Pharmaceutical Care of Epilepsy Flashcards by Holly Grey

What is epilepsy?

Sudden burst of intense electrical activity in the brain

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What is the most common type of seizures?

Focal seizure

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What is a focal seizure?

Burst of electrical activity happens in a specific part of the brain (focal point)

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What is the common site of a focal seizure?

Temporal lobe

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What can a focal seizure do?

Can spread from focal point to entire brain

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What are the different parts of the brain?

Parietal lobe (back at top)
Frontal lobe (front)
Temporal lobe (middle)
Occipital lobe (at the back (small))

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What is the other type of seizures?

Generalised seizures

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What are the different type of generalised seizures?

Atonic seizures
Tonic-clonic seizure
Myoclonic seizures
Tonic seizures
Absence seizures

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Describe an atonic seizure

Sudden loss of muscle control
Slump/fall forward
Head may drop

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Describe a tonic-clonic seizure

Normally get aura but can happen without
Body stiffens = phase 1
Body shakes = phase 2

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Describe a myoclonic seizure

Muscle spasms = localised to certain body parts

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What age does myoclonic seizures most occur in?

Ages 3 - 12 = younger patients

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Describe a tonic seizure

Body stiffens
Arms + legs
Fall backwards
Incontinence
Back arched

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Describe an absence seizure

Blank stare
NO rapid movements/involuntary movements
Blink rapidly/roll their eyes

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What is a generalised seizure?

Affects entire brain

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What other conditions may present similar epilepsy?

Vasovagal syncope (fainting)
Pseudoseizures (non-epileptic attacks)
Cardiac syncope
Hypoglycaemia
Hemiplegic migraine
Transient ischaemic attack

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What investigations can be done?

Clinical presentation
Medical history
Family history
EEG
ECG
MRI
Blood tests = FBC, U&Es + CBG

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What is the impact on daily life?

Loss of license
Baths/swimming = risk of drowning
Employment/education

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How do you manage epilepsy?

Dependent on seizure type
Tailored + specialised
Titration based on tolerance + efficacy

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What is the treatment goal?

Seizure-free on minimum number of antiepileptics

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What is crucial with AEDs?

ADHERENCE = OD + BD dosing

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What is the treatment for focal seizures?

1st line = Lamotrigine or Levetiracetam
IF unsuccessful = Carbamazepine, Oxcarbazepine + Zonisamide

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What is the treatment for tonic-clonic seizures?

1st line = sodium valproate
Alternative = Lamotrigine or Levetiracetam

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What is the treatment for tonic/atonic seizures?

1st line = sodium valproate
Alternative = Lamotrigine

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What is the treatment for absence seizures?

1st line = Ethosuximide 2nd line/ add-on = sodium valproate

What is the treatment for myoclonic seizures?

1st line = sodium valproate Alternative = Levetiracetam

What is the main drug for generalised seizures? WRITE IN AN EXAM

Sodium valproate

What are the different ways the medicines work?

Na+ inhibitor Enhance GABA Ca2+ inhibitors = absence seizures

What is the problem with sodium valproate?

Highly teratogenic = NEED to be enrolled into pregnancy prevention programme

What needs to be done when supplying sodium valproate?

Script valid for 7 days Need sufficient contraception Only give 30 day supply Supply alert card

What are the side effects of sodium valproate?

Hepatoxicity Blood dyscrasias - thrombocytopenia Pancreatitis Weight gain CNS = aggression, confusion + drowsiness Transient hair loss

What are the counselling points for hepatoxicity?

Jaundice (eyes + skin yellow) Vomiting drowsiness

What is the monitoring for hepatoxicity?

Monitor LFTS + clotting factors if signs/symptoms suggest

What are the counselling points for blood dyscrasias - thrombocytopenia (low platelets)?

Easy bleeding Sore throat Fever

What are the investigation for blood dyscrasias?

FBC

What are the counselling points for pancreatitis?

Abdomen pain N+V

What is the investigation for pancreatitis?

Amylase test

What needs to be considered with other medications when using sodium valproate?

Medications that lower seizure threshold Medications that may cause hepatoxicity Medicines that antagonise AED effect = increase risk of seizure

What are medicines that antagonise AED effect?

Quinolones SSRIs TCAs Antipsychotics

What are the CYP450 inhibitors? SICKFACES.COM

Sodium valproate Isoniazid Cimetidine Ketoconazole Fluconazole Alcohol + grapefruit juice Chloramphenicol Erythromycin Sulfonamides Ciprofloxacin Omeprazole Metronidazole

What is good about Lamotrigine?

Long t1/2 = take less frequently

What are the side effects of Lamotrigine?

Rash - Steven Johnson Syndrome N+V Dizziness Slight daytime drowsiness

What is the only other drug that gives the Steven Johnson Syndrome?

Allopurinol

What needs to be considered with other medications when taking Lamotrigine?

Contraceptives = decrease exposure CYP450 inducers CYP450 inhibitors

What are the CYP450 inducers? CRAP GPs

Carbamazepine Rifampicin Alcohol Phenytoin Griseofulvin Phenobarbitone Sulphonylureas

What is good about Levetiracetam?

Used regularly PO + IV Fewer drug interactions

What are the side effects of Levetiracetam?

Psychological (irritability, drowsiness + anxiety)

What is dangerous about Carbamazepine?

Narrow therapeutic index drug Toxicity risk >12mg/L

What are the signs + symptoms of toxicity of carbamazepine?

Cerebellar signs = ataxia, nystagmus, drowsiness Cardiovascular signs = arrhythmias, tachycardia, hyper/hypotension Electrolyte disturbances = decreased Na+, decreased K+, increased CBGs

What are the side effects of Carbamazepine?

Blood dyscrasias Hepatoxicity Rash Hyponatremia

What are the considerations for other medications when taking Carbamazepine?

Medications that lower seizure threshold Medications may cause hepatoxicity Medications that antagonise AED effects Enzyme inhibitors Enzyme inducers Medicines that lower Na+

Which medicines are advised that you stay on the same brand?

Carbamazepine Phenytoin Phenobarbital Primidone

Which medicines are advised you can change brand BUT only based clinical judgment?

Sodium valproate Lamotrigine

Which medicine does it NOT matter if you change brand?

Levetiracetam

How do you avoid AED withdrawal?

Gradual dose reduction Avoid abrupt withdrawal One medicine at a time

What is status epilepticus?

Medical emergency = seizure that lasts longer than 5 mins OR more than 1 seizure within 5 mins

What is the treatment for status epilepticus?

IV Lorazepam = preferred = lower risk of thrombophlebitis IV diazepam = effective

What is thrombophlebitis?

Inflammation of blood vessels

What is the problem with Phenytoin?

NOT used much anymore High risk = narrow therapeutic window Phenytoin sodium NOT bioequivalent to phenytoin base IV = needs large vein through large gage needle

What are the signs of phenytoin toxicity? >20mg/L

Slurred speech Nystagmus (eye movement) = 30mg/L Ataxia Confusion Hyperglycaemia Blurred vision

What are the side effects of Phenytoin?

Blood dyscrasias Rashes Low vit D Hepatoxicity

What are the interactions for Phenytoin?

Medicines that antagonise AED effect# Enzyme inhibitors Enzyme inducers Other antifolate medicines

Pharmaceutical Care of Epilepsy Flashcards

(62 cards)