Central Nervous System - Epilepsy

Question 1

1st line tx of focal seizures

Answer 1

lamotrigine/levetiracetam

Question 2

2nd line tx of focal seizures

Answer 2

carbamazepine, oxcarbazepine, zonisamide

Question 3

what are the different types of generalised seizures

Answer 3

-tonic-clonic
-absence
-absence + other
-myoclonic
-atonic
-tonic

-for child-bearing age = 2nd line tx

Question 4

tx of tonic-clonic seziures

Answer 4

1)sodium valproate
2)lamotrigine, levetiracetam

Question 5

tx of absence seizures

Answer 5

1)ethosuximide
2)sodium valporate

only one with different tx

Question 6

tx of absence + other type of seizures

Answer 6

1)sodium valproate
2) lamotrigine/ levetiracetam

Question 7

myoclinic seziures tx

Answer 7

1)sodium valproate
2) levetriacetam

Question 8

atonic seziures tx

Answer 8

1)sodium valproate
2)lamotrigine

Question 9

tonic seizures tx

Answer 9

1)sodium valproate
2)lamotrigine

Question 10

what is status epilepticus

Answer 10

-seizures that last longer than 5 mins

Question 11

immediate status epilepticus tx

Answer 11

• resuscitation and immediate emergency tx
  -if patient doesn’t have individualised tx give standard tx

Question 12

what is standard status epilepticus tx

Answer 12

• IV lorazepam (resuscitation if available)
• buccal midazolam/rectal diazepam (community)
• give second dose if seizure x stop within 5-10mins of 1st dose
• if seizure x respond after 2x benzodiazepine doses give levetiracetam, phenytoin, sodium valproate
• if seizure fails to respond try another 2nd line if still x respond give phenobarbital/general anaesthesia

Question 13

category 1 of anti-epileptic drugs

specific brands only

Answer 13

CP3
->carbamazepine, phenobarbital, phenytoin, primidone

Question 14

category 2 of anti-epileptic drugs

Answer 14

• maintain specific brands based on clinical judgement + pt factors
  -C2PLOTZRV
  ->clobazam, clonazepam, perampanes, lamotrigine, oxcarbazepine, topiramate, zonisamide, rufinamide and valproate

Question 15

category 3 of anti-epileptic drugs

Answer 15

-unnecessary to ensure - specific brands
- brivaracetam, ethosuximide, gabapentin, laxosamide, levetiracrtam, pregabalin, tigabine, vigabatrin

Question 16

what drugs interaction with carbamazepine, phenytoin and sodium valproate?

Answer 16

• drugs that cause hepatoxicity
• CYP inducers - phenytoin, phenobarbital + carbamazepine
• CYP inhibitors - sodium valproate
• drugs that lower seizure threshold
• hyponatraemia drugs - carbamazepine
• anti-folate drugs - phenytoin

Question 17

which drugs cause hepatoxicity and interact with carbamazepine, phenytoin and sodium valproate?

Answer 17

amiodarone
itraconazole
macrolides
alcohol

Question 18

which drugs lower seizure threshold and interact with carbamazepine, phenytoin and sodium valproate?

Answer 18

tramadol
theophylline
quinolones

Question 19

which hyponatraemic drugs interact with carbamazepine

Answer 19

SSRIs
Diuretics

Question 20

which anti-folate drugs interact with phenytoin

Answer 20

Methotrexate
Trimethoprim

Question 21

what are the s/e of carbamazepine, phenytoin and sodium valproate?

Answer 21

suicide
depression
hepatotoxicity
hypersensitivity
blood dyscrasia
vit D deficiency

Question 22

what is s/e of carbamazepine?

Answer 22

hyponatraemia

Question 23

what is s/e of phenytoin?

Answer 23

coarsening appearance + facial hair

Question 24

what is s/e of sodium valproate?

Answer 24

pancreatitis
teratogenic

Question 25

which antileptic drugs cause hypersensitivity as a s/e

Answer 25

***CP3L*** ->carbamazepine, phenobarbital, phenytoin, primidone, lamotrigine

Question 26

which antileptic drug cause skin rash as a s/e

Answer 26

**lamotrigine** -> steven-Johnson-syndrome

Question 27

which antileptic drugs cause blood dyscrasia as a s/e

Answer 27

***C.VET.PLZ*** ->carbamazepine, valproate, ethosuximide, topiramate, phenytoin, lamotrigine, zonisamide

Question 28

which antileptic drug lowers visual field as a s/e

Answer 28

vigabatrin

Question 29

which antileptic drug cause secondary glaucoma as a s/e

Answer 29

topiramate

Question 30

which antileptic drug cause enecphalopathy as a s/e

Answer 30

vigabatrin

Question 31

which antileptic drugs cause respiratory depression as a s/e

Answer 31

gabapentin pregabalin

Question 32

what is therapeutic range of carbamazepine

Answer 32

4-12mg/l

Question 33

what is therapeutic range of phenytoin

Answer 33

10-20mg/l

Question 34

what are the toxicity signs of carbamazepine

Answer 34

***HANDBAG*** -hyponatraemia -ataxia -nystagmus -drowsiness -blurred vision -arrythmia -GI disturbances

Question 35

what are the toxicity signs of phenytoin?

Answer 35

***SNACHD*** -slurred speech -nystagmus -ataxia -confusion -hyperglycaemia -double vision

Question 36

if you drive and have a epileptic fit what do you do?

Answer 36

STOP driving and inform DVLA

Question 37

How long do you have to wait to drive if you have had 1st unprovoked/single isolated seizure?

Answer 37

6 months

Question 38

how long do you have to wait to drive if you have an established epilepsy

Answer 38

1 year if pattern of seizures is established for 1yr then no impact on consciousness

Question 39

how long do you have to wait to drive if there are medication changes or withdrawal?

Answer 39

- don't drive for **6MT** after last dose, -if seizure occur then license removed for **1yr** ->**reinstated** after **6MT** if tx resumed + no seizure occur

Question 40

what is the caution of epilepsy and pregnancy

Answer 40

risk of harm to mother + fetus from convulsive seizures outweighs risk of continued therapy

Question 41

what is given in first trimester of pregnancy in epilepsy and why?

Answer 41

folic acid given to reduce risk of neural tube defects

Question 42

which injection is administered during pregnancy with epilepsy and why?

Answer 42

vit K to reduce neonatal haemorrhage

Question 43

which antiepileptic is most at risk in pregnancy?

Answer 43

Sodium valproate = PPI

Question 44

what does topiramate cause in pregnancy

Answer 44

cleft palate in babies