general info

Question 1

dosage frequency is often determined by the …

Answer 1

plasma drug half life

Question 2

the following 4 drugs have long half lives so can be given OD at bedtime

Answer 2

Lamotrigine, perampanel, phenobarbital, and phenytoin

Question 3

change from one antiepileptic drug

Answer 3

should be cautious, slowly withdrawing the first drug only when the new regimen has been established

Question 4

concurrent use of antiepileptic drugs increases

Answer 4

risk of adverse effects and drug interactions

Question 5

what to do if combination therapy does not reduce seziures

Answer 5

revert to the regimen (monotherapy or combination therapy) that provided the best balance between tolerability and efficacy

Question 6

aim of treatment

Answer 6

prevent the occurrence of seizures by maintaining an effective dose of one or more antiepileptic drugs (antiseizure medications)

Question 7

MHRA antiepileptics risk of suicidal thoughts and behaviours

Answer 7

all antiepileptic drugs may be associated with a small increased risk of suicidal thoughts and behaviour; symptoms may occur as early as 1 week after starting treatment.
patients and their carers should be advised to seek medical advice if any mood changes, distressing thoughts, or feelings about suicide or self-harming develop, and that the patient should be referred for appropriate treatment if necessary.

Question 8

Do you need to report any suspected adverse reactions to AEDs to Yellow Card?

Answer 8

yes

Question 9

Category 1: ensure pt is maintained on specific manufacturers product

Answer 9

3Ps and 1C
carb, phenytoin, primidone, phenobarbital

Question 10

Category 2: need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with the pt/carer taking into factors such as seizure freq, treatment Hx, potential implications to pt having a breakthrough seizure

Answer 10

Clobazam, clonazepam, eslicarbazepine acetate, lamotrigine, oxcarbazepine, perampanel, rufinamide, topiramate, valproate, zonisamide

Question 11

what is antiepileptic hypersensitivity syndrome

Answer 11

rare but potentially fatal syndrome
associated with some AEDs (3Ps and C, lacosamide, lamot, oxcarbazepine, rufinamide); rarely cross-sensitivity occurs between some of these AEDs

Question 12

how to remember which drugs are associated with antiepileptic hypersensitivity syndrome

Answer 12

3Ps and C + ROLL
Rufinamide, oxcarbazepine, lacosamide, lamotrigine

Question 13

3Ps and C + ROLL
Rufinamide, oxcarbazepine, lacosamide, lamotrigine

Answer 13

how to remember which drugs are associated with antiepileptic hypersensitivity syndrome

Question 14

these 3 drugs have a theoretical risk antiepileptic hypersensitivity syndrome

Answer 14

eslicarbazepine
stiripentol
zonisamide

Question 15

when do symptoms of antiepileptic hypersensitivity syndrome usually start, and what are the most common symptoms

Answer 15

1-8 weeks of exposure
fever, rash, lymphadenopathy (swollen lymph nodes)

Question 16

other systemic signs of antiepileptic hypersensitivity syndrome

Answer 16

liver dysfunction
haemotological
renal
pulmonary abnormalities
vasculitis
multi-organ failure

Question 17

what to do if pt has signs of antiepileptic hypersensitivity syndrome

Answer 17

withdraw drug immediately
do not re-expose
seek expert advice

Question 18

the decision to withdraw AEDs from a seizure-free pt may be considered after the pt has been seziure free for at least ……. depending on their individual circumstances

Answer 18

2 yrs

Question 19

if an antiepileptic drug is to be discontinued in a pt who has been seizure free for at least 2 years, you need to carry out

Answer 19

an assessement to determine the risk of seizure recurrence
if any doubt or concern, this needs to be done by epilepsy specialist

Question 20

if a pt has been seizure free for several years, if there still a risk of recurrence on drug withdrawal

Answer 20

yes significant risk of seizure recurrence

Question 21

withdrawal in pt recieving several AEDs

Answer 21

only one at a time

Question 22

avoid abrupt withdrawal, esp of these two, because this can precipitate severe rebound psychosis

Answer 22

• barbiturates
• BZDPN

Question 23

when withdrawing, reduction in dosage should be gradual and for most drugs, this would be over at least …
but in barbiturates and BZDPNs, withdrawal is typically…

Answer 23

3 months

over a longter period to reduce risk of drug related withdrawal symptoms

Question 24

what to do if seizures recur during or after discontinuation of AED

Answer 24

the last dose reduction should be reversed and guidance sought from an epilepsy specialist

Question 25

if a driver has a seizure of any type, can they still drive

Answer 25

must stop driving immediately and inform the DVLA

Question 26

patients who have had a first unprovoked epileptic seizure or single isolated seizure, they must not drive for .... driving may be resumed if .....

Answer 26

must not drive for 6 months; driving may then be resumed, provided the patient has been assessed by a specialist as fit to drive and investigations do not suggest a risk of further seizures.

Question 27

patients with established epilepsy can drive a motor vehicle as long as .....

Answer 27

they are not a danger to the public and are compliant with treatment and follow up

Question 28

for pt with established epilepsy, they must be seizure free for at least ..... to drive

Answer 28

at least one year (or have a pattern of seizures established for one year where there is no influence on their level of consciousness or the ability to act); also, they must not have a history of unprovoked seizures.

Question 29

can pt who have had a seizure whilst asleep drive

Answer 29

not for one year from the date of each seizure, unless - Hx or pattern of sleep seizures occuring only ever while asleep has been established over the course of at least one year from date of first sleep seizure - established pattern of purley asleep seizures can be demonstrated over the course of 3 years if the pt has previously had seizures whilst awake (or awake and asleep)

Question 30

DVLA recommends that pt should not drive during...

Answer 30

medication changes or withdrawal of antiepileptic drugs, and for 6 months after their last dose.

Question 31

if a seizure occurs due to a prescribed change or withdrawal of epilepsy treatment, the pt will have their driving license revoked for ... and reclincensing can be considered earlier if ...

Answer 31

1 yr relicensing can be considered earlier if treatment has been reinstates for 6 months and no further seizures have occured

Question 32

which AEDs are safest in pregnancy

Answer 32

lamot levet

Question 33

ZELP

Answer 33

these are the AEDs that are readily transferred into breast milk causing high infant serum drug concentrations

Question 34

can patients taking AEDs breastfeed?

Answer 34

- generally encourage females to BF - if on combo therapy or if other RF e.g. premature birth, close monitoring recommended - ensure they are aware of signs of toxicity in infant and advised to seek medical advice if these occur

Question 35

monitor the following in all infants that are breast fed

Answer 35

sedation, feeding difficulties, adequate weight gain, and developmental milestones Infants should also be monitored for adverse effects associated with the antiepileptic drug particularly with newer antiepileptics, if the antiepileptic is readily transferred into breast-milk causing high infant serum-drug concentrations (e.g. ethosuximide, lamotrigine, primidone, and zonisamide), or if slower metabolism in the infant causes drugs to accumulate (e.g. phenobarbital and lamotrigine).

Question 36

which AEDs are readily transferred into breast milk causing high infant serum drug concentrations

Answer 36

ZELP ethosuximide, lamotrigine, primidone, and zonisamide

Question 37

which AEDs can accumulate if there is slower metabolism in the infant (2)

Answer 37

phenobarbital and lamotrigine

Question 38

withdrawal effects may occur in infants if a mother suddenly stops breast-feeding, particularly if she is taking (3)

Answer 38

phenobarbital, primidone, or lamotrigine.

Question 39

these 3 are associated with established risk of drowsiness in BF babies and caution is required

Answer 39

Primidone, phenobarbital, and the benzodiazepines