Epilepsy Flashcards by Tiwah Poku

What 4 tests are used to diagnose epilepsy

EEG
Genetic testing
Antibody testing
MRI scan

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Which test is not used for idiopathic/self limiting epilepsy

MRI scan

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What diagnostic test is used for suspected autoimmune encephalitis

Antibody testing

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What is first line for focal seizures

Lamotrigene
Levetiracetam

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What is second line for focal seizures

Carbamazepine
Oxcarbazepine
Zonisamide

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First line for tonic clinic seizures

Sodium valproate

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Second line for tonic clinic seizures

Lamotrigene
Levetiracetam

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First line for absence seizures

Ethosuximide

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Second line for absence seizures

Sodium valproate

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First line for absence seizures with other types

Sodium valproate

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Second line for absence seizures with other types

Lamotrigene
Levetiracetam

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First line for myoclonic seizures

Sodium valproate

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Second line for myoclonic seizures

Levetiracetam

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First line for atonic seizures

Sodium valproate

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Second line for atonic seizures

Lamotrigene

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First line for tonic seizures

Sodium valproate

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Second line for tonic seizures

Lamotrigene

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Valproate is contraindicated in whom

Those under 55

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What is status epileptics

Seizure for more than 5 mins

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If a seizure is lasting more than 5 minutes in community what is given

Buccal Midazolam or rectal diazepam

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If a seizure is lasting more than 5 minutes in hospital what is given

Iv lorazepam

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Why is lorazepam give via IV but not other benzodiazepines

The others increase the risk of thrombophlebitis

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Medication has been given but the patient is still having a seizure after 10 minutes of administering it, what should be done ?

Give a second dose of the medication given before : buccal midazolam, rectal diazepam or iv lorazepam

After 2 doses of benzodiazepines the patient is still having a seizure, what should be given

Levetiracetam ( preferred ) Or Phenytoin Or Sodium valproate

After 2 doses of benzodiazepines and Levetiracetam the patient is still having a seizure, what should be given

Phenobarbital or General anaesthesia

Carbamazepine, phenytoin, phenobarbital and primidone are category 1 anti epileptics, what does this mean

Patients need to be prescribed the same brand each time

What does a category 2 antiepileptic mean

Patients should be given the same brand depends on the prescriber and the patient

What does a category 3 antiepileptic mean

There’s no need for a specific brand

What is the MHRA warning/advice for sodium valproate

Must be dispensed in full packs

Which 3 antiepileptics are considered high risk

Carbamazepine Phenytoin Sodium valproate

What are 5 side effects associated with carbamazepine, phenytoin, and sodium valproate

Vitamin d deficiency Skin disorders Hepatoxicity Blood dyscrasia Depression and suicide

A patient on phenytoin/ carbamazepine/ sodium valproate is considered about vitamin d deficiency, she wants to know the classic symptom she should look out for what is it?

Bone aches

Hyponatreamia and oedema are side effects associated with

Carbamazepine

Coarsening appearance and facial hair is associated with which medication

Phenytoin

Pancreatitis and teratogenicity is associated with which medication

Sodium valproate

Which antiepileptics have a risk of suicidal thoughts and behaviour

All of them

Which antiepileptics are associated with hypersensitivity reactions

Carbamazepine Phenytoin Phenobarbital Primidone Lamotrigene

Which side effect do all antiepileptics drugs cause but resolve over time

Sedation and dizziness

SJS is commonly associated with

Lamotrigene

What medication is associated with respiratory depression

Gabapentin

What medication is associated with encephalopathic symptoms and visual field defects

Vigabatrin

What medications are associated with acute psychotic reactions

Vigabatrin and Topiramate

What medication is associated with a risk of severe harm with injectables

Phenytoin

What medication is associated with glaucoma

Topiramate and cleft palate

Which medicine apart from sodium valproate require a PPP

Topiramate

Therapeutic range for carbamazepine

4-12 mg/l

Therapeutic range for phenytoin

10-20 mg/l

Signs of toxicity when on carbamazepine

Signs of toxicity when on phenytoin

R A N D S

How does Amiodarone interact with anti epileptics

Both cause hepatotoxicity

How does intraconazole interact with anti epileptics

Both cause hepatotoxicity

How does macrolides interact with anti epileptics

Cause hepatotoxicity

How does alcohol interact with anti epileptics

Cause hepatoxicity

Which anti epileptics are CYP enzyme inducers

Phenytoin Phenobarbital Carbamazepine

Which anti epileptics are CYP enzyme inhibitors

Sodium Valporate

Which 3 medications lower seizure threshold

Tramadol Theophylline Quinolones

Carbamazepine can cause hyponatremia so should not be given with which 2 medications

Diuretics SSRI’s

Which 2 medications should not be given with phenytoin

Antifolates such as methotrexate and trimethoprim

When prescribing anti epileptics in pregnancy what must be considered

Risk vs benefit If the risk is more than the benefit to mother and child, then discontinue or do not start medication

If a patient plans on getting pregnant but is on anti epileptics, what should they do

Continue contraception until discussed with GP/neurologist

A patient is on antiepileptics and has become pregnant what should she do

Continue anti epileptics and contact GP/neurologist immediately

Which medication has the highest risk

Sodium Valporate

What medications require a PPP

Topiramate Sodium Valporate

What advise is given to patients on sodium Valporate for pregnancy according to MHRA

Men and women must use contraception during use and 3months after stopping No review is needed if the patient is already on sodium Valporate and over 55 years old

Which medications have an increased risk to baby and mother [3]

Carbamazepine Phenytoin Phenobarbital

Which 3 medications have less of a risk to mother and baby

Lamotrigene Levetiracetam

What advise is given to people trying to get pregnant

Start folic acid as soon as you’re trying to get pregnant until week 12 of pregnancy Give vitamin k injection Which anti epileptics are CYP enzyme inducers

What is given to decrease the risk of neonatal haemorrhage to babies in mothers with epilepsy

Vitamin k injection

What advice is given too breastfeeding mothers on antiepileptics

Mothers are encouraged to breastfeed especially if on single meds unless on combined therapy or has risk factors e.g. premature birth so medication advice should be sort

Which antiepileptics are found in high concentrations of breast milk

PLEZ Primidone Lamotrigene Ethosuximide Zonisamide

Which antiepileptics have a risk of drowsiness [3]

PPB Primidone Phenobarbital Benzodiazepines

What happens if breastfeeding mothers stop benzodiazepines, phenobarbital, Primidone, lamotrigene suddenly

Withdrawal effects

How long after having your last seizure can you reapply with the dvla

1 year

How long after having your first seizure can you reapply with the dvla if you’re not at risk of having a second seizure

6 months

What are the rules after changing or reducing your medication

Do not drive 6 months after the last original dose

A patient has changed their dose of medication and has had a seizure, how long can they not drive for

1 year

A patient has had their original dose reinstated and hasn’t had a seizure for 3 months, they want to know when they can reapply with dvla

6 months s

Epilepsy Flashcards

(80 cards)