AEDs

Question 1

carbamazepine S/E?

Answer 1

can cause hyponatraemia (through SIADH)

Question 2

Tx of generalised/absence/myoclonic/tonic seizures?

Answer 2

valproate

Question 3

Tx of focal seizures?

Answer 3

carbamazepine/lamotrigine

Question 4

are AEDs okay in pregnant women?

Answer 4

all teratogenic to some degree
but weigh up pros/cons
valproate most teratogenic

Question 5

what to prescribe alongside valproate?

Answer 5

Vit D

Question 6

if can’t Tx absence seizures with valproate, what is second line?

Answer 6

ethosuximide

Question 7

what to monitor in valproate?

Answer 7

liver function

vALTproate

Question 8

if someone is having a seizure? (3)

Answer 8

(1) ensure patent airway
(2) put in recovery position
(3) check for provoking factors (e.g. plasma glucose, electrolytes, drugs and sepsis)

Question 9

define status epilepticus?

Answer 9

seizure lasting >30 mins

but intervene after 5 mins

Question 10

how long to wait to Tx a seizure?

Answer 10

5 mins

Question 11

Tx status epilepticus?

Answer 11

ABC, recovery position with O2, secure airway
IV lorazepam 4mg IV (or rectal diazepam/ buccal midazolam)
repeat after 10 mins if still fitting
(NEVER have someone fitting for >20mins w/t anaesthetist present)
IV phenytoin infusion
intubate then propofol

Question 12

lamotrigine S/E?

Answer 12

RASH

rarely Stevens–Johnson syndrome

Question 13

carbamazepine S/E?

Answer 13

rash
dysarthria
ataxia
nystagmus
⇓Na

Question 14

Phenytoin S/E?

Answer 14

Ataxia, peripheral neuropathy, gum hyperplasia, hepatotoxicity

Question 15

Sodium valproate S/E? (3 Ts)

Answer 15

Tremor, teratogenicity, tubby (weight gain)

Question 16

what (according to Pass the PSA) has best safety profile in pregnancy of all antiepileptic drugs?

Answer 16

lamotrigine