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CNS > info about epileptic drugs > Flashcards

info about epileptic drugs Flashcards

1
Q

what are some indications of carbamazepine?

A

focal seizures, tonic-clonic seizures, diabetic neuropathy, bipolar, alcohol withdrawal

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2
Q

which indications must you AVOID prescribing carbamazepine for? why?

A 
all other generalised seizures that are not tonic-clonic
eg
absence
myoclonic
atonic&clonic

it will worsen them

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3
Q

what is the prescribing and dispensing info for carbamazepine when indicated for epilepsy?

A

stick to the same brand

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4
Q

what is the pt and carer advice for carbamazepine?

A

can cause hepatic, blood and skin disorders

report if u get symptoms of blood disorders [ulcer, bruising, fever, rash, bleeding]

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5
Q

what is the plasma concentration range of carbamazepine that will provide OPTIMUM results?

when should plasma conc be measured?

A

4-12mg/L

[20-50micromol/L]

measured after 1-2 weeks

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6
Q

what are the toxicity signs of carbamazepine?

A

HAND BAG

hyponatraemia
ataxia [affects balance and co-ordination]
nystagmus [involuntary movements of eyes]
drowsiness

blurred vision
arrhythmia
GI disorders

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7
Q

what is a serious side effect of lamotrigine and when does it normally occur?

A

serious skin reactions [esp in children]
serious skin rash: stevens-johnson syndrome

usually occurs in first 8 weeks

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8
Q

which anti-epileptic drug increases the plasma conc of lamotrigine

A

valproate

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9
Q

what is the pt and carer advice for lamotrigine?

A

withdraw if rash or hypersensitivity develops and see GP

report signs of blood disorder

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10
Q

what are the prescribing and dispensing information regarding phenytoin?

A

preparations are not bioequivalent. phenytoin sodium [injections/caps] not the same as phenytoin base [liquids]

prescribe same brand each time

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11
Q

what is the MHRA warning of phenytoin?

A

risk of suicide thoughts and behaviours [with all anti-epileptics]
risk of severe harm from error with injectable phenytoin
maintain pt on same brand

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12
Q

which route of administration should NOT be used with phenytoin?

A

iM route

use IV

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13
Q

which supplements should you consider [and for which types of patients] in those taking phenytoin?

A

vitamin D for those immobilised for long time or with inadequate sun exposure

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14
Q

what is the MHRA warning of phenytoin?

A

discontinue and report if signs of blood disorder develop

report if rash occurs

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15
Q

what is the target plasma concentration range for phenytoin?

A

10-20mg/L

40-80micromol/L

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16
Q

what are the toxicity signs of phenytoin? [5]

A 
nystagmus
slurred speech
ataxia
confusion
HYPERglycaemia
17
Q

what are the serious interactions with phenytoin? [8]

A
  • miconazole: increases phenytoin toxicity
  • amiodarone: increases conc of phenytoin
  • DOACS: phenytoin decreases their exposure
  • carbamazepine: phenytoin decreases its conc
  • valproate: phenytoin decreases its conc
  • CHC & progesterone: phenytoin decreases their efficacy
  • ciclosporin: phenytoin decreases their conc
  • bupropion and buspirone: phenytoin decreases their exposure
18
Q

what are the side effects of PHENYTOIN?

A

PHENYTOIN

p-  p45 inducer
h - hirsutism [growth of hair on womans face/head]
e - enlarged gums [gingival hyperplasia]
ny - nystagmus/ataxia/vertigo etc
t- teratogenic
o- osteopenia
i - interferes with folic acid
n - neuropathy
19
Q

what are the serious side effects that can occur with topiramate?

A

cleft palate

myopia [short sightedness] with secondary angle-closure glaucoma. report any visual issues. seek specialist if you get intra-ocular pressure

20
Q

what should patients on ethosuximide report signs of/

A

bone marrow suppression

21
Q

what must a prescription for clobazam be endorsed with?

A

endorsed with SLS

22
Q

what is the MHRA warning of gabapentin?

A

risk of respiratory depression even without opioid drugs

adjust doses in pt with resp depression

23
Q

what cd schedule is gabapentin in?

A

schedule 3

24
Q

what must you observe pt taking gabapentin with and what is the advise that you must give them?

A

observe for signs of abuse/dependance

let them know that it can interact with alcohol and other drugs that cause CNS depression like opioids

25
Q

what are the Important safety warnings regaring sodium valproate?

A
  • risk of suicidal thoughts/behaviours [with all anti-epileptics]
  • spontaneous adverse reactions when switching a pt between diff brands
  • contraindicated in women with child bearing potential unless PPP is met
26
Q

is sodium valproate an inhibitor or inducer and what does this mean?

A

inhibitor - increases conc of other drugs

27
Q

which are stronger: inducers or inhibitors?

A

inducers

28
Q

which types of patients should vitamin D supplementation be considered in and why?

A

pt who have been immobilised for long times or who have had inadequate sun exposure or reduced dietary intake of calcium

bc sodium valproate can reduce bone density, also correcting vitamin D deficiency reduces seizure risk

29
Q

what are the side effects of sodium valproate?

A

valproate

valproate
appetite increased [weight gain]
liver failure
pancreatitis and p45 inhibitor
reversible hair loss
oedema
ataxia
teratogenicity and tremor
encephalopathy [brain damage]
30
Q

what are the important interactions with sodium valproate? [6]

A
  • lamotrigine: valproate increases its conc and can cause stevens johnson syndrome [more likely in chinese and thai]. monitor rash and adjust dose of lamotrigine
  • phenytoin: phenytoin decreases conc of valproate and valproate increases conc of phenytoin
  • pivmecillinam: increases risks of s/e
  • topiramate: increases sodium valproate toxicity
  • olanzapine: increases risk of s/e
  • ertapenem, imipenem, meropenem: avoid. decreases conc of valproate
31
Q

what is the pt and carer advice for sodium valproate?

A
  • warn pt to report signs of blood, hepatic disorder and pancreatitis
  • make sure women have a patient card and all important info like leaflets etc
32
Q

what is vigabatrin indicated for?

A

focal seizures

33
Q

what is the serious side effect of vigabatrin? what should patients report?

A

visual disturbances

report any visual symptoms asap

CNS (11 decks)

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