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M202 > W19 Anti-Epileptic Drugs (AEDS) (SW) > Flashcards

W19 Anti-Epileptic Drugs (AEDS) (SW) Flashcards

1
Q

What are some common anti-seizure medications?

A

Carbamazepine, Lamotrigine, Levetiracetam, Sodium valproate, Toprimate
Many others

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2
Q

What are some examples of enzyme inducers?
non-enzyme inducers?

A

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

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3
Q

What must be considered as choice of medication? (4)

A
  • Seizure type
  • Age
  • Sex
  • Concomitant medication/disease
  • tailored to person
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4
Q

Management of epilepsy?

A
  1. Monotherapy
  2. Monotherapy with an alternative drug
  3. Combination therapy
  4. Monotherapy ( A single antiepileptic drug should be prescribed wherever possible)
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5
Q

Branded prescribing

A

Drugs should be prescribed by brand

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6
Q

Sodium Valproate

Common SE?
Monitoring requirements?
Special precautions in use? (2)

A
  • 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
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7
Q

Pregnancy Prevention Programme
(for info)

A
  • 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.
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8
Q

Carbamazepine
What can it be used for?
Common adverse affects?

A
  • 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

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9
Q

Carbamazepine- monitoring
What should be monitored?

A

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

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10
Q

Carbamazepine – special precautions in use?

A
  • 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
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11
Q

Lamotrigine
Can be used for?
Common Adverse effects?

A
  • 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

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12
Q

Lamotrigine:
monitoring?
special precautions in use?

A

Measure plasma-drug conc throughout pregnancy inc shortly after birth and dose adjusted according to response
* Skin reactions
* Blood disorders
* Allergy and cross-sensitivity

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13
Q

Levetiracetam
Can be used for?
Common SE?
Monitoring?
Special precautions?

A

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

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14
Q

Topiramate
Can be used for?
Common adverse effects?
Special precautions?

A
  • 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
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15
Q

Phenytoin
Can be used for?
Common Adverse effects?
Monitoring?
Special precautions?

A
  • 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
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16
Q

Gabapentioids- Gabapentin and Pregablin
Can be used for?
Adverse effects?
Special precautions

A
  • 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
17
Q

Epilepsy in Pregnancy
Considerations?

A
  • 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?
18
Q

Routine annual review of epilepsy

A
  • 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

M202 (72 decks)

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