Anti Epileptic Flashcards

Question

Why may aeds be changed

Answer 1

• Change if unacceptable side effects, failure of treatment or on inappropriate drug • Start at initial dose and slowly increase to middle of recommended therapeutic range • Then slowly withdraw old drug over about 6 weeks Keep patient on the drug, start a new one, slowly titrations up until middle of therapeutic range, then take the old one away. Want them to overlap - initial one may have had some kind of effect

Answer 2

• Consider if patient seizure free for at least 2 years – 60% will have no further seizure when medication withdrawn • However, bear in mind the increased risk of seizure compared to those who continue on treatment – Epilepsy since childhood – Patients on more than one drug – Myoclonic or tonic-clonic seizures – Abnormal EEG in last year – Known underlying brain damage • Need to think about patient’s livelihood • DVLA recommends no driving for 6 months after stopping medication

Answer 3

CESSATION OF ANTIEPILEPTICS • Gradually taper off • Aim is to avoid withdrawal features – Recurrent seizures – Anxiety and restlessness • Lamotrigine, carbamazepine, phenytoin, sodiumvalproate, vigabatrin – Reduce dose by 10% every 2-4 weeks • Ethosuximide, barbiturates, benzodiazepines – Reduce dose by 10% every 4-8 weeks • If on more than one drug, withdraw from one drug at a time – 1 month between complete withdrawal from one drug and starting withdrawal from another

Answer 4

• Risk of congenital malformations – E.g.neuraltubedefects, hypospadias, cardiacdefects • Carbamazepine – Generally perceived as safe in pregnancy, although still carries risks • Sodium Valproate – Thought to cause decreased serum folate -> neural tube defects – Craniofacial and skeletal abnormalities – Developmental disorders after birth (mental and physical) • Try not to prescribe sodium valproate to females of childbearing age • Prescribe lowest effective dose – Divided over the day – Controlled-release tablets • Start folate supplementation before pregnancy • If no suitable alternative, counsel on risks and appropriate contraception • Specialist prenatal monitoring

Answer 5

``` PHENYTOIN • Common congenital malformations – Cleft lip and palate – Congenital heart defects (septal defects) • Anticonvulsant (epilepsy) • Cardiac depressant (arrhythmias) • Levels peak at 3 – 9 hours post dose • Therapeuticlevels:10mg/l–20mg/l • Toxicity  nausea, CNS dysfunction (confusion, nystagmus, ataxia), decreased consciousness, coma! ```

Answer 6

• Narrow therapeutic window • Non-linear pharmacokinetics • Therapeutic drug monitoring to: – Establish individual therapeutic concentration – Aid diagnosis of clinical toxicity – Assess compliance – Guide dose adjustments in patients with greater pharmacokinetic variability • Following loading dose, checked at 3-4 days, then 3-12 monthly if stable

Answer 7

Treatment of partial seizures (simple & complex) • Lamb – Lamotrigine • Top – Topiramate: can’t be explained off the Top a Ma Head – Also used in migraines • Gave – Gabapentin: wishes it worked like GABA but has pent up frustration • Funny – Phenytoin: can’t be funny for too long, so use in Status Epilepticus • Carbs – Carbamazepine: keeps Na channels inactive like phenytoin

Answer 8

eneral seizures: • Barbara – PheNObarbitol: NO barb means don’t use unless desperate • Valiantly – Sodium valproate: valiantly tries to do many things (including “attacking the liver enzymes”) • Sux – Ethosuximide: Sucks to learn it, but make sure it doesn’t go absent from revision • Good-Pam – Ends in Pam, so it’s a benzo – Acts quickly, so it’s good 1st line for status epilepticus

Answer 9

ABCDE -> lorazepam or midazolam benzodiazepines) | Pre-hospital: PR or buccal Hospital: IV

Answer 10

= epileptic seizures occurring continuously without recovery of consciousness in between Neither Funny nor Good So use Phenytoin or Benzodiazepines

Answer 11

• Following first seizure, patient deemed safe for discharge • Referral to First Fit Clinic follows • Advise patient of lifestyle changes in the meantime • If treatment initiated: AIM = CONTROL of seizures on FEWEST drugs with LOWEST dose and LEAST side effects

Answer 12

• Driving: – Epilepsy when awake, licence is taken away until 1 year seizure-free – If due to medication change: 6 months seizure-free – Seizures whilst asleep or don’t affect driving or consciousness – assessment of case by DVLA – If one-off seizure then can apply when 6 months seizure-free and assessment by DVLA • Do not operate dangerous machinery • Avoid potentially dangerous work or activities, e.g. swimming, climbing ladders • Bathe with supervision or leave bathroom door unlocked • Do not bathe babies alone • Do not cycle on busy roads • Avoid consuming alcohol

Answer 13

• Annual review – Check seizure control and if any precipitants – Compliance – Consider advice on contraception, pregnancy, employment issues and benefits • SUDEP (sudden unexpected death in epilepsy) – Increased risk in patient with uncontrolled seizures – Risk increases to 1 in 150 with poorly controlled seizures • Increased risk of mental health illness – Abnormal activity of neurotransmitters – Structural abnormalities – Functional abnormalities

Anti Epileptic Flashcards

(37 cards)