Epilepsy Flashcards

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1
Q

What investigations are done to diagnose epilepsy?

A
Clinical hx 
EEG 
MRI 
ECG
Bloods
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2
Q

What are some examples of sodium channel blockers used as AEDs?

A
Sodium valporate
Lamotrigine 
Carbamazepine 
Phenytoin 
Topiramate
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3
Q

What is the MOA of sodium channel blockers when used as AED?

A

Cause Na channels to remain inactive

Prevent axons from firing an AP

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4
Q

What are some examples of Ca channel blockers used as AEDs?

A

Ethosuximide

Sodium valporate

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5
Q

What is the MOA of Ca channel blockers used as AEDs?

A

Prevent activity of Ca channels
Prevent depolarisation

Used in absence seizures

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6
Q

What is the MOA of GABA potentiators used in epilepsy?

A

Enhance effect of GABA at the synaptic junction

Eg barbiturates, benzodiazepines

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7
Q

What is the MOA of GABA-transaminase inhibitors used in epilepsy?

A

Prevent breakdown of GABA

Eg vigabatrin

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8
Q

What is the MOA of keppra? (Used for epilepsy)

A

Binds to synaptic vesicles => inhibit pre-synaptic calcium channel activity
Therefore inhibits release of neurotransmitters

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9
Q

When should anti-epileptics be considered?

A
After a first unprovoked seizure with:
Neurological deficit 
EEG with epileptic activity 
Risk of further seizure is v dangerous (if the pt has a particular job)
Imaging shows a structural abnormality
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10
Q

How are AEDs initiated?

A

Start at lowest effective dose & titrate up

First line for generalised/tonic-clonic : lamotrigine or sodium valporate

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11
Q

How can anti-epileptics affect CYP enzymes?

A

Inducers:
Carbamazepine, phenytoin

Inhibitors:
Sodium valporate

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12
Q

What are some adverse effects of all AEDs?

A

Dizziness
Fatigue
Ataxia
Diplopia

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13
Q

How should anti-epileptics be changed?

A

Need to overlap new drug w/ old drug

Slowly withdraw old drug

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14
Q

How should anti-epileptics be stopped?

A

Gradually taper off
Aim to avoid withdrawal Sx

Consider if pt is seizure free for 2 yrs

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15
Q

What are some considerations for use of AEDs in pregnancy?

A

Risk of congenital malformations

Eg neural tube defects, hypospadias, cardiac defects

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16
Q

What congenital defects can result from a pregnant woman taking sodium valporate?

A

Neural tube defects eg spina bifida
Craniofacial and skeletal abnormalities
Developmental disorders - mental and physical

17
Q

What are some congenital malformations that can result from a pregnant woman taking phenytoin?

A

Cleft lip and palate

Congenital heart defects - eg septal defects

18
Q

Why does phenytoin require therapeutic drug monitoring?

A

Narrow therapeutic window

Risk of toxicity:
Nausea, CNS dysfunction, decreased consciousness, coma

19
Q

What drugs are used for the treatment of partial seizures?

A

Lamotrigine
Phenytoin
Carbamazepine

Gabapentin
Topiramate (also used for migraines)

20
Q

What drugs are used for treatment of general seizures?

A

Sodium valporate
Ethosuximide
Phenobarbital
Benzodiazepines (status epilepticus)

21
Q

What is the initial management of seizures?

A

Midazolam or lorazepam

22
Q

What is the treatment for status epilepticus?

A

Phenytoin of benzodiazepines