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*Neuro Block Pharm > Anticonvulsants: Introduction > Flashcards

Anticonvulsants: Introduction Flashcards

1
Q

At least __% of the population will have at least one seizure in their lifetime

A

10 percent

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2
Q

define seizure

A

Seizure: sudden change in behavior due to electrical hypersynchronization of neuronal networks in the cerebral cortex

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3
Q

During seizures, abnormal electrical activity can result in what 4 things?

A

o LOC- sometimes but not always
o Abnormal movements- people twitching around
o Atypical or odd behavior- people won’t remember what happened during the time before usually and during.
o Distorted perceptions- patients should not be able to remember what happened and timeline, if they do it is a red flag.

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4
Q

Site of origin determines the symptoms that are produced, for example motor cortex- what are the symptoms?

A

abnormal movements or generalized convulsion

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5
Q

Site of origin determines the symptoms that are produced, for exampleo Parietal or occipital lobe- what are the symptoms?

A

visual, auditory, or olfactory hallucinations

More perceptual defect than movement

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6
Q

epilepsy criteria

A

At least two unprovoked seizures occurring more than 24 hours apart

One unprovoked seizure and a probability of further seizures over the next 10 years

o Diagnosis of an epilepsy syndrome

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7
Q

Epilepsy Triggers- - Changes in physiologic factors such as?

A

o Blood gas
o pH
o Electrolytes
o Blood glucose

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8
Q

Epilepsy Triggers- - Changes in environmental factors such as?

A

o Sleep deprivation- has to be pretty significant sleep deprivation, massive amounts.
o EtOH intake or sudden withdrawal
o Stress

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9
Q

what are some Epilepsy Triggers other than environmental and physiologic factors?

A

o Trauma
o Neoplasms- brain tumor
o Genetic abnormality
o Post-stroke

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10
Q

We can control about what percent of epilepsy patients?

A

70-80%

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11
Q

About what percent of patients will require multiple medications

A

10-15%

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12
Q

T/F the vast majority of epilepsy patients need monotherapy

A

true

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13
Q

About what percent of patients will never achieve complete control

A

10%

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14
Q

About half of patients with new diagnosis will become seizure free with first ___

A

AED

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15
Q

with AEDs, Tolerability of ADRs is as important as _____

A

efficacy

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16
Q

AED Selection Factors

A
  • Drug effectiveness for seizure type(s)
  • Potential ADRs
  • DDIs
  • Comorbid medical conditions (especially hepatic and renal disease)
  • Age and gender (including childbearing plans)
  • Lifestyle and patient preferences
  • Cost
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17
Q

Is AED therapy recommended after a single seizure

A

Immediate AED therapy is usually not necessary after single seizure

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18
Q

when should you generally start AED therapy?

A

o In those at significant risk for recurrent seizures

o After two or more unprovoked seizures

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19
Q

All pts started on AED should be screened for which prior to initiation?

  • Hepatic failure
  • Renal failure
  • Depression/suicidal ideation
  • Osteoporosis
A

Depression/suicidal ideation

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20
Q

which is most important if a pt fails the first trial of AED monotherapy?

  • Use 2 drug monotherapy
  • Start second agent while tapering off failed agent
  • Immediately stop failed agent and start new one.
A
  • Start second agent while tapering off failed agent
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21
Q

T/F all pts who experience a seizure should be treated with AED therapy?

A

FALSE

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22
Q

What is distinguishing characteristic of cutaneous reaction?

A

involvement of mucous membrane

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23
Q

what is mechanism of reduced efficacy of OC when taking AEDs

A

metabolic enzyme induction by AED

24
Q

what is the most appropriate taper schedule when stopping AED therapy

A

6-8 months

25
Q

_______ with first AED may result from breakthrough seizures (lack of efficacy) or drug intolerance

A

Treatment failure

26
Q

after Initial AED Failure, Factors to consider for second agent is like that of initial therapy but may need to consider different___.

A

MOA

27
Q

when switching AED medications (Except in cases of severe ADR) the second medication is typically______ to therapeutic levels while tapering off initial AED

A

increased

28
Q

when switching AED medications, The second agent is tapered up slowly to _______.

A

effect or to ADR/toxicity

29
Q

when switching AED medications, Need to counsel patient on likely increase in___ during the overlap period but that they will likely decrease once first AED is tapered off

A

ADRs

30
Q

ADRs Common to AEDs

A
  • Increased risk of suicide
  • SJS, TEN, and drug rash with eosinophilia and systemic symptoms (DRESS) are rare but serious idiosyncratic reactions
  • Neurocognitive impact
  • Reduced vitamin levels of folate and B12
  • Bone loss
  • Lower gestational age, lower birth weight, smaller head circumference
  • Cognitive and developmental abnormalities of exposed children later in life
  • Teratogenicity
  • Weight changes
  • Nausea/vomiting
  • Sedation
  • Ataxia
  • Hyponatremia
31
Q

which AED drugs tend to cause worse teratogenicity

A

valproate, phenytoin, carbamazepine, phenobarbital, and topiramate

32
Q

Increased risk of suicide is a common ADR for AEDs, what do you need to do for patients on these drugs?

A

need to screen for depressions and monitor it.

33
Q

patients with which alleles are more common to get SJS, TEN, and drug rash with eosinophilia and systemic symptoms (DRESS) when taking certain AEDs?

A

**Higher risk with HLA-B1502 or HLA-A*3101 alleles

34
Q

if you are worried about a patient getting SJS, TEN, and drug rash with eosinophilia and systemic symptoms (DRESS), what is a red flag to look out for?

A

Fever, mucocutaneous lesions –> if it is on mouth, conjunctiva, any mucosa- RED FLAG

35
Q

An ADR for AEDs is Reduced vitamin levels of folate and B12, which pt population do you need to be concerned with this for?

A

Very important in patients who can become pregnant or are pregnant

36
Q

An ADR for AEDs is Reduced vitamin levels of folate and B12, what folate dose can you supplement with?

A

.4 mg or 400 mcg

37
Q

Many AEDs increase risk for osteoporosis so you need to monitor bone density regularly, how can you do this?

A

DXA scan

38
Q

AEDs can have bone loss as an ADR, what dosage of calcium and/or vitamin D can you give your patients?

A

 CA 600 BID

 Vit D 800 IU per day

39
Q

AEDs can cause teratogenicity, Common abnormalities are what? (5)

A 
	Neural tube folate important for this
	Congenital heart and urinary tract defects
	Skeletal abnormalities
	Cleft palate
	Face and finger dysmorphisms
40
Q

_____ should be routinely prescribed to all women of childbearing age taking AEDs (i.e., prior to becoming pregnant)

A

Folate

41
Q

when women become pregnant, Typically the AED that controls seizures should be continued. except for which AED?

A

valproate

42
Q

If a pregnant patient must take valproate or carbamazepine, what should the folate dose be?
and when is it best to start this folate supplementation?

A

folate dose should be 4 mg/d

best to start folate at least three months prior to conception

43
Q

hormone contraceptive Failure while taking AEDs is due to _____ induction of metabolism

A

hepatic enzyme

44
Q

if a patient is taking AEDs, what kind of hormonal contraceptive would be good options?

A

o Copper or levonorgestrel IUDs are highly effective
o Hormone levels with intrauterine hormone-releasing systems (Mirena) or depot injections of progesterone are not affected

45
Q

if you have to take an estrogen hormonal contraceptive while taking an AED, what should you do to the OC dose?

A
  • If must use OC, consider increasing dose to minimum of 50 mcg of estrogen component and/or use extended cycle regimens but realize that this may increase seizures
  • Efficacy of emergency contraception (Plan B) may be affected just as OC
46
Q

in regards to patients with seizures and driving, what to most stated require before allowing them to drive again?

A

Most require patients be free of seizures for some specified time period and submit a clinician’s evaluation regarding ability to drive safely

47
Q

how long should you wait before considering a trial of AED?

A

Should wait at least 2 to 4 years before considering a trial off AED

Patient must be seizure-free for that time

48
Q

when discontinuing an AED, how should you stop the drug?

A

Dose should be tapered very slowly (i.e., months)

49
Q

Reason to Consider Discontinuation of AED Therapy

A
  • Offers pt a sense of being “cured” v. chronic mediation confers permanent “disability”
  • No drug is entirely benign and ADRs associated with chronic therapy may take years to manifest
  • Cognitive and behavioral ADRs may be subtle and not fully recognized until drugs are stopped
  • Cost
  • Special circumstances such as pregnancy or comorbid condition where outcomes may be improved and management simplified in absence of AED therapy
50
Q

what things may predict a higher chance of seizure recurrence in patients that want to stop their AED medication?

A

o Epilepsy duration before remission (longer duration associated with higher risk)
o Seizure-free interval before antiseizure drug withdrawal (shorter interval associated with higher risk)
o Age at onset of epilepsy (onset in adulthood associated with higher risk)- the younger you are you have your first seizure, the lower the risk of recurrence.
o History of febrile seizures
o Number of seizures before remission (≥10 associated with higher risk)
o Absence of a self-limiting epilepsy syndrome (e.g., absence epilepsy, benign epilepsy with centrotemporal spikes)
o Epileptiform abnormality on EEG before withdrawal

51
Q

if a well-controlled patient suddenly has breakthrough seizure or toxicity, what do you need to consider might be the cause?

A

Generic Substitution by pharmacy

This requires you to counsel your patients on this matter!!!

52
Q

Immediate AED therapy is usually not needed for single seizure. it is Reserved for ______.

A

2+ seizures or if at high risk for recurrence

53
Q

things to base AED choice on (7)

A 
o	Seizure type
o	ADR profile
o	DDI
o	Comorbid conditions
o	Age/gender (childbearing plans)
o	Lifestyle and patient preferences
o	Cost
54
Q

If first AED is unsuccessful, try another as _______

A

monotherapy

55
Q

Regular office visits are suggested to improve compliance, what things should you discuss with your patient?

A 
o	Pt education
o	ADR review
o	Compliance questioning
o	+/- drug levels
o	Seizure calendar review
56
Q

since there is an increase risk of suicide ideation in patients taking AEDs, what three things do you need to look out for?

A

o Mood changes
o Depression
o Anxiety

*Neuro Block Pharm (8 decks)

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