Epilepsy Flashcards
Caution & monitoring for sodium valproate
liver toxicity - usually in first 6 months of therapy
What should be considered to prescribed with valproate
vitamin D supplementaion
Signs of hepatic dysfuntion
persistent vomiting, abdo pain, anorexia, jaundice, oedema, malaise, drowsiness or loss of seizure contol
Valproate in pregnancy
NO - teratogenic - highest risk antiepileptic
which antiepileptic drugs (AEDs) can be given once a day at night (4) due to long half life
phenytoin
phenobarbital
perampandel
lamotrigine
Category 1 AED - maintain on same brand
phenytoin
phenobaribital
primidone
carbemazepine
Category 2 AEDs - prescribe by brand at decision of prescirber
Valproate Lamotrigine Perampanel Retigabine rufinamide clobazam clonazepam oxcarbazepine eslicarbazepine zonisamide Topirimate
Category 3 AED - where brand doesnt matter
Levetiracetam Lacosamide Tiagabine Gabapentin Pregabalin Ethosuximide Vigabatrin
Drugs associated with antiepileptic hypersensitivity syndrome
carbemazepine laxosamide lamotrigine oxcarbazepime phenobarbital phenytoin primidone rufinamide
What are the symptoms of antiepileptic hypersensitivity syndrome
when do they start
between 1-8 weeks of exposure
rash, fever, lymphadenopathy
liver dysfunction, haematological, renal and pulmonary adnormalities, vasculitis and multiorgan failure
how long after a dose change should pt not drive
how long after a seizure
how long after no day time seizures but still nightime ones
6 months
1 year
3 years
First choice in focal seizures (2)
carbemazepine/lamotrigine
first choice in absecence seizures (2)
ethosuximide/valproate
First choice in all other types of seizure (1)
sodium valproate
……… increases lamotrigine concentration
valproate
where as the inducing epileptics reduce lamotrigine levels
phenytoin has a narrow theraputic index due to
non linear PK
three treatments for if seizure is lasting more than 5 mins
IV lorazepam
buccal midazolam
rectal diazepam
Carpemazepine monitoring/cautions (3)
blood, hepatic and skin disorders - report fever, rash, mouth ulcers, bruising, bleeding
Warning about the ingredients of gapapentin solution
levels of stuff (propylene glycol, acesulfame K and saccharin sodium) may excede recommend limits of daily intake for children and adults of low body weight
lamotridine cautions (1)
skin reactions - including SJS
