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Assessment 2.9 > Day 2- Seizures > Flashcards

Day 2- Seizures Flashcards

1
Q

Is epilepsy the 4th most common neurological disorder?

What drugs can cause drug induced seizures?

What are common causes of epilepsy?

A

Yes.

Antidepressants(Bupropion), Theophylline, Benzodiazepine withdrawal, barbiturate withdrawal, Tramadol, cocaine(other illict drugs), Herbs(ephedra, caffeine, ginkgo, ginseng).

Junvenile myoclonic epilepsy, dravet syndrome, childhood absence epilepsy, post traumatic, tuberous sclerosis, neurocysticercosis, impaired glycogen metabolism, anti-NMDA receptor encephalitis, unknown.

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2
Q

What can provoke a seizure?

What’s the difference between focal and generalized seizure?

How can you tell the difference between simple and complex focal seizures?

A

Alcohol withdrawal, alcohol, fever(esp in children), infection(meningitis), stroke/cerebral hemmorhage, acute head trauma, hyperventilation, stress, eclampsia, hyponatremia and calcemia and glycemia, renal/liver failure.

Focal(partial) is started in one hemisphere but can spread(secondary generalized) and generalized is both hemispheres.

if it’s complex it has dyscognitive features and impaires consciousness or amnesia to event.

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3
Q

What is an absence seizure(petit mal)?

What is a clonic seizure?

What is a tonic seizure?

A

Blank stare, sudden, very short.

Sustained bilateral rhythmic jerking.

Increased tone or stiffening of limbs bilaterally.

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4
Q

What is a tonic-clonic(grand mal) seizure?

What is an atonic seizure?

What is a myoclonic seizure?

A

stiffening, followed by rhythmic jerking.

drop attacks.

brief muscle contractions or jerks.

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5
Q

What is status epilepticus?

When do you start Antiseizure therapy?

When do you have poor outcomes with stopping medicine?

A

recurrent or continuous seizure activity lasting 30 minutes, patient does not regain baseline mental status, medical emergency.

Patients with more than 2 unprovoked seizure are generally started.

Bad stuff. Can stop if good. Always taper.

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6
Q

How do you dose your 1st ASD?

What are the drugs of choice for focal seizures?

What are the drugs of choice for absence seizures?

A

Start with product labeling, titrate until patient is seizure free, FDA labeled max dos reached, unacceptable side effects occur. If ineffective or untolerable add 2nd, and/or taper and discontinue 1st.

Carbamazepine, Phenytoin, Valproic Acid, Lamotrigine, Levetiracetem, Gabapentin, Oxcarbazepine, Topiramate.

Ethosuximide, Valproic Acid, Lamotrigine.

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7
Q

What are some ASD’s that worse seizure types?

What are drugs of choice for tonic-clonic seizures?

What are last line therapies for serious and refractory cases?

A

Carbamazepine and phenytoin can worsen myclonic and absence seizure.

Topiramate, Lamotrigine, Carbamazepine, Valproic Acid, Levetiracetem, Oxcarbazepine.

Ezogabine, Felbamate, Perampanel, Vigabatrin.

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8
Q

Which AED’s are associated with weight gain?

Which AED’s are associated with weight loss?

Which AED’s are associated with kidney stones?

A

Valproic Acid, Gabapentin, Pregablin, Vigabatrin.

Topiramate, Zonisamide, Felbamate.

Topiramate, Zonisamide.

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9
Q

Which AED’s are associated with oligohydrosis?

Which AED’s is CI’d in a patient with a sulfonamide allergy?

Which AED’s are associated with hepatic failure?

A

Topiramate, Zonisamide. Limit heat exposure, hydrate.

Zonisamide.

Valproic Acid, Felbamate, Phenytoin.

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10
Q

Which AED’s is associated with hyperammonemia?

Which AED’s can lower platelets?

Which AED’s is associated with hyponatremia?

A

Valproic Acid.

Valproic Acid.

Eslicarbazepine, Carbamazepine, Oxcarbazepine.

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11
Q

Which AED’s associated with memory/word finding?

What AED’s are associated with leukopenia?

Which AED is the most sedating?

A

Topiramate, start low and go slow.

Carbamazepine.

Phenobarbital and Primidone.

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12
Q

What are the concentration dependent side effects of phenytoin?

What are the chronic side effects associated with phenytoin?

Which AED is associated with alopecia?

A

CNS depression, nystagmus, ataxia, Level should be between 10-20.

Hirsutism, Gingival Hyperplasia(counsel patients to see dentist).

VPA

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13
Q

Which AED’s are associated with edema?

Which AED’s are associated with significant psychiatric events?

Which AED is associated with irregular menses?

A

Gaba/Pregab, Vigabatrin, VPA if they have liver damage.

Parampeneal, Leveteritacem.

VPA

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14
Q

Which AED should calcium and vitamin D supplementation be recommended?

How fast can IV phenytoin be administered? Forphenytoin?

Which AED’s require dose adjustment in renal impairment?

A

VA, Carbamazepine, Pheytoin, Phenobarb/primidone, Oxcarbazepine, Topiramate.

50 mg/min, 150 mg/min. Takes phenytoin 3-4 weeks to reach steady state and has a half life of 100 hours.

Gaba/pregab, Topiramate, Zonisamide, Levetiretacem.

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15
Q

Which AED exhibits michaelis-mentin kinetics?

Which AED’s have IV to PO conversion of 1:1?

Which AED’s have shown to have increased clearance in pregnancy?

A

Phenytoin, small dose adjustments have large effects on concentrations.

Levetiracetam, Lacosamide.

Lamotrigine

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16
Q

Which AED exhibit dose dependent bioavailability?

Which AED’s have well-established therapeutic ranges?

What are Valproic Acid’s black box warnings?

A

Gabapentin

Carbamzepine, Phenytoin, Phenobarbital, Ethosuximide, Primidone, Valproic Acid.

Hepatic Failure, N/V, lethargy, anorexia, edema, mitochondrial disease, pancreatitis, pregnancy/fetal risk.

17
Q

What is carbamazepine’s black box warning?

What is Vigabatrin and Ezogabine’s BBW?

What is Phenytoin/ Fosphenytoin’s BBW?

A

Aplastic anemia and agranulocytosis(CI’d if history of marrow suppression), SJS/TEN(HLA test in Asian population).

Permanent Vision Loss(SHARE REMS). Retinal abnormalities and vision loss for Ezogabine.

Cardiac: Hypotension, bradycardia, arrythmia(IV give slowly).

18
Q

What is Lamotrigine’s BBW?

What is Felbamate’s BBW?

What is Perampanel’s BBW?

A

SJS/TEN- stop at first sign of rash and titrate carefully. Fatal cases occur within first 2-8 weeks. Risk factors are starting with a high dose and rapid dose increase or taking concurrent valproic acid.

Aplastic anemia, Hepatic failure(death and liver transplant).

Serious, life threatening psychiatric and behavioral rxn.

19
Q

Which medications are highly protein bound?

What is phenytoin’s equation?

A

Valproic Acid and Phenytoin.

Adjusted level= measured total concentration / ((0.2 x albumin) +0.1).

20
Q

What are your big CYP inducers?

How does Lamotrigine interact with other drugs?

Which drugs affect oral contraceptives?

A

Phenytoin, Phenobarbital/primidone, Oxcarbazepine, topirmate, Carbamazepine.

Valproic acid increases lamotrigine. Carba, pheno, pheny, primidone, and rifampin decrease it.

Carba, Pheno, primidone, tompiramate, phenytoin, oxcarb.

21
Q

What is phenytoin’s therapeutic levels?

Do phenytoin and enteral tube feeds and apixaban have interactions?

Is carbamazepine is an autoinducer?

A

10-20.

Yes. lowers phenytoin, hold TF for 1-2 hours. Avoid in apixaban due to lowering it.

YES.

22
Q

Which AED’s have no or few major metabolic drug interactions?

What are the severely teratogenic ADE’s?

How do you treat prehospital status epilepticus?

A

Gaba, Levetiretacem.

Phenytoin, Valproic Acid, Carbamazepine, Phenobarbital, Topiramate.

rectal diazepam, intranasal midazolam.

23
Q

How do you treat impending (0-30) SE?

How do you treat SE(30-60)?

How do you treat refractory SE(>120)?

A

IV lorazepam.

1st line phenytoin or fosphenytoin,2nd line phenobarbital or valproic acid, 3rd line lacosamide, leveteritaceman.

Midazolam, pentobarbital, propofol.

24
Q

What are your abortive seizure options?

What is valproic acid’s therapeutic range? Carbamazepine? Phenobarbital?

What is Primidone’s therapeutic range? Ethosuximide?

A

Rectal Diazepam, Intranasal Midazolam, Sublingual lorazepam.

50-100. 4-12. 10-40.

5-12 mcg. 40-100.

25
Q

When is Carbamazepine CI’d?

What are Lamotrigine’s side effects?

Doex oxcarbazapine cause a rash?

A

Bone marrow suppression, Allergy to TCA’s, Use within 14 days of an MAOI.

Rash. Feeling off and dizziness at high doses. Do not increase dose more frequently than every 1-2 weeks to prevent rash.

Yes and hyponatremia.

Assessment 2.9 (6 decks)

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