Epilepsy Flashcards
Long half life - can be given once daily at bed-time
LP3 Lamotrigine Phenobarbital Phenytoin Perampanel
Avoid abrupt withdrawal…
Rebound seizures, therefore gradual withdrawal is required - one drug at a time
Category 1 (maintain specific brand)
CP3 Carbamazepine Phenobarbital Phenytoin Primidone
Category 2
depends on clinical judgement/patient
Lamotrigine
Valproate
Cloba/clonzepam
Topiramate
Category 3 (risk of confusion/dosing errors/patient anxiety - can be put on a specific brand)
Preg
Gaba
Levetiracetam
AHS
Rare, but fatal syndrome
CP3
Symptoms - 1-8 weeks of exposure
Symptoms include - fever, rash, renal/lung abnormalities, multi-organ failure = refer
MHRA
All AE drugs can cause suicidal thoughts/behaviour - within 1 week of starting - refer
Driving with Epilepsy (inform DVLA)
- First unprovoked seizure or single isolated seizure - do not drive for 6 months
- Seizure free for one year = can drive
- Med changes/withdrawal - do not drive for 6 months after their last dose, if seizure occurs - licensed will be revoked for 1 year
Pregnancy
Vit K - minimise risk of neonatal haem
1st trimester - increased teratogenic effects
Valproate - highest risk - PPP
Topiramate - monitor fetal growth
Focal seizures
(LFC)
Simple and complex
Carbamazepine (4-12mg/l)
Lamotrigine (SJS)
Generalised seizures
(affects all/most of the brain)
- TAMA
Tonic-clonic* - stiffen, shakes and lose consciousness - carb can be used
Atonic - limp, collapse
Myoclonic - sudden jerk, arms usually
Absence - no convulsion, brief loss of consciousness - val or ethosuximide
1st line = Sodium valproate
Vigabatrin - main side effect
Visual disturbances - report any changes
Status epilepticus (emergency)
Convulsive - lasts more than 5 minutes
- maintain BP/glucose (risk of hypo)
- parenteral thiamine - if alcohol abuse suspected
- IV lorazepam or diazepam, if seizure continues - phenytoin or fosphenytoin
