Epilepsy Flashcards
seizure definition
uncontrolled electrical activity in brain, which may produce physical convulsion, minor physical signs, thought disturbances, or a combo of these
epilepsy
at least 2 seizures unattributed to some other disease process (metbaolic, wdrawal etc. )
seizure incidence is highest in which ages
0-20 and 60-80
non-epileptic seizure causes
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
epileptic seizures patho
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
predictors of favorable outcome IN AED tx
seizure free >3yrs
monotherapy
background EEG normal
no psychomotor retardation
does not have juvenile myoclonic epilepsy
longer seizure-free period–> better dx
CBZ + VPA DDI
produces epoxide
factors favoring low risk for occurance after DC AEDs
> 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
epilepsy tx during pregnancy, what we CAN USE
what CANT we use?
no divalproex sodium–> neural tube defects
if >2yrs no seizure, can go w/ out tx
NO CBZ, VPA, LMG, PB
OC and AED compatibility
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. …
supplement w ______ in pregnant epileptics
folate!!! diet and suspension
if a pregnnat pateint w epilepsy is taking VPA or CBZ what should be done
offer dx amniocentesis for fetoprotein at wk 16, ultrasound wk 18, 22
what AEDs cause neural tube defects
CBZ and VPA
AED dose baby receives in breastfeeding is ____ than the dose received in utero
lower!
AEDs that can be used in breast feeding
CBZ, VPA, pheny, Primidone, PB
AEDs CI in breast feeding
ethosuximide, zonisamide, clonazepam, diazepam
LEV
MOA, use
dosing
AE
pearls
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)
LEV and focal partial onset seizure dosing
1g qd
inc 500mg/dose up to 3g qd
OXC
use
advantages
AE:
monitoring
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
LTG uses
dosing
adv, disadv
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
Gabapentin
use
absorption PK
dosing
adv
disadv
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
Phenytoin
use
dose
AE
conc dep, idiosyncratic, chronic
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
VPA
dose
Cp desired
AE
what AEDs dec VPA levels
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!!
CBZ dosing
Cpss
AE
DDI
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
