Epilepsy (2)

Question 1

80% of adult seizures are

Answer 1

focal

Question 2

all antiepileptic drugs (AEDs) carry what black box warning?

Answer 2

suicidality

Question 3

what 6 drugs are a concern for renal dz?

Answer 3

gabapentin
topiramate
zonisamide
lacosamide
levetriacetam
pregabalin

Question 4

what 2 drugs are a concern for hepatic dz?

Answer 4

valproate and felbamate

Question 5

which drug is contraindicated in diabetes?

Answer 5

valproate (bc wt gain and insulin resistance)

Question 6

chronic AED use is associated with….

Answer 6

osteoporosis

Question 7

name the 3 drugs that work by inactivating sodium channels

Answer 7

phenytoin
carbamazepine
lamotrigine

Question 8

6 drugs that enhance gaba mediated inhibition

Answer 8

BZDP
barbiturates
topiramate?
gabapentin
tiagabine
vigabatrin

Question 9

which 2 drugs decrease glutamatinergic excitation

Answer 9

PB and topiramate?

Question 10

carbamazepine

Answer 10

blocks Na+ channels
for focal and generalized szs
highly protein bound
metabolism thru autoinduction

Question 11

ADRs for carbmazepine (6)

Answer 11

veritgo 
nausea
HA
SIADH
leukopenia
stevens-johnson syndrome(HLA B 1502)

Question 12

oxycarbazepine

Answer 12

blocks Na channels
focal and sec gen tonic-clonic sz
fewer sfx than phenytoin or carbamazepine

Question 13

phenytoin

Answer 13

blocks na channels and affects 2nd messenger
focal and generalized sz and status epilepticus
highly protein bound
basic pH IV- phlebitis

Question 14

Fosphenytoin

Answer 14

h2o soluble prodrug of phenytoin

less phlebitis, pruitis, and parestheisas than phenytoin

Question 15

Phenytoin considerations/ADRs

Answer 15

antiarrythminc -dont stop abruptly
folic acid depleted!
gingival hyperplasia!
hirsutism
teratogen(cleft palate)

Question 16

lamotrigine

Answer 16

blocks na and ca channels(diminishes glutamate activity)

adjunctive in focal and generalized sz as well as absence szs

Question 17

lamotrigine kinetics and AES

Answer 17

100% oral absorption
55% protein bound

rash, confusion, NV, diplopia

Question 18

zonisamide

Answer 18

sulfonamide derivative
blocks NA and ca channels, enhances GABA
adjunct for foacl and generalized sz
good oral absorption

Question 19

zonisamide sfx

Answer 19

sedation, nausea, cognitive impairment, rash, oligohydrosis, kidney stones

Question 20

lacosamide

Answer 20

monotherapy or adjuct for focal onset sz
100% absorbed oral and renal excretion with p450 met
ADR: dizzy nausea

Question 21

ethosuximide

Answer 21

inhib Ca channels
DOC for absence szs
absorbed orally p40 met
sfx: nausea, lethargy ha, anxiety

Question 22

phenobarbital

Answer 22

improves GABA
for gen and focal szs
P450 met and induce
sfx: sedation*, irritability, ataxia, slow thinking

Question 23

tiagabine

Answer 23

inhib GABA reuptake
adjunct for focal sz
quickly absorbed, inc clearance in Peds
sfx:dizziness, fatigue, nervousness, diff concentrating

Question 24

vigabatrin

Answer 24

irreversible inhib of gaba transaminase(inc gaba)
for infant sz, refractory focal szs
limited use dt BLACK BOX WARNING: permanent vision loss

Question 25

Perampanel

Answer 25

non-compt AMPA receptor antagonist
for adjunct tx of focal onset sz in those over 12
warnings of serious alt of mood and agression

Question 26

topiramate

Answer 26

blocks Na, enhances GABA, antag NMDA
hep met
ADR:wt loss, impaired cognition, HA, paresthesias, metabolic acidosis
TERATOGENIC

Question 27

Felbamate

Answer 27

augments gaba, competes for NMDA

for refractory lennox-gastuat syndrome

Question 28

valproic acid and sodium vlproate

Answer 28

ca current block and na block and enhance GABA

for gen and focal szs

Question 29

valproic acid sfx

Answer 29

n, v, hair loss, abdom pain, sedation, acute hepatic failure, pancreatitis, thrombocytopenia

Question 30

gabapentin

Answer 30

binds ca channels
adjuct for refract sz and newly diagnosed focal monotherapy
nonprotein bound
adjust does for CKD

Question 31

levetiracetam

Answer 31

moa unk
for focal and gen sz
favorable pk profile completely absorbed and minimal protein bound

Question 32

pregabalin

Answer 32

related to gabapentin
modulates glutamate, noreadrenaline, and sub p
adjuct for partial onset sz
adjust dose for CKD
sfx:dizziness, somnolence, dry mouth, periph edema

Question 33

medication can be d/c if pt is sz free for _____ years. med must be tapered gradually

Answer 33

2-5 years

Question 34

status epilepticus is a sz lasting more than…

Answer 34

5 minutes

Question 35

Initial therapy for status epilepticus (SE) s/b a ____________ drug. 3 examples

Answer 35

benzodiazepine
lorazepam!(wait 1 min for response then repeat)
diazepam
midazolam

Question 36

_________ is the prefered secondline nonbenzo tx. ______ and ______ are alternatives.

Answer 36

Fosphenytoin

phenytoin
valproic acid

Question 37

benzos are good for…

Answer 37

termination of SE, admin 1-3 doses q1 minute

not indicated if sz has stopped

Question 38

Lorazepam

Answer 38

DOC for pt with IV access in SE
-may cause vein irritation, DILUTE
DOA: 12-24 hrs

Question 39

Diazepam

Answer 39

2nd choice to termnate sz bc lipophilic and dist out of brain quickly as well as short DOA (15min-2hrs)
however, if no IV acess this can be admin rectally

Question 40

Midazolam

Answer 40

3rd choice to terminate sz
can be given IM
or given by continuous infusion for refractory szs

Question 41

___________ are the 2nd line after 2-3 doeses of benzos

Answer 41

hydantoins

Question 42

levetriacetam and lacosamide

Answer 42

useful for focla or nonconvulsive szs

Question 43

Phenobarbital

Answer 43

prefered to phenytoin in Peds
3rd line agent if sz presists after 2-3 doses of benzo and loading dose of hydantoin
more CNS and resp dep than hydantoins
propylene glycol can cuase toxicity with repeated admin

Question 44

____________ and ________ are used for maintenance therapy

Answer 44

hydantoins and phenobarbital