Epilepsy: really really important content

Question 1

List the drugs that can induce seizures

will be on exam

Answer 1

BATHMIC
1) Bupropion
2) Alcohol, benzodiazepine or barbiturate withdrawal
3) Theophylline
4) Haloperidol and clozapine
5) Meperidine (opioid)
6) Illegal drug overdose (i.e., cocaine)
7) Carbapenem/ imipenem

Question 2

Medication that induce lamotrigine glucuronidation include what?

Will be on exam

Answer 2

1) Carbamazepine
2) Phenobarbital
3) Phenytoin
4) Primidone
5) Rifampin
6) Lopinavir/ ritonavir
7) Atanazivir/ ritonavir
+ estrogen

Question 3

What is the one med that inhibits lamotrigine glucuronidation?

will be on exam

Answer 3

Valproic acid

Question 4

1) Oral contraceptives do what to lamotrigine metabolism?
2) What does this mean you need to do?

“big test thing”

Answer 4

1) Estrogen induces UGT and increases lamotrigine metabolism
2) Increase lamotrigine dose; may see doses of 150 mg to 200 mg PO BID

Question 5

Lamictal
1) Must be re-titrated if a patient misses more than ____ half-lives duration of medication
2) Consider titration after missing _____ days of therapy w/ phenytoin, phenobarbital, primidone or carbamazepine
3) Consider after missing _______ days of therapy w/out valproic acid or an inducer
4) Consider after missing ______ days of therapy w/ valproic acid

“Know if you need to re-titrate”

Answer 5

1) 5
2) 2.5
3) 5
4) 10

Question 6

What ASDs may cause folate deficiency (with megaloblastic anemia) with long term use?

Answer 6

Phenobarbital + Phenytoin + Primidone

Question 7

What drug can cause purple glove syndrome with IV administration?

Answer 7

Phenytoin

Question 8

Valproate/ Divalproex has a boxed warning for what 3 things?
(important)

Answer 8

1) Hepatotoxicity; especially for children <2 years of age and with mitochondrial disorders
2) Fetal risk including neural tube defects, other major malformations, and decreased IQ
3) Pancreatitis including fatal hemorrhagic pancreatitis

Question 9

Which drug is assoc. with infection?

Answer 9

Lamictal/ lamitrigine

Question 10

What drug has a boxed warning for aggression, hostility, irritability, anger, and homicidal ideation?

“Know this”

Answer 10

Perampanel

Question 11

Rufinamide (Banzel):
1) Is contraindicated in what?
2) When should you use caution?

“unique”

Answer 11

1) Severe liver impairment or in familial short QT syndrome
2) With other drugs that shorten QT interval

Question 12

Vigabatrin (Sabril): What’s the weird disadvantage? Explain

Answer 12

Permanent vision loss in most patients after a certain duration of exposure requiring eye exams Q3 months; requires REMS* program registration

*A Risk Evaluation and Mitigation Strategy (REMS) is a drug safety program that the U.S. Food and Drug Administration (FDA) can require for certain medications with serious safety concerns to help ensure the benefits of the medication outweigh its risks.

Question 13

Any seizure that does not stop within ____ minutes should be aggressively treated as impending SE.

Answer 13

5

Question 14

IV _______________ is the preferred benzodiazepine for initial treatment of GCSE because of its efficacy and long duration of action in the central nervous system (CNS).

Answer 14

lorazepam

Question 15

List the meds you need to give for status epilepticus in order

Answer 15

0-30 minutes: lorazepam IV

30-60 minutes: phenytoin IV

> 120 minutes: midazolam IV, phenobarbital IV or propofol IV

Question 16

Why lorazepam at hospital and diazepam at home?

this is a test question

Answer 16

Lorazepam has the longest half life and longest efficacy. Also lipophilic and rapid acting.