Chapter 4 BNF (Epilepsy)

Question 1

What are examples of non epileptic seizures?

Answer 1

Organic eg hypoglycaemia

Psychogenic eg mental or emotional

Question 2

Which antiepileptics are not given twice daily?

Answer 2

Barbiturates
Lamotrigine
Phenytoin

Question 3

What’s first line and second line in partial focal seizures?

Answer 3

Carbamazepine or Lamotrigine

Oxcarbazepine sodium Valproate levetiracetam

Question 4

What’s first line in Tonic Clonic seizures?

Answer 4

Lamotrigine or Sodium valproate

Carbamazepine

Question 5

What’s first line in absence seizures?

Answer 5

Ethosuxamide or sodium Valproate

Lamotrigine

Question 6

What’s first line in myoclonic?

Answer 6

Sodium Valproate

Topiramate or levitiracetam

Question 7

What’s first line in tonic/atonic seizures?

Answer 7

Valproate

Question 8

What’s the option if monotherapy with antiepileptics doesn’t work?

Answer 8

Dual therapy then triple therapy

Question 9

What’s in category 2?

Answer 9

Lamotrigine
Valproate
Clonazepam
Topiramate

Question 10

What’s the risk with quick withdrawal of antiepileptics?

Answer 10

Rebound seizures (withdraw one at a time)

Question 11

How long must established epilepsy patients be seizure free before they can drive?

Answer 11

One year

Question 12

How long must patients be awake seizure free (if experiencing sleep seizures) before being allowed to drive?

Answer 12

One year if no awake seizures

3 years if awake seizures

Question 13

How long must someone wait to drive if they have an unprovoked seizure?

Answer 13

6 months

Question 14

How long after being withdrawn from antiepileptics can patients drive?

Answer 14

6 months

Question 15

Which antiepileptics must you monitor foetal growth with? Which causes a cleft palate?

Answer 15

Topiramate (cleft)

Levetiracetam

Question 16

Should patients on one antiepileptic be encouraged to breastfeed?

Answer 16

Yes

Question 17

When should patients on antiepileptics take folic acid?

Answer 17

Before pregnancy up to 12 weeks pregnant

Question 18

Which antiepileptics are present in high amounts in breast milk?

Answer 18

Zosunamise
Ethosuxamide
Lamotrigine
Primidone

Question 19

When is antiepileptic hypersensitivity most likely to occur?

Answer 19

1-8 weeks

Question 20

What’s the MHRA on antiepileptics?

Answer 20

Suicidal thoughts

Question 21

Which antiepileptics cause SJS?

Answer 21

Lamotrigine

Question 22

Which antiepileptic cause blood dyscrasias

Answer 22

C Vet plz

Question 23

Which antiepileptic causes eye problems?

Answer 23

Vagabatrin

Topiramate

Question 24

Which antiepileptic causes encephalopathy?

Answer 24

Vibagatrin

Question 25

Which antiepileptic has an MHRA for respiratory depression ?

Answer 25

Gabapentin

Question 26

Which antiepileptic is an enzyme inhibitor?

Answer 26

Sodium Valproate

Question 27

Which antiepileptics are enzyme inducers

Answer 27

Carbamazepine Phenytoin Phenobarbital

Question 28

What’s the target range for phenytoin?

Answer 28

10mg-20mg/L 6mg-15mg/L babies

Question 29

What are the side effects of phenytoin?

Answer 29

Change in appearance Blood dyscrasias (anti folate) Lower vit d Hepatotoxicity

Question 30

What’s mg of phenytoin base is equivalent to 100mg phenytoin sodium

Answer 30

92mg

Question 31

How does phenytoin work?

Answer 31

Binds you’re sodium channels in their inactive sites

Question 32

What are the side effects of IV phenytoin?

Answer 32

Bradycardia, hypotension

Question 33

What mg of fosphenytoin is equivalent to 1mg phenytoin sodium ?

Answer 33

1.5mg

Question 34

What are the side effects of IV fosphenytoin?

Answer 34

Severe cardiac reactions

Question 35

How does phenytoin interact with other medication? (Enzyme inducers, inhibitors etc)

Answer 35

Enzyme inhibitors - increases phenytoin concentration Enzyme inducers - reduce phenytoin concentration Anticonvulsant effect antagonised - drugs that lower seizure threshold Phenytoin is an inducer itself

Question 36

How does carbamazepine exert its effects?

Answer 36

Inhibits neuronal sodium channels

Question 37

What seizures are exacerbated by carbamazepine?

Answer 37

Myoclonic | Atonic

Question 38

What’s the desired concentration of carbamazepine?

Answer 38

4-12mg/L

Question 39

How does carbamazepine interact with other drugs?

Answer 39

Enzyme inhibitors Enzyme inducers Anticonvulsant effect antagonised Hyponatraemia: SSRIs , diuretics, NSAIDs TCAs Hepatotoxicity

Question 40

How does sodium valproate exert its effects?

Answer 40

Weak inhibitor of neuronal Sodium channels

Question 41

What are the side effects of sodium Valproate?

Answer 41

Blood dyscrasias Hepatotoxicity Pancreatitis

Question 42

How does sodium valproate interact with other drugs ?

Answer 42

Anticonvulsant effect antagonised Hepatotoxicity

Question 43

How is convulsive status epilepticus treated?

Answer 43

IV lorazepam Avoid diazepam

Question 44

How is non convulsive status epilepticus treated ?

Answer 44

Incomplete loss of awareness : oral antiepileptic Complete loss of awareness: IV lorazepam

Question 45

How are convulsive or febrile seizures treated in community ?

Answer 45

Diazepam rectal solution Midazolam oromucosal Repeat once after 10-15 mins

Question 46

Which antiepileptics cause Steven Johnson Syndrome?

Answer 46

Ethosuxamide Carbamazepine Lamotrigine (Ethan Carl Larry Stephen and Johnson )