Epilepsy

Question 1

Describe Grand Mal epilepsy

Answer 1

• tonic clonic
• random frequency
• loss of consciousness, bladder control
• post ictal coma

Question 2

Describe Petit Mal epilepsy

Answer 2

• absence seizure
• regular frequency (3Hz)
• no motor symptoms
• no post ictal coma

Question 3

Describe Status Epilepticus

Answer 3

• 30min continuous tonic clonc seizures, unconsciousness
• fever sweating, hypertension
• anoxia/hypoxia

Question 4

Drugs for grand mal

Answer 4

Carbamazepine, phenytoin, valproate, lamotrigine, barbiturates

Question 5

Drugs for petit mal

Answer 5

Ethosuxamide

Question 6

Drugs for status epilepticus

Answer 6

Phenytoin, BZDs

Question 7

Adjunct anti-epileptic drugs

Answer 7

Gabapentin, Vigabatrin, Tigabide

Question 8

Phenobarbitone, pentabarbitone

Pharmacodynamics + clinical use

Answer 8

Positively modulate GABA-A receptor, increases postsynaptic GABAergic transmission

Clinical use:
Grand mal

Question 9

BZDs: Clonazepam, clobazam, diazepam

Pharmacodynamics + clinical use

Answer 9

• Positively modulate GABA-A receptor, increases postsynaptic GABAergic transmission
• increases frequency of Cl channel opening

Clinical use:
status epilepticus

Question 10

Valproate

Pharmacodynamics + clinical use

Answer 10

-Blocks repetitive firing from voltage gated Na channels

Clinical use:
Grand mal, partial

Question 11

Carbamazepine

Pharmacodynamics + clinical use + significant side effects

Answer 11

-Blocks repetitive firing from voltage gated Na channels

Clinical use:
Grand mal, partial epilepsy, trigeminal neuralgia

Significant side effects:
Agranulocytosis, aplastic anaemia

Question 12

Lamotrigine

Pharmacodynamics + clinical use

Answer 12

-Blocks repetitive firing from voltage gated Na channels

Clinical use:
Grand mal, partial

Question 13

Phenytoin (hydantoin)

Pharmacodynamics + clinical use + significant side effects

Answer 13

-Blocks repetitive firing from voltage gated Na channels

Clinical use:
status epilepticus

Significant side effects:
nystagmus

Question 14

Ethosuximide (succinimide)

Pharmacodynamics + clinical use

Answer 14

-Blocks T type calcium channels (involved in generation of 3Hz activity in thalamic neurons)

Clinical use:
Petit mal (ineffective against Grand Mal cos doesn't enhance GABA)

Question 15

Vigabatrin

Pharmacodynamics + clinical use

Answer 15

-Blocks GABA metabolism (GABA transaminase inhibitor)

Clinical use:
adjunct therapy

Question 16

Tigabide

Pharmacodynamics + clinical use

Answer 16

-Blocks GABA reuptake (blocks GABA transporter-1)

Clinical use:
adjunct therapy

Question 17

Gabapentin

Pharmacodynamics + clinical use

Answer 17

-GABA agonist

Clinical use:
adjunct therapy

Question 18

Which antipsychotic can cause agranulocytosis and aplastic anaemia

Answer 18

Carbamazepine

Question 19

Major side effects of anti-epileptic drugs:

GI

Answer 19

• NnV

- Anorexia

Question 20

Major side effects of anti-epileptic drugs:

CNS

Answer 20

• Ataxis
• Dizziness
• Drowsiness
• Cognitive effects

Question 21

Major side effects of anti-epileptic drugs:

Psych

Answer 21

• Psychosis
• Agitation
• Restlessness
• Night tremors
• Depression
• Euphoria

Question 22

Major side effects of anti-epileptic drugs:

Mucosal/ Cutaneous

Answer 22

• Rashes
• Hair loss/ hirsutism
• Gum hyperplasia

Question 23

Which anti-epileptics cause drug induced Parkinsonism

Answer 23

• Valproate

- Lithium

Question 24

Describe a simple partial seizure

Answer 24

Person away of surroundings

Question 25

Describe a complex partial seizure

Answer 25

Person unaware of surroundings

Question 26

Describe a secondary generalised seizure

Answer 26

Partial seizure that evolved into generalised seizure

Question 27

Drugs for focal seizure

Answer 27

- Carbamezapine | - Lamotrigine

Question 28

Which contraceptives would not work with anti-epileptics

Answer 28

- Contraceptive patches (combined) - Progesterone-only pill - Implanon implant (progesterone-only) Note: COCP must contain at least 50 micrograms oestrogen

Question 29

When should PR diazepam/ buccal midazolam be given to a pt

Answer 29

1. Seizure lasting more than 5min | 2. 3 or more seizure within 1h

Question 30

Why is diazepam not given IV

Answer 30

It will cause thrombophlebitis

Question 31

Features of sodium valproate teratogenicity

Answer 31

* Spina bifida * Facial and skull malformations (including cleft lip, palate) * Malformations of limbs, heart, kidneys, urinary tract, sexual organs * Developmental problems * Increased risk of ASD, ADHD

Question 32

What antiepileptics are safe in pregnancy

Answer 32

1. Levetiracetam | 2. Lamotrigine

Question 33

Which anti epileptics cause cerebellar side effects

Answer 33

Phenytoin | Carbamazepine

Question 34

Which anti epileptics cause pancreatitis

Answer 34

Valproate

Question 35

Therapeutic range of phenytoin

Answer 35

10-20