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Pre-reg Exam 2021 > Epilepsy And Seizure Disorders > Flashcards

Epilepsy And Seizure Disorders Flashcards

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1
Q

What is epilepsy?

A

A sudden surge of electrical activity of neurones in the brain

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2
Q

What are non-epileptic seizures?

A

Unrelated to abnormal electrical activity in the brain

Organic
Psychogenic

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3
Q

What are the drugs used to treat seizures?

A 
Barbiturates - phenobarbital (ON), primidone, thiopental
Benzodiazepines 
Carbamazepine
Ethosuximide
Gabapentin, pregabalin 
Lacosamide
Lamotrigine (ON)
Levetiracetam 
Phenytoin (ON)
Sodium valproate
Topiramate
Zonisamide
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4
Q

What is the first line treatment for focal seizures with/without secondary generalisation?

A

Lamotrigine or carbamazepine

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5
Q

What is the second line treatment for focal seizures with/without secondary generalisation?

A

Levetiracetam
Valproate
Oxcarbazepine

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6
Q

What is the first line treatment for tonic clonic seizures?

A

Valproate

Carbamazepine

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7
Q

What is the second line treatment for tonic clonic seizures?

A

Lamotrigine

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8
Q

What is the first line treatment for absence seizures?

A

Ethosuximide or valproate

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9
Q

What is the second line treatment for absence seizures?

A

Lamotrigine

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10
Q

What is the first line treatment for myoclonic seizures?

A

Valproate

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11
Q

What is the second line treatment for myoclonic seizures?

A

Topiramate

Levetiracetam

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12
Q

What is the first line treatment for atonic/tonic seizures?

A

Valproate

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13
Q

What seizures use lamotrigine as first line?

A

Focal seizures

Tonic clonic

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14
Q

What seizures use carbamazepine as first line?

A

Focal

Tonic clonic

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15
Q

What seizures use levetiracetam as second line?

A

Focal

Myoclonic

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16
Q

What seizures use valproate as second line?

A

Focal

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17
Q

What seizures use valproate as first line?

A

Tonic clonic
Absence
Myoclonic
Atonic/tonic

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18
Q

What seizures use oxcarbazepine as second line?

A

Focal

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19
Q

What seizures use ethosuximide as first line?

A

Absence

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20
Q

What seizures use topiramate as second line?

A

Topiramate

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21
Q

What is the MHRA warning for epilepsy?

A

Antiepileptic drugs - new advice on potential harm when switching between different manufacturer products for a particular drug in the treatment of epilepsy

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22
Q

What are the category one antiepileptics?

A

Carbamazepine
Phenytoin
Phenobarbital
Primidone

Maintain on same product

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23
Q

What are the category two antiepileptics?

A

Valproate
Lamotrigine
Clonazepam
Topiramate

Clinical judgement and patient consultation

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24
Q

What are category three antiepileptics?

A

Levetiracetam
Gabapentin
Pregabalin
Ethosuximide

Do not need to maintain on same product

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25
How do you withdraw epilepsy treatment?
Gradually reduce dose under specialist supervision Avoid abrupt withdrawal - can precipitate severe rebound seizures Withdraw one epileptic drug at a time
26
Do you need to inform DVLA of epilepsy?
Yes, can drive car but not passenger carrying vehicle
27
How long do you need to be seizure free for in order to be able to drive?
1 year
28
When is there a driving ban in people with epilepsy?
During medication changes or withdrawal 6 months after last dose 6 months for first unprovoked epileptic seizure
29
Which antiepileptics have an increased risk of teratogenicity?
Valproate/valproate acid - highest risk Carbamazepine, phenytoin, phenobarbital, primidone, lamotrigine - increased risk Topiramate in first trimester - cleft palate
30
What do you have to be cautious with contraception and antiepileptics?
Enzyme inducing e.g. carbamazepine reduce efficacy of hormonal contraception
31
Which antiepileptics need dose adjustments in pregnancy?
Phenytoin Carbamazepine Lamotrigine
32
Which antiepileptics need foetal growth monitoring?
Topiramate | Levetiracetam
33
What needs to be taken before conception and until week 12 of pregnancy if taking antiepileptics?
5mg folic acid daily to reduce risk of neural tube defects
34
Which antiepileptics cause withdrawal effects in newborns?
Benzodiazepines and phenobarbital
35
What do you need to monitor if taking antiepileptics me breastfeeding?
Drowsiness Weight gain Feeding difficulty Developmental milestones
36
Which antiepileptics are present in high amounts in milk?
Zonisamide Ethosuximide Lamotrigine Primidone
37
Which antiepileptics accumulate due to a slower metabolism in infant?
Phenobarbital | Lamotrigine
38
Which antiepileptics inhibit the sucking reflex?
Phenobarbital | Primidone
39
Which antiepileptics have an established risk of drowsiness in babies?
Benzodiazepines Phenobarbital Primidone
40
Which antiepileptics have a higher risk of withdrawal when breastfeeding?
Phenobarbital | Primidone
41
What are the side effects of antiepileptics?
``` Antiepileptic hypersensitivity syndrome Risk of suicidal behaviour and thoughts Skin rashes Blood dyscrasias Eye problems Encephalopathic symptoms ```
42
What are the symptoms associated with anti epileptic hypersensitivity syndrome?
Rash Fever Lymphadenopathy Systemic involvement Discontinue immediately
43
What antiepileptics are associated with hypersensitivity syndrome?
``` Carbamazepine Phenytoin Phenobarbital Primidone Lamotrigine ```
44
What are the MHRA warnings for antiepileptics?
Small increased risk of suicidal behaviour and thoughts Gabapentin risk of severe respiratory depression
45
What are the counselling points for antiepileptics?
Report any mood changes, distressing thoughts or feelings about suicide or self harm Report signs of infection, bruising or bleeding Report new visual symptoms Report signs of raised intraocular pressure
46
What antiepileptics have a high risk of skin rashes?
Lamotrigine | Valproate
47
What antiepileptics have a risk of blood dyscrasias?
``` Ethosuximide Valproate Carbamazepine Phenytoin Lamotrigine Topiramate Zonisamide ```
48
Which antiepileptic causes visual field defects?
Vigabatrin Topiramate
49
Which antiepileptics cause encephalopathic symptoms?
Vigabatrin
50
What antiepileptics are enzyme inhibitors and cause an increased plasma concentration?
Sodium valproate
51
What antiepileptics are enzyme inducers and cause a decreased plasma concentration?
Carbamazepine Phenytoin Phenobarbital Interact with oral contraceptives and warfarin
52
What is the mechanism of action of phenytoin?
Binds to neuronal sodium channels in their inactive state, prolongs inactivity
53
What is phenytoin used for?
Focal seizures and generalised tonic clonic seizures Exacerbates absence and myoclonic seizures
54
That is the therapeutic range of phenytoin?
10-20mg/L 40-80 micromol/L
55
What are the monitoring requirements for phenytoin?
Small changes in dose = large changes in plasma concentration When protein binding is reduced, monitor the plasma free drug concentration
56
Why are the signs and symptoms of toxicity of phenytoin?
Snatched ``` Slurred speech Nystagmus Ataxia Confusion Hyperglycaemia Diplopia, blurred vision ```
57
What is the equivalent dose conversions of phenytoin sodium to phenytoin base?
100mg phenytoin sodium = 92 mg phenytoin base
58
What are the side effects of phenytoin?
``` Change in appearance Blood dyscrasias Hypersensitivity Rashes Low vitamin D = osteomalacia and rickets Hepatotoxicity Suicidal ideation Bradycardia Hypotension CV reactions ```
59
What are the counselling points for phenytoin side effects?
Report signs of infection Report fever, rash, swollen, lymph nodes Report signs of liver toxicity
60
What are the NHS improvement patient safety alerts for phenytoin?
Risk of death and severe harm from error with injectable phenytoin
61
What is the equivalent dose of fosphenytoin to phenytoin sodium?
Fosphenytoin 1.5mg = phenytoin sodium 1mg
62
What are the interactions that increase phenytoin concentration and therefore toxicity?
``` Amiodarone Cimetidine Miconazole Fluconazole Chloramphenicol Metronidazole Clarithromycin Fluoxetine Sertraline Diltiazem Valproate Trimethoprim ```
63
What are the interactions that decrease phenytoin concentration?
St. John’s wort | Rifampicin
64
What interactions antagonise the anticonvulsant effect of phenytoin?
``` Quinolones Tramadol Mefloquine SSRIs Antipsychotics TCA ```
65
What interactions increase the antifolate effect of phenytoin and therefore increase the risk of blood dyscrasias?
Methotrexate | Trimethoprim
66
Phenytoin is an enzyme inducer and reduces the concentration of which drugs?
``` Hormonal contraceptives Warfarin Corticosteroids Levothyroxine Liothyronine ```
67
What is the mechanism of action of carbamazepine?
Inhibits neuronal sodium channels | Stabilises membrane potential and reduces neuronal excitability
68
When is carbamazepine used?
First line in focal seizures, generalised tonic clonic seizure Exacerbates atonic, clonic and myoclonic seizure
69
What is the therapeutic range of carbamazepine?
4-12mg/L or 20-50 micromol/L Measures after 1-2 weeks
70
What are the signs and symptoms of carbamazepine toxicity?
I handbag ``` In coordination Hyponatraemia Ataxia Nystagmus Drowsiness Blurred vision and diplopia Arrhythmias GI disturbance ```
71
What are the side effects of carbamazepine?
``` Blood dyscrasias Hepatotoxicity Hypersensitivity reactions Rashes Hyponatraemia ```
72
What are the counselling points of carbamazepine side effects?
Signs of infection Signs of liver toxicity Fever, rash, lymphadenopathy
73
Who are at risk of SJS with carbamazepine use?
Han Chinese and Thai patients with allele
74
What are the monitoring requirements for carbamazepine?
Plasma concentration FBC LFT
75
Which side effects of carbamazepine are dose related and dose limiting?
``` Headache Ataxia Drowsiness Nausea Vomiting Blurred vision Unsteadiness Allergic skin reactions ``` MR reduce risk of side effects
76
What are the interactions that increase carbamazepine toxicity?
Cimetidine Macrolides Fluoxetine Miconazole
77
What interactions with carbamazepine decrease the concentration?
St Johns Wort | Phenytoin
78
What interactions with carbamazepine antagonise the anticonvulsant effects?
``` Quinolones Mefloquine SSRI Antipsychotics TCA ```
79
What interactions with carbamazepine increase the risk of hyponatraemia?
``` Aldosterone antagonists SSRIs TCAs Diuretics NSAIDs ```
80
What carbamazepine interactions increase the risk of hepatotoxicity?
``` Tetracyclines Sulfasalazine Sodium valproate Methotrexate Isoniazid Statins Fluconazole Alcohol ```
81
Carbamazepine is an enzyme inducer, which drugs does it reduce the concentration of?
Warfarin | Hormonal contraceptives
82
What is the mechanism of action of sodium valproate?
Weak inhibitor or neuronal sodium channels | Stabilises resting membrane potential and reduces neuronal excitability
83
When is sodium valproate used?
First line in all types of generalised seizures
84
What is the MHRA warnings for sodium valproate?
Valproate medicines are contraindicated in women and girls of childbearing potential unless in PPP and only if no other alternatives Contraindicated in pregnant women for bipolar disorder and only considered in epilepsy if no other alternative Consult GP immediately if pregnant/planning pregnancy
85
Who is the PPP for?
For all women of child bearing potential under specialist supervision
86
What contraceptives do the PPP need to use!
User independent methods | User dependent methods - 2+ e.g. COC + barrier method + pregnancy test
87
What are the side effects of sodium valproate?
Hepatotoxicity Blood dyscrasias Pancreatitis
88
What are the side effect counselling points for valproate?
Report signs of liver toxicity Report signs of infections Report signs of pancreatitis
89
What interactions with sodium valproate antagonise the anticonvulsant effects?
``` Quinolones Mefloquine SSRIs Antipsychotics TCA ```
90
What interactions with sodium valproate increase the risk of hepatotoxicity?
``` Statins Carbamazepine Tetracyclines Fluconazole Isoniazid Itraconazole Methotrexate Sulfasalazine ```
91
As valproate is an enzyme inhibitor, it increases the drug concentration of what drugs?
Other anti epileptics
92
What is status epilepticus?
Epileptic fits follow one after the other without regaining consciousness
93
What do you give for convulsive status epilepticus?
IV lorazepam Avoid diazepam as it causes thrombophlebitis
94
What do you give for incomplete loss of awareness for non-convulsive status epilepticus?
Continue or restart usual oral antiepileptic drug
95
What do you give for complete loss of awareness for non-convulsive status epilepticus?
IV Lorazepam
96
What do you give for febrile convulsions?
Paracetamol If > 5 mins then IV lorazepam
97
What do you give for convulsive seizures or febrile seizures > 5 mins in the community?
Diazepam rectal solution Midazolam oromucosal solution Repeat once after 10-15 mins if necessary

Pre-reg Exam 2021 (79 decks)

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