ch 21 Flashcards
1
Q
The term ___ refers to a group of chronic neurological disorders characterized by recurrent seizures, brought on by excessive excitability of neurons in the brain
A
epilepsy
2
Q
general term that applies to all types of epileptic events
A
seizure
3
Q
Seizures are initiated by synchronous, high frequency discharge form a group of hyperexcitable neurons called a
A
focus
4
Q
what type of seizures undergo a very limited spread to adjacent cortical areas beyond the focus
A
partial seizures (focal)
5
Q
what type of seizures does focal seizure activity conducted widely throughout both hemispheres
A
generalized
6
Q
olfactory hallucinations are what kind of seizure
A
simple partial
7
Q
twitching thumb what kind of seizure
A
simple parital
8
Q
what type of seizure has no loss of consciousness
A
simple partial
9
Q
what kind of symptoms for simple partial
A
discrete motor
sensory (local numbness, auditory, visual or olfactory hallucinations)
autonomic - nausea, flushing, salivation, urinary incontinency
psychoillusory symptoms - feelings of unreality, fear or depression
10
Q
what kind of seizures have impaired consciousness or lack of responsiveness, become motionless and stares with a fixed gaze followed by automatism
A
complex partial
11
Q
pt performs repetitive purposeless movements such as lip smacking or hand wringing, lasts 45-90 sec following a complex partial seizure
A
automatism
12
Q
this seizure type begin as simple or complex partial seizures and then evolve into generalized tonic clonic seizures. Consciousness is lost.
A
secondarily generalized seizures
13
Q
seizure with major convulsions,
A
tonic clonic
14
Q
what phase is characterized by a period of muscle rigidity
A
tonic phase
15
Q
phase characterized by synchronous muscle jerks
A
clonic phase
16
Q
Tonic-clonic seizures often cause _____ but not ______
A
urination
defecation
17
Q
what type of seizure is followed by postictal state
A
tonic clonic
18
Q
characterized by LOC for a brief time (10-30 seconds)
mild symmetrical motor activity but can also be without the motor activity. May experience hundreds a day. primarily in children and usually cease during the early teen years
A
Absence seizures (petit Mal)
19
Q
these seizures are characterized by sudden loss of muscle tone such as head drop or drop attack
A
atonic seizures
20
Q
these seizures consist of sudden muscle contraction that lasts for just 1 second.
A
myoclonic seizures
21
Q
seizure that lasts for 1 sec but limited to 1 limb of sudden muscle contraction
A
focal myoclonus
22
Q
seizure that lasts for 1 second but involve the entire body of sudden muscle contraction
A
massive myoclonus
23
Q
seizure that lasts for 15-30 min or longer. medical emergency
A
Status Epilepticus
24
Q
what age is febrile seizures most common
A
6 mos - 5 years
25
children who experience febrile seizures are at increased risk for epilepsy later in life
true or false
false
26
severe form of epilepsy usually develops during preschool years characterized by developmental delay and mix of partial and generalized seizures
Lennox-Gastaut syndrome
27
what is the treatment goal of treating epilepsy
reduce seizures to an extent that enables the patient to live a normal or nearly normal life - balance seizure control with side effects of drugs
28
non drug treatment for epilepsy
neurosurgery
vagus nerve stimulation
ketogenic diet
29
what type of seizures does phenytoin treat
tonic clonic
partial seizures
not absence seizures
30
ethosuximide is active against what seizures
absence
not tonic clonic or partial seizures
31
what older med treats all seizures
Valproic acid
32
what history is important for seizure diagnosis and treatment
```
age at which seizures began
frequency
duration
precipitating factors
times when they occur
```
33
what is used for diagnosis of seizures
electroencephalogram (EEG)
34
what other diagnostic tests may be used in the presence of seizures
CT
Positron emission tomography (PET)
MRI
35
if an antiseizure drug fails what are your steps
1) d/c current and change to a different antiseizure med
| 2) if second drug fails, you can either d/c and try a third or treat with a combo of antiseizure drugs
36
no drug should be considered ineffective until
it has been tested in sufficiently high dosages and for a reasonable time.
37
what is the best means for establishing dosing for absence seizures
observation of patient - if seizures stop, dose is sufficient. if they continue, they need higher dose
38
which type of seizures is plasma drug levels important in establishing effective dosing
tonic clonic seizures
39
it is estimated that nonadherence accounts for about _____% of all treatment failures in epilepsy.
50%
40
when withdrawing antiseizure drugs do to spontaneous remission of epilepsy what are the most important things to consider.
antiseizure drugs must be withdrawn slowly over a period of 6 weeks to several months or can lead to SE.
If they are on more than one drug, withdraw one at a time
41
what antiseizure drugs increased risk for suicidality- highest risk (2)
Topiramate
| Lamotrigine
42
what signs/symptoms indicate emergence or worsening of depression
```
increased anxiety
agitation
mania
hostility
SI thoughts or behavior
```
43
what anti seizure meds that we need to know decrease the effectiveness of oral contraceptives
Carbamazepine
oxcarbazepine
phenytoin
phenobarbital
topiramate
Lamotrigine
44
There is a risk of congenital anomalies with antiseizure drugs, however it is important that pregnant women with seizures take these drugs why?
risk to fetus from uncontrolled seizures is greater than risk to fetus
more than 90% of women who take antiseizure drugs while pregnant have normal pregnancies and infants born without problems
45
what antiseizure drug should be last resort in pregnancy
valproic acid
46
what supplement is important in pregnancy to reduce neural tube defects
folic acid
47
what should you do when prescribing antiseizure to pregnant
lowest effective dose
| monotherapy when possible
48
what drugs cause maternal or fetal or infant bleeding risks and what can be done
phenytoin
phenobarbital
carbamazepine
primidone
decrease synthesis of vit k dependent clotting factors
administer vit k to mother for 1 month prior to delivery and during delivery
49
what type of seizures does phenytoin treat
partial
| primary generalized tonic clonic
50
what kind of therapeutic index does phenytoin have and related to what organ
narrow
| liver metabolizes
51
linear or non-linear?
the relationship between most antiseizure drugs for dosage and plasma levels is _____. Phenytoin is _____
linear
| non-linear
52
phenytoin is drug of choice for what in who
tonic clonic seizures in adults and older children
53
what drug is drug of choice for treating tonic clonic seizures in young children
Carbamazepine (has to do with half life of drug and the liver)
54
Phenytoin can be administered by IV to treat
generalized convulsive SE
55
how do you d/c phenytoin
gradually, abrupt may cause seizures and can cause SE
56
what symptoms associated with tox while taking phenytoin
nystagmus (continuous back and forth movement of eyes)
sedation
ataxia (staggering gait)
diplopia (double vision)
cognitive impairment
57
side effect of phenytoin (mouth related)
gingival hyperplasia (excessive growth of gum tissue)
58
s/s
| gum swelling, tenderness and bleeding is what?
gingival hyperplasia
59
pt ed for phenytoin in regards to gingival hyperplasia
good oral hygiene
dental flossing
gum massage
(supplemental folic acid)
60
derm side effect of phenytoin
who is at high risk for this?
morbilliform (measles like rash) that can progress to SJS or TEN (toxic epidermal necrolysis)
genetic mutation - HLA-B 1502 occurs almost exclusively in People of asian descent. If they have this genetic mutation do not prescribe
61
what side effects of phenytoin are associated with the genetic mutation - HLA-B 1502 occurs almost exclusively in People of asian descent
SJS or TEN
Drug reaction with eosinophilia and systemic symptoms (DRESS)
discontinue the drug
62
This is characterized by skin eruptions (rash), lymphadenopathy, fever, multi-organ involvement (most commonly, hepatic, renal, pulmonary and hematologic)
Drug reaction with eosinophilia and systemic symptoms (DRESS)
63
Phenytoin on pregnancy - what are the effects on the infant
cleft palate
heart malformations
fetal hydantoin syndrome
bleeding tendencies
64
```
growth deficiency
motor or mental deficiency
microcephaly
craniofacial distortion
positional deformities of limbs
hypoplasia of nails and fingers
impaired neurodevelopment
```
characteristics of what
fetal hydantoin syndrome
65
what are the cardiovascular effects of phenytoin when given IV to treat SE
dysrhythmias
hypotension
minimize by giving no faster than 50mg/min
use cardiac monitors
66
adverse effects of Phenytoin esp in young women
Hirsutism (overgrowth of hair in unusual places)
67
what vitamin metabolism can be an adverse effect of phenytoin
Interferes with metabolism of vit D -> may cause rickets and osteomalacia
68
in phenytoin, very rarely ____ damage may occur
liver
69
what type of preparation of phenytoin may cause gastric discomfort
oral
70
is phenytoin a inducer or inhibitor of CYP drugs?
what drugs does this affect?
inducer
oral contraceptives
warfarin (an anticoagulant)
glucocorticoids (anti inflammatory and immunosuppressive drug)
71
drugs that increase plasma levels of phenytoin
Valproic acid (antiseizure)
alcohol (when taken acutely)
cimetidine (gastric ulcers)
isoniazid (TB)
diazepam (antianxiety and antiseizure)
(think mnemonic ACID)
72
what other antiseizure drug displaces phenytoin from binding sites on plasma protein
Valproic acid
73
drugs that decrease plasma levels of phenytoin causing breakthrough seizures
Carbamazepine
phenobarbital
chronic alcohol use
74
what drugs can increase CNS depressant effect when taken with phenytoin
alcohol
barbiturates
other CNS depressants
75
special instructions when giving phenytoin to a pt fed by enteral tube feedings
for patients receiving continuous tube feedings, hold feeds for 1-2 hours before and after phenytoin administration
76
Fosphenytoin and relation to phenytoin
fosphenytoin is a prodrug that is converted to phenytoin
77
what type of seizures does fosphenytoin treat
partial seizures and generalized tonic clonic seizures
78
what additional adverse effect for fosphenytoin that phenytoin doesnt have
temporary paresthesias and itching esp in groin area.
will resole when infusion rate is decreased or within 10 min after completion of infusion
fosphenytoin has all other side effects that phenytoin has
79
what kind of seizures does carbamazepine treat
```
partial seizures (simple and complex)
tonic clonic seizures
```
80
tell me about the half life of carbamazepine
its half life decreases as therapy progresses. During the initial phase of treatment, half life is about 40 hours. With continued treatment, the half life decreases to about 15 hours bc carbamazepine induces hepatic drug metabolizing enzymes (inducers) . By increasing its own metabolism, carbamazepine causes its own half life to decline
81
carbamazepine is drug of choice for
partial seizures
82
carbamazepine is not effective against
absence
myoclonic
atonic
83
what can you do to reduce adverse CNS effects for carbamazepine
give the largest portion of the daily dose at bedtime
start low and increase slow - dosage low initially and gradually increase every 1-3 weeks until seizure control is achieved
84
neurologic effects (adverse effect) associated with carbamazepine
visual disturbances - nystagmus, blurred vision, diplopia)
ataxia
vertigo
unsteadiness
headache
tolerance usually develops with continued use
85
heme side effects of carbamazepine
when should you withdraw?
leukopenia
anemia
thrombocytopenia
thrombocytopenia and anemia respond to drug d/c
leukopenia is usually transient and subsides even with continued drug use - only stop if WBC falls below 3,000 mm3
fatal aplastic anemia has occurred but is extremely rare
86
what plasma monitoring for carbamazepine
CBC before treatment and periodically after
87
what symptoms should a pt monitor for and report while taking carbamazepine
```
fever
sore throat
pallor
weakness
infection
easy bruising
petechiae
```
88
carbamazepine is associated with what fetal defect
increase risk for spina bifida
89
what co-morbidity can be a problem with carbamazepine
heart failure
promotes secretion of ADH (inhibits renal excretion of water) pg 159
90
what derm side effects associated with carbamazepine
SJS
TEN
photosensitivity
DRESS
SJS and TEN increased risk with HLA-B 1502 (Asian)
91
_____ and ____ failure have occurred with carbamazepine
hepatic and renal failure
92
carbamazepine is a hepatic drug _____
| what drugs does this effect
inducer
oral contraceptives
warfarin (an anticoagulant)
glucocorticoids (anti inflammatory and immunosuppressive drug)
93
what food can cause plasma levels to rise
Grapefruit juice can increase peak and trough levels
| pt should avoid
94
Blackbox for Valproate and Valproic acid
Fatal hepatic failure has occurred; young children and patients with mitochondrial disease are at increased risk
fatal and rapidly progressing pancreatitis has occurred: Common symptoms include n/v, anorexia and abd pain
highly teratogenic - neonates who survive may have major congenital malformations and decreased mental capacity
95
Most common adverse effect of Valproic acid
how can you minimize
GI effects - n/v and indigestion
taking with food and using enteric coated
96
what are the 2 serious but rare adverse effects of Valproic acid
Hepatotoxicity
| Pancreatitis
97
what age group are at highest risk for liver failure with Valproic acid
younger than 2 years old
98
signs and symptoms of liver injury
```
reduced appetite
malaise
nausea
abd pain
jaundice
```
99
signs of pancreatitis
abd pain
nausea
vomiting
anorexia
100
if pancreatitis occurs with Valproic acid, can they keep taking it
no
101
in addition to neural tube defects what 5 congenital defects is Valproic acid linked to
```
ASD
cleft palate
hypospadias
polydactyly
craniosynostosis
```
102
other adverse effects of valproic acid
```
rash
weight gain
hair loss
tremor
blood dyscrasias (leukopenia, thrombocytopenia, RBC aplasia)
```
significant CNS are uncommon
103
combining valproic acid with topiramate poses a risk for
hyperammonemia - which may occur with or without encephalopathy
104
symptoms of hyperammonemia
if you have these, what should you suspect
what plasma level do you need
vomiting
lethargy
altered LOC
altered cognitive function
hyperammonemic encephalopathy - check blood ammonia
105
what 2 antibiotics can reduce plasma levels of valproic acid
meropenem
imipenem/cilastatin
both are carbapenem abx
106
ethosuximide treats what type of seizures
only for absence
107
how many times a day is ethosuximide given
once a day
however twice a day is better tolerated
108
what plasma levels are used to help guide dosing for ethosuximide
trough levels
109
adverse effects during initial treatment for ethosuximide
drowsiness
dizziness
lethargy
diminish with continued use
110
GI effects of ethosuximide and how to reduce
n/v
| take with food
111
rare but serious adverse effects for ethosuximide
SLE
Leukopenia
aplastic anemia
SJS
112
what are the preferred antiseizure and why for breastfeeding
Valproic acid
Phenytoin
highly protein bound
113
Antiseizure BEERS list
carbamazepine
oxcarbazepine
phenobarbital
inappropriate for 65 and older
114
what extra precautions for antiseizure and older adults
increase risk for adverse events such as falls, start low and go slow
115
what is phenobarbital classified as
anticonvulsant barbiturate
116
what seizures does phenobarbital treat
partial seizures
generalized tonic-clonic
IV for generalized convulsive SE
sedation and promote sleep at night
117
most common side effect of phenobarbital
drowsiness - during initial therapy sedation occurs in practically all patients - with continued use, tolerance develops
118
Phenobarbital takes _____ to reach plateau plasma levels. what is done to help this
2-3 weeks
| loading doses
119
CNS effects phenobarbital
```
Drowsiness
some (adults and children) can have paradoxical effects - hyperactive and irritable
```
cognitive effects
depression
agitation
confusion
resp depression
120
phenobarbital and other barbiturates can increase the risk for
acute intermittent porphyria - so contraindicated in patients with a personal or familial history of this
121
phenobarbital can interfere with the metabolism of vitamins
D and K
rickets, osteomalacia
122
phenobarbital pot should be advised to avoid food high in
vit D, K and calcium
supplementation may be recommended for some
123
phenobarbital tox
nystagmus
ataxia
severe overdose causes
CNS depression
death from depression of resp
124
phenobarbital is a CYP
what drugs are a concern
inducer
oral contraceptives
warfarin (an anticoagulant)
glucocorticoids (anti inflammatory and immunosuppressive drug)
125
Pt on phenobarbital should avoid other drugs that cause
CNS depression such as alcohol benzodiazepines, opioids
126
phenobarbital and Valproic acid
compete for sites - phenobarbital must be reduced to avoid tox
127
Primidone is nearly identical to ______
phenobarbital
128
Primidone is given for what types of seizures
tonic-clonic
simple partial
complex partial
129
Primidone is typically given with
another antiseizure drug (usually phenytoin or carbamazepine) - NEVER with phenobarbital because its an active metabolite of primidone
130
what adverse effects are common during initial treatment of Primidone
Sedation
ataxia
dizziness
131
Primidone in older adults
confusion
132
Primidone in children
paradoxical hyperexcitability
133
Primidone is absolutely contraindicated for pt with
acute intermittent porphyria
134
Serious adverse reactions for Primidone
acute psychosis
leukopenia
thrombocytopenia
systemic lupus erythematosus
135
Primidone is a CYP
what drugs are a concern
inducer
oral contraceptives
warfarin (an anticoagulant)
glucocorticoids (anti inflammatory and immunosuppressive drug)
136
Oxcarbazepine is approved for
monotherapy and adjunctive therapy for management of partial seizures approved for use in both adults and children.
monotherapy for children aged 4 and older
adjunctive therapy for children as young as 2
137
CNS adverse effects of Oxcarbazepine
```
dizziness
drowsiness
double vision
nystagmus
headache
nausea
vomiting
ataxia
```
avoid driving and other hazardous activities until degree of drowsiness is low
138
electrolyte effects of Oxcarbazepine
Hyponatremia
watch combining with diuretics - monitoring may be needed
139
signs of hyponatremia
nausea
drowsiness
headache
confusion
140
derm side effects of Oxcarbazepine
SJS
| TEN
141
Heme effects of Oxcarbazepine
rare
blood dyscrasias
CBC to confirm
142
hypersensitivity adverse effects of Oxcarbazepine
multiorgan hypersensitivity reactions
143
symptoms of multiorgan hypersensitivity reactions for oxcarbazepine
```
fever
rash
lymphadenopathy
hematologic abnormalities
pruritus
hepatitis
nephritis
hepatorenal syndrome
oliguria
arthralgia
asthenia
```
if this happens d/c oxcarbazepine
144
long term use of oxcarbazepine may cause
decreased bone mineral density and can result in osteopenia and osteoporosis with an increased risk for fractures
145
Perampanel can _____ levels of oxcarbazepine
increase
146
Valproic acid can _____ levels of oxcarbazepine
decrease
147
Phenobarbital can ____ serum levels of oxcarbazepine
decrease
148
oxcarbazepine ____ phenytoin levels
increase
149
Phenytoin _____ serum oxcarbazepine raises phenytoin levels
decrease
150
oxcarbazepine can _____ serum levels of eslicarbazepine
increase
151
oxcarbazepine ____ enzymes that metabolize both estrogens and progestins
induce
152
Sodium depleting drugs can increase risk of ______ with oxcarbazepine
hyponatremia
153
Alcohol can ______ CNS depression caused by oxcarbazepine
Alcohol
154
drugs that cause DRESS
Phenytoin
fosphenytoin
Carbamazepine
lamotrigine
155
What newer antiseizure drug is uses for all seizure types
Lmotrigine
156
FDA approved Lamotrigine for
adjunctive therapy for partial seizures of partial seizures in adults and children older than 2 years old
adjunctive therapy of generalized seizures associated with lennox-gastaut in adults in children older than 2
adjunct therapy for generalized tonic clonic seizures
monotherapy of partial in pat at least 16 years old who are converting from another antiseizure drug
157
what drugs increase bleeding (vit k)
phenytoin
primidone
phenobarbital
carbamazepine
158
common side effects for Lamotrigine
```
dizziness
diplopia
blurred vision
n/v
headache
```
159
life threatening for Lamotrigine
SJS
TEN
DRESS
160
heme adverse effects for Lamotrigene
blood dyscrasias
| hypersensitivity and immune system reactions
161
```
pt taking Lamotrigene
experiences
headache
stiff neck
nausea
vomiting
rash
sensitivity to light
```
think aseptic meningitis (inflammation of meninges in the absence of bacterial infection)
d/c med
162
drugs that cause SJS
```
phenytoin
fosphenytoin
carbamazepine
ethosuximide
oxcarbazempine
lamotrigine
zonisamide
```
“CLEOPatra Found Zits”
"CLEOPatra Found Zits while looking for SJS"
163
Lamotrigene is dramatically affected by what drugs
that induce or inhibit cyp
inducers - carbamazepine
phenytoin
phenobarbital
inhibitors - Valproate
164
_____ may lower progestin
Lamotrigine
165
Gabapentin is approved for
adjunctive therapy of partial seizures
166
Gabapentin ER and Neurontin is approved for
not in seizures!
167
Absorption of Gabapentin and food
not affected by food
168
as the dosage of gabapentin gets larger, the percentage absorbed gets _____
smaller - the intestinal transport system for uptake of the drug becomes saturated
169
most common side effects of gabapentin
```
somnolence
dizziness
ataxia
fatigue
nystagmus
peripheral edema
```
diminishes with continued drug use
170
drugs with visual disturbances
```
carbamazepine
oxcarbazepine
lamotrigine,
pregabalin
topiramate,
felbamate
```
“Col. P.T. Fuzzy vision”
171
Pregabalin used for
adjunctive therapy of partial seizures
172
most common adverse effects for Pregabalin
dizziness
somnolence
persist for as long as the drug is taken
173
other side effects of Pregabalin
```
blurred vision
difficulty thinking
headache
peripheral edema
dry mouth
```
174
what other big adverse effects for Pregabalin
hypersensitivity reaction - angioedema, blisters, hives, rash, dyspnea, wheezing
rhabdomyolysis
175
signs of rhabdomyolyis
muscle pain
tenderness
weakness
176
abuse for Pregabalin
schedule V
| euphoria effect
177
abrupt d/c of Pregabalin
insomnia
nausea
headache
diarrhea
withdraw over a week or more
178
reproductive risks for Pregabalin
both males and females
179
Pregabalin drug interactions
dont combine with other CNS depressants such as alcohol, opioids, benzodiazepines
180
when is Keppra used
myoclonic seizures in adults and adolescents 12 and older
partial-onset seizures in adults and children 4 and older
primarily generalized tonic clonic seizures in adults and children 6 an dolder
181
when is Keppra used
adjunctive therapy in:
myoclonic seizures in adults and adolescents 12 and older
partial-onset seizures in adults and children 4 and older
primarily generalized tonic clonic seizures in adults and children 6 and older
182
what falls under the category of neuorpsychiatric symptoms
```
agitation
anxiety
depression
psychosis
hallucinations
depersonalization
```
183
Topiramate (topamax) is approved for
adjunct therapy of adults and children 2 and older with partial seizures, primary generalized tonic clonic seizures, and seizures associated with lennox gastaut syndrome
monotherapy of adults and children 10 and older with partial seizures or primary generalized tonic clonic seizures
184
adverse effects of topiramate
```
somnolence
dizziness
ataxia
nervousness
diplopia
nausea
anorexia
weight loss
cognitive effects - confusion, memory difficulties, altered thinking, reduced concentration, difficulty finding words)
kidney stones
paresthesias
```
185
Topiramate can cause what problem in relation to pH?
who is at increased risk for this?
what baseline should be drawn and monitored periodically?
metabolic acidosis
```
risk factors
renal disease
severe resp disorders
diarrhea
ketogenic diet
```
serum bicarbonate
186
symptoms to monitor Topiramate (topamax) for metabolic acidosis
hyperventilation
fatigue
anorexia
187
what environmental related health issue can be caused by Topiramate (topamax)
hypohydrosis (reduced sweating) increased risk of hyperthermia
188
adverse reaction r/t eyes on Topiramate (topamax)
angle closure glaucoma - can lead to blindness medical emergency
189
s/s angle closure glaucoma
ocular pain
unusual redness
sudden worsening or blurring of vision
190
psych effect of Topiramate (topamax)
increased risk for suicidality
191
Phenytoin and carbamazepine can _____ levels of Topiramate (topamax) by about 45%
decrease
192
Topiramate (topamax) combined with valproic acid increased risk of
hyperammonemia
193
Tiagabine is approved for
adjunct therapy of partial seizures in pt at least 12 years old
194
common adverse effects Tiagabine
```
dizziness
somnolence
asthenia
nausea
nervousness
tremor
confusion
abnormal thinking
trouble concentrating
```
195
levels of tiababine can be _____ by phenytoin, phenobarbital and carbamazepine
decreased
196
Zonisamide is in what drug class but used for seizures
sulfonamide abx but has not antimicrobial acitivity
197
Zonisamide is approved only for
adjunct therapy of partial seizures in adults
198
common adverse effects Zonisamide
```
drowsiness
dizziness
anorexia
headache
nausea
metabolic acidosis
```
199
severe side effects of zonisamide
severe psychiatric effects of depression and suicide
hypersensitivity reactions - SJS, TEN, fulminant hepatic necrosis
200
renal effects of zonisamide and pt education for it
nephrolithiasis (kidney stones) - drink 6-8 glasses of water a day
impair glomerular filtration - use with caution if history of kidney disease
201
s/s kidney stones
```
sudden back pain
abd pain
dysuria
hematuria
dark urine
```
202
Metabolic acidosis in children can cause what?
delay growth
kidney stones
fractures
203
environmental side effect of zonisamide
hypohidrosis - causes hyperthermia
204
CYP zonisamide
affected by CYP
inducers
St Johns wort
several antiseizures - phenytoin, phenobarbital, carbamazepine
inhibitors
grapefruit juice
azole antifungals (ketoconazole)
protease inhibitors (ritonavir)
205
Felbamate is approved for
adjunct or monotherapy for adults with partial seizures
adjunct therapy in children with Lennox -Gastaut syndrome
206
Adverse effects of Felbamte
aplastic anemia
liver damage and liver failure
GI (anorexia, nausea, vomiting)
CNS (insomnia, somnolence, dizziness, headache, diplopia)
207
Felbamate _____ levels of phenytoin and valproic acid
increases
208
levels of Felbamate are ____ by valproic acid
increased
209
levels of Felbamate are _____ by phenytoin and carbamazepine
reduced
210
Zonisamide cant be given to someone with an allergy to what drug
sulfa
211
Carbamazepine is contraindicated for
history of bone marrow suppression
preexisting hematologic abnormalities
HLA-B1502 (common in asian population) - risk for SJS or TEN
212
Felbamate is contraindicated for
anemia
| hepatic impairment
213
Gabapentin is contraindicated for
```
renal impairment (may require renal dosing)
History of drug abuse (at risk for psychological and physical dependence)
```
214
Oxcarbazepine is contraindicated for
osteopenia
| osteoporosis
215
Phenobarbital is contraindicated for
personal or family history of porphyria
pt with anemia
liver impairment
significant resp disease
216
IV phenytoin is contrindicated in
bradycardia
| AV block
217
Valproic acid contraindicated
hepatic dysfunction
children younger than 3 who are taking other antiseizure drugs
last resort in pregnancy
218
Zonisamide contraindication
conditions that contribute to increased risk of metabolic acidosis
sulfa alergy
219
Zonisamide contraindication
conditions that contribute to increased risk of metabolic acidosis
sulfa allergy
220
what traditional meds are approved for partial seizures which include simple partial, complex partial and secondarily generalized?
All traditional that we talked about except Ethosuximide
```
Carbamazepine
Fosphenytoin
Phenobarbital
Phenytoin
Primidone
Valproic acid
```
221
which newer meds are approved for partial seizures which include simple partial, complex partial and secondarily generalized?
all of the ones we talked about
```
Oxcarbazepine
Lamotrigine
Gabapentin
Pregabalin
Levetiracetam (Keppra)
Topiramate
Tiagabine
Zonisamide
Felbamate
```
222
What older meds are approved for Primary generalized tonic clonic seizures
```
Carbamazepine
Fosphenytoin
Phenobarbital
Phenytoin
Primidone
Valproic acid
```
223
What newer meds are approved for Primary generalized tonic clonic seizures
Lamotrigine
Levetiracetam (keppra)
Topiramate
224
What traditional meds and newer meds are approved for Primary generalized absence seizures
Ethosuximide
Valproic acid
Lamotrigine
225
What traditional meds and newer meds are approved for Primary generalized myoclonic seizures
Valproic acid
Lamotrigine
levetiracetam
topiramate
226
monotherapy for newer seizure meds
Felbamate
Lamotrigine
Oxcarbazepine
Topiramate
(FLOT)
