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MODE OF ACTION
INDICATION
1.
CARBAMAZEPINE
Prolongation of Na+
channel inactivation
PHENYTOIN
Prolongation of Na+
channel inactivation
SODIUM
VALPROATE
Block voltage-gated
inward positive
+
currentsNa or
++
Ca
Highly Pleiotrophic
2.
3.
4.
5.
Simple/Complex Partial
seizures
Tonic-clonic seizures
Trigeminal Neuralgia
MDP
Diabetic Neuropathy
1.
2.
3.
1.
Lamotrigine
DIAZEPAM
LORAZEPAM
Prolongation of Na+
channel inactivation
Bind to GABA
inhibitory receptors
to reduce firing rate.
Primary / secondary
generalized Tonic-Clonic
2. Prevention of relapse in
BPD
3. Trigeminal Neuralgia
Given PR in initial status
epilepticus
CI/INTERACTION
Auto-inducer; i.e
increase their
own metabolism.
Interact w/
warfarin lamotrigine
Fetal hydantoin
syndrome
Auto-inducer
Causes liver
toxicity
Neural tube
defects
inhibits CYP450
enzymes
ADVERSE EFFECTS
Leucopenia
Diplopia, Blurring of vision
SIADH
Drowsiness
Ataxia
Generalized rash
Risk of Steven Johnson syndrome(HLA-B 1502 PM)
Ataxia and Nystagmus
Cognitive impairment
Hirsutism
Gingival hyperplasia
Coarsening of facial features
Dose-dependent zero order kinetics.
Apetite / Weight gain
Liver failure
Pancreatitis
Reversible hair loss
Oedema
Ataxia
Tremor / Thrombocytopenia
Encephalopathy
Steven Johnson syndrome - rash
Diplopia, Blurring of vision
Photosensitivity
Agitation
Tremor
ABCDE
Oxygen
Safe environment
Keep patient supported during seizure protecting from injury. As soon as movements cease put into recovery
position and ensure she is watched until she has recovered consciousness
Precipitating factors
Employment/education
Driving
Free prescriptions
Dangerous situations
Psychological issues
Status epilepticus
Management
Myoclonus
First-line treatment:
Sodium valproate
Consider levetiracetam or topiramate if sodium valproate unsuitable or not tolerated
Adjunctive treatment:
Sodium valproate, levetiracetam or topiramate
Clobazam, clonazepam, piracetam or zonisamide (after discussion with tertiary centre)
Treatment
ABC assessment
Screening for Wernicke's encephalopathy or Korsakoff , and treatment 2x 500 mg thiamine should be given IV three times daily for three days. Continued OD for 5 more days if
the patient is responsive to the treatment
Benzodiazepines
Fixed-dose regimens
Note risks of respiratory depression and can precipitate hepatic encephalopathy in patients with ALD
EPILEPSY