Epilepsy

Question 1

seizure definition

Answer 1

uncontrolled electrical activity in brain, which may produce physical convulsion, minor physical signs, thought disturbances, or a combo of these

Question 2

epilepsy

Answer 2

at least 2 seizures unattributed to some other disease process (metbaolic, wdrawal etc. )

Question 3

seizure incidence is highest in which ages

Answer 3

0-20 and 60-80

Question 4

non-epileptic seizure causes

Answer 4

metabolic disturbances (renal disease, dialysis, a deficiency state, local effects of brain tumor)
wdrawal from sedative/hypnotic drugs including ethanol, infection, renal failure, hypoxic encephalopathy, febrile convulsions

Question 5

epileptic seizures patho

Answer 5

a cluster of cells known as foci, spontaneously depolarize and fire at abnormal rate which causes synchronous fire, adjacent cells are recruited to do so too –> seizure

Question 6

predictors of favorable outcome IN AED tx

Answer 6

seizure free >3yrs
monotherapy
background EEG normal
no psychomotor retardation
does not have juvenile myoclonic epilepsy
longer seizure-free period–> better dx

Question 7

CBZ + VPA DDI

Answer 7

produces epoxide

Question 8

factors favoring low risk for occurance after DC AEDs

Answer 8

> 2 yr seizure free
normal EEG
short duration of epilepsy prior to tx
few seizures after starting AED
control w monotherapy
<16 yo at onset of seizures
presence of absence seizures only

Question 9

epilepsy tx during pregnancy, what we CAN USE
what CANT we use?

Answer 9

no divalproex sodium–> neural tube defects
if >2yrs no seizure, can go w/ out tx
NO CBZ, VPA, LMG, PB

Question 10

OC and AED compatibility

Answer 10

DIV SOD does not affect OC efficacy BUT is teratogenic…

Phenobarbital, phenytoin, primidone, and CBZ inc CL of estrogen and dec OC effectiveness

if we inc E dose to compensate, inc risk of seizure, stroke etc. …

Question 11

supplement w ______ in pregnant epileptics

Answer 11

folate!!! diet and suspension

Question 12

if a pregnnat pateint w epilepsy is taking VPA or CBZ what should be done

Answer 12

offer dx amniocentesis for fetoprotein at wk 16, ultrasound wk 18, 22

Question 13

what AEDs cause neural tube defects

Answer 13

CBZ and VPA

Question 14

AED dose baby receives in breastfeeding is ____ than the dose received in utero

Answer 14

lower!

Question 15

AEDs that can be used in breast feeding

Answer 15

CBZ, VPA, pheny, Primidone, PB

Question 16

AEDs CI in breast feeding

Answer 16

ethosuximide, zonisamide, clonazepam, diazepam

Question 17

LEV
MOA, use
dosing
AE
pearls

Answer 17

AMDA glutamate receptor antag, most seizure types
500mg BID, inc 500mg/dose up to 1.5g BID
renal dsoe adjustments based on GFR
potentiates CNS depressants (benzos and opiates)

Question 18

LEV and focal partial onset seizure dosing

Answer 18

1g qd
inc 500mg/dose up to 3g qd

Question 19

OXC
use
advantages
AE:
monitoring

Answer 19

adjunctive tx in partial seizures 6+ yo
5mg/kg/d titrate 5mg/kg/d qwk up to 30-50mg/kg/d
dec DDI (low ppb, low hepatic enzyme effects)
AE: somnolence, dizziness, HA, NV, RASH (4-5%)
monitor Na, hepatic

Question 20

LTG uses
dosing
adv, disadv

Answer 20

0.5mg/kg/d x2wks, 1mg/kg/d x2wks, inc 1mg/kg/d q2wk until respond
adv: broad spec, no sedation, low teratogenicity
disadv: SJS–> NEED to titrate slowly

Question 21

Gabapentin
use
absorption PK
dosing
adv
disadv

Answer 21

partial seizures, momo tx or add on
target dose is 30mg/kg/d
MDD 1800mg/d
TID dosing
PK: inc dose–> dec amt absorbed (can titrate rapidly)

adv: no PK interactions, used for pain and mood too, dec neurotoxic AE
disadv: TID dosing, somnolence, weight gain, dizzy, ataxia, considered a low potency drug

Question 22

Phenytoin
use
dose
AE
conc dep, idiosyncratic, chronic

Answer 22

generalized sz
200-400mg qd
[ ]-dep AE: nystagmus, double or blurred vision, drowsy, dizzy, HA
idiosyncratic AE: aplastic anemia, granulocytopenia, hepato tox, SJS< lupus-like rxn
chronic AE: gum hypertrophy, acne, hirsutism, periph n, cerebellar damage, megaloblastic anemia, OP, fetal dec vit K

Question 23

VPA
dose
Cp desired
AE
what AEDs dec VPA levels

Answer 23

15mg/kg/d div 3-4 doses, in 5mg/kg/d qwk
max is 60mg/kg/d
Cp d 50-120mg/L
AE: NVD, abdominal pain —> take w food or milk
CBZ, LTG, PHT, RIF dec VPA levels!!

Question 24

CBZ dosing
Cpss
AE
DDI

Answer 24

600-2000mg/d div BID, QID
Cpss at 2-4 d = 4-12mg/L
AE: drowsy, HA, diplopia, NV, hyponatremia, water intoxication, transient leukopenia
CBZ induces DOAC, OC, CS, CYA, doxy, halop, ADs, theophylline metab
CBZ metab inhibited by cimetidine, clarithro, erythro, danazol, fluoxetine