Epilepsy Flashcards
Describe Grand Mal epilepsy
- tonic clonic
- random frequency
- loss of consciousness, bladder control
- post ictal coma
Describe Petit Mal epilepsy
- absence seizure
- regular frequency (3Hz)
- no motor symptoms
- no post ictal coma
Describe Status Epilepticus
- 30min continuous tonic clonc seizures, unconsciousness
- fever sweating, hypertension
- anoxia/hypoxia
Drugs for grand mal
Carbamazepine, phenytoin, valproate, lamotrigine, barbiturates
Drugs for petit mal
Ethosuxamide
Drugs for status epilepticus
Phenytoin, BZDs
Adjunct anti-epileptic drugs
Gabapentin, Vigabatrin, Tigabide
Phenobarbitone, pentabarbitone
Pharmacodynamics + clinical use
Positively modulate GABA-A receptor, increases postsynaptic GABAergic transmission
Clinical use:
Grand mal
BZDs: Clonazepam, clobazam, diazepam
Pharmacodynamics + clinical use
- Positively modulate GABA-A receptor, increases postsynaptic GABAergic transmission
- increases frequency of Cl channel opening
Clinical use:
status epilepticus
Valproate
Pharmacodynamics + clinical use
-Blocks repetitive firing from voltage gated Na channels
Clinical use:
Grand mal, partial
Carbamazepine
Pharmacodynamics + clinical use + significant side effects
-Blocks repetitive firing from voltage gated Na channels
Clinical use:
Grand mal, partial epilepsy, trigeminal neuralgia
Significant side effects:
Agranulocytosis, aplastic anaemia
Lamotrigine
Pharmacodynamics + clinical use
-Blocks repetitive firing from voltage gated Na channels
Clinical use:
Grand mal, partial
Phenytoin (hydantoin)
Pharmacodynamics + clinical use + significant side effects
-Blocks repetitive firing from voltage gated Na channels
Clinical use:
status epilepticus
Significant side effects:
nystagmus
Ethosuximide (succinimide)
Pharmacodynamics + clinical use
-Blocks T type calcium channels (involved in generation of 3Hz activity in thalamic neurons)
Clinical use: Petit mal (ineffective against Grand Mal cos doesn't enhance GABA)
Vigabatrin
Pharmacodynamics + clinical use
-Blocks GABA metabolism (GABA transaminase inhibitor)
Clinical use:
adjunct therapy
Tigabide
Pharmacodynamics + clinical use
-Blocks GABA reuptake (blocks GABA transporter-1)
Clinical use:
adjunct therapy
Gabapentin
Pharmacodynamics + clinical use
-GABA agonist
Clinical use:
adjunct therapy
Which antipsychotic can cause agranulocytosis and aplastic anaemia
Carbamazepine
Major side effects of anti-epileptic drugs:
GI
- NnV
- Anorexia
Major side effects of anti-epileptic drugs:
CNS
- Ataxis
- Dizziness
- Drowsiness
- Cognitive effects
Major side effects of anti-epileptic drugs:
Psych
- Psychosis
- Agitation
- Restlessness
- Night tremors
- Depression
- Euphoria
Major side effects of anti-epileptic drugs:
Mucosal/ Cutaneous
- Rashes
- Hair loss/ hirsutism
- Gum hyperplasia
Which anti-epileptics cause drug induced Parkinsonism
- Valproate
- Lithium
Describe a simple partial seizure
Person away of surroundings
Describe a complex partial seizure
Person unaware of surroundings
Describe a secondary generalised seizure
Partial seizure that evolved into generalised seizure
Drugs for focal seizure
- Carbamezapine
- Lamotrigine
Which contraceptives would not work with anti-epileptics
- Contraceptive patches (combined)
- Progesterone-only pill
- Implanon implant (progesterone-only)
Note: COCP must contain at least 50 micrograms oestrogen
When should PR diazepam/ buccal midazolam be given to a pt
- Seizure lasting more than 5min
2. 3 or more seizure within 1h
Why is diazepam not given IV
It will cause thrombophlebitis
Features of sodium valproate teratogenicity
- Spina bifida
- Facial and skull malformations (including cleft lip, palate)
- Malformations of limbs, heart, kidneys, urinary tract, sexual organs
- Developmental problems
- Increased risk of ASD, ADHD
What antiepileptics are safe in pregnancy
- Levetiracetam
2. Lamotrigine
Which anti epileptics cause cerebellar side effects
Phenytoin
Carbamazepine
Which anti epileptics cause pancreatitis
Valproate
Therapeutic range of phenytoin
10-20
