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PEBC > 26 - Seizures/Epilepsy > Flashcards

26 - Seizures/Epilepsy Flashcards

1
Q

non-pharms for seizure

A
  • avoid sleep deprivation
  • keep alcohol consumption to a minimum
  • avoid cocaine and amphetamines
  • ketogenic or atkins diet may decrease seizure frequency
  • yoga or mildfulness-based therapy may help
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2
Q

if sensitive to phenytoin, avoid _____

A

carbamazepine

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3
Q

first line for absence seizures

A

ethosuximide

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4
Q

What is primidone’s active metabolite?

A

phenobarbital

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5
Q

Definition of epilepsy?

A

-either 2 unprovoked seizures occurring more than 24 hours apart, 1 unprovoked seizure at a high (>60%) probability of further seizures over the next 10 years or 1 unprovoked seizure and a clearly identifiable epilepsy syndrome

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6
Q

An aura indicates the onset of what type of seizure?

A

focal (partial) seizure

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7
Q

What is a simple partial seizure?

A
  • focal seizures without impairment of awareness

- usually brief, less than 60 seconds

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8
Q

What is a complex partial seizure?

A

focal seizures with impairment of awareness

-usually last 1-2 mins

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9
Q

List the 4 types of generalized seizures

A
  • Absence
  • Generalized tonic-clonic
  • Atonic
  • Myoclonic
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10
Q

Describe an absence seizure (petit-mal)

A
  • usually lasts only 5-10 seconds
  • can recur daily
  • no warning signs
  • onset in childhood
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11
Q

Describe a generalized tonic-clonic seizure (grand-mal)

A
  • tonic/clonic phases

- can begin as a focal seizure or can involve entire brain at onset

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12
Q

Describe an atonic seizure

A
  • abrupt loss of consciousness and muscle tone

- return to awareness in seconds

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13
Q

Describe myoclonic seizures

A

-“shock-like” jerks

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14
Q

Which AEDs can we measure serum levels for

A

phenytoin, phenobarbital, primidone, CBZ, VPA

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15
Q

First choice monotherapy for generalized tonic-clonic

A
  • CBZ
  • lamotrigine
  • levetiracetam
  • phenytoin
  • VPA/divalproex
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16
Q

First choice montherapy for absence seizures

A

ethosuximide

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17
Q

First choice monotherapy for myoclonic and atonic seizures

A

VPA/divalproex

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18
Q

First choice monotherapy for focal (partial) seizures with or without secondary generalization

A
  • CBZ
  • lamotrigine
  • levetiracetam
  • phenytoin
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19
Q

Women of childbearing age taking an AED should receive what daily supplementation to prevent neural tube defects?

A

folic acid 1 mg daily

20
Q

_____ may be better tolerated than CBZ and have similar effectiveness in obtaining long-term seizure freedom

A

lamotrigine

21
Q

____ may be superior to lamotrigine and topiramate

A

VPA

22
Q

For childhood absence epilepsy, ____ and _____ are similarly effective in preventing seizures and both meds are superior to lamotrigine

A

ethosuximide and BPA

23
Q

Ethosuximide is associated with lower rates of ______ difficulties than VPA so it is first choice for childhood absence epilepsy

A

attention

24
Q

For patients with traumatic brain injury, AEDs prevent seizures in the first ___ days after the injury but have no effect on development of later seizures

A

7

25
Q

What are some dose-related adverse effects of AEDS?

How do you manage them?

A
  • dizziness, sedation, fatigue, cognitive and psychiatric symptoms, nausea
  • try reducing the dose or slow release formulation or more frequent administration with lower doses of IR AED
26
Q

What is an idiosyncratic reaction to AED?

A

skin rash

27
Q

Which AEDs are most likely to cause skin rash

A

phenytoin, CBZ, lamotrigine

28
Q

When is rash most likely to occur?

A

within 6 weeks but can occur at any time

29
Q

If a definite drug rash develops, how do you manage this?

A

stop AED. Continuation can result in SJS

30
Q

What type of people are at higher risk for CBZ-associated rash?

A

Han Chinese descent with certain human leukocyte antigen (HLA) status

*consider checking HLA status in these patients before starting CBZ therapy

31
Q

AEDs can also cause other idiosyncratic reactions such as ?

A

hematopoiesis or hepatic toxicity

32
Q

Long-term use of enzyme-inducing AEDs and VPA have been associated with what?

A

increased risk fo low bone density and fracture

33
Q

Pre-pregnancy considerations:

Ideally if patient on COC, how much estrogen should it have if they’re on enzyme inducing AED?

A

> 50 mcg EE but no COC products currently available with EE > 35 mcg

34
Q

Pre-pregnancy considerations:

What are some options for women to prevent pregnancy on enzyme inducing AEDs?

A
  • depot shot
  • IUD (hormonal and non-hormonal)
  • barrier contraception (less effective)
35
Q

Pre-pregnancy considerations:

Which AED is actually decreased by COCs?

A

lamotrigine

  • levels can be expected to drop by at least 50% after starting COC
  • consider doubling lamotrigine dose after starting a COC
36
Q

If they are pregnant and on an anti-epileptic drug that will not be stopped, how much folic acid and when do they need it?

A
  • Ideally 1mg folic acid daily at least 3 months prior to conception until 12 weeks gestation
  • Then from 12 weeks gestation continuation through pregnancy and for 4-6 weeks postpartum or as long as breastfeeding continues, they need folic acid 0.4-1mg daily.
37
Q

Which AEDs are associated with low rates of teratogenicity?

A

lamotrigine, levetiracetam and oxcarbazepine

38
Q

Levels of AEDs can ____ when pregnancy due to increased clearance

A

decrease

39
Q

If a pregnant person is controlled on an AED that may cause teratogenic effects do you switch?

A

No, the risk of congenital malformations is highest in 1st trimester when many women don’t even know they are pregnant

A change in controlled therapy puts person at risk of another seizure which can harm the mom and fetus

40
Q

What vitamin is routinely given to all newborns of a mom on an AED?

A

vitamin K bc enzyme-inducing AEDs can potentially increase the degradation of vitamin K in the fetus

41
Q

Do you still recommend breastfeeding while on AED?

A

Yes

42
Q

Infants whose mothers are taking _____ may be sedated

A

barbiturates

43
Q

AED levels may _____ after delivery

A

increase

44
Q

If a patient is controlled but they are below the serum target range, do you increase the drug.

A

no - “treat the patient, not the serum level”

45
Q

Is CBZ a pro drug?

A

yes

46
Q

100 mg phenytoin sodium = ___ mg phenytoin base

A

92

PEBC (130 decks)

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