption
What is the relationship between plasma drug concentrations and dose of phenytoin?
Non-linear
What symptoms would raise red flags for a patient taking carbamazepine?
fever, rash, bleeding, bruising, mouth ulcers due to risk of leucopenia
Name the contra-indications of carbamazepine
Acute porphyrias, AV conduction abnormalities, history of bone marrow suppression
Which anti-epileptics are particualrly associated with a high risk of steven johnsons syndrome?
Carbamazepine, Levetriacetam, Phenytoin, Phenobarbital
Which-anti-eplileptic should be withdrawn in cases of acute liver disease, or aggravated liver disease?
Carbamazepine
Which anti-eplieptic has an increased risk of cutaneous adverse reactions with it’s use?
Carbamazepine
