Epilepsy Flashcards

Question

avoid prescribing what with phenytoin?

Answer 1

``` amiodarone: peripheral neuropathy apixaban (reduces its efficacy) carbamazepine (reduces) ciclosporin (reduces) CHC (reduces) dabigatran (reduces) enteral feeds (reduces efficacy of phenytoin) flucanazole (increases its concnetration) ```

Answer 2

Hypersensitivity to carbamazepine, or structurally related drugs, e.g. tricyclic anti-depressants. • Patients with atrioventricular block, a history of bone marrow depression or a history of hepatic porphyria's.

Answer 3

Blurred vision, somnolence and dizziness, oedema, fluid retention, weight increase, hyponatraemia Decreased platelet or white blood cell counts occur occasionally to frequently in association with use of carbamazepine. Agranulocytosis and aplastic anaemia have been associated with carbamazepine (although rare)

Answer 4

Anticoagulants, antidepressants, antifungals, antipsychotics, contraceptives and immunosuppressants. Co-administration with diuretics might induce hyponatremia Lithium in combination might enhance neurotixicty

Answer 5

``` enzyme inhibitors: cimetidine antifungal agents (ketoconazole) erythromycin ciclosporin Psoralen: (from grape fruit juice, interaction with DHPs and statins) ``` this takes 1-2 days and reverses quickly!

Answer 6

``` Barbiturates Rifampicin Griseofulvin Phenytoin Ethanol Carbamazepine –autoinduction! St John’s Wort ``` takes weeks!

Answer 7

``` alcohol- hepatotoxicity risk TCAs and SSRIs: high risk of hypoantremia Diuretics: high risk of hypoantremia Apixaban (reduced levels) Atrovastatin (hepatotoxicity) ciclosporin (reduced) Cimetidine (increased) Fluconzole (hepatotoxicity) Clarithromycin (increased concentrations of carbemazepine) contraception less effective ```

Answer 8

careful with carbemazepine, lamotrigine and phenytoin's effects on contraception sodium valproate and pregnancy

Answer 9

A first line drug choice in generalised, absence or partial seizures, especially if these occur as part of the syndrome of generalised epilepsy. The most likely mode of action for Epilim is potentiation of the inhibitory action of gamma amino-butyric acid (GABA) through an action on the further synthesis or further metabolism of GABA.

Answer 10

Pregnancy as it can cause foetal abnormalities therapy should be changed if a woman wants to become pregnant. Active liver disease or a history of hepatic dysfunction, in cases of hypersensitivity or porphyria.

Answer 11

• Nausea, diarrhoea and weight gain, tremors, dysmenorrhoea • Transient confusion on imitation of therapy, alopecia, skin rash and thrombocytopenia • Fatal hepatic and pancreatic failure can occur although this is rare

Answer 12

One of the “newer” classes of AED it can be used first line for patients with partial seizures with or without generalisation or tonic-clonic convulsions • It inhibits sustained repetitive firing of neurones and inhibits release of glutamate • (the neurotransmitter which plays a key role in the generation of epileptic seizures). • It can also be used to teat bipolar disorder (FYI) always worth confirming the indication with your patient.

Answer 13

not by first pass metabolism, not affected by liver enzymes | eliminated by kidney

Answer 14

Hypersensitivity, severe liver or renal | impairment

Answer 15

• Personality changes, headache nausea and vomiting • Skin rashes including Stevens–Johnson syndrome and toxic epidermal necrolysis have been seen with lamotrigine although this is associated with: • High initial doses of lamotrigine and exceeding the recommended dose escalation of lamotrigine therapy • Concomitant use of valproate

Answer 16

``` alcohol (CNS depression) baclofen (CNS depression) carbemazepine CHC desmopressin (hypantremia risk) opioids (CNS depression) phenytoin (lamotrigine decrease) ```

Epilepsy Flashcards

(40 cards)