Neuro - My Flash Cards
What age of onset for a new headache is a red flag? And why?
Over 50 years
Temporal arthritis (giant cell arthritis) - particularly if uni-lateral headache in temporal region of brain
What can a thunderclap headache be a symptom of? Does this require referral?
Haemorrhage, stroke or aneurism
Refer to A+E / 999
Apart from a sudden onset of head pain, what are the symptoms of haemorrhage/aneurysm?
Nausea and vomiting
Stiff neck
Photophobia
Why should you refer if a patient taking CPCs experiences an aura for the 1st time?
Increased risk of stroke with COCs and migraine
What can the symptoms of red eyes with a halo be a sign of?
Acute glaucoma - refer to GP or optician/ ophthalmologist
What is temporal arthritis/giant cell arthritis? How is it treated?
Chronic vasculitis characterised by inflammation in the arteries
Medical emergency! Refer and treat with glucocorticoids initially
What is 1st line for focal seizures?
Lamotrigine or levetiracetam
What is second line for focal seizures?
Carbamazepine, oxcarbazepine or zonisamide
What is 1st line for absence seizures?
Ethosuximide
What is 2nd line for absence seizures?
Sodium valproate
If woman of child-baring age then lamotrigine
What anti-epileptics should not be used in absence or myoclonic seizures?
Carbamazepine
oxcarbazepine,
phenytoin,
phenobarbital,
tiagabine,
vigabatrin,
gabapentin and pregabalin
What is 1st line for myoclonic seizures?
Sodium valproate
Levetiracetam for women of child-baring age
What are the key side effects of phenytoin including signs of overdose?
Overdose: nystagmus, slurred speech, tremor, confusion
Other side effects:
Skin rashes
Bradycardia and hypotension with IV
Bone marrow suppression (due to anti-folate effects)
Increase vitamin D metabolism = osteoporosis
Arrhythmias due to blocking Na+ in the heart
Which antiepileptics have a long half life and therefore can be given once daily?
Phenytoin
Phenobarbital
Perampanel
Lamotrigine
However - tend to split large doses to avoid high peak plasma concentration
Most antiepileptics are given twice a day
How are phenytoin levels monitored?
After IV loading take levels 2-4 hours post dose then monitor every 24 hours until stabilised
Pre-dose (trough) level to be taken 5 days after starting maintenance treatment or any dose changes
Then a second sample after 5-10 days as further accumulation may occur (due to long half life)
Apart from drug levels, what else should be monitored when a patient is on phenytoin?
U+Es, LFTs, FBC and vitamin D levels
(ECG if IV)
Do you dilute phenytoin IV
You can but there is a risk of precipitation- therefore give through 5micron filter
If giving neat - high risk of extravasation so give slowly through peripheral vein
What are the cautions around enteral feeding and phenytoin?
Phenytoin reacts with feed therefore allow 2 hour feed break pre-and post drug administration
Which anti-epileptics are cautioned in the HLA-B allele? Which population are most at risk?
Carbamazepine: pre-treatment screening required for Han Chinese or Thai
Risk of SJS
Phenytoin to a lesser extent - no pre-screening required
Which anti-epileptics are cautioned in the HLA-A allele? Which population are most at risk?
Carbamazepine - no pre-screening required but increased risk of cutaneous reactions in European and Japanese origin
What is neuroleptic malignant syndrome?
Life threatening neurological disorder characterised by confusion, fever and rigidity
What are the key interactions for lamotrigine?
Carbamazepine - decreased levels of lamotrigine
COCs - decreased levels of lamotrigine
Sodium valproate - increased levels of lamotrigine (reduce dose and monitor for rash)
Desmopressin - hyponatraemia (monitor sodium)
Which antiepileptic can cause pancreatitis?
Sodium valproate
What are the main counselling points for sodium valproate?
PPP (women)
Blood or hepatic disorders
Pancreatitis signs : nausea and vomiting, abdominal pain
