AED factfiles

Question 1

Valproate indications

Answer 1

Migraine
Epilepsy

Question 2

Sodium valproate and vitamin D

Answer 2

Consider vitamin D supplementation in patients who are immobilised or who have an inadequate sun exposure or dietary intake of calcium

Question 3

What category is sodium valproate

Answer 3

Category 2

Question 4

Withdrawal of SV

Answer 4

Avoid abrupt - reduce over at least 4 weeks

Question 5

KEY side effects of SV

Answer 5

Hepatic dysfunction
Pancreatitis
Blood disorders

Discontinue if these occur

Question 6

Interactions of SV

Answer 6

Lamotrigine- Valproate increases the exposure of lamotrigine, monitor rash

Phenytoin- Valproate affects the concentration of phenytoin. Phenytoin decreases the concentration of valproate

Topiramate- increases the risk of toxicity when given with valproate

Question 7

Monitoring for SV

Answer 7

LFT

Question 8

What category is levetiracetam

Answer 8

3

Question 9

Levetiracetam side effects

Answer 9

Anxiety
Depression
Increased risk of infection
Movement disorders
Nausea and vomiting

Question 10

RARE side effects of levetiracetam

Answer 10

QT prolongation
AKI
Agranulocytosis
Hyponatreamia
Neutropenia
Pancreatitis
SCAR

Question 11

MTX and levetiracetam

Answer 11

Levetiracetam decreases the clearance of MTX

Question 12

What does levetiracetam mainly interact with

Answer 12

CNS depressants (amitriptyline, diazepam, mirtazapine, pizotifen, quetiapine, tramadol)

Question 13

What injection at birth minimises the risk of neonatal haemorrhage associated with AED

Answer 13

Vitamin K

Question 14

Which AED require monitoring during pregnancy

Answer 14

Phenytoin, carbamazepine, lamotrigine.

Dose should be adjusted on the basis of plasma-drug conc monitoring

Question 15

How to reduce the risk of neural tube defects

Answer 15

Folic acid 5mg is advised before conception and throughout the first trimester

Question 16

Phenytoin therapeutic range

Answer 16

10-20mg/L

Question 17

Symptoms of phenytoin toxicity

Answer 17

Nystagmus
Diplopia
Slurred speech
Ataxia
Confusion
Hyperglycaemia

Question 18

Can phenytoin cause blood dyscarias

Answer 18

Yes

Question 19

Which category is phenytoin

Answer 19

1- SHOULD REMAIN ON SAME BRAND

Question 20

Phenytoin side effects

Answer 20

Gingival hyperplasia
Vit d deficiency
Coarsening of facial features
Hair changes

Question 21

Which drugs do phenytoin reduce the plasma concentrations of

Answer 21

Warfarin
COC
POP
EHC

Question 22

Which drugs increase phenytoin concentrations

Answer 22

Fluconazole
Diltazem
Cimetidine
Trimethoprim
Topiramate

Question 23

Lamotrigine counselling

Answer 23

Should be aware of bone marrow failure

Question 24

Cautions with lamotrigine therapy

Answer 24

Myoclonic seizures may be exacerbated
Parkinson disease may be exacerbated

Question 25

Lamotrigine with other AED

Answer 25

Valproate increases plasma levels of lamotrigine whereas enzyme inducer like carbamazepine reduce it

Question 26

RARE side effects of lamotrigine

Answer 26

SCARS SJS (especially first 8 weeks)

Question 27

Lamotrigine in impairment

Answer 27

May accumulate in renal 50% reduction in hepatic and 70% in severe impairment

Question 28

Stopping lamotrigine therapy

Answer 28

Avoid abrupt withdrawal - taper over 2 weeks at least

Question 29

1st unprovoked seizure or single isolated seizure must not drive for .....

Answer 29

6 months

Question 30

Established epilepsy need to be seizure free for...

Answer 30

1 year

Question 31

Driving and sleep seizures

Answer 31

Must not drive for a year unless only have sleep seizures/ established pattern of asleep seizures over a Course of 3 years if they have had An awake seizures

Question 32

When do the DVLA recommend not to drive

Answer 32

- Changes in drug/dose - During withdrawal - 6 months after last dose

Question 33

Carbamazepine therapeutic range

Answer 33

4-12 mg/L

Question 34

Which drugs do carbamazepine reduce the plasma conc of

Answer 34

Warfarin Ciclosporin Simvasatin DOAC

Question 35

Which drugs increase plasma conc of carbamazepine

Answer 35

macrolides Grapefruit Cimetidine Miconazole

Question 36

Vitamin D and carbamazepine

Answer 36

Consider in those with inadequate sun exposure or long periods of immobility

Question 37

Adverse effects of carbamazepine

Answer 37

SJS Anti-epeileptic hypersensitivity syndrome (fever, rash, lymphadenopathy)

Question 38

Which category is carbamazepine

Answer 38

1

Question 39

Which electrolyte does carbamazepine disturb

Answer 39

Sodium- Hyponatraemia

Question 40

Key counselling for carbamazepine

Answer 40

Patients should be reminded to report any symptoms such as fever, rash, mouth ulcers, bleeding, bruising