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Pharm Y3S2 > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What percentage of patients with epilepsy will become seizure free with treatment?

A

70%

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2
Q

What is SUDEP?

A

Sudden unexpected death in epilepsy

During seizure, where no other causes are found

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3
Q

Define seizure.

A

Episode of neurological dysfunction of abnormal firing of neurones, manifesting as changes in motor control, autonomic function, senses or behaviour

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4
Q

Define epilepsy.

A

Recurrent, spontaneous seizures arising from abnormal electrical activity in the brain

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5
Q

What may cause an acute symptomatic seizure?

A 
Head injury
Infection
Electrolyte imbalance
Migraine
Encephalitis
Syncope
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6
Q

What information is needed to diagnose epilepsy?

A 
Description of attack
Family history
Blood tests (Na)
ECG
Medication history
MRI
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7
Q

Why should an EEG never be used in isolation to diagnose epilepsy?

A

10% of epileptic patients show no changes
Some healthy patients show abnormalities
Main role is classification

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8
Q

What is a partial seizure?

A

Occurs in one part of the brain

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9
Q

What is a simple partial seizure?

A

Maintain consciousness

May present with aggression prior

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10
Q

What is a complex partial seizure?

A

Lose consciousness
May get an aura
Autonomic movements such as playing with clothes, lip smacking

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11
Q

What is a secondary generalisation?

A

Partial seizure that spreads to another part of the brain

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12
Q

What is a tonic-clonic seizure?

A

Tonic phase- muscles tense and patient may let out a cry (diaphragm)
Clonic phase- limb shaking, usually self-terminate within 1-2 minutes
Post distal phase- exhaustion, confusion

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13
Q

What is an absence seizure?

A

May only last seconds

Person looking into distance

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14
Q

What is a myoclonic seizure?

A

Limbs jerk

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15
Q

What is an atonic seizure?

A

Drop attack

Patient loses all tone and falls

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16
Q

Give examples of potential seizure triggers?

A 
Fatigue
Stress
Alcohol
Flashing lights
Excitement
Menstruation
Missing meals
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17
Q

What is first line treatment in epilepsy?

A

Sodium valproate

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18
Q

What is the normal starting dose of sodium valproate?

A

600mg daily in 1-2 divided doses

Increase gradually every 3 days

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19
Q

Compare the oral and IV doses of sodium valproate?

A

The doses are equivalent

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20
Q

What monitoring is required with sodium valproate?

A

Transient liver changes

Blood and pancreatic disorders

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21
Q

What is the main contraindication of sodium valproate?

A

Avoid in pregnancy and women of childbearing potential

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22
Q

Give side effects of sodium valproate.

A

Nausea
GI irritation
Weight gain
Hair loss

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23
Q

When is carbamazepine first line treatment?

A

Focal seizures

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24
Q

What is the normal starting dose of carbamazepine?

A

100-200mg 1-2 times daily

Increased every 2 weeks

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25
What monitoring is required with carbamazepine?
Blood, liver and skin disorders
26
Compare the oral and suppository doses of carbamazepine.
125mg suppository is equivalent to 100mg oral dose
27
Give side effects of carbamazepine.
``` Headache N+V Drowsiness Rash Ataxia Hyponatraemia ```
28
When is lamotrigine indicated?
In focal and generalised seizures
29
What is the normal starting dose of lamotrigine?
25mg daily | Titrated every 2 weeks
30
What is the most important side effect of lamotrigine?
Serious skin reactions
31
Which AED is generally considered the safest in pregnancy?
Lamotrigine
32
What formulations of lamotrigine are available?
Oral tablet | Dispersible tablet
33
Give side effects of lamotrigine.
N+V Diarrhoea Dry mouth Skin reactions
34
How is carbamazepine metabolised?
Via CYP3A4
35
What is important to consider with co-administration of sodium valproate and lamotrigine?
Valproate blocks the metabolism of lamotrigine
36
When is levetiracetam indicated?
In partial seizures | Adjunctive therapy in myoclonic and tonic-clonic
37
What is the normal starting dose of levetiracetam?
250mg daily Increased every 1-2 weeks Up to 1.5g BD
38
Compare the oral and IV doses of levetiracetam?
They are equivalent
39
Give side effects of levetiracetam.
``` Nasopharyngitis Somnolence Fatigue Dizziness Headache Mood changes ```
40
When is phenytoin indicated?
Role in refractory seizures and status epilepticus
41
What is the normal starting dose of phenytoin?
3-4mg/kg.day | Normally 200-500mg/day
42
Describe the PK of phenytoin.
Narrow therapeutic index Half life of 4-72 hours Steady state reached after 7-10 days Highly albumin bound
43
Describe the effects of phenytoin on the liver.
High hepatic metabolism | Strong inducer of CYP450
44
Compare the base and sodium forms of phenytoin.
Base in liquid or chewable tablets Sodium in IV or capsules 100mg phenytoin sodium is equal to 92mg phenytoin base
45
Give side effects of phenytoin.
``` N+V Constipation Drowsiness Parasthesia Gingival hyperplasia Acne Hirsutism Coarsening of facial features ```
46
Give signs of phenytoin overdose.
``` Nystagmus Ataxia Diplopia Slurred speech Confusion Hyperglycaemia ```
47
Which AEDs fall into category 1 for brand name prescribing?
Phenytoin Carbamazepine Phenobarbital
48
Which AEDs fall into category 2 for brand name prescribing?
Sodium valproate Lamotrigine Oxcarbazepine
49
Which drug class in particular can reduce effectiveness of lamotrigine?
Oral contraceptives
50
What is status epilepticus?
Medical emergency | Tonic clonic seizure lasting longer than 30 minutes or repeated within 30 minutes
51
Describe the stages of treatment of status epilepticus.
Rectal diazepam may be given en route to hospital IV lorazepam 0.1mg/kg (usually 4mg), repeated once after 10-20 minutes if seizure continues Give usual AEDs if already on treatment IV diazepam or buccal midazolam may be alternative to lorazepam but risk of thrombophlebitis Phenytoin IV 20mg/kg over 20 minutes (phenobarbital if already on phenytoin) General anaesthesia if above does not work
52
Describe the requirements for AED withdrawal.
Must be seizure free for 2 years Must occur slowly over months One drug at a time if on combination therapy
53
What are the 3 main social considerations in epilepsy?
Cannot be refused employment under 2010 Equality Act but H+S must be considered Driving licensed must be revoked, 1 year seizure free for renewal Alcohol can trigger seizures and interact with AEDs
54
Give three potential types of non-epileptic seizures.
Febrile seizure- due to increased temperature Trauma Metabolic- hyponatraemia, hypoglycaemia
55
Describe a paroxysm.
'Breath holding attack' Anoxic tonic-clonic seizure Over-exaggerated temper trantrum
56
What is a reflex anoxic seizure?
Response to something they are introduced to i.e. cold food, trauma, fright
57
Describe a febrile seizure.
Generalised tonic-clonic seizure Last between 3 and 5 minutes Short lived and self resolving Associated with rapid rising body temperature
58
What steps can be taken when a child is experiencing a febrile seizure?
Reassur parents Cool child down Try not to pick them up Often due to child getting ill
59
What is Dravets syndrome?
Genetic mutation of SCN1A in most sufferers Intractable seizures Developmental delay Failure to thrive Dysregulated autonomic nervous system (lower body temperature)
60
What is the treatment for Dravets Syndrome?
Sodium valproate AND clobazam ADD stiripentol if first two don't work
61
What must be done to doses of VPA and CLB if stiripentol is added?
Reduced | Stiripentol is strong inhibitor of CYP450, 2C19, 2D6 and 3A4
62
From what age is stiripentol licensed?
Over 3 years
63
What is the normal dose for stiripentol?
10mg/kg BD for 1 week 15mg/kg BD for 1 week Then alter for age Younger patients can have dose increased over a shorter period
64
Describe the gastric pH of children under 2? What AED in particular is affected by this?
Gastric pH higher | Oral bioavailability of phenytoin <75%
65
Describe the gastric motility of children ? What AEDs in particular are affected by this?
Reduced peak levels of phenobarbital | Slower time to reach peak levels of carbamazepine
66
What impact do milk based diets have on phenytoin?
Absorption reduced by 35% if administered with enteral feed
67
How does metabolism of AEDs vary in children?
Increased hepatic extraction Liver is larger by SA Higher mg/kg doses needed for carbamazepine and VPA CYp enzyme expression >50% higher in children under 12 years
68
What are the characteristics of Lennox-Gastaut Syndrome?
``` Drop attacks Generalised absence seizures Atypical focal absence seizures Tonic seizures Can have developmental delay and learning difficulties ```
69
Describe the treatment for Lennox-Gastaut Syndrome.
First line- VPA Second line- LMT, TPA, CLB, PHY Corticosteroids can reduce inflammation and neuronal damage Surgery to remove affected area
70
Describe the PK of sodium valproate.
Half life 4-8 hours in children, 8-20 hours in adults 90% protein bound Renally cleared
71
Describe the PK of carbamazepine.
``` Half life of 30 hours after single dose 15 hours after repeated dose 0.5-12 hours when given with phenytoin 65% protein bound Hepatically metabolised ```
72
What are the four main categories of anti-convulsant?
Sodium channel inhibitors Calcium channel inhibitors GABA-mediated inhibition enhancers Glutamate receptor inhibitors
73
How do sodium channel inhibitors work?
No firing of action potential | Dampen down excitation
74
How do calcium channel inhibitors work?
Without calcium entry into the cell, there is no transmitter release Reduce excessive glutamate release
75
Describe the production and action of GABA?
Synthesis of GABA mediated by glutamic acid decarboxylase Release in response to action potential and presynaptic calcium elevation Reuptake via receptors into neurons and glia cells Four GABA transporters identified (GATs) Breakdown occurs within cells by mitochondrial enzyme GABA-transaminase
76
Describe the action of glutamate receptors?
AMPA and kainate (ionotropic) sites open a channel through receptor allowing sodium and small amounts of calcium to enter NMDA (ionotropic) sites open a channel allowing large amounts of calcium and sodium, channel is blocked by magnesium in the resting state, only activated by higher voltages

Pharm Y3S2 (29 decks)

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