Card Set Information
what is the differential diagnosis of gum hypertrophy?
acute monocytic leukaemia
familial gingival fibroplasia
: phenytoin, nifedipine, ciclosporin, ACEi
how would you evaluate a person with a FIRST ever seizure?
1. really 1st one? family, deja vu
2. really a seizure? witness
3. was a seizure provoked? CNS insult (alcohol, head injury, stroke, hypoglycaemia or drugs such as clozapine, tramadol), temp high, electrolytes
4. was seizure unprovoked? higher chance recurrence
5. was seizure triggered? strobe lighting, tv?
what investigations need do be done in a first time seizure?
REFER TO CONSULTANT NEUROLOGIST
: FBC, U&E, LFT, glucose, calcium, INR, alcohol and drug toxin screen (serum and urine), LP (if CT shows no increase in ICP)
: CT, MRI brain
: arrhythmia, long QT (if miss this, AED very cardiotoxic!)
what is the differential diagnosis of seizures?
Breath holding spell
: episodes of apnoea esp. in children may get LOC
what are the precipitants of a seizure? meaning and example
: lower the seizure THRESHOLD. if diagnosed with epilepsy, should avoid theses precipitants
physical or mental exhaustion
: flickering lights
alcohol intoxication or withdrawal
what are the rules for epilepsy and driving?
1. patient must inform the DVLA themselves and tell them about their seizure
2. if 12 months seizure free then can drive
3. if only night/sleep seizures for 3 years then can drive
4. if the patient had a SINGLE seizure with a normal MRI and EEG, they can drive after 6 months
which drugs are used for generalised seizures?
which drugs are used for partial seizures?
which ant-epileptic drug is safest in pregnancy and breast feeding?
which info about AED needs to be given to the patient?
dosage schedule, what happens if missed dose
: OCP, NSAIDS
how is AED treatment started?
one drug initially
build UP dose
note there will be initial side effects but have to continue to take (dizzy)
if one monotherapy doesn't work then try ANOTHER MONOTHERAPY BEFORE DUAL
how is the progress monitored?
what is the termination policy for AED?
if been seizure free on drug after 3 years then can stop
unfavourable factors for stopping
: seizure on AEDs, need for >1 drug
favourable factors for stopping
: increased length of remission on trial
what are the 2 main SE of carbamazepine?
what is the dose-serum level relationship?
what is carbamazepine used for?
and tonic-clonic seizures with PARTIAL ONSET
which other drug must you be careful to take with carbamazepine?
OCP as cbz is hepatic enzyme inducer so could get pregnant on it
what is sodium valproate used for?
drug of choice for primary GENERALISED epilepsy
what are the SE of valproate?
tremor at high dose
what effect does valproate have on hepatic enzymes?
INHIBITS liver enzymes
what is the mechanism of action of valproate?
increased GABA activity/secretion
what is lamotrigine used for?
monotherapy or adjunctive for ALL types of seizure
what are the side effects of lamotrigine?
toxic epidermal necrolysis
what is phenytoin used for?
tonic clonic seizures
what are the side effects of phenytoin?
what happens in overdose of phenytoin?
if a pregnant women needs AED what needs to be done?
risk of AED v risk of seizure
refer to specialist
all cause neural tube defects
: counsel the pt
offer screening for neural tube defects
give folate supplementation
: cbz is ok
name some drugs which are hepatic enzyme inducers and their effects on specific drugs
: reduced AED, warfarin and OCP effect so seizure, clot and pregnant!
name some drugs which are hepatic enzyme inhibitors
: increase AED, warfarin and oral hypoglycaemic
which drugs have high protein bindings? and which drugs can displace them?
: warfarin, NSAIDs, AEDs