7a

Question 1

which drugs can aggravate myoclonic/absence seizures?

Answer 1

PHY CARB GABA

CBZ
OXC
PHY
Gabapentin
Pregab
tiagabine
vigabatrin

Question 2

common inducers vs inhibitors

Answer 2

CBZ, PHY and PHB are inducers: reduce the efficacy of other drugs metabolized by the liver
VPA is an inhibitor: reduces clearance of medications metabolized by the liver

Question 3

drugs for first line of generalized absence seizures?

Answer 3

Ethosux
VPA
LTG

Question 4

only ASM with FDA indication as adjunctive therapy against generalized myoclonic seizures?

Answer 4

LEV

Question 5

approach to generalized seizure types such as LGS?

Answer 5

Start with broad spectrum agent: VPA, LTG, TPM, ZNS, LEV
adjunctive therapies approved for LGS can be added in addition if needed: felbamate, rufinamide, clobazam

Question 6

antibiotics that lower the seizure threshold?

Answer 6

4th generation cephalosporins, quinolones, carbapenems, isoniazid, unsubstituted penicillins

Question 7

antipsychotics that lower the seizure threshold?

Answer 7

clozapine, chlorpromazine

Question 8

antidepressants that lower the seizure threshold?

Answer 8

bupropion and TCAs

Question 9

pain meds that lower the seizure threshold?

Answer 9

tramadol, meperidine

Question 10

estrogen is though to lower seizure threshold as well

Answer 10

just know

Question 11

supplements that can provoke seizures

Answer 11

ephedrine/pseudoephedrine
phenylpropanolamine
creatine
ginkgo biloba
St. John’s wort

Question 12

drugs that can provoke seizures

Answer 12

meth
pcp
cocaine

Question 13

when should CSF be acquired after first time seizure?

Answer 13

when concerned for meningitis, intracranial malignancy (after inc ICP is excluded)

Question 14

after first seizure, risk of recurrence?

Answer 14

with normal eval, 30-50% will have seizure recurrence

Question 15

Autism is considered an abnormal neuro exam

Answer 15

just know, 71% have seizure recurrence

Question 16

ASMs that require longer titration?

Answer 16

LTG
TPM
cenobamate
perampanel

Question 17

asian patients should be tested for ___ before starting ___

Answer 17

HLA B 1502 before CBZ use

Question 18

What needs to be checked when checking the level of phenytoin, VPA, phenobarbital?

Answer 18

Highly protein bound, so must use albumin to correct the level, check free and total values if albumin is low.

Question 19

effects of ASMs on elimination

Answer 19