W19 Anti-Epileptic Drugs (AEDS) (SW) Flashcards
What are some common anti-seizure medications?
Carbamazepine, Lamotrigine, Levetiracetam, Sodium valproate, Toprimate
Many others
What are some examples of enzyme inducers?
non-enzyme inducers?
Carbamazepine*, Phenytoin, Phenobarbital,
Topiramate (at dose 200mg daily or more), Lamotrigine, Gabapentin
*most potent and common- many interactions
They induce liver enzymes to make them work faster
What must be considered as choice of medication? (4)
- Seizure type
- Age
- Sex
- Concomitant medication/disease
- tailored to person
Management of epilepsy?
- Monotherapy
- Monotherapy with an alternative drug
- Combination therapy
- Monotherapy ( A single antiepileptic drug should be prescribed wherever possible)
Branded prescribing
Drugs should be prescribed by brand
Sodium Valproate
Common SE?
Monitoring requirements?
Special precautions in use? (2)
- Abdo pain, agitation, alopecia, anaemia ,warn of signs of hepatic dysfunction and pancreatitis
Dont need to monitor plasma levels, but monitor liver function during first 6 months and FBC pre/post surgery
- Highly teratogenic – effective contraception and pregnancy prevention programme required
- The MHRA advises considering vitamin D supplementation in patients who are immobilised for long periods or who have inadequate sun exposure or dietary intake of calcium
Pregnancy Prevention Programme
(for info)
- Valproate must not be used in any woman or girl able to have children unless there is a pregnancy prevention programme (PPP) in place.
- Healthcare professionals who seek to prescribe valproate to their female patients must make sure they are enrolled in the PPP.
- Prescribing MUST now be in specialist care since November 2023.
- At least one highly effective method of contraception (preferably a user-independent form such as an intrauterine device or implant) or two complementary forms of contraception including a barrier method should be used.
Carbamazepine
What can it be used for?
Common adverse affects?
- focal and secondary generalised tonic-clonic seizures
- primary generalised tonic-clonic seizures
- can exacerbate certain other seizure types
Dizziness, Drowsiness, Dry mouth, Fatigue, Eosinophilia, Fluid imbalance, GI discomfort
Carbamazepine- monitoring
What should be monitored?
Plasma concentration (4-12 mg/litre) measured after 1-2 weeks (esp in pregnancy- lower end of therapeutic range)
Blood counts, hepatic and renal function tests
Carbamazepine – special precautions in use?
- Presence of HLA-B1502 and HLA-A3101 alleles can cause Stevens-Johnson syndrome or inc risk of cutaneous adverse reactions
- Cross-sensitivity with oxcarbazepine, phenytoin, phenobarbital, primidone
- Vitamin D supplementation for pt who are immobilised for long periods/ inadequate sun exposure/ dietary intake of calcium
- Blood, hepatic or skin disorders- look out for symptoms eg fever, rash, mouth ulcers, bleeding, bruising
Lamotrigine
Can be used for?
Common Adverse effects?
- Monotherapy of focal seizures,
- Monotherapy of primary and secondary generalised tonic-clonic seizures
- Monotherapy of seizures associated with Lennox-Gastaut syndrome
- As an adjunct in many different seizure types
- Can exacerbate certain other seizure types
Aggression, agitation, diarrhoea, dry mouth, n&v, headache, nausea, pain, rash, sleep disorders, tremor, vomiting
Lamotrigine:
monitoring?
special precautions in use?
Measure plasma-drug conc throughout pregnancy inc shortly after birth and dose adjusted according to response
* Skin reactions
* Blood disorders
* Allergy and cross-sensitivity
Levetiracetam
Can be used for?
Common SE?
Monitoring?
Special precautions?
Monotherapy of focal seizures with or without secondary generalisation
* Adjunctive therapy of focal seizures with or without secondary generalisation
* Adjunctive therapy of myoclonic seizures and tonic-clonic seizures
Anxiety, appetite dec, asthenia, cough, abnormal behaviour, cough, depression
Monitor during pregnancy
* Seek advice is depression/suicidal ideation emerge
* Effects on driving and skilled tasks
Topiramate
Can be used for?
Common adverse effects?
Special precautions?
- Monotherapy of generalised tonic-clonic seizures or focal seizures with or without secondary generalisation
- Adjunctive treatment of generalised tonic-clonic seizures or focal seizures with or without secondary generalisation
- Adjunctive treatment for seizures associated with Lennox-Gastaut syndrome
- So many
- Acute myopia with secondary-angle closure glaucoma
Phenytoin
Can be used for?
Common Adverse effects?
Monitoring?
Special precautions?
- Tonic-clonic seizures
- Focal seizures
- May exacerbate seizures in patients with absence or myoclonic seizures (including juvenile myoclonic epilepsy)
and myoclonic-atonic seizures
Agranulocytosis and loads more
Monitor plasma conc, blood counts, ECG and BP
- Narrow therapeutic index
- Vit D supplementation
- HLA Allele
- Overdose symptoms eg nystagmus
- Allergy and cross-sensitivity
- Blood and skin disorders
Gabapentioids- Gabapentin and Pregablin
Can be used for?
Adverse effects?
Special precautions
- Gabapentin: Adjunctive treatment of focal seizures with or without secondary generalisation and Monotherapy
for focal seizures with or without secondary generalisation - Pregabalin: Adjunctive therapy for focal seizures with or without secondary generalisation
- Both may exacerbate certain seizure types
- Gabapentin and Pregablin are classed as Class C, Schedule 3 CDs
Epilepsy in Pregnancy
Considerations?
- Pre-conception
-folic acid supplementation - specialist advice essential
- discontinue therapy?
- establish seizure control with the lowest possible dose of a single drug?
- change drug?
- change to m/r if not already taking?
Routine annual review of epilepsy
- Ensure the person and their carers are aware of who to contact if there are problems relating to their epilepsy
- Assess seizure control by asking about seizure frequency and severity, and any changes since the person was last
reviewed - Ask about how epilepsy is affecting the person’s daily functioning and quality of life, and provide advice on sources of
information and support for the person, their family and/or carers. - Ensure that any carer for a person with epilepsy is aware how to recognize and manage a seizure.
- Ask about any adverse effects and compliance with antiepileptic drug treatment.
- For people taking antiepileptic drugs whose seizures are controlled, advise about the increased risk of osteoporosis when taking long-term carbamazepine, phenytoin, primidone, phenobarbital, or sodium valproate
