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NAPLEX 2023 > Chapter 71: Seizures/Epilepsy > Flashcards

Chapter 71: Seizures/Epilepsy Flashcards

1
Q

What is the most common test used to diagnose epilepsy

A

EEG

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2
Q

Key drugs that can lower the seizure threshold

A 
Bupropion
Clozapine
Theophylline
Varenicline
Carbapenems (esp. imipenem)
Lithium
Meperidine
Penicillin
Quinolones
Tramadol
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3
Q

Where does a focal seizure start

A

One side of the brain, but can spread to the other side

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4
Q

Where does a generalized seizure start

A

Both sides of the brain

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5
Q

If a focal seizure results in no loss of consciousness, it is called

A

focal aware seizure

previously known as simple partial seizure

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6
Q

If a focal seizure results in loss of consciousness, it is called

A

focal seizure with impaired awareness

previously complex partial seizure

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7
Q

What are tonic symptoms

A

rigid or tense muscles

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8
Q

Generalized seizures with non-motor symptoms are called

A

absence seizures

“staring spells”

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9
Q

What is status epilepticus

A

A seizure that lasts beyond 5 minutes. It is a medical emergency

after 30 min, long-term damage occurs

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10
Q

What are the 3 phases of status epilepticus called and what are the time intervals for them

A

0-5 minutes = stabilization phase
5-20 minutes = initial treatment phase
20-40 minutes = second treatment phase

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11
Q

What should be done during the stabilization phase of SE

A

Time the seizure
Start EEG, oxygen may be needed
Check AED levels, electrolytes, if BG low - treat with D25-D50

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12
Q

What should be done during the initial treatment phase of SE

A

If seizure continues:
Give IV lorazepam (Ativan)
Alternatives if IV unavailable: IM midazolam (Versed) or rectal diazepam (Diastat)

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13
Q

What should be done during the second treatment phase (20-40 min) of SE

A

If seizure continues:
Give regular AED: IV fosphenytoin, valproic acid, levetiracetam (phenobarbital if others are unavailable)

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14
Q

Diastat AcuDial packages contain two rectal syringes prefilled with diazepam rectal gel. What doses does it come in

A

2.5, 10 and 20 mg

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15
Q

How do you use Diastat AcuDial

A
  • Syringes must be dialed to the right dose and locked BEFORE DISPENSING
  • Once locked, the green band should say “READY,” and the syringe cannot be unlocked
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16
Q

CBD brand name for seiures

A

Epidiolex

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17
Q

What kind of diet can be used in patients with refractory seizures

A

Ketogenic

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18
Q

What is the ratio of fats : protein and carbs combined in a ketogenic diet

A

4:1

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19
Q

What medication is used for absence seizures

A

ethosuximide

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20
Q

What is the MOA of benzodiazepines as AED

A

Increases GABA

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21
Q

What is the MOA of Valproic acid as AED

A

Increases GABA

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22
Q

What is the MOA of ethosuximide as AED

A

T-type Ca channel blocker - slows down or stops transmission or the electrical signal

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23
Q

What is the MOA of carbamazepine as AED

A

Na channel blocker - decr. neurons firing rate

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24
Q

What is the MOA of phenytoin/fosphenytoin as AED

A

Na channel blocker - decr. neurons firing rate

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25
Q

Which neurotransmitters are responsible for causing a seizure

A 
Deficiency in GABA (inhibitory NT)
Excess glutamate (excitatory)
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26
Q

Side effects of carbamazepine, oxcarbazepine, and eslicarbazepine

A

hyponatremia, rash, enzyme inducers

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27
Q

Side effects of gabapentin and pregabalin

A

Weight gain, peripheral edema, mild euphoria

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28
Q

Side effects of phenobarbital and primidone (prodrug of phenobarbital)

A

Sedation, dependence/tolerance/OD risk, enzyme inducers

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29
Q

Side effects of topiramate and zonisamide

A

Weight loss, metabolic acidosis
Nephrolithiasis and oligohydrosis/hyperthermia (in children)

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30
Q

All AEDs should be supplemented with

A

calcium and vitamin D

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31
Q

Women of childbearing age should supplement with ___ while on AEDs

A

folate

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32
Q

If taking valproic acid, what should you supplement with

A

possibly carnitine

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33
Q

If taking lamotrigine and valproic acid, what should you supplement with if alopecia develops

A

Supplement with selenium and zinc

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34
Q

Lamotrigine brand name

A

Lamictal

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35
Q

Lamotrigine dose for weeks 1 and 2

A

25 mg daily

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36
Q

Lamotrigine boxed warning

A

Serious skin reactions including SJS/TEN

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37
Q

Lamotrigine side effect

A

Alopecia (supplement selenium and zinc)

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38
Q

Lamictal starter kits are used to ensure correct dosing. Which color is the standard starting dose? When should you use it?

A

Orange
Use if no interacting medications

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39
Q

Lamictal starter kits are used to ensure correct dosing. Which color is a lower starting dose compared to the others? When should you use it?

A

Blue
Use if taking valproic acid (enzyme inhibitor)

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40
Q

Lamictal starter kits are used to ensure correct dosing. Which color is a higher starting dose compared to the others? When should you use it?

A

Green
Use if taking an enzyme inducer (e.g., carbamazepine, phenytoin, phenobarbital, primidone), and not taking valpoic acid

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41
Q

Lamotrigine drug interactions

A

Valproic acid increased lamotrigine concentrations more than two-fold. Use lower starting dose (blue box)

Inducers like carbamazepine, phenytoin, phenobarbital, & primidone decrease lamotrigine concentrations by 40%. Use the higher starting dose (green box)

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42
Q

Levetiracetam brand name

A

Keppra, Keppra XR

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43
Q

Keppra IV:PO ratio

A

1:1

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44
Q

Keppra warnings

A

psych reactions, including psychotic symptoms, somnolence, fatigue

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45
Q

T/F: Keppra does not have any significant drug interactions

A

True

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46
Q

Topiramate brand name

A

Topamax

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47
Q

Another use for topiramate

A

Migraine ppx

48
Q

Topiramate warnings

A

Metabolic acidosis, oligohydrosis (reduced perspiration), nephrolithiasis (kidney stones), angle-closure glaucoma, hyperammonemia, fetal harm, visual problems

49
Q

Topiramate side effects

A

Somnolence, difficulty with memory/concentration/attention, weight loss, anorexia

50
Q

Topiramate monitoring

A

electrolytes (especially bicarbonate), intraocular pressure

51
Q

Topiramate drug interaction

A

Can decrease OC effectiveness. Non-hormonal contraception is recommended

52
Q

Depakene generic name

A

Valproic acid

53
Q

Depakote, Depakote ER, Depakote Sprinkle generic name

A

Divalproex

54
Q

Another use of divalproex

A

Bipolar and migraine ppx

55
Q

Valproic acid therapeutic range

A

50-100 mcg/mL (total level)

alb < 3.5 must adjust with formula (phenytoin formula)

56
Q

Valproic acid boxed warning

A

hepatic failure, fetal harm (neural tube defects and low IQ scores)

57
Q

Valproic acid warnings

A

Hyperammonemia (treat with carnitine in symptomatic adults only), thrombocytopenia (increased bleeding risk)

58
Q

Valproic acid side effects

A

Alopecia (supplement selenium and zinc), weight gain

59
Q

Valproic acid monitoring

A

LFTs (baseline and frequently in the first 6 months), platelets

60
Q

What is the drug interaction between valproic acid and lamotrigine

A

risk of serious rash

lower lamotrigine dose and titrate slowly

61
Q

Tegretol generic name

A

Carbamazepine

62
Q

Carbamazepine therapeutic range

A

4-12 mcg/mL

63
Q

Carbamazepine boxed warnings

A

Serious skin reactions: patients of Asian descent should be tested for HLA-B*1502 allele prior to initiation
Aplastic anemia and agranulocytosis

64
Q

Tegretol should be tested for ____ allele

A

HLA-B*1502

65
Q

Carbamazepine contraindications

A

Myelosuppression

66
Q

Carbamazepine warnings

A

hyponatremia (SIADH), fetal harm

67
Q

Carbamazepine monitoring

A

CBC with diff and platelets, electrolytes (especially Na)

68
Q

Carbamazepine drug interactions

A

Enzyme inducer, autoinducer - decreases levels of other drugs and itself

69
Q

Which drugs can decrease levels of OCs and non-hormonal contraceptive is recommended

A

Topiramate, carbamazepine, oxcarbazepine, phenobarbital, primidone, phenytoin

PS PORCS + topiramate + primidone

70
Q

Vimpat generic name

A

Lacosamide

71
Q

What class of drug is Lacosamide

A

C-V

72
Q

Lacosamide warnings

A

Prolongs PR interval and increases risk of arrhythmias

73
Q

lacosamide DDIs

A

caution with 2C19, 2C9, and 3A4 inhibitors (can increase lacosamide levels)

74
Q

Trileptal generic name

A

Oxcarbazepine

75
Q

Oxcarbazepine warnings

A

Increased risk of serious skin reactions: consider screening patients of Asian descent for HLA-B*1502 prior to initiating therapy
Hyponatremia

76
Q

Oxcarbazepine monitoring

A

Serum Na levels

77
Q

Phenobarbital therapeutic range for adults

A

20-40 mcg/mL

78
Q

Phenobarbital warnings

A

Habit forming, respiratory depression, fetal harm

79
Q

Phenobarbital side effects

A

Physiological dependence, tolerance, hangover effect

80
Q

Phenobarbital (and primidone) is a strong ____ of most enzymes

A

inducer

81
Q

Dilantin generic name

A

Phenytoin

82
Q

Cerebyx generic name

A

Fosphenytoin

83
Q

Phenytoin IV:PO ratio

A

1:1

84
Q

Phenytoin therapeutic range (total level and free level)

A

total level: 10-20 mcg/mL
free level: 1-2.5

Ten Y Two in = in range of 10 - 20

85
Q

Phenytoin IV administration rate should not exceed ___ mg/min & fosphenytoin IV should not exceed ___ mg PE/min. If given faster than these rates ____ and ____ can occur

A

Phenytoin - 50 mg/min
fosphenytoin - 150 mg PE /min

if faster risk of hypotension and cardiac arrhythmias

86
Q

Phenytoin can cause extravasation, which leads to ____

A

Purple glove syndrome, characterized by edema, pain and bluish discoloration of the skin which can sometimes lead to tissue necrosis

87
Q

Phenytoin should be avoided in patients with a positive ____

A

HLA-B*1502
Can also cause fetal harm

88
Q

Phenytoin dose-related (toxicity) side effects

A

Nystagmus, ataxia, diplopia/blurred vision

89
Q

Phenytoin chronic side effects

A

Gingival hyperplasia, hair growth, hepatotoxicity

pheny to INCH - grows gingival hyperplasia, hair

90
Q

Phenytoin monitoring

A

Serum phenytoin concentration, LFTs
IV: continuous cardiac and respiratory monitoring

91
Q

Phenytoin and fosphenytoin are strong ____ of several enzymes

A

inducers

92
Q

Phenytoin and fosphenytoin both have high ____

A

protein binding & can displace other highly protein-bound drugs or be displaced by other highly protein-bound drugs, causing an increase in levels that can lead to toxicity

93
Q

Between Phenytoin and fosphenytoin, which has lower risk of purple glove syndrome

A

fosphenytoin

94
Q

Between Phenytoin and fosphenytoin, which one requires a filter

A

Phenytoin

remember GAL PLAT

95
Q

Phenytoin must be diluted in ___, is stable for ___ hours, and should not be ____

A

NS (DIAPACE)
4 hours
refrigerated (Dear Pharmacist, Being Frigid Makes Me Edgy)

96
Q

Tube feeds (increase/decrease) phenytoin absorption

A

decrease
Hold feedings 1-2 hours before and after administration

97
Q

Zarontin generic name

A

ethosuximide

98
Q

Ethosuximide warnings

A

Serious skin rash (SJS/TEN), blood dyscrasias

99
Q

Felbamate boxed warnings

A

Hepatic failure, aplastic anemia

100
Q

Fenfluramine boxed warning & warnings

A

boxed warning: valvulr heart disease, pHTN
warning: decr. appetite, weight loss

101
Q

Gabapentin brand name

A

Neurontin

102
Q

Pregabalin brand name

A

Lyrica

103
Q

Pregabalin drug schedule

A

C-V

104
Q

What is the prodrug of phenobarbital

A

Primidone

105
Q

Vigabatrin boxed warning

A

Causes permanent vision loss (≥ 30% patients)

106
Q

Zonisamide contraindication

A

Hypersensitivity to sulfonamides

107
Q

Zonisamide side effects

A

Similar to topiramate, including oligohidrosis/hypertheramia and risk of nephrolithiasis

108
Q

All AEDs cause:

A

CNS depression (e.g, dizziness, confusion, sedation, and ataxia/coordination difficulties)

109
Q

Which AEDs are enzyme inducers

A 
Carbamazepine
Oxcarbazepine
Phenytoin
Fosphenytoin
Phenobarbital
Primidone

PS PORCS

110
Q

Which AED(s) are enzyme inhibitors

A

Valproic acid (increases lamotrigine levels)

111
Q

Which AED has the highest teratogenic risk

A

Valproic acid

112
Q

The levels of all AEDs (increase/decrease) during pregnancy and may require a dose (increase/decrease)

A

Decrease
Increase

113
Q

Which two AEDs can cause reduced or lack of sweating in young children

A

Topiramate and zonisamide

114
Q

Which AEDs come in formulations that are easy to swallow for children

A

Lamotrigine (ODT, chewable tablets)
Levetiracetam (ODT, oral solution)

115
Q

A child who remains seizure free for ____ can often be tapered off AEDs

A

1-2 years

116
Q

Formula to adjust phenytoin dose

A

phenytoin correction = total phenytoin measured/ [(0.2 x albumin) + 0.1]

NAPLEX 2023 (88 decks)

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