2. MTB Step 3 - Seizures Flashcards
Cards Complete:
DIAGNOSIS
What are (4) Tests that should be done one all patients having a Seizure?
- Sodium, Calcium, Glucose, Oxygen, Creatinine, and Magnesium levels
- Head CT urgently; MRI later if the initial testing shows nothing
- Urine Toxicology screening
- Liver and Renal function
DIAGNOSIS
What should be performed if the initial set of diagnostic tests does not reveal the etiology of the Seizure?
Electroencephalogram (EEG)
TREATMENT
What is the ONLY thing that is clear when it comes to Status Epilepticus in Seizure Disorders?
The Management:
- 1st Line: Benzodiazepines, such as Ativan (lorazepam).
- 2nd Line: If the seizure persists after moving the clock forward 10–20 minutes, then add Fosphenytoin.
- 3rd Line: If the seizure persists after moving the clock forward another 10–20 minutes, then add Phenobarbital.
- 4th Line: If the seizure persists after moving the clock forward 10–20 minutes again, then add General Anesthesia, such as Pentobarbital, Thiopental, Midazolam, or Propofol.
TREATMENT
Chronic antiepileptic drug therapy is generally not indicated after a single Seizure. What are (4) Exceptions to this (when should you treat chronically after the first seizure)?
- Strong family history of seizures
- Abnormal EEG
- Status Epilepticus that required Benzodiazepines to stop the seizure
- Non-correctable precipitating cause, (i.e., brain tumor)
TREATMENT
What are (5) First-Line therapies for the Long-Term management of Seizures that are all equal in efficacy?
- Valproic Acid
- Carbamazepine
- Phenytoin
- Levetiracetam (Keppra)
- Lamotrigine (Lamictal) - has efficacy equal to those agents but is associated with the development of Stevens-Johnson syndrome and severe skin reactions.
TREATMENT
What are (4) Second-Line therapies for the Long-Term management of Seizures that are all equal in efficacy?
- Gabapentin
- Phenobarbital
- Lacosamide
- Zonisamide
TREATMENT
What is considered the Best Antiepileptic drug for Absence or Petit Mal Seizures?
Ethosuximide
TREATMENT
Which Antiepileptic drug is the Most Dangerous in Pregnancy?
Valproic Acid
TREATMENT
Which (2) Antiepileptic drugs are considered the Safest in Pregnancy?
- Levetiracetam (Keppra)
- Lamotrigine
TREATMENT
Which Antiepileptic drug has the Highest Risk of Hyponatremia?
Carbamazepine
TREATMENT
What increases the metabolism of Lamotrigine to ineffective levels?
ESTROGENS
This OCPs
TREATMENT
What Test will predict Stevens-Johnson syndrome induced by Carbamazepine and Phenytoin?
HLA B*1502 Testing
TREATMENT
What are (2) Disorders that many of the Antiepileptic drugs are associated with?
- Bone Loss
- Osteoporosis