Anticonvulsants and Benzodiazepines Flashcards
1
Q
Major classifications of epilepsy/seizure (3)
A
- Partial
- Generalized
- Unclassified
2
Q
Types of partial seizures (3)
A
- Simple
- Complex
- Partial leading to generalized
3
Q
Types of generalized (convulsive/non-convulsive) seizures (7)
A
- Absence
- Atypical absence
- Myoclonic
- Clonic
- Tonic
- Tonic-Clonic
- Atonic
4
Q
What is status epilepticus
A
Seizure of >15 minutes in duration or multiple within30 minutes with no recovery between them
5
Q
Causes of electrical disturbances of epilepsy (4)
A
- Alteration in membrane
- Calcium, sodium conductances implicated
- Imbalance between excitatory and inhibitory neurons
- Potentiation
6
Q
Where are most epileptic drugs metabolized
A
Liver
7
Q
How many half lives before evaluating drug effectiveness
A
5
8
Q
T/F All epileptic drugs are teratogenic
A
True
9
Q
What seizures are phenobarbital effective against (3)
A
- Simple partial
- Complex partial
- Febrile
10
Q
Which is more effective… Phenobarbital or carbamazepine
A
Carbamazepine
11
Q
How does phenobarbital effect adults and kids
A
Adults - drowsiness
kids - hyperactivity
12
Q
T/F Physical dependence is common with chronic use of phenobarbital
A
True
13
Q
T/F It is easy to wean infant from phenobarbital
A
False
14
Q
What seizures is primidone (mysoline) effective against
A
Most types except ABSENCE
15
Q
What generation is phenytoin (Dilantin)
A
1st generation
16
Q
What seizures is phenytoin (dilatin) effective against
A
Most types except ABSENCE
17
Q
What is the prime area of use for phenytoin (dilatin)
A
Post-traumatic seizures
18
Q
What does toxicity/chronic use of phenytoin (dilatin) cause
A
Cerebellar degeneration
19
Q
Side effects of phenytoin (dilatin) (4)
A
- Gingival hyperplasia
- Vitamin K deficiency
- Cleft palate deformity
- Bone marrow hypoplasia
20
Q
What is ethosuximide (zarontin) indicated for
A
ABSENCE seizure
21
Q
What seizure types is carbamazepine (tegretol) effective against
A
Most seizure types except ABSENCE
22
Q
What is carbamazepine (tegretol) metabolized into
A
Carbamazepine-10. 11-epoxide
23
Q
Side effect of carbamazepine (tegretol)
A
Transient rash
24
Q
T/F Regular blood work/monitoring is needed for carbamazepine (tegretol)
A
True
25
What medication has the broadest spectrum of antiepileptic activity
Valproic acid (Depakene, Stavzor)
26
Side effects of valproic acid (depakene, stavzor) (3)
1. Behavioral changes (bipolar disorder)
2. Hair loss
3. Weight gain
27
T/F we need to monitor drug level and response/side effects regularly for valproic acid (depakene, stavzor)
True
28
What generation is oxcarbazepine (trileptal, oxtellar XR)
2nd Generation
29
Does oxcarbazepine (trileptal, oxtellar XR) produce epoxied metabolite
Nope
30
What does oxcarbazepine (trileptal, oxtellar XR) not producing epoxied metabolite mean
Very little toxicity
31
What are the indications for use of oxcarbazepine (trileptal, oxtellar XR)
Primary mono therapy for primary and secondary epilepsy syndrome
32
Do we need continuous blood monitoring for oxcarbazepine (trileptal, oxtellar XR)
Nope
33
What baseline blood monitoring do we need for oxcarbazepine (trileptal, oxtellar XR)
Sodium level
34
What generation is eslicarbazepine (aptiom)
3rd Generation
35
Warning for eslicarbazepine (aptiom) (2)
1. Suicidal ideation
2. Aggressive behavior
36
What regular blood monitoring should be done for eslicarbazepine (aptiom) (2)
1. Sodium
2. Chloride
37
When should LFTs be evaluated for eslicarbazepine (aptiom)
Baseline only
38
T/F eslicarbazepine (aptiom) are not the first drug of choice
True
39
When is lamotrigine (lamictal) indicated
Adjunctive treatment in patients over age of 18 years old
40
What adjunctive treatments is lamotrigine (lamictal) used for (3)
1. Partial onset generalized tonic-clinic seizures
2. Secondarily generalized tonic-clinic seizures
3. Lennox-Gastaut syndrome
41
Risk of using lamotrigine (lamictal)
Severe life threatening rash (Steven Johnston Syndrome)
42
T/F lamotrigine (lamictal) is available in a PO form
True
43
T/F lamotrigine (lamictal) interferes with folate metabolism
True
44
T/F zonisamide (zonegran) is a carbonic anhydride inhibitor
True
45
What does zonisamide (zonegran) being a carbonic anhydrase inhibitor put the pt at risk of developing
Kidney stones
46
T/F zonisamide (zonegran) is a sulfonamide
True
47
T/f zonisamide (zonegran) suppresses appetite
True
48
What type of patient should we not use lacosamide (vimpat)
Hepatic insufficiency
49
What warnings does lacosamide (vimpat) carry (3)
1. Cardiac
2. Hepatic
3. Psychiatric
50
Major side effects/risks of cenobamate (xcopri) (3)
1. DRESS and multi organ sensitivity
2. Shortens QT interval
3. Suicidal ideations
51
What do we need to monitor for with tiagabine (gabitril)
Suicidal tendencies
52
Side effect of ezogabine (potiga)
Significant risk of retinal pigment dystrophies
53
What does retinal pigment dystrophies lead to with ezogabine (potiga) (2)
1. Vision loss (reversible)
2. Destruction of photoreceptors
54
What is the risk of vigabatrin (sabril)
Risk of irreversible vision loss
55
What is the only way you can acquire vigabatrin (sabril)
The SHARE program because its distribution is limited
56
T/F gabapentin (neurontin, horizant) is only used for adjunctive treatment
True
57
Major side effects of gabapentin (neurontin, horizant) (2)
1. Edema
2. Somnolence
58
What schedule is pregabalin (lyrica)
IV
59
Side effects of topiramate (topamax, trokendi XR) (3)
1. Weight loss
2. Kidney stones (higher doses)
3. Acute angle glaucoma (higher doses)
60
What patient age can we use perampanel (fycompa) for
12 years and older
61
T/F perampanel (fycompa) has multiple reactions with medications metabolized by CYP 450 and CYP 3A
True
62
What is the black box warning on perampanel (fycompa)
Aggressive behavior and suicidal ideation
63
What schedule is perampanel (fycompa)
III
64
What are the 2 barbiturates used in the treatment of seizures
1. Phenobarbital
2. Primidone (metabolized into phenobarbital)
65
What do barbiturates do/action
CNS depression
66
How long after discontinuing perampanel (fycompa) do we need to monitor patients for black box warning
1 month
67
T/F leviteracetam (keppra) is a first line agent for seizures
True
68
Does leviteracetam (keppra) have any significant drug interactions
NO, which is why we use it (EXTREMELY SAFE)
69
Do we have to dose adjust for hepatic or renal patients when using leviteracetam (keppra)
Nope… Remember it is safe.
70
T/F Brivaracetam (briviact) requires CBC monitoring
True
71
What is rufinamide (banzel) used to treat
Adjunctive treatment for Lennox Gastaut syndrome ONLY
72
Who is rufinamide (banzel) contraindicated for
Patiens with short QT syndrome so check baseline EKG
73
What is cannabidiol (epidiolex) used to treat (2)
1. Lennox Gastaut syndrome
2. Dravet syndrome (intractable seizures)
74
When is stiripentol (diacomit) used
Only as an add-on to clobazam for dravet syndrome over the age of 2 years
75
What is fenfluramine (fintepla) used to treat
Dravet syndrome in patients over 2 years old
76
What are the 3 objectives of anticonvulsants
1. Reduce seizures to maximum extent possible
2. Avoid chronic drug related adverse effects
3. Maintain normal psychosocial and vocational adjustment
77
T/F Less than 50% of patients become seizure free for more than 12 months
True
78
What should be start with someone who is taking an anticonvulsant and wants to get pregnant
Folic acid supplementation 6 months before pregnancy
79
T/F We want to employ monotherapy as much as possible
True
80
When do we start anticonvulsants (2)
1. After second defined episode
2. If lesion identified in epilptogenic regions of the brain, with or without seizure
81
What are the epileptogenic regions of the brain (2)
1. Temporal lobe (hippocampus)
2. Frontal lobe
82
How long do you have to be seizure free in NY to drive
12 months
83
When can driving trial begin
3 months minimum
84
How often is medical justification required for someone to drive who has seizures
Yearly
85
What is lorazepam (ativan, loreev XR) used to treat
Status epilepticus
86
What is diazepam (valium) used to treat
Skeletal muscle relaxation
87
T/F Diazepam (vallium) is the only muscle relaxant that doesn't effect the liver enzymes
True
88
T/F Alprazolam (xanax) is the only benzo without anti-depressant action
True
89
What is alprazolam (xanax) metabolized into
a-hydroxyalprazolam
90
T/F a-hydroxyalprazolam has a long half-life so it accumulates in the body
True
91
T/F chlordiazepoxide (librium) requires CBC and LFT monitoring
True
92
What is a risk of using chlordiazepoxide (librium) for greater than 4 months
Porphyria (edema forms)
93
What is chlordiazepoxide (librium) associated with long term
Extrapyramidal effects (parkinsonism)
94
What is temazepam (restoril) used to treat
Disabling insomnia
95
How long can temazepam (restoril) be used for insomnia
<10 days due to dependence
96
What category is temazepam (restoril)
IV
97
T/F midazolam (versed) is very long acting
False
98
Whatdoes midazolam (versed) do
Induces insomnia during procedures
99
What can the nasal formulation of midazolam (versed) be used for
Seizure rescue in patients over 12 years old
100
What category are the new benzos
I
101
What is the designer (new) benzo we need to know
Remimazolam (byfavo)
102
What is the defined antagonist of remimazolam (byfavo)
Flumazenil
103
What does having a defined antagonist mean for remimazolam (byfavo)
There is increased safety in cases of overdose
104
How long should procedures be if using remimazolam (byfavo)
30 minutes or less
105
What is the non-benzo benzo
Buspirone (buspar)
106
What is buspirone (buspar) a partial agonist of
5-HT 1 A receptors
107
T/F buspirone (buspar) has less sedation
True
108
T/F buspirone (buspar) has a high abuse potential
False
109
T/F there is no withdrawal or dependence with buspirone (buspar)
True
110
What is buspirone (buspar) the drug of choice for
Severe anxiety in those recovering from alcohol or sedative drug dependence
