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Pharm Exam 4 - Class Review > ch 21 > Flashcards

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

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2
Q

general term that applies to all types of epileptic events

A

seizure

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3
Q

Seizures are initiated by synchronous, high frequency discharge form a group of hyperexcitable neurons called a

A

focus

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4
Q

what type of seizures undergo a very limited spread to adjacent cortical areas beyond the focus

A

partial seizures (focal)

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5
Q

what type of seizures does focal seizure activity conducted widely throughout both hemispheres

A

generalized

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6
Q

olfactory hallucinations are what kind of seizure

A

simple partial

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7
Q

twitching thumb what kind of seizure

A

simple parital

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8
Q

what type of seizure has no loss of consciousness

A

simple partial

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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

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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

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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

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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

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13
Q

seizure with major convulsions,

A

tonic clonic

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14
Q

what phase is characterized by a period of muscle rigidity

A

tonic phase

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15
Q

phase characterized by synchronous muscle jerks

A

clonic phase

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16
Q

Tonic-clonic seizures often cause _____ but not ______

A

urination

defecation

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17
Q

what type of seizure is followed by postictal state

A

tonic clonic

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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)

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19
Q

these seizures are characterized by sudden loss of muscle tone such as head drop or drop attack

A

atonic seizures

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20
Q

these seizures consist of sudden muscle contraction that lasts for just 1 second.

A

myoclonic seizures

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21
Q

seizure that lasts for 1 sec but limited to 1 limb of sudden muscle contraction

A

focal myoclonus

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22
Q

seizure that lasts for 1 second but involve the entire body of sudden muscle contraction

A

massive myoclonus

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23
Q

seizure that lasts for 15-30 min or longer. medical emergency

A

Status Epilepticus

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24
Q

what age is febrile seizures most common

A

6 mos - 5 years

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25
Q

children who experience febrile seizures are at increased risk for epilepsy later in life

true or false

A

false

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26
Q

severe form of epilepsy usually develops during preschool years characterized by developmental delay and mix of partial and generalized seizures

A

Lennox-Gastaut syndrome

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27
Q

what is the treatment goal of treating epilepsy

A

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

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28
Q

non drug treatment for epilepsy

A

neurosurgery
vagus nerve stimulation
ketogenic diet

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29
Q

what type of seizures does phenytoin treat

A

tonic clonic
partial seizures

not absence seizures

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30
Q

ethosuximide is active against what seizures

A

absence

not tonic clonic or partial seizures

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31
Q

what older med treats all seizures

A

Valproic acid

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32
Q

what history is important for seizure diagnosis and treatment

A 
age at which seizures began
frequency
duration
precipitating factors
times when they occur
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33
Q

what is used for diagnosis of seizures

A

electroencephalogram (EEG)

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34
Q

what other diagnostic tests may be used in the presence of seizures

A

CT
Positron emission tomography (PET)
MRI

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35
Q

if an antiseizure drug fails what are your steps

A

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

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36
Q

no drug should be considered ineffective until

A

it has been tested in sufficiently high dosages and for a reasonable time.

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37
Q

what is the best means for establishing dosing for absence seizures

A

observation of patient - if seizures stop, dose is sufficient. if they continue, they need higher dose

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38
Q

which type of seizures is plasma drug levels important in establishing effective dosing

A

tonic clonic seizures

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39
Q

it is estimated that nonadherence accounts for about _____% of all treatment failures in epilepsy.

A

50%

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40
Q

when withdrawing antiseizure drugs do to spontaneous remission of epilepsy what are the most important things to consider.

A

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

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41
Q

what antiseizure drugs increased risk for suicidality- highest risk (2)

A

Topiramate

Lamotrigine

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42
Q

what signs/symptoms indicate emergence or worsening of depression

A 
increased anxiety
agitation
mania
hostility
SI thoughts or behavior
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43
Q

what anti seizure meds that we need to know decrease the effectiveness of oral contraceptives

A

Carbamazepine
oxcarbazepine

phenytoin
phenobarbital

topiramate
Lamotrigine

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44
Q

There is a risk of congenital anomalies with antiseizure drugs, however it is important that pregnant women with seizures take these drugs why?

A

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

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45
Q

what antiseizure drug should be last resort in pregnancy

A

valproic acid

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46
Q

what supplement is important in pregnancy to reduce neural tube defects

A

folic acid

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47
Q

what should you do when prescribing antiseizure to pregnant

A

lowest effective dose

monotherapy when possible

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48
Q

what drugs cause maternal or fetal or infant bleeding risks and what can be done

A

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

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49
Q

what type of seizures does phenytoin treat

A

partial

primary generalized tonic clonic

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50
Q

what kind of therapeutic index does phenytoin have and related to what organ

A

narrow

liver metabolizes

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51
Q

linear or non-linear?

the relationship between most antiseizure drugs for dosage and plasma levels is _____. Phenytoin is _____

A

linear

non-linear

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52
Q

phenytoin is drug of choice for what in who

A

tonic clonic seizures in adults and older children

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53
Q

what drug is drug of choice for treating tonic clonic seizures in young children

A

Carbamazepine (has to do with half life of drug and the liver)

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54
Q

Phenytoin can be administered by IV to treat

A

generalized convulsive SE

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55
Q

how do you d/c phenytoin

A

gradually, abrupt may cause seizures and can cause SE

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56
Q

what symptoms associated with tox while taking phenytoin

A

nystagmus (continuous back and forth movement of eyes)

sedation

ataxia (staggering gait)

diplopia (double vision)

cognitive impairment

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57
Q

side effect of phenytoin (mouth related)

A

gingival hyperplasia (excessive growth of gum tissue)

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58
Q

s/s

gum swelling, tenderness and bleeding is what?

A

gingival hyperplasia

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59
Q

pt ed for phenytoin in regards to gingival hyperplasia

A

good oral hygiene
dental flossing
gum massage

(supplemental folic acid)

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60
Q

derm side effect of phenytoin

who is at high risk for this?

A

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

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61
Q

what side effects of phenytoin are associated with the genetic mutation - HLA-B 1502 occurs almost exclusively in People of asian descent

A

SJS or TEN

Drug reaction with eosinophilia and systemic symptoms (DRESS)

discontinue the drug

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62
Q

This is characterized by skin eruptions (rash), lymphadenopathy, fever, multi-organ involvement (most commonly, hepatic, renal, pulmonary and hematologic)

A

Drug reaction with eosinophilia and systemic symptoms (DRESS)

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63
Q

Phenytoin on pregnancy - what are the effects on the infant

A

cleft palate
heart malformations
fetal hydantoin syndrome
bleeding tendencies

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64
Q 
growth deficiency
motor or mental deficiency
microcephaly
craniofacial distortion
positional deformities of limbs
hypoplasia of nails and fingers 
impaired neurodevelopment

characteristics of what

A

fetal hydantoin syndrome

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65
Q

what are the cardiovascular effects of phenytoin when given IV to treat SE

A

dysrhythmias
hypotension

minimize by giving no faster than 50mg/min

use cardiac monitors

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66
Q

adverse effects of Phenytoin esp in young women

A

Hirsutism (overgrowth of hair in unusual places)

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67
Q

what vitamin metabolism can be an adverse effect of phenytoin

A

Interferes with metabolism of vit D -> may cause rickets and osteomalacia

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68
Q

in phenytoin, very rarely ____ damage may occur

A

liver

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69
Q

what type of preparation of phenytoin may cause gastric discomfort

A

oral

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70
Q

is phenytoin a inducer or inhibitor of CYP drugs?

what drugs does this affect?

A

inducer

oral contraceptives

warfarin (an anticoagulant)

glucocorticoids (anti inflammatory and immunosuppressive drug)

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71
Q

drugs that increase plasma levels of phenytoin

A

Valproic acid (antiseizure)

alcohol (when taken acutely)
cimetidine (gastric ulcers)
isoniazid (TB)
diazepam (antianxiety and antiseizure)

(think mnemonic ACID)

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72
Q

what other antiseizure drug displaces phenytoin from binding sites on plasma protein

A

Valproic acid

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73
Q

drugs that decrease plasma levels of phenytoin causing breakthrough seizures

A

Carbamazepine
phenobarbital
chronic alcohol use

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74
Q

what drugs can increase CNS depressant effect when taken with phenytoin

A

alcohol
barbiturates
other CNS depressants

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75
Q

special instructions when giving phenytoin to a pt fed by enteral tube feedings

A

for patients receiving continuous tube feedings, hold feeds for 1-2 hours before and after phenytoin administration

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76
Q

Fosphenytoin and relation to phenytoin

A

fosphenytoin is a prodrug that is converted to phenytoin

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77
Q

what type of seizures does fosphenytoin treat

A

partial seizures and generalized tonic clonic seizures

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78
Q

what additional adverse effect for fosphenytoin that phenytoin doesnt have

A

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

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79
Q

what kind of seizures does carbamazepine treat

A 
partial seizures (simple and complex)
tonic clonic seizures
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80
Q

tell me about the half life of carbamazepine

A

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

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81
Q

carbamazepine is drug of choice for

A

partial seizures

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82
Q

carbamazepine is not effective against

A

absence
myoclonic
atonic

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83
Q

what can you do to reduce adverse CNS effects for carbamazepine

A

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

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84
Q

neurologic effects (adverse effect) associated with carbamazepine

A

visual disturbances - nystagmus, blurred vision, diplopia)

ataxia

vertigo

unsteadiness

headache

tolerance usually develops with continued use

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85
Q

heme side effects of carbamazepine

when should you withdraw?

A

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

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86
Q

what plasma monitoring for carbamazepine

A

CBC before treatment and periodically after

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87
Q

what symptoms should a pt monitor for and report while taking carbamazepine

A 
fever
sore throat
pallor
weakness
infection 
easy bruising
petechiae
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88
Q

carbamazepine is associated with what fetal defect

A

increase risk for spina bifida

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89
Q

what co-morbidity can be a problem with carbamazepine

A

heart failure

promotes secretion of ADH (inhibits renal excretion of water) pg 159

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90
Q

what derm side effects associated with carbamazepine

A

SJS
TEN
photosensitivity
DRESS

SJS and TEN increased risk with HLA-B 1502 (Asian)

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91
Q

_____ and ____ failure have occurred with carbamazepine

A

hepatic and renal failure

92
Q

carbamazepine is a hepatic drug _____

what drugs does this effect

A

inducer

oral contraceptives

warfarin (an anticoagulant)

glucocorticoids (anti inflammatory and immunosuppressive drug)

93
Q

what food can cause plasma levels to rise

A

Grapefruit juice can increase peak and trough levels

pt should avoid

94
Q

Blackbox for Valproate and Valproic acid

A

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
Q

Most common adverse effect of Valproic acid

how can you minimize

A

GI effects - n/v and indigestion

taking with food and using enteric coated

96
Q

what are the 2 serious but rare adverse effects of Valproic acid

A

Hepatotoxicity

Pancreatitis

97
Q

what age group are at highest risk for liver failure with Valproic acid

A

younger than 2 years old

98
Q

signs and symptoms of liver injury

A 
reduced appetite
malaise
nausea
abd pain
jaundice
99
Q

signs of pancreatitis

A

abd pain
nausea
vomiting
anorexia

100
Q

if pancreatitis occurs with Valproic acid, can they keep taking it

A

no

101
Q

in addition to neural tube defects what 5 congenital defects is Valproic acid linked to

A 
ASD
cleft palate
hypospadias
polydactyly
craniosynostosis
102
Q

other adverse effects of valproic acid

A 
rash
weight gain
hair loss
tremor
blood dyscrasias (leukopenia, thrombocytopenia, RBC aplasia)

significant CNS are uncommon

103
Q

combining valproic acid with topiramate poses a risk for

A

hyperammonemia - which may occur with or without encephalopathy

104
Q

symptoms of hyperammonemia

if you have these, what should you suspect

what plasma level do you need

A

vomiting
lethargy
altered LOC
altered cognitive function

hyperammonemic encephalopathy - check blood ammonia

105
Q

what 2 antibiotics can reduce plasma levels of valproic acid

A

meropenem
imipenem/cilastatin

both are carbapenem abx

106
Q

ethosuximide treats what type of seizures

A

only for absence

107
Q

how many times a day is ethosuximide given

A

once a day

however twice a day is better tolerated

108
Q

what plasma levels are used to help guide dosing for ethosuximide

A

trough levels

109
Q

adverse effects during initial treatment for ethosuximide

A

drowsiness
dizziness
lethargy

diminish with continued use

110
Q

GI effects of ethosuximide and how to reduce

A

n/v

take with food

111
Q

rare but serious adverse effects for ethosuximide

A

SLE
Leukopenia
aplastic anemia
SJS

112
Q

what are the preferred antiseizure and why for breastfeeding

A

Valproic acid
Phenytoin

highly protein bound

113
Q

Antiseizure BEERS list

A

carbamazepine
oxcarbazepine
phenobarbital

inappropriate for 65 and older

114
Q

what extra precautions for antiseizure and older adults

A

increase risk for adverse events such as falls, start low and go slow

115
Q

what is phenobarbital classified as

A

anticonvulsant barbiturate

116
Q

what seizures does phenobarbital treat

A

partial seizures
generalized tonic-clonic

IV for generalized convulsive SE
sedation and promote sleep at night

117
Q

most common side effect of phenobarbital

A

drowsiness - during initial therapy sedation occurs in practically all patients - with continued use, tolerance develops

118
Q

Phenobarbital takes _____ to reach plateau plasma levels. what is done to help this

A

2-3 weeks

loading doses

119
Q

CNS effects phenobarbital

A 
Drowsiness
some (adults and children) can have paradoxical effects - hyperactive and irritable

cognitive effects
depression
agitation
confusion

resp depression

120
Q

phenobarbital and other barbiturates can increase the risk for

A

acute intermittent porphyria - so contraindicated in patients with a personal or familial history of this

121
Q

phenobarbital can interfere with the metabolism of vitamins

A

D and K

rickets, osteomalacia

122
Q

phenobarbital pot should be advised to avoid food high in

A

vit D, K and calcium

supplementation may be recommended for some

123
Q

phenobarbital tox

A

nystagmus
ataxia

severe overdose causes
CNS depression
death from depression of resp

124
Q

phenobarbital is a CYP

what drugs are a concern

A

inducer

oral contraceptives

warfarin (an anticoagulant)

glucocorticoids (anti inflammatory and immunosuppressive drug)

125
Q

Pt on phenobarbital should avoid other drugs that cause

A

CNS depression such as alcohol benzodiazepines, opioids

126
Q

phenobarbital and Valproic acid

A

compete for sites - phenobarbital must be reduced to avoid tox

127
Q

Primidone is nearly identical to ______

A

phenobarbital

128
Q

Primidone is given for what types of seizures

A

tonic-clonic
simple partial
complex partial

129
Q

Primidone is typically given with

A

another antiseizure drug (usually phenytoin or carbamazepine) - NEVER with phenobarbital because its an active metabolite of primidone

130
Q

what adverse effects are common during initial treatment of Primidone

A

Sedation
ataxia
dizziness

131
Q

Primidone in older adults

A

confusion

132
Q

Primidone in children

A

paradoxical hyperexcitability

133
Q

Primidone is absolutely contraindicated for pt with

A

acute intermittent porphyria

134
Q

Serious adverse reactions for Primidone

A

acute psychosis
leukopenia
thrombocytopenia
systemic lupus erythematosus

135
Q

Primidone is a CYP

what drugs are a concern

A

inducer

oral contraceptives

warfarin (an anticoagulant)

glucocorticoids (anti inflammatory and immunosuppressive drug)

136
Q

Oxcarbazepine is approved for

A

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
Q

CNS adverse effects of Oxcarbazepine

A 
dizziness
drowsiness
double vision
nystagmus
headache
nausea
vomiting
ataxia

avoid driving and other hazardous activities until degree of drowsiness is low

138
Q

electrolyte effects of Oxcarbazepine

A

Hyponatremia

watch combining with diuretics - monitoring may be needed

139
Q

signs of hyponatremia

A

nausea
drowsiness
headache
confusion

140
Q

derm side effects of Oxcarbazepine

A

SJS

TEN

141
Q

Heme effects of Oxcarbazepine

A

rare
blood dyscrasias
CBC to confirm

142
Q

hypersensitivity adverse effects of Oxcarbazepine

A

multiorgan hypersensitivity reactions

143
Q

symptoms of multiorgan hypersensitivity reactions for oxcarbazepine

A 
fever
rash
lymphadenopathy
hematologic abnormalities
pruritus
hepatitis
nephritis
hepatorenal syndrome
oliguria
arthralgia
asthenia

if this happens d/c oxcarbazepine

144
Q

long term use of oxcarbazepine may cause

A

decreased bone mineral density and can result in osteopenia and osteoporosis with an increased risk for fractures

145
Q

Perampanel can _____ levels of oxcarbazepine

A

increase

146
Q

Valproic acid can _____ levels of oxcarbazepine

A

decrease

147
Q

Phenobarbital can ____ serum levels of oxcarbazepine

A

decrease

148
Q

oxcarbazepine ____ phenytoin levels

A

increase

149
Q

Phenytoin _____ serum oxcarbazepine raises phenytoin levels

A

decrease

150
Q

oxcarbazepine can _____ serum levels of eslicarbazepine

A

increase

151
Q

oxcarbazepine ____ enzymes that metabolize both estrogens and progestins

A

induce

152
Q

Sodium depleting drugs can increase risk of ______ with oxcarbazepine

A

hyponatremia

153
Q

Alcohol can ______ CNS depression caused by oxcarbazepine

A

Alcohol

154
Q

drugs that cause DRESS

A

Phenytoin
fosphenytoin
Carbamazepine
lamotrigine

155
Q

What newer antiseizure drug is uses for all seizure types

A

Lmotrigine

156
Q

FDA approved Lamotrigine for

A

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
Q

what drugs increase bleeding (vit k)

A

phenytoin
primidone
phenobarbital
carbamazepine

158
Q

common side effects for Lamotrigine

A 
dizziness
diplopia
blurred vision
n/v
headache
159
Q

life threatening for Lamotrigine

A

SJS
TEN
DRESS

160
Q

heme adverse effects for Lamotrigene

A

blood dyscrasias

hypersensitivity and immune system reactions

161
Q 
pt taking Lamotrigene 
experiences 
headache
stiff neck
nausea
vomiting
rash 
sensitivity to light
A

think aseptic meningitis (inflammation of meninges in the absence of bacterial infection)

d/c med

162
Q

drugs that cause SJS

A 
phenytoin
fosphenytoin
carbamazepine
ethosuximide
oxcarbazempine
lamotrigine
zonisamide

“CLEOPatra Found Zits”

“CLEOPatra Found Zits while looking for SJS”

163
Q

Lamotrigene is dramatically affected by what drugs

A

that induce or inhibit cyp

inducers - carbamazepine
phenytoin
phenobarbital

inhibitors - Valproate

164
Q

_____ may lower progestin

A

Lamotrigine

165
Q

Gabapentin is approved for

A

adjunctive therapy of partial seizures

166
Q

Gabapentin ER and Neurontin is approved for

A

not in seizures!

167
Q

Absorption of Gabapentin and food

A

not affected by food

168
Q

as the dosage of gabapentin gets larger, the percentage absorbed gets _____

A

smaller - the intestinal transport system for uptake of the drug becomes saturated

169
Q

most common side effects of gabapentin

A 
somnolence
dizziness
ataxia
fatigue 
nystagmus
peripheral edema

diminishes with continued drug use

170
Q

drugs with visual disturbances

A 
carbamazepine
oxcarbazepine
lamotrigine, 
pregabalin
topiramate, 
felbamate

“Col. P.T. Fuzzy vision”

171
Q

Pregabalin used for

A

adjunctive therapy of partial seizures

172
Q

most common adverse effects for Pregabalin

A

dizziness
somnolence
persist for as long as the drug is taken

173
Q

other side effects of Pregabalin

A 
blurred vision
difficulty thinking
headache
peripheral edema
dry mouth
174
Q

what other big adverse effects for Pregabalin

A

hypersensitivity reaction - angioedema, blisters, hives, rash, dyspnea, wheezing

rhabdomyolysis

175
Q

signs of rhabdomyolyis

A

muscle pain
tenderness
weakness

176
Q

abuse for Pregabalin

A

schedule V

euphoria effect

177
Q

abrupt d/c of Pregabalin

A

insomnia
nausea
headache
diarrhea

withdraw over a week or more

178
Q

reproductive risks for Pregabalin

A

both males and females

179
Q

Pregabalin drug interactions

A

dont combine with other CNS depressants such as alcohol, opioids, benzodiazepines

180
Q

when is Keppra used

A

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
Q

when is Keppra used

A

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
Q

what falls under the category of neuorpsychiatric symptoms

A 
agitation
anxiety
depression
psychosis
hallucinations
depersonalization
183
Q

Topiramate (topamax) is approved for

A

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
Q

adverse effects of topiramate

A 
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
Q

Topiramate can cause what problem in relation to pH?

who is at increased risk for this?

what baseline should be drawn and monitored periodically?

A

metabolic acidosis

risk factors
renal disease
severe resp disorders
diarrhea
ketogenic diet

serum bicarbonate

186
Q

symptoms to monitor Topiramate (topamax) for metabolic acidosis

A

hyperventilation
fatigue
anorexia

187
Q

what environmental related health issue can be caused by Topiramate (topamax)

A

hypohydrosis (reduced sweating) increased risk of hyperthermia

188
Q

adverse reaction r/t eyes on Topiramate (topamax)

A

angle closure glaucoma - can lead to blindness medical emergency

189
Q

s/s angle closure glaucoma

A

ocular pain
unusual redness
sudden worsening or blurring of vision

190
Q

psych effect of Topiramate (topamax)

A

increased risk for suicidality

191
Q

Phenytoin and carbamazepine can _____ levels of Topiramate (topamax) by about 45%

A

decrease

192
Q

Topiramate (topamax) combined with valproic acid increased risk of

A

hyperammonemia

193
Q

Tiagabine is approved for

A

adjunct therapy of partial seizures in pt at least 12 years old

194
Q

common adverse effects Tiagabine

A 
dizziness
somnolence
asthenia
nausea
nervousness
tremor
confusion
abnormal thinking
trouble concentrating
195
Q

levels of tiababine can be _____ by phenytoin, phenobarbital and carbamazepine

A

decreased

196
Q

Zonisamide is in what drug class but used for seizures

A

sulfonamide abx but has not antimicrobial acitivity

197
Q

Zonisamide is approved only for

A

adjunct therapy of partial seizures in adults

198
Q

common adverse effects Zonisamide

A 
drowsiness
dizziness
anorexia
headache
nausea
metabolic acidosis
199
Q

severe side effects of zonisamide

A

severe psychiatric effects of depression and suicide

hypersensitivity reactions - SJS, TEN, fulminant hepatic necrosis

200
Q

renal effects of zonisamide and pt education for it

A

nephrolithiasis (kidney stones) - drink 6-8 glasses of water a day

impair glomerular filtration - use with caution if history of kidney disease

201
Q

s/s kidney stones

A 
sudden back pain
abd pain
dysuria
hematuria
dark urine
202
Q

Metabolic acidosis in children can cause what?

A

delay growth
kidney stones
fractures

203
Q

environmental side effect of zonisamide

A

hypohidrosis - causes hyperthermia

204
Q

CYP zonisamide

A

affected by CYP

inducers
St Johns wort
several antiseizures - phenytoin, phenobarbital, carbamazepine

inhibitors
grapefruit juice
azole antifungals (ketoconazole)
protease inhibitors (ritonavir)

205
Q

Felbamate is approved for

A

adjunct or monotherapy for adults with partial seizures

adjunct therapy in children with Lennox -Gastaut syndrome

206
Q

Adverse effects of Felbamte

A

aplastic anemia
liver damage and liver failure
GI (anorexia, nausea, vomiting)
CNS (insomnia, somnolence, dizziness, headache, diplopia)

207
Q

Felbamate _____ levels of phenytoin and valproic acid

A

increases

208
Q

levels of Felbamate are ____ by valproic acid

A

increased

209
Q

levels of Felbamate are _____ by phenytoin and carbamazepine

A

reduced

210
Q

Zonisamide cant be given to someone with an allergy to what drug

A

sulfa

211
Q

Carbamazepine is contraindicated for

A

history of bone marrow suppression

preexisting hematologic abnormalities

HLA-B1502 (common in asian population) - risk for SJS or TEN

212
Q

Felbamate is contraindicated for

A

anemia

hepatic impairment

213
Q

Gabapentin is contraindicated for

A 
renal impairment (may require renal dosing)
History of drug abuse (at risk for psychological and physical dependence)
214
Q

Oxcarbazepine is contraindicated for

A

osteopenia

osteoporosis

215
Q

Phenobarbital is contraindicated for

A

personal or family history of porphyria
pt with anemia
liver impairment
significant resp disease

216
Q

IV phenytoin is contrindicated in

A

bradycardia

AV block

217
Q

Valproic acid contraindicated

A

hepatic dysfunction
children younger than 3 who are taking other antiseizure drugs
last resort in pregnancy

218
Q

Zonisamide contraindication

A

conditions that contribute to increased risk of metabolic acidosis

sulfa alergy

219
Q

Zonisamide contraindication

A

conditions that contribute to increased risk of metabolic acidosis

sulfa allergy

220
Q

what traditional meds are approved for partial seizures which include simple partial, complex partial and secondarily generalized?

A

All traditional that we talked about except Ethosuximide

Carbamazepine
Fosphenytoin
Phenobarbital
Phenytoin
Primidone
Valproic acid
221
Q

which newer meds are approved for partial seizures which include simple partial, complex partial and secondarily generalized?

A

all of the ones we talked about

Oxcarbazepine
Lamotrigine
Gabapentin
Pregabalin
Levetiracetam (Keppra)
Topiramate
Tiagabine
Zonisamide
Felbamate
222
Q

What older meds are approved for Primary generalized tonic clonic seizures

A 
Carbamazepine
Fosphenytoin
Phenobarbital
Phenytoin
Primidone
Valproic acid
223
Q

What newer meds are approved for Primary generalized tonic clonic seizures

A

Lamotrigine
Levetiracetam (keppra)
Topiramate

224
Q

What traditional meds and newer meds are approved for Primary generalized absence seizures

A

Ethosuximide
Valproic acid

Lamotrigine

225
Q

What traditional meds and newer meds are approved for Primary generalized myoclonic seizures

A

Valproic acid

Lamotrigine
levetiracetam
topiramate

226
Q

monotherapy for newer seizure meds

A

Felbamate
Lamotrigine
Oxcarbazepine
Topiramate

(FLOT)

Pharm Exam 4 - Class Review (14 decks)

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