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Pharmacy Exam 2021 > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Class 1 Drugs

A

Carbamazepine, phenobarbital, phenytoin, primidone

Maintain on specific product

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2
Q

Class 2 Drugs

A

Clobazam, clonazepam, esclicarbazepine, lamotrigine, oxcarbazepine, perampanel, rufinamide, topirimate, valproate, zonisamide. Maintaining on specific product down to clinical judgement.

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3
Q

Class 3 Drugs

A

Bivarcetam, ethosuxamide, gabapentin, lacosamide, levetiracetam, pregabalin, tiagabine, vigabatrin.
Can have any brand

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4
Q

Focal seizure treatment

A

Carbamazepine/lamotrigine first line.

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5
Q

Tonic clonic seizure treatment

A

Sodium valproate first line. Lamotrigine if valproate unsuitable (though may exacerbate myoclonic seizures).

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6
Q

Absence seizure treatment

A

Ethosuxamide or sodium valproate first line, lamotrigine alternative if both unsuitable

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7
Q

Myoclonic seizure treatment

A

Sodium valproate first line if newly diagnosed, topiramate and levetiracetam alternatives if unsuitable.

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8
Q

Atonic and tonic seizures treatment

A

Sodium valproate first line, lamotrigine if unsuitable

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9
Q

Risk factors

A

Premature birth, family history, head trauma, infections such as meningitis and encephalitis.

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10
Q

Complications

A

Sudden unexpected death in epilepsy (SUDEP), injury caused by seizure (such as RTA, falls, etc), depression and anxiety disorders.

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11
Q

SUDEP risk factors

A 
Uncontrolled or frequent seizures
Tonic-clonic seizures
Seizures that begin at a young age.
Many years of living with epilepsy.
Missed doses of medicine.
Drinking alcohol.
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12
Q

ADRs

A

ANTI-EPILEPTIC HYPERSENSITIVITY REACTION:
rash, fever, lymphadenopathy in first 1-8/52- STOP immediately (Linked with CP3L drugs)
sedation and dizziness, suicidal thoughts and behaviour (MHRA warning), acute psychotic reactions, weight gain or loss, skin rashes, impaired bone health, minor blood dyscrasias, elevation of liver enzymes

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13
Q

Enzyme inducers

A 
Carbamazepine
Eslicarbazepine acetate
Oxcarbazepine
Perampanel (at a dose of 12 mg daily or more)
Phenobarbital
Phenytoin
Primidone
Rufinamide
Topiramate (at a dose of 200 mg daily or more)
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14
Q

Non enzyme inducers

A 
Acetazolamide
Clobazam
Clonazepam
Ethosuximide
Gabapentin
Lacosamide
Lamotrigine
Levetiracetam
Perampanel (at a dose of less than 12 mg daily)
Pregabalin
Sodium valproate
Tiagabine
Topiramate (at a dose of less than 200 mg daily)
Vigabatrin
Zonisamide
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15
Q

Carbamazepine indications

A

First line in tonic clonic and focal seizures.

Trigeminal Neuralgia

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16
Q

Carbamazepine mechanism of action

A

inhibits neuronal Na channels

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17
Q

Carbamazepine ADRs

A

Dose related: GI upset and neurological effects (ataxia, dizziness).
Hypersensitivity (presents as rash).
Oedema and hyponatremia due to ADH like effect.

18
Q

Carbamazepine and pregnancy

A

Risk of neural tube defects - folate supplementation recommended. Doses should be adjusted based on plasma drug concentration.

19
Q

Carbamazepine warnings

A

Hepatic, renal or cardiac diseases.

20
Q

Carbamazepine interactions

A

Drugs metabolised by CYP enzymes (such as warfarin, oestrogens, progestogens). CYP inhibitors (such as macrolides) increase concentration.
Drugs that lower seizure threshold (antipsychotics, tramadol, ciprofloxacin etc)

21
Q

Carbamazepine levels

A

Taken immediately before dose: 4-12mg/L - takes 1-2 weeks to reach steady state

22
Q

Non- epileptic seizures

A

Eg Febrile: not caused by abnormal electrical activity

23
Q

Non BD dosed anti epileptics

A

Phenobarbital (ON), Carbamazapine (MR, OD), Lamotrigine (ON), Perampanel (ON), rest usually BD

24
Q

Partial vs Generalised seizures

A

Partial (only affects part of brain): Focal

Generalised (affects whole of both hemispheres): Tonic clonic, absence, myoclonic, (a)tonic.

25
Q

Antiepileptic withdrawal principles

A

Withdraw slowly
Withdraw under specialist supervision
Withdraw one at a time if on combination therapy

26
Q

Driving: Epilepsy/multiple unprovoked seizures

A

Need to inform DVLA
Must be 12 months free of seizures for car & motorcycles, must be 10 years free w/o epilepsy medication for bus/lorry.
First unprovoked seizure: must not drive for 6 months (1 year if underlying risk factors).

27
Q

Driving: First unprovoked seizure

A

Need to inform DVLA
Must not drive for 6 months (1 year if underlying risk factors) - Bus/lorry - 5 years, after which must have assessment showing risk <2% annually.

28
Q

Anti-epileptics in pregnancy - teratogenicity

A

Inc risk of teratogenicity:
Highest risk VALPROATE (minor and major risks, developmental delays, etc)
Increased risk: Carbamazepine, Phenytoin (antifolate), phenobarbital, primidone, lamotrigine (CP3L)
Cleft palate: Topirimate in first trimester

29
Q

Contraception and epilepsy

A

Enzyme inducers - inc metabolism of hormonal metabolism, inc risk of unplanned pregnancy

30
Q

Pregnancy and plasma concentration

A

Need to monitor plasma concentration of: Phenytoin, carbamazepine, lamotrigine

31
Q

Anti-epileptics and pregnancy

A

Refer to specialist if planning to become pregnant
5mg folic acid reduces risk of neural tube defects if taken taken before pregnancy and for first 12 weeks.
Monitor foetal growth: topiramate and levetiracetam
Vit K injection in newborn to prevent haemorrhage
Notify UK Epilepsy and pregnancy register
Withdrawal effects in newborns (particularly benzos/phenobarb)

32
Q

Anti-epileptics and breastfeeding

A

Monitor feeding difficulties, weight gain, drowsiness, developmental milestones
ZELP present in milk in high quantities (Zonisamide, Ethosuxamode, Lamotrigine, Primidone
Phenobarbital and Primidone (largely metabolised to phenobarb) inhibit suckling reflex
AVOID abrupt withdrawal of breastfeeding - risk of withdrawal esp with phenobarb/primidone

33
Q

Phenytoin MOA

A

binds to Na receptors of neuronal cells in inactive state, increases inactivity, reduces seizures.

34
Q

Phenytoin uses

A

Focal/tonic clonic. Exacerbates absence, myoclonic.

35
Q

Phenytoin therapeutic range

A

10-20mg/L, 40-80mmol/L

36
Q

Plasma Phenytoin drug monitoring

A

Non-linear relationship between dose and plasma conc, so small dose changes lead to large plasma concs.
Highly protein bound - high risk in pts with low protein binding, (eg, pregnant, elderly, paeds, hepatic imp)

37
Q

Phenytoin signs of Toxicity

A 
SNAtCHeD
Slurred Speech
Nystagmus (uncontrolled repetitive eye movements)
Ataxia
Confusion
Hyperglycaemia
Double/blurred vision
38
Q

Phenytoin ADRs

A

Changes of appearance: coarsening of facial features, gingival hypertrophy (good oral hygiene), acne
Blood dycrasias - counsel signs of infection (leucopenia that’s severe, progressive or associated with symptoms requires withdrawal)
Hypersensitivity reaction - report fever, rash, swollen lymph nodes (Rash - can continue if mild and not recurring, otherwise stop)
Low vitamin D - Rickets and osteomalacia (phenytoin increases vit d metabolism
hepatotoxicity
suicidal ideation (as with all anti-epileptics)

39
Q

IV (fos)phenytoin ADRs

A

Phenytoin- Bradycardia/hypotesion
Fosphenytoin- asystole, cardiac arrest, VF, heart block, bradycardia, hypotension. (Fosphenytoin 1.5g=1g Phenytoin sodium, Fosphenytoin IV/IM only, can be given more rapidly than phenytoin.)

40
Q

Phenytoin Interactions

A 
Seizure threshold reduced by SSRIs, quinolone, tramadol, antipsychotics, mefloquine, TCA and related antidepressants.
Inc conc (toxicity) - amiodarone, cimetidine, miconazole, fluconazole, chloramphenicol, metronidazole, trimethoprim etc.
Red conc (treatment failure) - SJW, rifampicin (Inducers)

Pharmacy Exam 2021 (16 decks)

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