Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHRM 845 > 48 - 49 PCOL of seizure disorders > Flashcards

48 - 49 PCOL of seizure disorders Flashcards

1
Q

lowering the seizure threshold: medications

usual doses

A
  • bupropion
  • clozapine
  • theophylline
  • varenicline
  • phenothiazine antipsychotics
  • CNS stimulants (amphetamines)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

lowering the seizure threshold: medications

high doses and impaired renal function

A
  • carbapenems (imipenem)
  • lithium
  • meperidine
  • penicillin
  • quinolones
  • tramadol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

___ seizures are the most common

A

partial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Lifelong treatment?

not necessarily - long term studies have shown that successful antiseizure medication withdrawals may occur after a seizure free period of ___ - ___ years

A

2-5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Lifelong treatment?

risk factors for recurrence
- < 2 years seizure free
- onset of seizure after age ___
- history of atypical febrile seizures
- 2-6 years before good seizure control
- greater than __ seizures before control acheived
- ___ seizures most common
- abnormal EEG throughout treatment
- brain injury, dementia
- withdrawal or ___ or ___

A
  • 12
  • 30
  • partial
  • pheytoin, valproate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

drug resistant epilepsy

failure of at least ___ trials of antiseizure meds

reasons for failure
- failure to reach ___ target
- alteration of drug targets in the CNS
- drugs missing the real target

management
- rule out wrong drug/diagnosis (pseudo-resistance)
- ___ therapy
- electrical/surgical intervention

A

2
CNS
combo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

status epilepticus

defined as continuous seizure activity lasting ___ min or more
OR
two or more discrete seizures with incomplete ___ between seizures
- ___ drug therapy commonly used in this situation

possible drug therapy
- ___ (first line) - lorazepam or midazolam
- levetiracetam
- valproate
- lacosamide
- phenobarbital
- pheytoin
- topiramate

A

5, recovery
- IV
- benzodiazepines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

status epilepticus treatment

0-5 min (stabilization
- start ECG and ___ if needed
- check serum concentration of antiseizure meds and electrolytes
- if BG low, treat with D25-D50

5-20 min (initial treatment phase)
- if seizure continues IV ___ or IV ___
- alternatives if hese are nor effective: rectal ___ or intranasal/buccal midazolam

20-40 min (second treatment phase)
- if seizure continues: IV ___ , IV ___ , IV ___
- may use ___ phenobarbitalif there is not access to above meds

40-60 min (third phase)
- repeat second line therapy
- anesthetic doses of the following plus continuous EEG monitoring (thiopental, midazolam, phenobarbital, propofol)

A
  • O2
  • midazolam, lorazepam
  • diazepam
  • fosphenytoin, valproic acid, levetiracetam
  • phenobarbital
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

phenytoin/fosphenytoin loading dose

phenytoin contains ___, leads to hypotension, limits infusion rate
- ___ mg/kg IV, may give additional dose 10 min after load
- up to ___ mg/min IV infusion

A

propylene glycol
20
50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

phenytoin/fosphenytoin loading dose

produrg of phenytoin, better IV tolerance
- ___ mg PE (phenytoin equivalents) / kg IV, may give additional dose 10 min after load
- up to ___ mg PE/min IV infusion

A

20
150

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

phenytoin/fosphenytoin loading dose

  • cardiac monitoring required
  • may also cause a local reaction called ___
A

purple glove syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

oral phenytoin dosing considerations

MUST obtain both phenytoin serum concentration and serum ___ in the same blood draw
- therapeutic serum concentration range: ___ - ___ mcg/mL

phenytoin is highly ___ bound

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

valproae loading dose

IV to PO conversion __ : ___ mg/mg
- LD:15 - 30 mg/kg IV
- subsequent doses: 15 mg/kg/day titrated to 60 mg/kg/day

desired serum concentration = ___ mcg/mL (range ___ - ___ mcg/mL)

A

1:1
80, 50-120

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

first line treatments

partial onset
CLLOPPV

A

carbamazepine
lamotrigine
levetiracetam
oxcarbazepine
phenytoin
pregabali
valproate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

first line treatments

tonic-clonic (generalized)
CLOPPV

A

carbamazepine
lamotrigine
oxcarbazepine
phenobarbital
phenytoin
valproate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

first line treatments

absence (generalized)
ELV

A

ethosuximide
lamotrigine
valproate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

first line treatments

myoclonic (focal or generalized)
LTV

A

levetiracetam
topiramate
valproate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

first line treatments

lennox-gastaut
FLRTV

A

felbamate
lamotrigine
rufinamide
topiramare
valproate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

first line treatments

atonic (generalized)
VLRT

A

valproate
lamotrigine
rufinamide
topiramate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

1A2 and 2C9 inducers, UGHR inducers
CPP

A

carbamazepine
phenobarbital
phenytoin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

3A4 inducers
CLOPPT

A

carbamazepine
lamotrigine
oxcarbazepine
phenobarbital
phenytoin
topiramate

22
Q

UGT inhibitor

A

valproate

23
Q

lamotrigine dosing

boxed warning for ___
- ___ substrate, high initial serum concentrations associated with boxed warning

A

SJS/TEN
UGT

24
Q

lamotrigine dosing

dosing with UGT inhibitor ( ___ )
___ mg every other x14 days
___ mg daily x14 days
___ mg daily x 7 days
___ mg daily

A

valproate
25
25
50
100

25
Q

lamotrigine dosing

without concomitant UGT drug interactions
___ mg daily x14 days
___ mg daily x14 days
___ mg daily x 7 days
___ mg daily

A

25
50
100
200

26
Q

lamotrigine dosing

with UGT inducers ( 3)
___ mg daily x14 days
___ mg daily x14 days
___ mg daily x 7 days
___ mg daily

A

carbamazepine, phenytoin, phenobarbital
50
100
200
400

27
Q

anticonvulsant hypersensitivity syndrome

  • black box warning - genetic screen for ___ allele prior to initiating ___ or its derivatives
  • pts with positive allele should avoid that drug/derivatives
  • strong correlation for this allele and AHS in pts of ___ descent
  • positive ___ in those of northern european and asian descent may confer similar risk
A
  • HLA-B*1502, carbamazepine
  • asian
  • HLA-A*3101
28
Q

DRESS Syndrome

potentially life threatening - estimated mortality rate of 10%
- occurs ___ - ___ weeks after initiation of drug therapy
- associated with carbamazepine, cenobamate, lamotrigine, phenobarbital, phenytoin, valproate, zonisamide
- increased risk in pts with ___ allele (northern european/asian)

A

2-6
HLA-A*3101

29
Q

antiseizure drug withdrawal syndrome

associated with ___ D/C
- may cause recurrence of seizures
- should always be ___ for D/C

A

abrupt
tapered

30
Q

antiseizure drug therapt in pregnancy

  • drug serum concentrations may be altered due to changes in ___
  • many antiseizure medications have known teratogenic risks
  • ___ is not recommened in pregnancy due to neural tube defecrs and decreased ___ in the offspring
  • supplemental ___ should be considered during pregnancy
  • infant should receive vitamin L 1 mg IM at birth ro decrease risk of ___ disease
A

Vd
valproate, IQ
folic acid
hemorrhagic

31
Q

contraceptic drug interactions

  • mediated by CYP ___ induction - estrogen compunds are major ___ substrates
  • antiseizure drugs that are inducers will significantly lower the serum concentration/efficacy of estrogen containing contraceptives

interaction can be minimized by using higher-dose estrogen contraceptives - warning for increased risk of thromboembolism
- can use progestin only contraceptives (depo or IUDs too)
- estrogen can significantly decrease ___ serum concentration (50%) and ___ decreases ___ concentrations

A

3A4, 3A4
lamotrigine, lamotrigine, estrogen

32
Q

cardiovascular AE

  • lamotrigine, phenytoin/fosphenytoin assocaited with ___
  • lacosamide and pregabalin cause ___ interval changes
  • heart block: ___
  • fenfluramine assocaited with ___ heart disease
A

arrhythmia
PR
lacosamide
valvular

33
Q

electrolytes, acidosis, and bone loss

carbamazepine and its derivatives cause hypo ___ and syndrome of inappropriate ___ release

phenytoin - altered vitamin ___ metabolism and decreased ___ concentrations leading to osteoporosis with long term use

topiramate - decreased serum bicarbonate leading to metabolic acidosis, kidney ___, monitor serum bicarb ( is also a ___ inhibitor)
- associated with decreased ___ , heat intolerance, and oligohydrosis

A
  • hyponatremai, ADH (SIADH)
  • D, Ca
  • stones
  • carbonic anhydrase
  • sweating
34
Q

psychiatric SE of antiseizure meds

levetiracetam
- psychosis, suicidal, mood changes, depression (most often seen in children)

perampanel
- boxed warning: ___ events (use in caution with previous existing psychosis)

valproate
- acute mental status changes related to ___ ; differentiate from sedation SE

topiramate
- associated with ___ dsyfunction is dose increased to rapidly, uses a slow dosen titration

A

psychosis
neuropsychiatric
hyperammonemia
cognitive

35
Q

vision abnormalities

topiramate
- post marketing warning for vision loss, myopia. and ___ detachement

vigamabtrin
- CI in pts who have other risk factors for irreversible vision loss

A

rentinal

36
Q

respiratory depression

evaluate apptopriateness of ___ or pregabalon use and risk for respiraotry depression in pt taking CNS depresseants, pulmonary disease, or elderly

A

gabapentin
pregabalin

37
Q

clinical pearls

carbamazepine: strong CYP ___ , ___ , ___ , and ___ and P-GP inducer

oxacarbazepine induced ___

A

1A2, 2C9, 2C19, 3A4

  • 3A4
38
Q

carbamazepine and its derivatives cause ___

A

hyponatremia

39
Q

valproate and cause ___ - monitor CBC/platelets
can cause ___ , weight gain, and sedation

A

thrombocytopenia
PCOS

40
Q

topiramate and zonisamide
- weight ___
- oligohydrosis
- kidney ___

A

loss
stones

41
Q

phenytoin absorption is ___ when given with ___ feedings. Hold feeding __ - ___ hours before or after

A

decreased
enteral
1-2

42
Q

phenytoin causes ___ hyperplasia and ___

A

gingival
hyperplasia

43
Q

zonisamide is CI if theres a ___ allergy

A

sulfa

44
Q

gabapentin and pregabalin are ___ eliminated, decrease dose in impairment

A

renally

45
Q

lamortrigine has been assoicated with ___ in people with inderlying cardiac conditins

A

arrhythmia

46
Q

T or F: cannabis and THC can help control seizures, epecially those refractory to current AED medications

A

T
used for lennox-gastaut and dravet syndrome

47
Q

epidiolex - ___ oral solution
- indicated for ___ and ___ syndrome

A

cannabidiol
lennox-gastaut
dravet

48
Q

keto diet

  • most often used in ___ seizure disorders to reduce frequency, can be used in adults with refractory seizures

fats:carbs/proteins ___ : ___ or ___ : ___

SE:
- hyperlipidemia
- weight ___
- constipation
- kidney stones
- decreased bone mass/growth

adults seem to response only while one the diet. Effects in chidlren may continue after diet is D/C

A

child
3:1, 4:1
loss

49
Q

depresssion in epilepsy

T or F: all seizure drugs carry a warning for increased risk of sucidal thinking

A

T

50
Q

depresssion in epilepsy

antidepressants also carry a warning for increased risk of suicidal thinking in patients < ___ years old

A

24

51
Q

depresssion in epilepsy

use of ___ should be avoided in patients with uncontrolled seizure disorders

A

bupropion

PHRM 845 (62 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions