Epilepsy

Question 1

What are the category 1 AEDs?

Answer 1

Carbamazepine, phenytoin, phenobarbital, primidone

Question 2

What are the PPP AEDs?

Answer 2

Valproate and topiramate

Question 3

What is static epilepticus?

Answer 3

Seizure lasting more than 5 minutes

Question 4

What are the first line treatments of static epilepticus?

Answer 4

IV lorazepam, buccal midazolam, rectal diazepam

Question 5

Why is diazepam not given IV for seizures?

Answer 5

Risk of thrombophlebitis - blood clot

Question 6

What is the 1st and 2nd line treatment of atonic seizures along with other types of seizures?

Answer 6

Ethosuximide 1st and sodium valproate 2nd

Question 7

When can you reapply to DVLA after having a seizure and now controlled with AEDs?

Answer 7

At least 1 year

Question 8

When can you reapply to DVLA after having a seizure with low risk of a 2nd seizure?

Answer 8

6 months seizure free

Question 9

What is first line for focal seizures?

Answer 9

Lamotrigine or levetiracetam

Question 10

What is 2nd line for focal seizures?

Answer 10

Carbamazepine, oxcarbazepine, zonisamide

Question 11

What is 2nd line for atonic and tonic seizures?

Answer 11

Lamotrigine

Question 12

What is 2nd line for myoclonic seizures?

Answer 12

Levetiracetam

Question 13

What is 2nd line for absence seizures with other types and tonic-clonic seizures?

Answer 13

Lamotrigine or levetiracetam

Question 14

What are the side effects specific to carbamazepine?

Answer 14

Hyponatraemia and oedema

Question 15

What are the side effects specific to phenytoin?

Answer 15

Coarsening appearance and facial hair

Question 16

What are the side effects specific to sodium valproate?

Answer 16

Pancreatitis and teratogenic

Question 17

What are the 5 side effects in common with carbamazepine, sodium valproate and phenytoin?

Answer 17

Depression and suicide
Blood dyscrasias
Hepatotoxicity
Skin disorders
Vitamin D deficiency

Question 18

What is the therapeutic range for carbamazepine?

Answer 18

4-12mg/L

Question 19

What is the therapeutic range for phenytoin?

Answer 19

10-20mg/L

Question 20

What are the 3 CYP inducer AEDs?

Answer 20

Phenytoin, Carbamazepine, Phenobarbital

Question 21

What is the CYP inhibitor AED?

Answer 21

Sodium valproate

Question 22

How long can you not drive for after a change/reduction in medication? And what if you have a seizure?

Answer 22

6 months but if had seizure during period then 1 year

Question 23

If a medication change returns to original treatment, how long until they can drive?

Answer 23

6 months seizure free

Question 24

For men on sodium valproate what is the pregnancy prevention plan?

Answer 24

Male patient and female partner must use effective contraception and 3 months after stopping valproate

Question 25

What is a key phenytoin interaction?

Answer 25

Anti-folates - methotrexate, trimethoprim, co-trimoxazole

Question 26

Which AED is most likely to cause Stevens-Johnson syndrome?

Answer 26

Lamotrigine

Question 27

Which AED is most likely to cause respiratory depression?

Answer 27

Gabapentin

Question 28

Which AED is most likely to cause glaucoma and cleft palate?

Answer 28

Topiramate

Question 29

Which AED is most likely to cause encephalopathic symptoms and visual field defects?

Answer 29

Vigabatrin

Question 30

During status epilepticus, how long do you wait to give a second dose of IV lorazepam/buccal midazolam/rectal diazepam?

Answer 30

5-10 minutes

Question 31

If status epilepticus does not stop after 2 doses of benzodiazepines, what drugs can you give?

Answer 31

Levetiracetam, phenytoin, sodium valproate Levetiracetam favoured

Question 32

During status epilepticus, what is next line if 2 rounds of AEDs have failed?

Answer 32

Phenytoin or general anaethesia

Question 33

What is 2nd line for absence seizures

Answer 33

Sodium valproate

Question 34

What are 3 drugs that lower seizure threshold

Answer 34

Tramadol Theophylline Quinolones

Question 35

Which AEDs have high presence in milk

Answer 35

Primidone Lamotrigine Ethosuximide Zonisamide

Question 36

Which AEDs causes risk of drowsiness to infant BF

Answer 36

Primidone Phenobarbital Benzos

Question 37

Which AEDs can cause withdrawal effects if mother stops BF abruptly

Answer 37

Benzos Phenobarbital Primidone Lamotrigine