Pre Reg > EPILESPY > Flashcards

EPILESPY Flashcards

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1
Q

What is the first step in the diagnosis of epilepsy?

A

Refer after the first seizure

Assess for a second seizure.

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2
Q

What 4 tests are used for diagnosing epilepsy?

A

MRI Scan
EEG
Genetic testing
Antibody testing

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3
Q

What is the purpose of EEG testing in epilepsy diagnosis?

A

To assess for epileptic activity

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4
Q

What type of testing is done for suspected autoimmune encephalitis?

A

Antibody testing

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5
Q

What is the first line treatment for focal seizures?

A

Lamotrigine or Levetiracetam

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6
Q

What are the second line treatments for focal seizures?

A
  • Carbamazepine
  • Oxcarbazepine
  • Zonisamide
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7
Q

What is the first line treatment for generalized tonic-clonic seizures?

A

Sodium Valproate

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8
Q

What is the second line treatment for generalized tonic-clonic seizures?

A
  • Lamotrigine
  • Levetiracetam
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9
Q

What is the treatment for absence seizures?

A
  • Ethosuximide
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10
Q

What is the first line treatment for myoclonic seizures?

A

Sodium Valproate

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11
Q

What is the first line treatment for atonic seizures?

A

Sodium Valproate

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12
Q

What is the definition of status epilepticus?

A

Seizure lasting more than 5 minutes

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13
Q

What should be available for a patient experiencing status epilepticus?

A

Individual management plan

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14
Q
A
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15
Q

Which test is not used if its idiopathic/ self limiting epilepsy

A

MRI scan

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16
Q

What is the first line treatment for **absence seizures with other types of seizures

A

Sodium valproate

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17
Q

What is second line for absence seizures

A

Sodium Valporate

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18
Q

What is the second line treatment for **absence seizures with other types of seizures

A

Lamotrigene/ levetiracetam

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19
Q

What is the second line treatment for myoclonic seizures?

A

Levetiracetam

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20
Q

What is the second line treatment for atonic seizures?

A

Lamotrigene

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21
Q

What is the first line treatment for tonic seizures**?

A

Sodium Valporate

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22
Q

What is the second line treatment for tonic seizures**?

A

Lamotrigene

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23
Q

What age range can Valporate not be used in

A

Under 55’s

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24
Q

What is your role as a pharmacist in status epilepticus

A

Provide resuscitation and immediate emergency treatment.

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25
Treatment for status epilepticus lasting more than 5 mins if resuscitation facilities are available
Iv lorazepam
26
Treatment for status epilepticus lasting more than 5 mins if resuscitation facilities are not available
Buccal Midazolam or rectal diazepam
27
A patient has been having a seizure for over 5 mins and has been given buccal Midazolam, 5-10 mins after it is not working, what do you do
Give second dose
28
A patient has been having a seizure for over 5 mins and has been given buccal Midazolam, 5-10 mins after it is not working so was given a 2nd dose, what do you do next if they seizure continues
Give levetiracetam Phenytoin and sodium Valporate can also be considered
29
A patient has been experiencing status epilepticus lasting over 30 mins and has been given 2 doses of buccal Midazolam and levetiracetam but the seizure continue, what 2 drugs can be considered now
General anaesthesia Phenobarbital
30
Category 1 anti epileptic drug means ….
Patient needs to be prescribed the same brand each time
31
What category drugs are carbamazepine, phenobarbital, phenytoin, and primidone
1 Needs to be the same brand each time
32
Category 2 anti epileptic drug means ….
Same brand can be given depending on prescriber and patient
33
Category 3 anti epileptic drug means ….
No need for specific brand
34
What category drugs are - levetiracetam, lacosamide, tiagabine, Gabapentin, pregabalin, ethosuximide, brivaracetam and vigabatrin
Category 3 = no need for specific brands
35
What category drugs are - valporate, lamotrigene, perampanel, retigabine, rufinamide, clobazam, clonazepam, oxycarbamazepine, eslicarbazepine, Topiramate, zonisamide
2 - same brand depends on prescriber and patient
36
MHRA warning for the dispensing of sodium valporate
Dispensed in full packs
37
3 antiepileptic drugs that are considered high risk
Carbamazepine Phenytoin Sodium valporate
38
5 side effects of high risk antiepileptic drugs
Blood dyscrasia Depression and suicide Hepatotoxicity Skin disorders Vitamin d deficiency
39
2 side effects exclusive to carbamazepine
Hyponatraemia Oedema
40
2 side effects exclusive to phenytoin
Coarsening appearance and facial hair
41
2 side effects exclusive to sodium valporate
Pancreatitis Teratogenic
42
Which antiepileptic drugs can give a patient bone aches and why
High risk drugs - carbamazepine, phenytoin, sodium valporate as thyroid can cause vitamin deficiency
43
All antiepileptic drugs have a risk of what side effect
Suicidal thoughts and behaviour
44
Hypersensitivity reactions can happen with which 4 anti epileptic drugs
Carbamazepine Phenobarbital Phenytoin Primidone Lamotrigene
45
What side effect do all antiepileptic drugs cause when starting and what advice should be given
Sedation and dizziness on starting Resolves over time
46
All antiepileptic drugs affect weight loss or weight gain, is that true or false
True
47
Which enzyme increases due to antiepileptic drugs
Liver enzymes
48
Antiepileptic drugs should not be given to patients with a particular MSK condition, what is it and why
Avoid in those with osteoporosis Can cause impaired bone health
49
SJS is most associated with which antiepileptic drug
Lamotrigene
50
Respiratory depression is most associated with which antiepileptic drug
Gabapentin
51
Encephalopathic symptoms and visual field defects is most associated with which antiepileptic drug
Vigabatrin
52
Acute psychotic reactions is most associated with which antiepileptic drugs [2]
Vigabatrin Topiramate
53
Risk of severe harm with injectable due to risk is most associated with which antiepileptic drug
Phenytoin
54
Glaucoma and cleft palate is most associated with which antiepileptic drug
Topiramate
55
Therapeutic range for carbamazepine
4-12 mg/l
56
7 signs of carbamazepine toxicity
Blurred vision Allergic skin reactions Dizziness Headache Ataxia Nausea and vomitting Drowsiness REMEMBER :BAD HAND
57
Therapeutic range for phenytoin
10-20 mg/l
58
5 signs of phenytoin toxicity
Respiratory depression Ataxia Nystagmus Double vision Slurred speech
59
Anti epileptic drugs can cause hepatotoxicity, which 4 drugs would they interact with
Itraconazole Amiodarone Macrolides Alcohol
60
3 enzyme inducers that are antiepileptics q
Phenytoin Carbamazepine Phenobarbital
61
Name an antiepileptic that is an enzyme inhibitor
Sodium valporate
62
What 3 drugs lower seizure threshold
Tramadol Theophylline Quinolones
63
Carbamazepine causes hyponatraemia, what 2 drug classes should be avoided
Diuretics SSRI’s
64
Phenytoin interacts with antifolates , name 2 anifoltates
Methotrexate Trimethoprim
65
Pregnant women are given antiepileptic meds based on risk vs benefits, if medication is deemed that the risk outweighs benefits to the mother and child, what should be done
Discontinue or do not start
66
If a patient on anti epileptics plans on getting pregnant, what should be done
Continue contraception until discussed
67
If a patient on anti epileptics and becomes pregnant, what should be done
Continue antiepileptics and contact GP/ Neurologists immediately
68
Which antiepileptic is the highest risk to pregnancy and what does this require
Sodium valporate Requires PPP
69
PPP Advice given for those on valporate
Men and women must be contraception during use and 3 months after stopping
70
Apart from Valporate what other drug requires PPP
Topiramate
71
Which 3 antiepileptics have a high risk to baby and mum
Carbamazepine Phenytoin Phenobarbital
72
What should be started if a patient is on an antiepileptic and is planning on getting pregnant
Start folic acid as soon as you’re trying to get pregnant and until 12 weeks of pregnancy
73
Why is vitamin k given to pregnant women wit epilepsy
Reduce risk of neonatal haemorrhage to the baby
74
Does a patient on a PPP need to sign a risk acknowledgment form and if so how often
Yes Yearly to make them aware of risks
75
Which mothers are advised to breastfeed
Those on single medications
76
What is the risk associated with breastfeeding when on combination therapy
Premature
77
Which antiepileptics has a high concentration of in breast milk
Primidone Lamotrigene Ethosuximide Zonisamide THINK PLEZ
78
Which antiepileptic drugs have a high risk of drowsiness when breastfeeding
Primidone Phenobarbital Benzodiazepines THINK PPB
79
Which 4 drugs are likely t cause withdrawal effects of the mother suddenly stops breastfeeding
Phenobarbital Primidore Lamotrigene Benzodiazepines
80
When must you tell DVLA and stop driving immediately if youve had any seizures or blackouts?
Immediately
81
When can you reapply for your license after having your last seizure
1 year
82
A patient has had a seizure for the 1st time and is not at risk of having a 2nd, when can they reapply
6 months
83
A patient has had their medication changed/reduced, when they drive
6 months after the last original dose
84
A patient has had their medication changed/reduced and they’ve had a seizure on their new dose, when can they drive?
1 year later
85
A patient has had their medication changed/reduced but has had their original dose reinstated, when can they reapply for a license
After not having seizures for 6 months you can reapply
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