EPILEPSY

Question 1

WHICH KEY DRUGS CAN LOWER SEIZURE THRESHOLDS

Answer 1

BUPROPION
CLOZAPINE
THEOPHYLLINE
VARENICLINE
CARBAPENEMS
LITHIUM
MEPERIDINE
PENICILLIN
QUINOLONES
TRAMADOL

Question 2

SEIZURE EPILEPTICUS

Answer 2

SEZURES LASTING BEYOND 5 MINUTES
MEDICAL EMERGENCY

Question 3

STATUS EPILEPTICUS TREATMENT: PHASES AND TIMING

Answer 3

STABILIZATION: 0-5 MINUTES
INITIAL TREATMENT: 5-20 MINUTES
SECOND TREATMENT: 20-40 MINUTES

Question 4

STAUS EPILEPTICUS STABILIZATION PHASE

Answer 4

START TIMING SEIZURE
SUPPORT: OXYGEN
MONITOR: ECG, AED LEVELS, ELECTROLYTES, BG

Question 5

STATUS EPILEPTICUS: INITIAL TREATMENT PHASE

Answer 5

BENZO INJECTION, THEN ALTERNATIVES
- IV LORAZEPAM
- IM MIDAZOLAM
- RECTAL DIAZEPAM
- BUCCAL, NASAL MIDAZOLAM

Question 6

STATUS EPILEPTICUS: SECOND TREATMENT PHASE

Answer 6

GIVE REGULAR AED: FOSPHENYTOIN, VALPROIC ACID, KEPPRA, PHENOBARBITAL

IF SEIZURE CONTINUES, NO CLEAR TREATMENT

Question 7

KETOGENIC DIET HELPS WITH WHAT KIND OF SEIZURES

Answer 7

REFRACTORY SEIZURES

Question 8

A KETOGENIC DIET CONSISTS OF…

Answer 8

4:1 RATIO OF FTS TO COMPINED PROTEIN AND CARBS
PUTS BODY IN KETOSIS, REDUCING SEIZURE FREQUENCY

Question 9

WHICH AED IS SPECIFICALLY INDICATED FOR ABSENCE SEIZURES

Answer 9

ETHOSUXAMIDE

Question 10

WHICH AED CAN CAUSE VISION LOSS

Answer 10

VIGABATRIN

Question 11

AED MOA: BEZODIAZEPINE

Answer 11

↑ GABA

Question 12

AED MOA: VALPROIC ACID

Answer 12

↑ GABA

Question 13

AED MOA: ETHOSUXAMIDE

Answer 13

T-TYPE CA CHANNEL BLOCKER
SLOWS TRANSMISSION OF ELECTRICAL SIGNAL

Question 14

AED MOA: CARBAMAZEPINE

Answer 14

NA CHANNEL BLOCKER

Question 15

AED MOA: PHENYTOIN

Answer 15

NA CHANNEL BLOCKER

Question 16

CARBAMAZEPINE IS “COUSIN” TO WHICH AGENTS AND HAVE WHICH SHARED ADR?

Answer 16

OXCARBAZEPINE AND ESLICARBAZEPINE
↓NA, RASH, ENZYME INDUCTION

Question 17

GABAPENTIN AND PREGABALIN ADR

Answer 17

WEIGHT GAIN, PERIPHERAL EDEMA, MILD EUPHORIA

Question 18

PHENOBARBITAL IS “COUSIN” TO WHICH AGENTS AND HAVE WHAT SHARED ADR?

Answer 18

PRIMIDONE
SEDATION,
DEPENDENCE/TOLERANCE/OVERDOSE RISK
ENZYME INDUCTION

Question 19

TOPIRAMATE IS “COUSIN” WITH WHAT AGENT AND HAS WHAT SHARED ADR?

Answer 19

ZONISAMIDE
WEIGHT LOSS, METABOLIC ACIDOSIS
NEPHROLITHIASIS AND OLIGOHIDROSIS/HYPERTHERMIA

Question 20

WHAT VITAMINS/SUPPLEMENTS SHOULD BE TAKEN WITH AEDS

Answer 20

ALL: CA, VIT D
WOMEN OF CHILD BEARING AGE: FOLATE
VALPROIC ACID: CARNITINE
LAMOTRIGINE & VALPROATE: SELENIUM AND ZINC IF ALOPECIA

Question 21

LAMOTRIGINE INITIAL DOSING

Answer 21

WEEKS 1 AND 2: 25 MG DAILY

Question 22

LAMOTRIGINE BOXED WARNING

Answer 22

SJS/TENS, DRESS

Question 23

LAMOTRIGINE SIDE EFFECTS

Answer 23

ALOPECIA - CAN SUPPLEMENT WITH SELENIUM AND ZINC

Question 24

LAMOTRIGINE STARTER KIT COLOR DOSES

Answer 24

ORANGE = STANDARD STARTING DOSE
BLUE = LOWER STARTING DOSE (USED IF TAKING ENZYME INHIBITOR)
GREEN = HIGHER STARTING DOSE (USED IF TAKING ENZYME INDUCER)

Question 25

WHICH AEDs ARE ENZYME INHIBITOR

Answer 25

VALPROIC ACID

Question 26

WHICH AEDs ARE ENZYME INDUCERS

Answer 26

CARBAMAZEPINE PHENYTOIN PHENOBARBITAL/PRIMIDONE

Question 27

WHICH AEDS ARE BROAD SPECTRUM

Answer 27

LAMOTRIGINE KEPPRA TOPIRAMATE VALPROATE

Question 28

WHICH AEDS ARE NARROW SPECTRUM

Answer 28

CARBAMAZEPINE LACOSAMIDE OXCARBAZEPINE PHENOBARBITAL PHENYTOIN

Question 29

CARBAMAZEPINE THERAPEUTIC RANGE

Answer 29

4 - 12 MCG/ML

Question 30

CARBAMAZEPINE BOXED WARNING

Answer 30

SJS/TEN, HLA-B*1502 APLASTIC ANEMIA AND AGRANULOCYTOSIS

Question 31

CARBAMAZEPINE CONTRAINDICATION

Answer 31

MYELOSUPPRESSION

Question 32

CARBAMAZEPINE WARNING

Answer 32

SIADH (↓ NA) FETAL HARM

Question 33

WHICH AED IS AN AUTOINDUCER

Answer 33

CARBAMAZEPINE

Question 34

LACOSAMIDE WARNIGN

Answer 34

EXTENDS PR INTERVAL AND ↑RISK OF ARRHYTHMIAS

Question 35

OXCARBAZEPINE CONTRAINDICATION AND WARNINGS

Answer 35

HYPERSENSITIVITY TO CARBAMAZEPINE SJS/TEN, HLA-B*1502

Question 36

PHENOBARBITAL THERAPEUTIC RANGE

Answer 36

20 - 40 MCG/ML IN ADULTS 15 - 40 IN CHILDREN

Question 37

PHENOBARBITAL WARNINGS

Answer 37

HABIT FORMING, RESPIRATORY DEPRESSION FETAL HARM

Question 38

PHENOBARBITAL SIDE EFFECTS

Answer 38

PHYSIOLOGICAL DEPENDENCE TOLERANCE HANGOVER EFFECT

Question 39

PHENOBARBITAL CONTRAINDICATION

Answer 39

HEPATIC IMPAIRMENT

Question 40

PHENYTOIN/FOSPHENYTOIN THERAPEUTIC RANGE

Answer 40

10 - 20 MCG/ML TOTAL LEVEL 1 - 2.5 MCG/ML FREE LEVEL

Question 41

PHENYTOIN/FOSPHENYTOIN BOXED WARNING

Answer 41

PHENYTOIN IV RATE SHOULD NOT EXCEED 50 MG/MINUTE FOSPHENYTOIN IV SHOULD NOT EXCEED 150 MG PE/MINUTE IF FASTER, RISK OF CARDIAC ARRHYTHMIAS

Question 42

PHENYTOIN/FOSPHENYTOIN WARNINGS

Answer 42

EXTRAVASATION LEADING TO PURPLE GLOVE SYNDROME HLA-B*1502, SJS/TEN, DRESS FETAL HARM

Question 43

PHENYTOIN/FOSPHENYTOIN DOSE RELATED SIDE EFFECT

Answer 43

NYSTAGMUS ATAXIA DIPLOPIA

Question 44

PHENYTOIN/FOSPHENYTOIN CHRONIC USE SIDE EFFECT

Answer 44

GINGIVAL HYPERPLASIA HAIR GROWTH HEPATOTOXICITY

Question 45

GIVING PHENYTOIN WHILE ON NG-TUBE

Answer 45

ENETERAL FFEDING ↓ PHENYTOIN ABSORPTION HOLD FEEDING 1-2 HOURS BEFORE AND AFTER ADMIN

Question 46

ETHOSUXIMIDE WARNING

Answer 46

SJS/TEN BLOODS DYSCRASIAS

Question 47

FELBAMATE BOXED WARNING

Answer 47

HEPATIC FAILURE APLASTIC ANEMIA

Question 48

FENFLURAMINE BOXED WARNING

Answer 48

VALVULAR HEART DISEASE PULMONARY HTN ↓ APPETITE/WEIGHT LOSS

Question 49

ZONISAMIDE CONTRAINDICATION

Answer 49

HYPERSENSITIVITY TO SULFONAMIDES

Question 50

ZONISAMIDE SIDE EFFECTS

Answer 50

OLIGOHIDROSIS/HYPERTHERMIA NEPHROLITHIASIS

Question 51

ADJUSTING PHENYTOIN DOSES

Answer 51

(TOTAL PHENYTOIN MEASURED) / ( [0.2 X ALBUMIN] + 0.1) ADJUST IF ALBUMIN IS LOW <3.5 AND CRCL ≥ 10