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BNF CNS > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Which antiepileptics have long half lives and so can be given OD at bedtime?

A

lamotrigine, perampanel, phenobaribtal and phenytoin

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2
Q

Can multiple antiepileptics be used together?

A

Ideally, monotherapy should be prescribed. If one drug fails, it should be slowly withdrawn and another antiepileptic started as concurrent use of multiple antiepileptic can lead to DDI and ADRs. Wherever possible use a single AE drug

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3
Q

If a patient is on an AED for an alterative indication e.g. neuropathic pain should the brand be specfied?

A

No - only a requirement if used for epilepsy

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4
Q

What AED are in risk category 1?

A 
PPP C
Phenyoin
Primidone
Phenobaribtal 
Carbamazepine
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5
Q

What is the advise with category 1 AED?

A

Phenytoin, primidone, carbamazepine and phenobarbital - Drs are advised to maintain patient on a specific manufacturers product

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6
Q

What AED fit into category 2?

A

Clobazam, Clonazepam, Eslicarbazepine, Lamotrigine, Topiramate, valporate, zonisomide, oxcarbazapine

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7
Q

What is the advise for prescribing category 2 AEDs?

A

Need for continued supply of a particular maufacturers product should be based on clinical judgement and consultation wiht the pt

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8
Q

Example of Category 3 AEDs

A

Ethosuximide, Gabapentin, Lacosamide, Levetiracetam, Vigabtrin, Birvaracetam

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9
Q

What is the prescribing advise for Category 3 AEDs?

A

unnecessary to maintain on the same brand as therapeutic equivalance can be assummed

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10
Q

Whast is antiepileptic hypersensitivty syndrome?

A

A rare but fate syndrome associated with some AEDs. Symptoms start between weeks 1 and 8 weeks of exposure and include fever, rash, lymphadenopathy. The AED should be withdrawn immediately and pt should NOT be reexposed

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11
Q

What drugs can hold the risk of Antiepileptic hypersensitivity syndrome?

A

Carbamazepine, Lamotrigine, Oxcarbazepine, phenobarbital, phenytoin, primidone, rufinamide

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12
Q

The MHRA alerted that all AED can hae a small increased risk of what?

A

suicidal thoughts andd behaviour - after 1 week of treatment. Advise pt to seek medical advice if they develop any mood changes, distressing thought or feelings about suicide

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13
Q

What can happen if bariburates or benzodiazepnines are withdrawn abruptly?

A

Withdrawal seizures

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14
Q

What must a driver do if they have a seizure?

A

Stop driving immediately and inform the DVLA

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15
Q

How long must a driver not drive for following their first unprovoked oor single isolated seizure?

A

6 months (driving may then resume following assessment by a specialist)

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16
Q

Can patients wiht established epilepsy drive?

A

Yes, provided they are not a danger to themselves of the public and are compliant wiht treatment follow up and have no history of unprovoked seizures

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17
Q

Patients who have had a seizure whilst asleep cannot drive for how long?

A

1 year - unless a history of pattern of sleep seizures occuring only ever while asleep has been established over the course of 1 year or an established pattern of purely asleep seizures can be demonstrated over the course of 3 years if the patient has previously had awake seizures

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18
Q

If a patient is having medication changes or withdrawl should they drive

A

No and for 6 months after their last dose. If a seizure occurs due to withdrawal their license is revoked for 1 year

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19
Q

What is the risk of pregnancy and epilepsy?

A

Teratogenicity of AEDs espeically in 1st trimester

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20
Q

What AED has the highest risk of teratogenicity?

A

Valporate

developmental disorders 30-40%) malformations (10%

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21
Q

What must a women be under to be on valporate?

A

PPP (pregnancy provention programme)

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22
Q

What risk does topiramate hold in pregnancy?

A

Risk of malformations e.g. cleft palate

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23
Q

If a patient becomes pregnant whilst taking AEDs and cannot withdraw what is advised to be given?

A

folate 5mg ( to cover for NTD)

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24
Q

Foetal growth should be monitored in patients taking which 2 AEDs

A

Topiramate and levetiracetam

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25
Q

What condition should women in their 2nd trimester experiencing seizures be checked for before chaging AEDs?

A

eclapsia

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26
Q

Injection of what medication can reduce the risk of neonatal haemorrhage when giving birth if mother is on AEDs?

A

Vitamin K

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27
Q

All women with epilepsy taking antiepileptics or not should be encouraged to notify who?

A

Epilepsy and pregancy register

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28
Q

Can a mother breastfeed when on AEDs?

A

Yes if on monotherapy, if on combo therapy specialist adivce should be sought. Monitor infant for sedation, feeding difficulties, adepquate weight gain and developmetal milestones

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29
Q

What antiepileptics have an established risk of drowsiness in BF babies?

A

Phenobarbital, primidone, Benzos

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30
Q

First line drug(s) for Focal seizures with or without secondary generalisation

A

Carbamazepine or Lamotrigine

31
Q

First line drug(s) for tonic clonic seizures

A

Valporate or lamotrigine if young female

32
Q

First line drug(s) for absence seizures

A

Ethosuximide or valporate

33
Q

First line drug(s) for myoclonic seizures

A

Valporate or if premenopausal topimarate/levetirCETAM

34
Q

Drug of choice in atonic and tonic seizures

A

Sodium valporate - if contraindicated seek specialisdt advice
Tonic / atonic - respond poorly to tradition meds

35
Q

Examples of epilepsy syndromes

A

Dravet, Lennox-Gastaut syndrome

36
Q

What AED is also licensed for generalised anxiety disorder?

A

Pregabalin

37
Q

What is primidone the pro-drug of?

A

Phenobaribtal

38
Q

what is meant by Phenytoins ‘non linear kinetics’

A

A small dosage increase in some patients may produce a large increase in plasma concentrations with acute toxic side effects

39
Q

What is the pro drug of Phenytoin and why can it be benefitical to use?

A

Fosphenytoin - can be given IM (unlike phenytoin) so good if parenteral access only

40
Q

What should female patients be co-prescribed/advised when on topiramte?

A

Should have adequate contraception - risk of Cleft palarte malformations

41
Q

what 2 monitoring parameters are important with valporate?

A

LFTs and FBC

42
Q

Valporic acid (semi sodium valporate) is not used in epilepsy - what disorder is it used in?

A

acute mania associated with bipolar disorder

43
Q

What drug can be used to treat epilepsy associated with menstration?

A

Acetylzolamide (a carbonic anhydrase inhibitor)

44
Q

What drug is used in the adjunct treatment of cortical myoclonas?

A

Piracetam

45
Q

In status epilepticus, seizures lasting >5 mins should be treated with what drug?

A 
Lorazepam IV ( repeat once after 10 mins if seizures recur) IV diazepam can also be used but carries risk of thrombophlebitis
- if resus facilities are not avaliable, oromucosal midazolam or recal midazolam can be given
46
Q

If after 25 minutes, seizures are not controlled - what drugs should be used?

A

Phenobaribtal or Phenytoin or fosphenytoi

47
Q

What antipyretic can be used in febrile convulsions

A

paracetamol

48
Q

what electrolyte abnormality can carbamazapine cause/

A

hyponatreamia

49
Q

What should patients be advised to report when starting on carbamazepine?

A

report any signs of blood, liver or skin disorders e.g. mouth ulcers, fevers,rash, bruising or bleeding

50
Q

What supplementation is sometimes advised to be used alongside immobile patients on carbmazepine?

A

calcium (bone fracture risk)

51
Q

What pre-treatment screening is required with carbamazapine?

A

HLA-B*1502 allele in indivduals with hans chineses or thai origin ( risk of SJS)

52
Q

optimum plasma level for carbmazepine?

A

4 -12 mg/L

53
Q

What shuld be monitored when givine Fosphenytoin?

A

HR, BP, RR, ECG and observe patient for 30 mins post infusion due to cardiovascualr reaction reported with its use

54
Q

what are the 2 MHRA warnings associated with Gabapentin?

A
  1. Risk of severe respiratory depression

2. Risk of abuse and dependance (reclassified to CD3)

55
Q

what is the dose equivalanence of phenytoin sodium:phenytoin base>

A

PS 100mg = 92mg PB

56
Q

MHRA alert: risk of deth and severe harm from error of injectable XX - what is drug XX?

A

Phenytoin

57
Q

How should phenytoin be given if patient is enterally fed?

A

break in feeding 2 hours before and after dose

58
Q

Side effects of Phenytoin

A

Gingival hyperplasia, Agranulocytosis, bone fracture, hair changes, pneumonitis ( oral route), bradycardia, hypotension

59
Q

Overdose signs of phenytoin

A

nystagmus, diplopia, slurred speech, hyperglycaemia, confusion

60
Q

what fraction of phenytoin should be monitored?

A

Unbound fraction

61
Q

Why is phenytoin cautioned in heptatic impairment?

A

Phenytoin binds to albumin - risk of accumulation due to decrease PPB, hypoalbuminaemia or hypobilirubinaemia

62
Q

optimum level of plasma phenytoin

A

10-20mg/L

63
Q

in neonates < 3 months, the optimum level of phenytoin is reduced due to reduced protein binding. What is the recommended plasma level?

A

6-15mg/l

64
Q

how should IV phenytoin be given?

A

Into a large vein

65
Q

other than epilepsy, what can valporate be used to in?

A

Prophylaxis of migraine + mania

66
Q

What must be updated annualling in females taking valporate?

A

Annual risk acknowledgement form - to support compliance to the PPP

67
Q

Side effects of sodium valporate

A

Alopecia, weight gain, agitation, abdominal pain. menstrual infrequencies

68
Q

What should be routinely monitored during valporate therapy?

A

LFTs - baseline + 6 months

FBC baseline

69
Q

What AED has been associated wihth acute myopia with secondary angle closed glaucoma?

A

Topiramate - occurs within 1 month of treatment

70
Q

What AED can cause weight loss?

A

Zonisamide - monitor weight throughout treatment

71
Q

What AED is contraindicated in sulfonamide hypersensitivity?

A

Zonisamide

72
Q

optimum plasma phenobarbital levels

A

15-40mg/L

73
Q

What is the antidocte to midazolam / Lorazepam overdose?

A

Flumazenil

BNF CNS (9 decks)

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