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Chapter 16 Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Phenobarbitone

A

A) Barbiturate

B)

  1. Epilepsy (Partial, Generalised tonic-clonic, Neonatal and Febrile seizures)
  2. Status Epilepticus (unresponsive to benzodiazepines and phenytoin)

C)
60 - 240 mg ONCE daily at BEDTIME

D)

  1. Therapeutic Drug Monitoring (steady state may not be achieved for 2-4weeks)
  2. Hypersensitivity reactions (rash)
  3. Respiratory Depression
  4. Decreased thyroxine
  5. Renal
  6. Hepatic
  7. Interactions
  8. BMD monitoring
E) 
Labels: 1, 5, 9, 21, A*
#Avoid alcohol (worsen S/E)
S/E: CNS (Sedation, Confusion, Depression, Altered Mood and Behaviour, Cognitive impairment)
Skin (Rash)
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2
Q

Primidone

Mysoline®

A

A) Barbiturate

B)
1. Epilepsy (partial and generalised tonic-clonic)

C)
125 mg nocte - 1.5 g in 2 doses

D)

  1. Hypersensitivity reactions (rash)
  2. Respiratory depression
  3. Thyroxine (decreased)
  4. BMD monitoring
  5. Renal
  6. Hepatic
  7. Interactions
E) 
Labels: 1, 5, 9, 21, A
# Avoid alcohol (worsen S/E)
S/E: CNS (Sedation, Confusion, Depression, Altered Mood and Behaviour, Cognitive impairment)
Skin (Rash)
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3
Q

Clobazam

Frisium®

A

A) Benzodiazepine

B)
1. Epilepsy (refractory)

C)
Initially 5-10 mg NOCTE
Max 60 mg daily (APF23 says 80mg)

D)

  1. Tolerance and Dependence
  2. Periodic blood counts
  3. LFTs
  4. Renal
E) 
Labels: 1, 9
# Avoid Alcohol
S/E: 
CNS (light-headedness, dizziness, dry mouth or headaches) - dizziness may persist into the following day
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4
Q

Clonazepam

Paxam®, Rivotril®

A

A) Benzodiazepine

B)

  1. Epilepsy (refractory)
  2. Status Epilepticus

C)
Initially 0.5 - 1 mg NOCTE
2 - 8 mg daily (in divided doses)

D)

  1. Tolerance and Dependence
  2. Periodic Blood Counts
  3. LFTs

E)
Labels: 1, 9, 21 and A*
S/E:
# May initially cause dizziness and tiredness. These should eventually decrease or disappear.
# Drowsiness and dizziness may persist into the following day
Note: Take this medicine only as often and for as long as your doctor recommends

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5
Q

Diazepam

Valium®

A

A) Benzodiazepine

B)

  1. Acute treatment of seizures (including Status Epilepticus)
  2. Muscle spams
  3. Prevention of RECURRENT febrile seizures

C)
2 - 15 mg daily in divided doses
Max: 60 mg daily

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6
Q

Midazolam

A

Used in IV - don’t worry.

Used for Status Epilepticus

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7
Q

Acetazolamide

Diamox®

A

A) Systemic Carbonic Anhydrase Inhibitor

B)

  1. Epilepsy (menstrual-related, adjunctive or refractory)
  2. Perioperative reduction of intraocular pressure (acute angle-closure crisis)
  3. Chronic open-angle glaucoma (other failed tx)

C)
1. Epilepsy: 4 mg/kg - 30 mg/kg in 3-4 doses
Max: 1g daily
2. Chronic open-angle glaucoma: initially 125 mg BD - 250 mg QID
3. Perioperative decrease in intraocular pressure: 250 - 1 g daily in divided doses

D)

  1. Hepatic (contraindicated)
  2. Renal (dose adjust)
  3. Signs of allergy (rash) and sulfonamide
  4. Tolerance (50% don’t tolerate)
  5. Sodium or Potassium (decreased)
  6. Worsening of Gout

E)
Labels: 10a, 12 and B
#Take tablets with meals to reduce risk of stomach upset
#If you develop signs of an allergic reaction (e.g. rash, itching, red welts on the skin, fever) tell your doctor.
S/E:
NUMBNESS and TINGLING of the extremities and face,
CNS (fatigue, drowsiness and depression),
Unfavourable (decreased libido + metallic taste)

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8
Q

Carbamazepine

Tegretol®

A

A) Anti-epileptic or Mood-stabiliser

B)

  1. Epilepsy (partial and generalised tonic-clonic)
  2. Trigeminal and Glossopharyngeal neuralgias
  3. Bipolar DIsprder

C)
Start: 50-100 mg BD
Usual range: 400 mg - 1.2 g daily (divided doses)
Max: 2 g daily (divided doses)

D)
1. TDM
2. Changes in mood or behaviour
3. Complete Blood Count (bone marrow suppression)**
4. BMD
5. Hypersensitivity and skin reactions **
6. Multi-organ hypersensitivity syndrome **
7. LFTs
8.. Drug interactions
NOT renal

E)
Labels: 5, 9, 12+, 18, A*, B
#May initially cause drowsiness, dizziness, headaches and nausea. Disappears/Decreases with continued use
#Avoid alcohol (increase S/E)
#Tell your doctor immediately if rash, sore throat, fever, mouth ulcers, bruising or bleeding occurs.

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9
Q

Ethosuximide

Zarontin®

A

A) Anti-Epileptic

B)
1. Absence seizures

C)
Start: 250 mg BD
Max: 1.5 g daily (in 2 doses)

D) 
1. TDM (rarely)
2. Complete blood count (leucopenia)
3. Hypersensitivity
NO renal or LFTS

E)
Labels: 1, 9, 21, A*
#Increase the effects of alcohol
#Tell your doctor immediately if fever, sore throat, mouth ulcers, bruising or rash develops.
S/E:
GIT (anorexia, n+v, epigastric pain, weight loss),
CNS (drowsiness, dizziness, headaches)

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10
Q

Gabapentin

Neurontin®

A

A)
Anti-epileptic / Adjuvant analgesic

B)

  1. Partial seizures +/- generalised seizures (adjunctive)
  2. Neuropathic pain
C)
#Epilepsy: 
Start: 300 mg NOCTE
Usual: 900 mg - 1.8 g daily (in 3 doses)
Max: 3.6 g daily
#Neuropathic pain:
Start: 100 mg - 300mg NOCTE
Usual: 1.8 g - 3.6 g daily (in 3 doses)
D) 
1. Changes in mood or behaviour
2. Abrupt cessation (withdrawal symptoms)
3. Renal
NO LFTs

E)
Labels; 1, 9, 12
#Neuropathic pain: might take 2-4 weeks before you notice an improvement
#Take your first dose at bedtime
S/E:
CNS (fatigue, sedation, dizziness, amnesia, abnormal thinking)
Motor (tremor, dry mouth, weight gain)

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11
Q

Lacosamide

Vimpat®

A

A) Anti-epileptic

B)
1. Partial seizures +/- secondary generalised seizures (adjunctive)

C)
Start: 50 mg BD
Max: 200 mg BD

D)
1. Drugs that lower seizure threshold
2. Abrupt cessation
3. ECG (prolongs PR interval)
4. Renal (reduce dose)
NO LFTs
E) 
Labels: 9, 12
#Increases the effects of alcohol
S/E: 
CNS (dizziness, headaches, nausea, drowsiness, fatigue)
Vision (diplopia, blurred vision)
Motor (abnormal coordination, tremor)
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12
Q

Lamotrigine

Lamictal®

A

A) Anti-epileptic / Mood stabiliser

B)

  1. Partial seizures + Generalised seizures (adjunct or monotherapy)
  2. Bipolar disorder (prevention of depressive episodes)
C)
*Monotherapy:
Start: 25 mg daily
Usual: 100 - 200 mg daily (1-2 doses)
*Valproate
Start: 25 mg every second day
*Enzyme inducer:
Start: 50 mg daily
Usual: 200 - 400 mg daily (in 2 doses)
Max: 700 mg daily 
D) 
1. Changes in mood or behaviour
2. Severe skin reactions**
3. Drug interactions (valproate + enzyme inducers)
4. Hepatic impairment (reduce dose)
NO Renal

E)
Labels: 1, 9, 21
#May initially cause blurred vision, headaches, dizziness. Decreases/Disappear with continued use
#Tell your doctor immediately if you develop a rash, fever or swollen glands
#Increase effects of alcohol

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13
Q

Levetiracetam

Keppra®

A

A) Anti-epileptic

B)

  1. Partial seizures +/- secondary generalised seizures (monotherapy)
  2. Adjunctive therapy of partial, generalised and juvenile myoclonic epilepsy in patients >12 years

C)
Start: 250-500 mg BD
Max: 1.5 g BD

D)
1. Behavioural effects**
2. Hypersensitivity
3. Renal (reduce dose)
NO LFTs
E)
Labels: 1, 9
#Increase effects of alcohol
S/E:
Mood (Depression, anxiety, nervousness, emotional liability, irritability)
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14
Q

Oxcarbazepine

Trileptal®

A

A) Anti-epileptic

B)

  1. Partial and Generalised seizures (adjunct or mono)
    - fewer CNS s/e + interactions than carbamazepine

C)
Start: 300 mg BD
Usual: 600 mg - 2.4 g daily (in 2 doses)

D)
1. Sodium concentration (low)
2. Hypersensitivity reactions
3. Complete Blood Count (leucopenia, thrombocytopenia, etc)
4. Renal (reduce dose)
NO LFTs
E)
Label: 5, 9, 12, 21, A*
#Increase effects of alcohol
# Tell your doctor immediately if rash, sore throat, fever, mouth ulcers, bruising or bleeding occur
S/E:
GIT: (n+v, constipation, diarrhoea)
Skin: (rash, acne, alopecia)
CNS (somnolence, fatigue, dizziness, headache)
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15
Q

Perampanel

Fycompa®

A

A) Anti-epileptic

B)
1. Partial seziures +/- secondary generalised seizures (adjunct)

C)
Start: 2 mg ONCE daily
Usual: 4 - 8 mg ONCE daily
Max: 12 mg ONCE daily

D)

  1. Behavioural and Psychiatric effects**
  2. Hepatic (main route)
  3. Renal (avoid if < 50 mL/min)

E)
Labels: 1, 9
#Taken once daily at bedtime
#You may be more likely to FALL while taking this medicine
#Avoid alcohol - worsen s/e
#Tell your doctor - significant changes to mood or behaviour
S/E
Behavioural + Psychiatric (aggression, anxiety, confusion, paranoia, suicidal)
CNS (drowsiness, dizziness, vertigo, fatigue)
GIT (nausea, weight gain)
Motor (ataxia, balance disorder, fall)

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16
Q

Phenytoin

Dilantin®

A

A) Anti-epileptic

B)

  1. Epilepsy (partial, generalised tonic-clonic)
  2. Status epilepticus (IV)
  3. Seizure prophylaxis (neurosurgery)

C)
Start: 4 - 5 mg/kg (1 or 2 doses)
Usual: 200 - 500 mg daily (1 or 2 doses)
Max: 600 mg (APF)

D) 
1. TDM - total phenytoin + free phenytoin **
2. Serum albumin **
3. Changes in mood or behaviour
4. BMD
5. Hypersensitivity reactions
6. Other medications (interactions)
7. Hepatic (dose reduce)
NO renal

E)
Labels: 5, 9, 12+, 21, A*
#Increase effects of alcohol
#Visit dentist regularly; good dental care can help prevent enlarged gums
#Tell your doctor immediately - fever, sore throat, rash, mouth ulcers, bruising or bleeding
S/E:
UGLY (purple glove syndrome, skin eruption, gingival hypertrophy, hirsutism)
CNS (insomnia, sedation, confusion, vertigo)
Motor (ataxia)
Mood (behavioural disturbances, agitation)
Eye (nystagmus, diplopia, blurred vision)

17
Q

Pregabalin

Lyrica®

A

A) Anti-epileptic / Co - analgesic

B)

  1. Partial seizures +/- secondary generalised (adjunct)
  2. Neuropathic pain

C)
Start: 75 mg BD (25 mg daily if renal)
Max: 300 mg BD

D) 
1. Changes in mood or behaviour
2. Pain score
3. Compliance (avoid abrupt cessation)
4. Renal (dose reduce)
NO LFTs

E)
Labels: 1, 9, 12
#Increase effects of alcohol
#May take a week before noticeable improvement in pain
S/E
CNS (dizziness, drowsiness, confusion, lethargy, memory impairment)
Eye (visual disturbances - blurred vision, diploplia)
Motor (ataxia, impaired balance, oedema)

18
Q

Tiagabine

Gabitril®

A

A) Anti-epileptic

B)
1. Partial seizures +/- secondary generalisation (adjunct)

C)
Start: 2.5 - 5 mg TDS
Usual (normal): 15 - 30 mg daily (in 3 doses)
Usual (enzyme-inducers); 30 - 50 mg daily (in 3 doses)

D)
1. Changes in mood or behaviour (suicidal/depressive)
2. Other drugs (CYP3A4 substrate)
3. Compliance
4. Hepatic
NO renal
E)
Labels: 1, 9, B (stomach upset)
#increases effects of alcohol
#may cause n+v, diarrhoea, dizzineness and insomnia. decreases with cont. use.
S/E:
GIT (nausea, vomiting, diarrhoea)
CNS (dizziness, fatigue, somnolence, insomnia, confusion, concentration difficulty)
Mood (nervousness, depression)
Motor (ataxia, speech disorder)
19
Q

Topiramate

Topamax®

A

A) Anti-epileptic

B)

  1. Partial seizures +/- secondary generalisation (monotherapy or adjunct)
  2. Generalised tonic-clonic (monotherapy or adjunct)
  3. Seizures associated with Lennox-Gastaut syndrome (adjunct)
  4. Prevention of migraine

C)
Start: 25 - 50 mg once NOCTE (or in 2 doses)
Usual: 25 - 200 mg BD
Max: 1 g daily

D)
1. Decreased visual acuity or ocular pain** (stop tx)
2. Decreased sweating and hyperthermia, especially in hot weather**
3. Serum Bicarbonate concentration (METABOLIC ACIDOSIS - reduce or cease).**
4. Changes in mood or behaviour
5. Renal** (associated nephrolithiasis - drink more water)
NO Liver

E)
Labels: 1, 9, 12, 21, A* (caps)
#Alcohol may worsen S/E
#Tell your dr immediately if EYESIGHT changes or you have EYE PAIN
#Make sure you drink enough WATER every day, especially if you’ve had kidney stones in the past
#Topiramate may REDUCE or prevent SWEATING, which may affect your body’s ability to cool down. Tell your dr.
S/E
CNS (somnolence, fatigue, headache, dizziness, confusion, amnesia, impaired concentration
Mood (depression, emotional lability, nervousness, agitation, hallucinations)
Motor (weight loss, speech disorder)

20
Q

Valproate

Epilim®

A

A) Anti-epileptic

B)

  1. Primary generalised epilepsy (everything)
  2. Bipolar disorder
  3. Prevention of migraines (when other tx failed)
C)
EPILEPSY &amp; BIPOLAR DISORDER
Start: 600 mg daily (in 2 doses)
Usual: 1 - 2g daily (in 2 doses)
Max: 2.5 g daily

PREVENTION OF MIGRAINE
Usual: 200 - 400 mg BD

D)
1. TDM** (steady state achieved 3-5 days)
2. Complete Blood Count (thrombocytopenia, etc)**
3. Symptoms of thrombocytopenia (spontaneous bruising/bleeding)
4. BMD
5. Symptoms of hepatitis or pancreatitis (cease)
6. Hepatic impairment** (valproate-induced hepatic failure)
7. Hypersensitivity reactions
8. Drug interactions
9. Ammonia (high = hyperammonaemic encephalopathy)**
NO renal

E)
Labels: 9, 10a, 12+, 21, A* (enteric coated), B (stomach upset)
#APPETITE may increase - pay more attention to DIET to avoid weight gain
#Tell your dr - Fever, Rash, Abdominal pain, Vomiting, Jaundice, Bruising, Bleeding
#Some S/E decreases/disappears with cont. use
S/E
GIT (nausea, vomiting, increased appetite, weight gain)
Ugly (weight-gain, thinning/loss of hair (temp),
Motor (tremor, paraesthesia, ataxia)
CNS (drowsiness, dizziness, memory impairment)
FEMALE (menstrual irregularities, PCOS, hyperandrogenism)

21
Q

Vigabatrin

Sabril®

A

A) Anti-epileptic

B)

  1. Epilepsy (complex partial seizures - adjunct)
  2. Infantile spasms

C)
2 - 4 g daily (in 1 or 2 doses)

D)
1. VISUAL FIELD DEFECT - test visual fields (irreversible)**
2. Changes in mood or behaviour
3. Renal function (reduce dose)
4. Hypersensitivity reactions
No Liver

E)
Labels: 9, 12+, 21, A* (granules)
#increase effects of alcohol
#Report any new VISION problems
#May need to have regular eye tests
S/E:
EYE (diplopia)
CNS (fatigue, sedation, hedache, memory impairment, insomnia, dizziness)
Mood (abnormal thinking, nervousness, depression, hallucinations, psychosis)
Motor (weight gain, arthralgia, peripheral neuropathy, tremor)

22
Q

Zonisamide

Zonegran®

A

A) Anti-epileptic

B)
1. Partial seizures +/- secondary generalisations (adjunct or monotherapy)

C)
Start: 25 mg BD or 100 mg ONCE daily (mono)
Usually: 300 - 500 mg ONCE daily
Max: 500 mg daily

D)

  1. Serum Bicarbonate (METABOLIC ACIDOSIS)**
  2. Decreased sweating and hyperthermia**
  3. Changes in mood or behaviour (psychiatric)
  4. Hypersensitivity
  5. Drug interactions (CYP3A4 substrate)
  6. Renal (reduce dose)
  7. Hepatic (avoid)
  8. Weight (loss)

E)
Labels: 1, 5, 9, 21, A (caps)
#increases effects of alcohol
#drink enough WATER every day
#may reduce/prevent sweating - affect body’s ability to cool down - tell dr
#tell dr immediately - rash, fever, severe muscle pain or weakness, vomiting, rapid breathing, palpiations, severe pain in the abdomen or lower back
S/E:
CNS (drowsiness, dizziness, confusion, impaired concentration and memory)
Mood (agitation, irritability, depression)
GIT (anorexia, nausea, weight loss, abdo pain, diarrhoea or constipation)

Chapter 16 Neurology (7 decks)

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