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CPT > Epilepsy + Anti Epileptic Drugs > Flashcards

Epilepsy + Anti Epileptic Drugs Flashcards

1
Q

What is the key excitatory neurotransmitter?
What receptor in involved?

A

Glutamate
NMDA receptor

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2
Q

What is the key inhibitor neurotransmitter?
What receptor in involved?

A

GABA
Via GABAA/B receptors

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3
Q

What is a seizure?

A

Clinical manifestation of abnormal excessive excitation + synchronisation of a group of neurones within the brain

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4
Q

What determines how a seizure presents?

A

Where uncontrolled signalling occurs (can be anywhere in brain)

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5
Q

What is an epileptic seizure?

A

A transient occurrence of signs and/or symptoms due to abnormal excessive or synchoronous neuronal activity in the brain

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6
Q

What is epilepsy?

A

A disorder of the brain characterised by a predisposition to generate epileptic seizures unprovoked by a systemic or neurological insult

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7
Q

Risk factors of epilepsy

A
  • premature birth
  • complicated febrile seizure
  • head trauma, infection or tumour
  • cerebrovascular disease
  • dementia + neurodegenerative disorders
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8
Q

Define prodrome

A

Early signs or symptoms a seizure may be coming hours to days before

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9
Q

What does the term ictal mean?

A

During a seizure

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10
Q

What does the term interictal mean?

A

Between seizures

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11
Q

What does the term post ictal mean?

A

After seizure subsides

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12
Q

What class of drug is carbamazepine?

A

Sodium channel blocker

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13
Q

What are uses of carbamazepine?

A

Epilepsy
Trigeminal neuralgia

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14
Q

What is the mechanism of action of carbamazepine?

A

Sodium channel blocker
- blocks VGNC in excitatory neurone
- reduces Ca2+ influx + glutamate release

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15
Q

what are adverse drug reactions of carbamazepine?

A
  • dizziness
  • skin ash
  • eosinophilia
  • leukopenia
  • hyponatraemia
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16
Q

What are important drug drug interactions of carbamazepine?

A
  • reduces COCP effect
  • increases warfarin metabolism
  • CYP3A4 inhibitors e.g.clarithryomycin + diltiazem increase [carbamazeipine]
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17
Q

Why should carbamazepine not been given during pregnancy?

A

Teratogenic
- Neural tube defects
- Bone marrow depression
- AV conduction issues

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18
Q

What is the mechanism of action of phenytoin?

A

Sodium channel blocker
- blocks VGNC in excitatory neurone
- reduces Ca2+ influx + glutamate

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19
Q

What are adverse drug reactions of phenytoin?

A
  • dizziness
  • skin rash
  • visual disturbances
  • arrhythmia
  • gingival hyperplasia
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20
Q

What is gingival hyperplasia?

A

Overgrowth of gums

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21
Q

Classifications of sezuires

A

Focal onset
Generalised onset
Unknown onset

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22
Q

What is a tonic clonic seizure?

A

Typical epileptic fit
- tonic stage: loss of consciousness, stiff body
- clonic stage: limbs jerk, possible loss of bladder/bowel control

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23
Q

What is an absence seizure?

A

Loss of awareness of surroundings
- staring blankly into space
- looks like daydreaming
- slight jerking of body
- unable to remember them

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24
Q

What is a clonic seizure?

A

Body shakes + jerks but does not go stiff at start

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25
Q

What is a tonic seizure?

A

Body muscles become stiff

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26
Q

What is a atonic seizure?

A

All muscles suddenly relax

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27
Q

What class of drug is sodium valproate?

A

Anticonvulsant

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28
Q

Uses of sodium valproate

A

Most types of epilepsy

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29
Q

What is the mechanism of action for sodium valproate?

A

Increases GABA synthesis + transcription of channel coding genes

30
Q

What are adverse drug reactions of sodium valproate?

A
  • hepatotoxicity
  • appetite stimulant
  • alopecia
  • thrombocytopenia
31
Q

What are contraindications of sodium valproate?

A

teratogentic
- Avoided where pregnancy is possible
- Unless pregnancy prevention programme is in place

32
Q

What are important drug drug interactions for sodium valproate?

A

Increases [lamotrigine] + [phenytoin] > decreases their action by displacing them off blood proteins

33
Q

Outline the prescription of sodium valproate

A

No one under 55 will be newly prescribed unless two specialists agree there is no other effective or tolerated treatment, or there are reasons that the reproductive risk doesnt apply

34
Q

Describe the pregnancy prevention programme

A

At least one highly effective contraceptive method
OR
Two complimentary forms including barrier

35
Q

What class of drug is lamotrigine?

A

Na+ and Ca2+ channel blocker

36
Q

What are the uses of lamotrigine?

A

Focal seizures
Generalised tonic clonic seizures

37
Q

What is the mechanism of action of lamotrigine?

A

Na+ and Ca2+ channel blocker
- less enters excitatory neurone > less glutamate released to post synaptic neurone

38
Q

What are adverse drug reactions of lamotrigine?

A

Aggression
Agitation
Hypersensitivity

39
Q

What are important drug drug interactions of lamotrigine?

A

Sodium valproate + phenytoin increases [lamotrigene]
Oral contraceptive pill decreases [lamotrigene]

40
Q

What are the uses of levetiracetam?

A

Focal seizures

41
Q

What is the mechanism of action of levetiracetam?

A

Synaptic vesicle protein inhibition
- Reduces synchronised burst firing without affecting neuronal excitability
- reduced glutamate release from excitatory neurone

42
Q

What are adverse drug reactions of levetiracetam?

A

Anxiety
Drowsiness
Dizziness

43
Q

What are important drug drug interactions of levetiracetam?

A

CNS depressants

44
Q

What is status epilepticus?

A

Condition where epileptic fits follow one another without recovery on consciousness between them

45
Q

When is a seizure a medical emergency

A
  • lasts >5 minutes
  • status epilepticus (multiple seizure without recovery in between)
46
Q

What is the stepwise approach of status epilepticus treatment

A
  • benzodiazepines
  • 2nd dose benzodiazepine
  • 2nd line - levetiracetam or phenytoin or sodium valproate
  • alternative 2nd line agent
  • barbiturates + general anaesthesia
    5-10 minute interval between each
47
Q

What drug class should be administer first in the treatment of status epilepticus?

A

Benzodiazepines

48
Q

Examples of benzodiazepiness

A

Diazepam
Lorazepam
Midazolam

49
Q

Compare the duration action of midazolam + diazepam

A

midazolam: short actin
diazepam: longer acting

50
Q

What benzodiazepine is better in hepatic dysfunction + why?

A

lorazepam
Phase 2 metabolism

51
Q

What are the uses of benzodiazepines?

A

Anxiety
Status epilepticus
Insomnia associated with anxiety

52
Q

What is the mechanism of action of benzodiazepines

A
  • potentiate GABA activity at GABAA receptor
  • hyperpolarisation of cell via increased Cl- influx
53
Q

What are adverse drug reactions of benzodiazepines?

A

Ataxia
Depression
Drowsiness
Hypotension
Muscle weakness
Sleep disorders

54
Q

What can high doses of benzodiazepines cause?

A

Respiratory depression

55
Q

Why should benzodiazepines be used short term?

A

Addictive
Risk of overdose

56
Q

What are important drug drug interactions of benzodiazepines?

A

Other CNS depressants

57
Q

What is sudden unexplained death in epilepsy SUDEP?

A

Deaths in people with epilepsy who are otherwise healthy that are not caused by known causes

58
Q

Relationship between carbamazepine + CYP450 enzymes

A

It induces CYP3A4 so increases its own metabolism

59
Q

Describe a focal seizure

A
  • remains conscious
  • arises in one hemisphere of the brain
  • split into aware + impaired awareness
  • can have motor onset e.g. jolting
  • or non motor onset e.g. smacking lips
60
Q

Describe an simple focal seizure

A
  • conscious
  • normal awareness
  • no post ictal symptoms
  • arises in one hemisphere
61
Q

What is a secondary generalised seizure?

A

Starts focal but then comes generalised

62
Q

Describe a complex focal seizure

A
  • conscious but impaired awareness
  • can get post ictal symptoms e..g confusion, groggy
  • often in temporal lobe
  • arises in one hemisphere
63
Q

Describe a generalised seizure

A

Arises in both hemispheres
Often unconscious

64
Q

Types of generalised onset seizures

A

Tonic clonic
Tonic
Clonic
Atonic
Myoclonic (can be conscious)
Absence (can be conscious)

65
Q

What is a myoclonic seizure?

A

Seizure of muscle or groups of muscles
Can be conscious

66
Q

Examples of post ictal symptoms

A

Embarrassment
Confusion
Fatigue
Headache
Muscle aching/pain
Frustration

67
Q

What is an aura?

A

A warning that a seizure in coming

68
Q

Diagnosis of epilepsy

A
  • electroencephalogram
  • MRI
  • detailed patient history + eyewitness accounts
69
Q

What needs to be considered in women on COCP when prescribed carbamazepine?

A

Carbamazepine increases action of CYP450 enzymes on COCP so higher dose of COCP is needed

70
Q

Uses of phenytoin

A

Second line status epilepticus

CPT (28 decks)

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