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NAPLEX REVIEW > Epilepsy/Seizures > Flashcards

Epilepsy/Seizures Flashcards

1
Q

Partial seizures

A

start in 1 side of brain (can spread across)

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2
Q

Simple partial seizure

A

No LOC

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3
Q

Complex partial seizure

A

LOC

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4
Q

Genearlized seizures

A

Starts in both parts of brain and leads to LOC

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5
Q

Status epilepticus

A

> 5 minutes or > or = to 2 or more seizures without regaining consciousness in between

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6
Q

Pregnancy Category D

A

Carbamazepine, Clonazepam, Phenobarb/Primidone, Phenytoin/Fosphenytoin, Topiramate, VPA (VPA is D for seizures and X if for migraine prophylaxis)

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7
Q

Preganancy Category C

A

Lyrica, Neurontin, Lamictal, Keppra

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8
Q

Most common AEs of AEDs

A

CNS depression

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9
Q

Inducers

A

Carbamazepine, Oxcarbazepine, Fospehnytoin/Phenytoin, Phenobarb/Primidone, Topiramate

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10
Q

With inducers you need to add…

A

Vitamin D and Ca+2

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11
Q

DI with inducers

A

Use a non-hormonal birth control

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12
Q

Drugs that lower seizure threshold

A

Antipsychotics, antivirals, bupropion, carbapenems (imipenem), cephalosporins, FQs, Lindane, Li+2 and theophylline (in toxicity), Meperidine, Metoclopramide, Penicillins, Tramadol, Natural products (primrose oil, gingko, melatonin, dendrobium)

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13
Q

Medguide required with AEDs stating….

A

Increased risk of suicidality

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14
Q

Dosing requirements

A

Upward titration and tapering off

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15
Q

DOC for status epilepticus

A

IV Ativan (midazolam IM alternative) follwed by phenytoin (max 50 mg/min) or fosphenytoin (max 150 mg/min)

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16
Q

Keppra, Keppra XR generic

A

Levetiracetam

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17
Q

Keppra indicated for…

A

adjunctive therapy for all types except absence seizures

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18
Q

AEs of Keppra

A

Somnolnce, dizziness, weakness, infection (must report signs)

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19
Q

Tx for partial seizures (including secondarily generalized)

A

Carbamazepine, Lamictal, Keppra, Oxcarbazepine

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20
Q

Tx for primary generalized tonic-clonic

A

Lamictal, Keppra, Valproate

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21
Q

Tx for absence seizures (which are often outgrown)

A

Ethosuximide, Valproate

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22
Q

Tx for atypical absence seizures, myoclonic, atonic

A

Ethosuximide, Keppra, Lamictal, VPA

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23
Q

Minimal DIs

A

Lamictal, Lyrica, Gabapentin, Lacosamide

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24
Q

Lamictal generic

A

Lamotrigine

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25
Q

Lamictal indicated for…

A

adjunctive therapy for all types except absence seizures, also bipolar

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26
Q

Lamictal has chewable formulation

A

and ODT

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27
Q

Lamictal MOA

A

excitation (glutamate and aspartate)

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28
Q

Lamictal AEs

A

N/V, insomnia, somnolence, rash (SJS/TEN), headache

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29
Q

Lamictal formulations

A

3 different kinds (orange for those not taking interacting meds), blue for those on VPA (due to VPA inc { }s of lamictal), and green (for those taking inducers) - different type

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30
Q

VPA DI with Lamictal

A

VPA increases Lamictal 2x = inc SJS risk

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31
Q

Tegretol, Tegretol XR, Carbatrol, Epitol generic

A

Carbamazepine

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32
Q

Carbamazepine MOA

A

NA blocker (similar to TCAs)

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33
Q

Tegretol indications

A

Trigeminal neuralgia, bipolar (Equetro), and partial seizures

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34
Q

TR of Tegretol

A

4-12 mcg/mL

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35
Q

AEs of Tegretol

A

SIADH (inc water retention, same sodium, dilutional hyponatremia), hypothyroidism, SJS/TEN (ALL ASIANS MUST BE TESTED FOR ALLELE HLA-B*1502), aplastic anemia, agranulocytosis, photosensitivity, ataxia, dry mouth due to anticholinergic effects

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36
Q

Carbamazepine is an inducer/inhibitor…

A

inducer (AUTOINDUCER - even decreases concentrations of itself)

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37
Q

Trileptal, Oxtellar XR generic

A

Oxcarbazepine

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38
Q

Oxcarbazepine indications

A

partial seizures

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39
Q

Cross-sensitivity with

A

Carbamazepine (25-30%)

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40
Q

Oxcarbazepine AEs

A

hyponatremia, SJS/TEN (Asians CAN be tested for HLA-B*1502), nystagmus/vision disturbances

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41
Q

Oxcarbazepine reduced in…

A

renal impairment CrCl <30

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42
Q

Depakene, Depacon, Stavzor generic

A

Valproate/Valproic Acid

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43
Q

Depakote, Depakote ER, Depakote Sprinkle generic

A

Divalproex

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44
Q

TR of VPA

A

50-100 mcg/mL

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45
Q

VPA/Depakote Boxed warnings

A

Hepatic failure (mostly in children

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46
Q

AEs of VPA/Depakote

A

Hyperammonemia, tremor, PCOS, alopecia, anorexia, weight gain

Dose related: thrombocytopenia (monitor platelets), diplopia and blurred vision occur with toxic doses

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47
Q

VPA pregnancy category

A

D for seizures, X for migraine prophylaxis

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48
Q

VPA MOA

A

increase GABA (Ca and Na blocker)

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49
Q

Dilantin, Dilantin Infatabs, Phenytek generic

A

Phenytoin

50
Q

Phenytoin/Fosphenytoin MOA

A

fast Na channels –> stabilizing neuronal membrane

51
Q

Fosphenytoin is dosed in…

A

Pehnytoin equivalents (PE) - 1:1

52
Q

Phenytoin follows ________ kinetics

A

Michaelis-Mentin kinetics (saturable kinetics), sometimes small doses lead to a greatly increased plasma [ ]

53
Q

Low albumin (<3.5) can affect which AEDs?

A

VPA/Divalproex and Phenytoin/Fosphenytoin

54
Q

Prodrug of Phenytoin

A

Fosphenytoin

55
Q

IV Phenytoin is a vesicant and can lead to

A

purple glove syndrome

56
Q

Max rate of IV phenytoin infusion

A

50 mg/min

57
Q

Max rate of fosphenytoin infusion

A

150 mg/min

58
Q

AEs of Phenytoin/Fosphenytoin

A

SJS/TEN (should screen Asian patients for HLA-B*1502)
Dose-related: nystagmus, ataxia, dizziness, confusion, blurred vision, displopia, slurred speach
Chronic use: skin thickening, gingival hyperplasia, coarsening of facial features (uglifying drug)

59
Q

Phenytoin/Fosphenytoin are inducers/inhibitors

A

INDUCERS

60
Q

IV Phenytoin can only be mixed with

A

NS (requires a filter and is stable for 4 hours)

61
Q

IV: PO of Phenytoin

A

1:1

62
Q

If albumin is low must correct PHT

A

corrected PHT = (PHT measured)/((0.2xalb) +1)

63
Q

Enteral feedings must be separated by…

A

1-2 hours prior or 1-2 hours after phenytoin

64
Q

Topamax generic

A

Topiramate

65
Q

Topamax MOA

A

enhances GABA (inhibitory)

66
Q

Warnings of Topamax

A

metabolic acidosis, oligohydrosis (reduced perspiration/hyperthermia), nephrolithiasis (kidney stones), hyperammonemia, visual problems (reversible)

67
Q

AEs of Topamax

A

paresthesias, weight loss, anorexia, mood changes

68
Q

Indications of Topamax

A

adjunctive for seizures, migraine prophylaxis

69
Q

Must titrate Topamax due to

A

CNS effects

70
Q

Pregnancy category of Topamax

A

D - cleft palate/lip

71
Q

Lyrica generic

A

Pregabalin

72
Q

AEs of Pregabalin

A

Fluid retention

73
Q

MOA of Pregabalin

A

excitatory neurons (glutamate and aspartate) through Ca chanells

74
Q

Pregabalin indications

A

Adjunctive therapy for partial seizures and neuropathic pain

75
Q

AEs of Pregabalin

A

Weight gain, ataxia, diplopia, blurred vision, dry mouth, mild euphoria

76
Q

Neurontin generic

A

Gabapentin

77
Q

Neurontin indications

A

Postherptic neuralgia, RLS, seizures

78
Q

AEs of Gabapentin

A

Diplopia, weight gain/edema, dry mouth, blurred vision

79
Q

Gabapentin off-label uses

A

fibromyalgia, pain, headache, peripheral neuropathy, drug abuse, alcohol withdrawal

80
Q

DIs with Pregabalin/Gabapentin

A

None significant - but use caution with glitazones and pregabalin due to additive edema

81
Q

Phenobarbital/Primidone are what class

A

Barbiturate

82
Q

Things barbiturates have in common with opioids and benzos

A

Physical dependence, tolerance, and addictive potential

83
Q

TR of Phenobarbital/Primidone

A

20-40 mcg/mL

84
Q

Do not give Phenobarb injection by

A

SC administration

85
Q

Paradoxical reactions of Phenobarbital/Primidone

A

hyperactive/aggressive behavior (with acute pain or in PEDs)

86
Q

Primidone is a prodrug of

A

Phenobarbital and Phenylethylmalonamide (PEMA) - both are active metabolites

87
Q

AEs of Phenobarbital/Primidone

A

Physiological dependence, tolerance, and hangover effects

Also SJS/TEN

88
Q

Phenobarbital/Primidone are inducers/inhibitors

A

INDUCERS

89
Q

VPA is an inducer/inhibitor

A

INHIBITOR

90
Q

Ethosuximide brand name

A

Zarontin

91
Q

Ethosuximide AEs

A

Very well tolerated (GI -N/V/ weight loss/abdominal pain) and hiccups)

92
Q

Ethosuximide DOC for

A

absence seizures

93
Q

Lacosamide brand name

A

Vimpat

94
Q

Warnings of Lacosamide

A

Increased PR interval - arrhythmias - use caution in CV patients and monitor ECG at baseline and at SS

95
Q

Clobazam brand

A

Onfi

96
Q

Clobazam class

A

Benzo

97
Q

Clobazam indication

A

Lennox-Gastaut syndrome

98
Q

Ezogabine brand

A

Potiga

99
Q

Potiga used for

A

Refractory partial seziures

100
Q

Potiga BBW

A

retinal abnormalitis (vision loss - 33% after 4 yr tx)

101
Q

Felbamate brand

A

Felbatol

102
Q

Felbatol indication

A

Refractory seizures

103
Q

BBW of Felbatol

A

Hepatic failure and aplastic anemia (must sign informed consent to take)

104
Q

Perampanel brand

A

Fycompa

105
Q

Fycompa BBW

A

neuropsych events

106
Q

Vigabatrin brand

A

Sabril

107
Q

Sabril indications

A

Refractory seizures

108
Q

Sabril BBW

A

permanent vision loss (30% of patients)

109
Q

Zonisamide brand

A

Zonegran

110
Q

CI of Zonegran

A

Hypersensitivity to sulfonamides

111
Q

AEs of Zonegran

A

oligohydrosis, nephrolithiasis

112
Q

Teratogenic AEDs

A

Carbamazepine, Phenytoin, Clonazepma, Topiramate, Phenobarbital, VPA

113
Q

Hepatotoxicity AEDs

A

Carbamazepine, Felbamate, Phenobarb/Primidone, Phenytoin, VPA

114
Q

Decreases efficacy of oral contraceptives with these AEDs

A

Carbamazepine, Clobazam, Oxcarbazepine, Perampanel, Phenobarb, Phenytoin, Primidone, Topiramate

115
Q

Fatal pancreatits AEDs

A

VPA

116
Q

Aplastic anemia AEDs

A

Carbamazepine (and agranulocytosis), Felbamate

117
Q

SJS AEDs

A

Carbamazepine, Lamictal, Oxcarbazepine, Phenobarb, Tigabine, Zonisamide, Phenytoin/Fosphenytoin

118
Q

Oligohydrosis AEDs (inability to sweat, risk of heat stroke, and highest risk in children)

A

Topiramate, Zonisamide

119
Q

Nephrolithiasis (kidney stones) AEDs

A

Topiramate, Zonisamide

120
Q

Weight gain AEDs

A

VPA, Gabapentin, Pregabalin

121
Q

Weight loss AEDs

A

Felbamate, Ethosuximide, Topiramate, Zonisamide

122
Q

Hyponatremia AEDs

A

Carbamazepin, Oxcarbazepine (more common)

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