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PHA333 > Wk 32 - Epilepsy in practice: AEDs > Flashcards

Wk 32 - Epilepsy in practice: AEDs Flashcards

1
Q

What is the dose for sodium valproate?

A
  • initially 600mg daily divided 1-2 doses
  • Inc 150-300mg every 3 days
  • Maintenance: 1-2g daily
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2
Q

What are the common side effects of sodium valproate?

A
  • Alopecia, tremor, weight gain, menstrual irregularities

- Hepatotoxicity, pancreatitis, blood disorders, SCARS

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3
Q

What are the effects of valproate as an enzyme inhibitor?

A
  • Inc toxicity w/ lamotrigine, phenytoin, phenobarbital + carbamazepine
  • Inc adverse effect w/ olanzapine
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4
Q

Give examples of an effect of other drugs on valproate

A

Carbapenems red conc valproate

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5
Q

What monitoring is required for sodium valproate?

A
  • TDM - plasma valproate conc not useful index of efficacy tf routine monitoring unhelpful
  • LFTs - before + during 1st 6 months
  • FBC - before treatment + surgery
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6
Q

Outline the rules of sodium valproate in pregnancy

A
  • Highly teratogenic: neurodevelopmental disorders + malformations
  • Not used unless pregnancy prevention programme met + judged by specialist
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7
Q

What is the pregnancy prevention programme?

A
  • Highly effective contraception: intrauterine, implant or barrier method
  • Risk acknowledgement form: signed + up to date
  • Annual review by specialist
  • Refer to specialist if unplanned pregnancy or patient plans pregnancy
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8
Q

What is the dose for carbamazepine?

A
  • Initially 100-200mg 1-2 times a day
  • Inc 100-200mg every 2 weeks
  • Usual dose: 0.8-1.2g daily in divided doses
  • IR, MR, liquid + suppositories (max 1g)
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9
Q

What are the side effects of carbamazepines?

A
  • Dizziness, drowsiness, ataxia
  • Hyponatraemia
  • Hepatotoxicity
  • SCARS
  • Leucopenia
  • Thrombocytopenia
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10
Q

What drugs does carbamazepine have an effect on as an enzyme inducer?

A
  • DOACS
  • Warfarin
  • COC
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11
Q

What are the effects when taking phenytoin + carbamazepine together?

A
  • Carb inc phenytoin levels

- Phenytoin red conc carb

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12
Q

What inc concentration of carbamazepine?

A
  • Clarithromycin
  • Diltiazem
  • Grapefruit juice
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13
Q

What dec concentration of carbamazepine?

A
  • Phenytoin
  • Rifampicin
  • Theophylline
  • St johns wort
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14
Q

What is the monitoring requirement pre-treatment of carbamazepine?

A
  • FBC, U+E + LFTs
  • Test HLA-B1502 in chinese + thai
  • Test HLA-A 3101 in european + japanese
  • Bc inc risk of stevens-johnsons syndrome
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15
Q

What is the monitoring requirements for carbamazepine?

A
  • Plasma conc 4-12mg/l - measure after 1-2wks
  • Not routinely monitored - only if toxic or non-compliance
  • Trough level
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16
Q

What is the dose for phenytoin?

A

Inc increments of 25-50mg

  • Initially 150-300mg OD
  • Maintenance 200-500mg daily
  • Tabs (sodium), chewable tabs (base), suspension (base), IV (sodium)
17
Q

What are the side effects of phenytoin?

A
  • Coarsening of facial features
  • Gingival hyperplasia
  • Bone marrow suppression
  • Vit D deficiency, bone fractures
  • Folate deficiency
  • Hepatotoxicity
  • Rash, SCARS
  • Toxicity - nystagmus, diplopia, slurred speech, ataxia, confusion, + hyperglycaemia
18
Q

Which drugs increase phenytoin concentrations?

A
  • Clarithromycin
  • Valproate
  • Fluconazole
19
Q

Which enzyme inducers red phenytoin levels?

A
  • John’s wort

- Rifampicin

20
Q

Which drugs can increase or decrease levels of phenytoin?

A
  • Carbamazepine

- Ciprofloxacin

21
Q

What are the monitoring requirements for phenytoin?

A
  • HLAB 1502 in chinese + thai
  • LFTs
  • FBC
  • U+E
  • Trough level (5-7 days)
22
Q

What is the loading dose for IV phenytoin?

A

20mg/kg

23
Q

What is the maintenance dose for IV phenytoin + how is it administered + monitored?

A
  • 100mg TDS
  • 0.2 micron filter into large vein
  • BP, RR + ECG
24
Q

What is the dose for lamotrigine?

A
  • 25mg OD for 14 days
  • Inc 50mg OD for further 14 days
  • Inc upto 100mg every 7-14 days
  • Maintenance: 100-200mg daily in 1-2 divided doses
  • Tabs, dispersible tabs
25
Q

What is the dose of lamotrigine when given w/ valproate?

A

25mg on alternate days for 14 days

26
Q

What is the dose of lamotrigine when given with enzyme inducers?

A

50mg OD for 14 days

27
Q

What are the side effects of lamotrigine?

A
  • Agitation, arthralgia, dry mouth, fatigue, sleep disorders, tremor
  • Stevens-johnson syndrome + toxic epidermal necrolysis
  • Hepatic disorders
  • Blood disorders
  • Disseminated intravascular coagulation

PHA333 (35 decks)

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