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Pharmacy Pre-Reg > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Definition of a seizure

A

Abnormal firing of neurones manifesting as changes in motor control, sensory perception, behaviour and autonomic function

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2
Q

What is epilepsy?

A

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

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3
Q

What should be collected before diagnosing a patient with epilepsy?

A 
Description of attack
Family history
Bloods
ECG 
Medication history
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4
Q

What two tests can be used when diagnosing and classifying epilepsy and why?

A

MRI - to identify structural abnormalities

EEG - Classify the type of epilepsy (monitoring electrical activity in the brain)

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5
Q

What determines the types of epilepsy?

A

Area in the brain in which the seizure occurs

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6
Q

What are the types of partial seizures? Describe them (2)

A

Simple partial - General strange feelings, sometimes described as an aura, remain awake and aware

Complex partial - Loss of awareness accompanied by random body movements (smacking lips, hand/arm movements, random noises etc.), no memory of this seizure

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7
Q

What are the types of generalised seizures? Describe them (6)

A

Tonic - Muscles seize up, may lose balance and fall

Clonic - Shaking and jerking, may lose consciousness

Tonic-Clonic - Initial tonic stage, then body starts jerking (clonic stage), may have difficulty remembering

Myoclonic - Very quick, sudden twitch/jerk (like an electrical shock), normally aware

Absence - Short-term loss of awareness, may appear to be daydreaming or staring into space, unlikely to remember them

Atonic - Sudden relaxation of all muscles, may result in falling, generally able to resume normal activity soon after

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8
Q

What are common seizure triggers? (8)

A 
Menstrual cycle
Fatigue/Lack of sleep
Stress
Alcohol
Flashing lights
Excitement
Missing meals
Medication
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9
Q

What types of medication reduce seizure threshold? (8)

A 
Quinolones
SSRIs
Tramadol
Illicit drugs
Tricyclic antidepressants
Theophylline
Antipsychotics
Some penicillins
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10
Q

When would treatment for epilepsy be started and what is the general principle of treatment?

A

After second seizure

Start low, go slow

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11
Q

When would epilepsy treatment be initiated after a first seizure? (4)

A

If there is a neurological deficit present
EEG shows definitive epileptic activity
Risk of further seizure is considered unacceptable by patient
Brain imaging shows structural abnormality

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12
Q

When would adjunctive therapy be considered for epilepsy treatment?

A

If two first-line drugs have been tried as monotherapy

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13
Q

How should antiepileptics be switched?

A

Optimise second drug before withdrawing initial therapy

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14
Q

What should be done if combination therapy is not effective?

A

Revert back to regimen that has best seizure control

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15
Q

What can result from initiating antiepileptic therapy?

A

Suicidal ideation

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16
Q

What should all patients be given alongside antiepileptics?

A

Vitamin D supplements

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17
Q

What are MHRA category 1 AEDs and which drugs are included?

A

Have to prescribe same brand to prevent loss of seizure control

Phenytoin, carbamazepine, primidone, phenobarbital

18
Q

What are MHRA category 2 AEDs and which drugs are included?

A

Decision to keep patient on same brand is down to clinical judgement

Clobazam, clonazepam, topiramate, valproate, esclicarbazepine, oxcarbazepine, rufinamide, zonisamide, perampanel, lamotrigine

19
Q

What are MHRA category 3 AEDs and which drugs are included?

A

No need to keep patients on same brand

Ethosuxamide, lacosamide, gabapentin, pregabalin, levetiracetam, tiagabine, vigabatrin

20
Q

What is antiepileptic hypersensitivity syndrome?

A

Rare but potentially fatal reaction to AEDs
Usually occurs within 1-8 weeks of initiating treatment

Symptoms - Fever, rash, liver dysfunction, lymphadenopathy, haematological/renal/pulmonary abnormalities, vasculitis, multi-organ failure

21
Q

When could AED withdrawal be considered? How should this be actioned?

A

If 2 years seizure free

Under specialist, gradual withdrawal over 2-3 months, if combined therapy only one drug at a time

22
Q

What should be done if a patient experiences seizures after AED withdrawal?

A

Reverse last reduction of treatment

23
Q

What are the rules surrounding driving with epilepsy/seizures? (3)

A

Stop driving immediately -

If epileptic seizures (after diagnosis) - Can reapply after a year without seizures

If seizure was due to medication change or reduction - can reapply after 6 months seizure-free and on previous medication

If one-off seizure without epilepsy diagnosis - can reapply after 6 months if no seizures/medical advice states not high-risk of a recurrent seizure

24
Q

What are the rules surrounding driving if having seizures whilst asleep/seizures that do not affect consciousness? (3)

A

Awake and asleep - If only seizures in past 3 years have been asleep, may still be able to drive

Asleep only - May still be able to drive if it has been at least 12 months since first seizure

Not affecting consciousness - May still be able to drive if these are the only type of seizures had and first was 12 months ago

Driving should still be stopped until appropriate guidance from the DVLA is received

25
Q

What should be done if a woman diagnosed with epilepsy falls pregnant?

A

They should be registered on the UK Epilepsy and Pregnancy Register, regardless of AED treatment

26
Q

If a woman diagnosed with epilepsy plans to get pregnant, what should they be treated with? Why?

A

5mg folic acid OD before conception and throughout pregnancy to prevent neural tube defects

27
Q

What is the link between lamotrigine and hormonal contraceptives?

A

Reduced efficacy of contraceptives

28
Q

Give 3 examples of AEDs which may need altering during pregnancy. Why?

A

Phenytoin, carbamazepine and lamotrigine

Plasma concentration of these may change during pregnancy

29
Q

What should be monitored in pregnancy if on levetiracetam or topiramate?

A

Foetal growth

30
Q

What can be done to reduce risk of neonatal haemorrhage?

A

Injection of vit K at birth

31
Q

What are the most teratogenic AEDs?

A

Valproate and topiramate

32
Q

What are the risk percentages associated with valproate and pregnancy?

A

10-11% risk of congenital defects

30-40% risk of neurodevelopmental defects

33
Q

What is the risk associated with using topiramate in the first trimester of pregnancy?

A

Cleft palate

34
Q

What should be used if under the pregnancy prevention programme?

A

ONE user-independent method or TWO user-dependent methods (incl. barrier method)

35
Q

What can be done aside from PPP to reduce risks of valproate in pregnancy?(6)

A 
Annual review
Complete risk acknowledgement form
Dispense in original packs
Ensure pack has warning sticker and PIL
Provide patient card at each dispensing 
Exclude pregnancy before intiating
36
Q

What is the dosage of valproate? (initiation, titration and max)

A

Initially 600mg/day in 1-2 divided doses

Increase in steps of 150-300mg every 3 days to max. 2.5g/day

37
Q

What are the cautions/contraindications of sodium valproate? (3)

A 
Lupus
Severe hepatic dysfunction
Mitochondrial disorders (due to risk of liver toxicity)
38
Q

Which systems do the main side effects of valproate arise from? (4)

A

Liver toxicity
GI side effects
Blood SEs (hypoNa/SIADH, blood dyscrasias, drug rash, SJS/TEN)
CNS SEs (aggression, headache, EPSE, suicidal ideation)

39
Q

Give 3 random side effects of valproate

A

Hair loss (grows back curly)
Menstrual disturbances
Reduced bone mineral density

40
Q

What are the monitoring requirements for valproate?

A

LFTs and FBC

Patient to report signs of blood disorders, liver disorders and pancreatitis

Pharmacy Pre-Reg (8 decks)

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