general info Flashcards
dosage frequency is often determined by the …
plasma drug half life
the following 4 drugs have long half lives so can be given OD at bedtime
Lamotrigine, perampanel, phenobarbital, and phenytoin
change from one antiepileptic drug
should be cautious, slowly withdrawing the first drug only when the new regimen has been established
concurrent use of antiepileptic drugs increases
risk of adverse effects and drug interactions
what to do if combination therapy does not reduce seziures
revert to the regimen (monotherapy or combination therapy) that provided the best balance between tolerability and efficacy
aim of treatment
prevent the occurrence of seizures by maintaining an effective dose of one or more antiepileptic drugs (antiseizure medications)
MHRA antiepileptics risk of suicidal thoughts and behaviours
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.
Do you need to report any suspected adverse reactions to AEDs to Yellow Card?
yes
Category 1: ensure pt is maintained on specific manufacturers product
3Ps and 1C
carb, phenytoin, primidone, phenobarbital
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
Clobazam, clonazepam, eslicarbazepine acetate, lamotrigine, oxcarbazepine, perampanel, rufinamide, topiramate, valproate, zonisamide
what is antiepileptic hypersensitivity syndrome
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
how to remember which drugs are associated with antiepileptic hypersensitivity syndrome
3Ps and C + ROLL
Rufinamide, oxcarbazepine, lacosamide, lamotrigine
3Ps and C + ROLL
Rufinamide, oxcarbazepine, lacosamide, lamotrigine
how to remember which drugs are associated with antiepileptic hypersensitivity syndrome
these 3 drugs have a theoretical risk antiepileptic hypersensitivity syndrome
eslicarbazepine
stiripentol
zonisamide
when do symptoms of antiepileptic hypersensitivity syndrome usually start, and what are the most common symptoms
1-8 weeks of exposure
fever, rash, lymphadenopathy (swollen lymph nodes)
other systemic signs of antiepileptic hypersensitivity syndrome
liver dysfunction
haemotological
renal
pulmonary abnormalities
vasculitis
multi-organ failure
what to do if pt has signs of antiepileptic hypersensitivity syndrome
withdraw drug immediately
do not re-expose
seek expert advice
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
2 yrs
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
an assessement to determine the risk of seizure recurrence
if any doubt or concern, this needs to be done by epilepsy specialist
if a pt has been seizure free for several years, if there still a risk of recurrence on drug withdrawal
yes significant risk of seizure recurrence
withdrawal in pt recieving several AEDs
only one at a time
avoid abrupt withdrawal, esp of these two, because this can precipitate severe rebound psychosis
- barbiturates
- BZDPN
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…
3 months
over a longter period to reduce risk of drug related withdrawal symptoms
what to do if seizures recur during or after discontinuation of AED
the last dose reduction should be reversed and guidance sought from an epilepsy specialist
if a driver has a seizure of any type, can they still drive
must stop driving immediately and inform the DVLA
patients who have had a first unprovoked epileptic seizure or single isolated seizure, they must not drive for ….
driving may be resumed if …..
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.
patients with established epilepsy can drive a motor vehicle as long as …..
they are not a danger to the public and are compliant with treatment and follow up
for pt with established epilepsy, they must be seizure free for at least ….. to drive
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.
can pt who have had a seizure whilst asleep drive
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)
DVLA recommends that pt should not drive during…
medication changes or withdrawal of antiepileptic drugs, and for 6 months after their last dose.
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 …
1 yr
relicensing can be considered earlier if treatment has been reinstates for 6 months and no further seizures have occured
which AEDs are safest in pregnancy
lamot
levet
ZELP
these are the AEDs that are readily transferred into breast milk causing high infant serum drug concentrations
can patients taking AEDs breastfeed?
- 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
monitor the following in all infants that are breast fed
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).
which AEDs are readily transferred into breast milk causing high infant serum drug concentrations
ZELP ethosuximide, lamotrigine, primidone, and zonisamide
which AEDs can accumulate if there is slower metabolism in the infant (2)
phenobarbital and lamotrigine
withdrawal effects may occur in infants if a mother suddenly stops breast-feeding, particularly if she is taking (3)
phenobarbital, primidone, or lamotrigine.
these 3 are associated with established risk of drowsiness in BF babies and caution is required
Primidone, phenobarbital, and the benzodiazepines
