Epilepsy Drugs

Question 1

What are the dosing options for valporate

Answer 1

twice daily

or

one daily

Question 2

what is the contraindication for valporate

Answer 2

pregnancy
severe liver impairment

Question 3

what patients group do we reccomend to take vitamin d for people who are taking valporate

Answer 3

immobilised
inadequate sun exposure
inadequate dietary calcium

Question 4

what is the period in which we should be most careful of live dysfunction for valporate

Answer 4

first 6 months

Question 5

In what type of therapy is liver dysfunction highest with sodium valporate

Answer 5

combination therapy

Question 6

when should we discontinue valporate

Answer 6

hepatic dysfunction symptoms
pancreatitis
prolonged prothrombin time

Question 7

what are the main side effects of valporate

Answer 7

gi disturbance
drowsy
thrombocytopenia
weight gain (obesity)

Question 8

what are the notable side effects of valporate

Answer 8

gynecomastia
rhabdomyolysis
male infertility
teratogenic

Question 9

How long should valporate be given over iv

Answer 9

3-5 mins

Question 10

in a patient under 55 what needs to be done before valporate can be given

Answer 10

2 independent specialists agree

Question 11

what drugs does valporate increase the concentrations of

Answer 11

phenobarbital
primidone
nimodipine

Question 12

what drug does valporate decrease the concentration of but increase free form version of it

Answer 12

phenytoin

Question 13

what anticoagulant does valporate increase the effect of

Answer 13

warfarin

Question 14

what drug does valporate increase the risk of toxicity of

Answer 14

lamotrigine

Question 15

what does the levetiracetam loading schedule depend on

Answer 15

type of seizure

Question 16

when should the doses of levetiracetam be increased minimum

Answer 16

minimum every two weeks

Question 17

what is the max dose of levetiracetam

Answer 17

1.5g BD

Question 18

what should levetiracetam be used with caution in

Answer 18

QT prolongation

Question 19

what are the common side effects of levetiraccetem

Answer 19

mood disturbance
(aggression)
depression
Insomnia

Increased risk of infection

Question 20

what are the notable side effects for levetiracetam

Answer 20

severe cutaneous adverse reactions

nuetropenia
AKI
Hyponatraemia

Hepatic disorders

Question 21

what are the cautions for levetiracetam

Answer 21

hepatic impairment (reduce by 50% if less than 60mls/min)

renal impairment

Question 22

what is the max dose of levetiracetam for a patient with 50-80mls/min

Answer 22

2g daily

Question 23

what is the max dose of levetiracetam for a patient with 30-50mls/min

Answer 23

1.5g daily

Question 24

what is the max dose of levetiracetam for a patient with <30mls/min

Answer 24

1g daily

Question 25

what does levetiracetam decrease the clearance of

Answer 25

methotrexate so we need to monitor both

Question 26

what other medications can lead to increase sedation with levetiracetam

Answer 26

alcohol opioids benzodiazepines

Question 27

what is the loading dose regimen for lamotrigine

Answer 27

25mg OD for 14 days 50mg OD for 14 days 100mg OD for 7 days

Question 28

what is the maintenance dose for lamotrigine

Answer 28

200mg can be given in divided dose

Question 29

what are the cautions for lamotrigine

Answer 29

parkinsons as can excacerbate symptoms myoclonic seizures

Question 30

what condition is lamotrigine associated with amonst many other anti epileptic meds

Answer 30

hypersensitivity syndrome

Question 31

when it comes to using contraception with lamotrigine what is preffered and why should we not use COC, contraceptic patch and vaginal ring

Answer 31

the three reduce the levels of lamotrigine so instead use cont contraception without pill free break

Question 32

what are the side effect of lamotrigine

Answer 32

Aggression Drowsy GI Insomnia Tremor (hence why cant give in parkinsons)

Question 33

what are the notable side effects of lamotrigine

Answer 33

oedema hallucination disseminated intravascular coagulation hepatic disorders

Question 34

what does lamotrigine increase the concentration of

Answer 34

valporate

Question 35

what is the loading schedule of topirimate

Answer 35

25mg at night for 7 days increasing by 25-50mg every 7 to 14 days

Question 36

what are the cautions of topirimate

Answer 36

acute porphyria's metabolic acidosis nephrolithiasis

Question 37

When using contraception with topiramate what should be used

Answer 37

highly effective forms or progesterone only pill + condoms

Question 38

what contraceptives cannot be given with topirimate

Answer 38

combined pill desogestral

Question 39

what are the side effects of topirimate

Answer 39

usual suspects + alopecia anaemia cognitive impairment

Question 40

what are the noteable side effects of topiramate

Answer 40

eye inflammation hepatic failure neutropenia

Question 41

what medication can it increase the exposure of but have its concentration reduced by

Answer 41

phenytoin

Question 42

what enzyme does topirimate inhibit

Answer 42

CYP2C19

Question 43

because topirimate inhibits a CYP2C19 what medications cant be used with it

Answer 43

proton pump inhibitors clopidogrel citalopram

Question 44

what drug is there cross sensitivity with phenobarbital

Answer 44

carbemazepine

Question 45

what should phenobarbital be avoided in

Answer 45

renal impairment hepatic impairment

Question 46

what medications cannot be taken when a patient has acute porphyrias

Answer 46

phenobarbital topirimate

Question 47

what are the cautions of phenobarbital

Answer 47

elderly children history of alchohol or drug abuse respiratory depression

Question 48

what are the side effects of phenobarbital

Answer 48

sedation!!!

Question 49

what enzyme does phenobarbital induce

Answer 49

CYP3A4

Question 50

what is phenytoin indicated in

Answer 50

tonic clonic seizures status epilepticus

Question 51

how is phenytoin dosed

Answer 51

by weight OR 150-300mg

Question 52

what are the dose increases for phenytoin based on

Answer 52

plasma levels

Question 53

before we can treat status epilecticus with phenytoin what must first be given

Answer 53

slow iv loading dose

Question 54

what is the maintenance dose for status epilecticus of phenytoin

Answer 54

100mg 6-8 hours

Question 55

what are the cautions of phenytoin

Answer 55

pregnancy older age infection low albumin enteral feeding HF respiratory depression