Epilepsy Flashcards
(29 cards)
Tx focal seizures
- got to take TWO Ls to get you FOCUSED, COZ we do
1st: Levetiracetam or Lamotrigine (two Ls)
2nd: Carbamazepine, Oxcarbazepine or Zonisamide (COZ)
Tx generalised seizures
- 1st line for absence seizures
1st: sodium valporate
2nd: Lamotrigine or Levetiracetam
Absence seizures
1st: ethosuximide
2nd: sodium valporate
If patient is under 55, DO NOT use sodium valporate
What is status epilepticus?
- what is the treatment
Seizures lasting longer than 5 mins
- Tx: IV lorazepam (in hospital)
- can use REACTAL diazepam or BUCCAL midazolam (in community)
In startups epilpeticus, what do you give if seizure fails to respond after 2 benzodiazepines
Levetiracetam
- phenytoin or sodium valporate
- if one doesnt work, try another
If it still fails to respond
- phenobarbital
- general anaesthesia
Category 1 antiepileptics
Must be kept on the same brand
Carbamazepine
Phenobarbital
Phenytoin
Primidone
Category 2 antiepilpetics
Need to supply a particular brand based on clinical judgement
- sodium valporate
- Lamotrigine
Category 3 anti-epileptics
No specific measures required for prescribing
- Levetiracetam
- lacosamide
- pregblin/ gabapentin
Which side effects do carbamazepine, phenytoin and sodium valproate all have in common?
Blood dyscrasia
Hepatotoxicity
Skin disorders (Stevens-Johnson syndrome)
Vitamin D deficiency- can cause osteoporosis
Side effect only associated with carbamazepine?
HYPOnatreaemia and oedema
Side effects only associated with Phenytoin?
Facial hair
Coarsening appearance
Side effects only associated with sodium valporate
Pancreatitis
Is teratogenic- all patients must be on PPP
Which anti-epileptics have a risk of suicidal thoughts and behaviours?
ALL of them
Which anti-epileptics are associated with hypersensitivity reactions?
- CPPPL
Carbamazepine, phenobarbital, phenytoin, primidone and Lamotrigine
- Lamotrigine can cause Stevens-Johnson syndrome
Side effect of gabapentin
Respiratory depression
Side effect of topiramate
Glaucoma
Cleft palate
- females must be on a PPP
What is the therapeutic range for carbamazepine?
4-12 mg/L
What are the signs of toxicity with Carbamazepine?
- BAD HAND
Blurred vision
Allergic skin reactions
Dizziness
Headaches
Ataxia (lackof co-ordination)
Nausea and vomiting
Drowsiness
Therapeutic range of phenytoin
10-20 mg/L
- same as theophylline
Signs of toxicity of phenytoin
- RANDS
Respiratory
Ataxia (lack of co-ordination)
Nystagmus (involuntary eye movements)
Double vision
Slurred speech
WhIch antiepileptic are CYP enzyme INDUCERS?
Phenytoin, phenobarbital and carbamazepine
Which anti-epileptics are enzyme INHIBITIORS?
Sodium valporate
Examples of drugs that lower seizure threshold
- should not be used with anti-epileptics
Tramadol
Theophylline
Quinolones
Examples of drugs that cause HYPOnatraemia
- should not be used with CARBAMAZEPINE
SSRIS
Diuretics
Examples of drugs that are anti-folates
- should not be used with PHENYTOIN
Methotrexate
Trimethoprim (and CO-TRIMOXAZOLE)
