1. what is the differential diagnosis of gum hypertrophy?
    • pregnancy
    • scurvy
    • acute monocytic leukaemia
    • familial gingival fibroplasia
    • drugs: phenytoin, nifedipine, ciclosporin, ACEi
  2. 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?
  3. what investigations need do be done in a first time seizure?
    • Blood: FBC, U&E, LFT, glucose, calcium, INR, alcohol and drug toxin screen (serum and urine), LP (if CT shows no increase in ICP)
    • Imaging: CT, MRI brain
    • EEG
    • ECG: arrhythmia, long QT (if miss this, AED very cardiotoxic!)
    • Cardiac echo
  4. what is the differential diagnosis of seizures?
    • syncope
    • TIA
    • hypoglycaemia
    • Drug/alcohol intoxication
    • Migraine
    • Clonus
    • Hyperventilation
    • Narcolepsy
    • Breath holding spell: episodes of apnoea esp. in children may get LOC
  5. what are the precipitants of a seizure? meaning and example
    • precipitants: lower the seizure THRESHOLD. if diagnosed with epilepsy, should avoid theses precipitants
    • febrile illness
    • hyperventilation
    • sleep deprivation
    • emotional stress
    • physical or mental exhaustion
    • photic stimulation: flickering lights
    • drugs
    • alcohol intoxication or withdrawal
  6. 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
  7. which drugs are used for generalised seizures?
    • sodium valproate
    • lamotrigine
  8. which drugs are used for partial seizures?
    • carbamazepine
    • sodium valproate
    • lamotrigine
  9. which ant-epileptic drug is safest in pregnancy and breast feeding?
  10. which info about AED needs to be given to the patient?
    • side effects
    • dosage schedule, what happens if missed dose
    • interactions: OCP, NSAIDS
    • pregnancy
  11. 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
  12. how is the progress monitored?
    • seizure frequency
    • drug levels
    • side effects
  13. 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
  14. what are the 2 main SE of carbamazepine?
    • allergy
    • teratogenic
  15. what is the dose-serum level relationship?
  16. what is carbamazepine used for?
    • partial seizures
    • and tonic-clonic seizures with PARTIAL ONSET
  17. which other drug must you be careful to take with carbamazepine?
    OCP as cbz is hepatic enzyme inducer so could get pregnant on it
  18. what is sodium valproate used for?
    drug of choice for primary GENERALISED epilepsy
  19. what are the SE of valproate?
    • teratogenic
    • acute hepatitis
    • weight gain
    • tremor at high dose
    • hair thinning
  20. what effect does valproate have on hepatic enzymes?
    INHIBITS liver enzymes
  21. what is the mechanism of action of valproate?
    increased GABA activity/secretion
  22. what is lamotrigine used for?
    monotherapy or adjunctive for ALL types of seizure
  23. what are the side effects of lamotrigine?
    • rash
    • stephen-johnson's syndrome
    • toxic epidermal necrolysis
    • GI symp
    • psych symp
    • blood dyscrasias
  24. what is phenytoin used for?
    tonic clonic seizures
  25. what are the side effects of phenytoin?
    • hirsutism
    • weight gain
    • acne
    • gum hypertrophy
  26. what happens in overdose of phenytoin?
    • sedation
    • cerebellar syndrome
  27. 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: aFP
    • give folate supplementation
    • breastfeeding: cbz is ok
  28. name some drugs which are hepatic enzyme inducers and their effects on specific drugs
    • phenytoin
    • phenobarbitone
    • carbamazepine
    • rifampicin
    • effects: reduced AED, warfarin and OCP effect so seizure, clot and pregnant!
  29. name some drugs which are hepatic enzyme inhibitors
    • sodium valproate
    • allopurinol
    • amiodarone
    • erythromycin
    • effects: increase AED, warfarin and oral hypoglycaemic
  30. which drugs have high protein bindings? and which drugs can displace them?
    • valproate
    • phenytoin
    • displaced by: warfarin, NSAIDs, AEDs
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