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S3 Case 2 - Mental Health > Pharmaceutical Care of Epilepsy > Flashcards

Pharmaceutical Care of Epilepsy Flashcards

1
Q

What is epilepsy?

A

Sudden burst of intense electrical activity in the brain

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2
Q

What is the most common type of seizures?

A

Focal seizure

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3
Q

What is a focal seizure?

A

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

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4
Q

What is the common site of a focal seizure?

A

Temporal lobe

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5
Q

What can a focal seizure do?

A

Can spread from focal point to entire brain

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6
Q

What are the different parts of the brain?

A

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

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7
Q

What is the other type of seizures?

A

Generalised seizures

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8
Q

What are the different type of generalised seizures?

A

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

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9
Q

Describe an atonic seizure

A

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

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10
Q

Describe a tonic-clonic seizure

A

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

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11
Q

Describe a myoclonic seizure

A

Muscle spasms = localised to certain body parts

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12
Q

What age does myoclonic seizures most occur in?

A

Ages 3 - 12 = younger patients

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13
Q

Describe a tonic seizure

A

Body stiffens
Arms + legs
Fall backwards
Incontinence
Back arched

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14
Q

Describe an absence seizure

A

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

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15
Q

What is a generalised seizure?

A

Affects entire brain

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16
Q

What other conditions may present similar epilepsy?

A

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

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17
Q

What investigations can be done?

A

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

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18
Q

What is the impact on daily life?

A

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

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19
Q

How do you manage epilepsy?

A

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

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20
Q

What is the treatment goal?

A

Seizure-free on minimum number of antiepileptics

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21
Q

What is crucial with AEDs?

A

ADHERENCE = OD + BD dosing

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22
Q

What is the treatment for focal seizures?

A

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

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23
Q

What is the treatment for tonic-clonic seizures?

A

1st line = sodium valproate
Alternative = Lamotrigine or Levetiracetam

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24
Q

What is the treatment for tonic/atonic seizures?

A

1st line = sodium valproate
Alternative = Lamotrigine

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25
Q

What is the treatment for absence seizures?

A

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

26
Q

What is the treatment for myoclonic seizures?

A

1st line = sodium valproate
Alternative = Levetiracetam

27
Q

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

A

Sodium valproate

28
Q

What are the different ways the medicines work?

A

Na+ inhibitor
Enhance GABA
Ca2+ inhibitors = absence seizures

29
Q

What is the problem with sodium valproate?

A

Highly teratogenic
= NEED to be enrolled into pregnancy prevention programme

30
Q

What needs to be done when supplying sodium valproate?

A

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

31
Q

What are the side effects of sodium valproate?

A

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

32
Q

What are the counselling points for hepatoxicity?

A

Jaundice (eyes + skin yellow)
Vomiting drowsiness

33
Q

What is the monitoring for hepatoxicity?

A

Monitor LFTS + clotting factors if signs/symptoms suggest

34
Q

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

A

Easy bleeding
Sore throat
Fever

35
Q

What are the investigation for blood dyscrasias?

A

FBC

36
Q

What are the counselling points for pancreatitis?

A

Abdomen pain
N+V

37
Q

What is the investigation for pancreatitis?

A

Amylase test

38
Q

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

A

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

39
Q

What are medicines that antagonise AED effect?

A

Quinolones
SSRIs
TCAs
Antipsychotics

40
Q

What are the CYP450 inhibitors?
SICKFACES.COM

A

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

41
Q

What is good about Lamotrigine?

A

Long t1/2 = take less frequently

42
Q

What are the side effects of Lamotrigine?

A

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

43
Q

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

A

Allopurinol

44
Q

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

A

Contraceptives = decrease exposure
CYP450 inducers
CYP450 inhibitors

45
Q

What are the CYP450 inducers?
CRAP GPs

A

Carbamazepine
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas

46
Q

What is good about Levetiracetam?

A

Used regularly PO + IV
Fewer drug interactions

47
Q

What are the side effects of Levetiracetam?

A

Psychological (irritability, drowsiness + anxiety)

48
Q

What is dangerous about Carbamazepine?

A

Narrow therapeutic index drug
Toxicity risk >12mg/L

49
Q

What are the signs + symptoms of toxicity of carbamazepine?

A

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

50
Q

What are the side effects of Carbamazepine?

A

Blood dyscrasias
Hepatoxicity
Rash
Hyponatremia

51
Q

What are the considerations for other medications when taking Carbamazepine?

A

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

52
Q

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

A

Carbamazepine
Phenytoin
Phenobarbital
Primidone

53
Q

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

A

Sodium valproate
Lamotrigine

54
Q

Which medicine does it NOT matter if you change brand?

A

Levetiracetam

55
Q

How do you avoid AED withdrawal?

A

Gradual dose reduction
Avoid abrupt withdrawal
One medicine at a time

56
Q

What is status epilepticus?

A

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

57
Q

What is the treatment for status epilepticus?

A

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

58
Q

What is thrombophlebitis?

A

Inflammation of blood vessels

59
Q

What is the problem with Phenytoin?

A

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

60
Q

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

A

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

61
Q

What are the side effects of Phenytoin?

A

Blood dyscrasias
Rashes
Low vit D
Hepatoxicity

62
Q

What are the interactions for Phenytoin?

A

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

S3 Case 2 - Mental Health (15 decks)

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