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GPhC Exam > CNS: Epilepsy > Flashcards

CNS: Epilepsy Flashcards

(54 cards)

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1
Q

What is epilepsy?

A

A condition caused by a sudden surge of electrical activity of neurons, causing seizures

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2
Q

What is the first line treatment for all generalized seizures?

A

Sodium valproate

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3
Q

What is the most important factor to consider when choosing an appropriate antiepileptic?

A

The presenting epilepsy syndrome (or the seizure type if syndrome is unclear)

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4
Q

What influences the dosage frequency of most antiepileptics?

A

The plasma-drug half-life

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5
Q

What four antiepileptics have long half-lives, and therefore can be given once a day (at bedtime)?

A

Lamotrigine
Phenobarbital
Phenytoin
Perampanel

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6
Q

What are the two main types of seizure? How are they determined (2)?

A

Focal - affects one part of the brain

Generalised - affects both sides/multiple parts of the brain; symptoms affect whole body

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7
Q

What are four main types of generalised seizures?

A

Tonic-clonic
Absence
Myoclonic
Atonic and tonic

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8
Q

What are three main characteristics for tonic-clonic seizures?

A

Body stiffens
Followed by convulsions
Loss of bladder/bowel control

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9
Q

What can be used for tonic-clonic seizures when sodium valproate is inappropriate?

A

Lamotrigine

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10
Q

What type of seizure can lamotrigine exacerbate?

A

Myoclonic

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11
Q

What are three characteristics of an absence seizure?

A

Brief loss of consciousness
No convulsions
Common in children

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12
Q

What are the preferred drugs for monotherapy in absence seizures? (3)

A

Sodium valproate OR ethosuximide, alternatively lamotrigine

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13
Q

What are two characteristics of a myoclonic seizure?

A

Brief/short

Shock-like muscle jerks

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14
Q

What are the preferred drugs for monotherapy in myoclonic seizures? (3)

A

Sodium valproate

Alternatively, levetiracetam or topiramate

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15
Q

What are two characteristics of atonic/tonic seizures?

A

Brief loss of consciousness

Body sometimes falls to the ground as muscles are too weak to support it

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16
Q

What are the preferred drugs for monotherapy in atonic/tonic seizures? (3)

A 
Sodium valproate (lamotrigine can be used as adjunct therapy)
Alternatively, rufinamide or topiramate
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17
Q

What are the preferred drugs for monotherapy of focal seizures?
Remember: fo-CA-L

A

Carbamazepine or lamotrigine

Alternatively, levetiracetam, oxcarbazepine or sodium valproate

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18
Q

What did the MHRA conclude about switching between brands for antiepileptics?

A

Some antiepileptics need to be prescribed by brand as switching can cause loss of seizure control

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19
Q

What are four examples of category 1 antiepileptics?

A

Carbamazepine
Phenobarbital
Phenytoin
Primidone

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20
Q

What are four examples of category 2 antiepileptics?

A

Topiramate
Lamotrigine
Sodium valproate
Clonazepam

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21
Q

What are four examples of category 3 antiepileptics?

A

Levetiracetam
Gabapentin
Pregabalin
Ethosuximide

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22
Q

How should antiepileptics be withdrawn/switched? (3)

Study These Flashcards
A

Slowly/gradually
One at a time
Under specialist supervision

23
Q

What should a driver do if they get a seizure?

Study These Flashcards
A

Stop driving and tell the DVLA ASAP

24
Q

How long before someone who has had their first seizure can drive again?

25
What two criteria need to be met before patients with established epilepsy can drive?
Seizure free for a year | No history of unprovoked seizures
26
How long do patients who have had a seizure while asleep have to wait before driving again? What are the two exclusion criteria?
1 year, unless: an pattern of no seizures while awake for a year after the first sleep seizure has been established; there haven't been any seizures while awake for three years (if they previously had seizures while awake)
27
How long do patients who have recently changed/withdrawn their antiepileptics wait before driving again?
6 months
28
When can sodium valproate be used in females? (2)
They satisfy the criteria for the Pregnancy Prevention Programme There are no other appropriate alternatives
29
What two antiepileptics are safe in pregnancy?
Levetiracetam | Lamotrigine
30
What is a side effect of topiramate in pregnancy?
The baby may develop a cleft palate
31
What should be given to babies shortly after birth if their mum was on antiepileptics? Why?
Vitamin K, to reduce the likelihood of neonatal hemorrhage
32
What should happen if a lady on antiepileptics becomes pregnant unexpectedly?
No changes to their meds should be made (the risk of seizures > the risk of continued therapy)
33
If a patient on antiepileptics is planning to get pregnant, what supplement should she be offered?
Folic acid
34
What two antiepileptics are more likely to cause withdrawal symptoms in newborns?
Benzodiazepines and phenobarbital
35
What three antiepileptics are associated with risk of drowsiness in breast-fed babies?
Primidone Phenobarbital Benzodiazepines
36
What should infants be monitored for if their mother is on antiepileptics? (4)
Sedation Weight gain Developmental milestones Feeding difficulties
37
Which antiepileptic can reduce the efficacy of hormonal contraception?
Carbamazepine
38
What are three common symptoms of antiepileptic hypersensitivity syndrome?
Rash Fever Lymphadenopathy
39
What drugs are associated with antiepileptic hypersensitivity syndrome? (5)
``` Carbamazepine Phenytoin Phenobarbital Primidone Lamotrigine ```
40
When is antiepileptic hypersensitivity syndrome most likely to occur? What should happen if it's suspected?
Within the first 8 weeks of treatment; discontinue drug immediately
41
What did the MHRA concluded about all antiepileptics? What should patients do if they experience it?
There is a small risk of suicidal ideation - patients should report any changes in mood or distressing thoughts
42
Which antiepileptic is most likely to cause serious skin reactions (e.g. SJS, toxic epidermal necrolysis)? What can increase the risk of developing this?
Lamotrigine; concomitant use with sodium valproate
43
What drugs are most likely to cause blood dyscrasias? | Remember: C VET PLZ
``` Carbamazepine Sodium valproate Ethosuximide Topiramate Phenytoin Lamotrigine Zonisamide ```
44
Which antiepileptics are most likely to cause visual issues? (2)
Vigabatrin | Topiramate
45
Which antiepileptic is most likely to cause encephalopathic symptoms? What should be done if the patient experiences them?
Vigabatrin - reduce dose or withdraw
46
What did the MHRA conclude about gabapentin? Which groups of patients are more prone to experiencing it? (4)
``` Can cause severe respiratory depression - esp. if patients have existing respiratory issues; are old; have renal impairment; or are on other CNS depressants ```
47
Which antiepileptics are enzyme inducers, and can decrease the plasma conc. of other drugs? (3)
Carbamazepine Phenytoin Phenobarbital
48
Which antiepileptic is an enzyme inhibitor, and can increase the plasma conc. of other drugs?
Sodium valproate
49
What is status epilepticus?
A medical emergency where seizures last for more than 30 mins, or there are several seizures without regained consciousness in-between
50
What should be administered if a patient experiences convulsive status epilepticus?
IV lorazepam
51
What should be administered if a patient experiences non-convulsive status epilepticus, with signs of awareness?
Their usual antiepileptic drug
52
What should be administered if a patient experiences non-convulsive status epilepticus, with loss of awareness OR failure to respond to their normal antiepileptic?
IV lorazepam
53
What should be administered if a patient experiences febrile convulsions for less than 5 mins?
An antipyretic i.e. paracetamol
54
What should be administered if a patient experiences febrile convulsions for longer than 5 mins?
IV lorazepam

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