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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
Lamictal indicated for...
adjunctive therapy for all types except absence seizures, also bipolar
26
Lamictal has chewable formulation
and ODT
27
Lamictal MOA
excitation (glutamate and aspartate)
28
Lamictal AEs
N/V, insomnia, somnolence, rash (SJS/TEN), headache
29
Lamictal formulations
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
30
VPA DI with Lamictal
VPA increases Lamictal 2x = inc SJS risk
31
Tegretol, Tegretol XR, Carbatrol, Epitol generic
Carbamazepine
32
Carbamazepine MOA
NA blocker (similar to TCAs)
33
Tegretol indications
Trigeminal neuralgia, bipolar (Equetro), and partial seizures
34
TR of Tegretol
4-12 mcg/mL
35
AEs of Tegretol
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
36
Carbamazepine is an inducer/inhibitor...
inducer (AUTOINDUCER - even decreases concentrations of itself)
37
Trileptal, Oxtellar XR generic
Oxcarbazepine
38
Oxcarbazepine indications
partial seizures
39
Cross-sensitivity with
Carbamazepine (25-30%)
40
Oxcarbazepine AEs
hyponatremia, SJS/TEN (Asians CAN be tested for HLA-B*1502), nystagmus/vision disturbances
41
Oxcarbazepine reduced in...
renal impairment CrCl <30
42
Depakene, Depacon, Stavzor generic
Valproate/Valproic Acid
43
Depakote, Depakote ER, Depakote Sprinkle generic
Divalproex
44
TR of VPA
50-100 mcg/mL
45
VPA/Depakote Boxed warnings
Hepatic failure (mostly in children
46
AEs of VPA/Depakote
Hyperammonemia, tremor, PCOS, alopecia, anorexia, weight gain Dose related: thrombocytopenia (monitor platelets), diplopia and blurred vision occur with toxic doses
47
VPA pregnancy category
D for seizures, X for migraine prophylaxis
48
VPA MOA
increase GABA (Ca and Na blocker)
49
Dilantin, Dilantin Infatabs, Phenytek generic
Phenytoin
50
Phenytoin/Fosphenytoin MOA
fast Na channels --> stabilizing neuronal membrane
51
Fosphenytoin is dosed in...
Pehnytoin equivalents (PE) - 1:1
52
Phenytoin follows ________ kinetics
Michaelis-Mentin kinetics (saturable kinetics), sometimes small doses lead to a greatly increased plasma [ ]
53
Low albumin (<3.5) can affect which AEDs?
VPA/Divalproex and Phenytoin/Fosphenytoin
54
Prodrug of Phenytoin
Fosphenytoin
55
IV Phenytoin is a vesicant and can lead to
purple glove syndrome
56
Max rate of IV phenytoin infusion
50 mg/min
57
Max rate of fosphenytoin infusion
150 mg/min
58
AEs of Phenytoin/Fosphenytoin
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
Phenytoin/Fosphenytoin are inducers/inhibitors
INDUCERS
60
IV Phenytoin can only be mixed with
NS (requires a filter and is stable for 4 hours)
61
IV: PO of Phenytoin
1:1
62
If albumin is low must correct PHT
corrected PHT = (PHT measured)/((0.2xalb) +1)
63
Enteral feedings must be separated by...
1-2 hours prior or 1-2 hours after phenytoin
64
Topamax generic
Topiramate
65
Topamax MOA
enhances GABA (inhibitory)
66
Warnings of Topamax
metabolic acidosis, oligohydrosis (reduced perspiration/hyperthermia), nephrolithiasis (kidney stones), hyperammonemia, visual problems (reversible)
67
AEs of Topamax
paresthesias, weight loss, anorexia, mood changes
68
Indications of Topamax
adjunctive for seizures, migraine prophylaxis
69
Must titrate Topamax due to
CNS effects
70
Pregnancy category of Topamax
D - cleft palate/lip
71
Lyrica generic
Pregabalin
72
AEs of Pregabalin
Fluid retention
73
MOA of Pregabalin
excitatory neurons (glutamate and aspartate) through Ca chanells
74
Pregabalin indications
Adjunctive therapy for partial seizures and neuropathic pain
75
AEs of Pregabalin
Weight gain, ataxia, diplopia, blurred vision, dry mouth, mild euphoria
76
Neurontin generic
Gabapentin
77
Neurontin indications
Postherptic neuralgia, RLS, seizures
78
AEs of Gabapentin
Diplopia, weight gain/edema, dry mouth, blurred vision
79
Gabapentin off-label uses
fibromyalgia, pain, headache, peripheral neuropathy, drug abuse, alcohol withdrawal
80
DIs with Pregabalin/Gabapentin
None significant - but use caution with glitazones and pregabalin due to additive edema
81
Phenobarbital/Primidone are what class
Barbiturate
82
Things barbiturates have in common with opioids and benzos
Physical dependence, tolerance, and addictive potential
83
TR of Phenobarbital/Primidone
20-40 mcg/mL
84
Do not give Phenobarb injection by
SC administration
85
Paradoxical reactions of Phenobarbital/Primidone
hyperactive/aggressive behavior (with acute pain or in PEDs)
86
Primidone is a prodrug of
Phenobarbital and Phenylethylmalonamide (PEMA) - both are active metabolites
87
AEs of Phenobarbital/Primidone
Physiological dependence, tolerance, and hangover effects | Also SJS/TEN
88
Phenobarbital/Primidone are inducers/inhibitors
INDUCERS
89
VPA is an inducer/inhibitor
INHIBITOR
90
Ethosuximide brand name
Zarontin
91
Ethosuximide AEs
Very well tolerated (GI -N/V/ weight loss/abdominal pain) and hiccups)
92
Ethosuximide DOC for
absence seizures
93
Lacosamide brand name
Vimpat
94
Warnings of Lacosamide
Increased PR interval - arrhythmias - use caution in CV patients and monitor ECG at baseline and at SS
95
Clobazam brand
Onfi
96
Clobazam class
Benzo
97
Clobazam indication
Lennox-Gastaut syndrome
98
Ezogabine brand
Potiga
99
Potiga used for
Refractory partial seziures
100
Potiga BBW
retinal abnormalitis (vision loss - 33% after 4 yr tx)
101
Felbamate brand
Felbatol
102
Felbatol indication
Refractory seizures
103
BBW of Felbatol
Hepatic failure and aplastic anemia (must sign informed consent to take)
104
Perampanel brand
Fycompa
105
Fycompa BBW
neuropsych events
106
Vigabatrin brand
Sabril
107
Sabril indications
Refractory seizures
108
Sabril BBW
permanent vision loss (30% of patients)
109
Zonisamide brand
Zonegran
110
CI of Zonegran
Hypersensitivity to sulfonamides
111
AEs of Zonegran
oligohydrosis, nephrolithiasis
112
Teratogenic AEDs
Carbamazepine, Phenytoin, Clonazepma, Topiramate, Phenobarbital, VPA
113
Hepatotoxicity AEDs
Carbamazepine, Felbamate, Phenobarb/Primidone, Phenytoin, VPA
114
Decreases efficacy of oral contraceptives with these AEDs
Carbamazepine, Clobazam, Oxcarbazepine, Perampanel, Phenobarb, Phenytoin, Primidone, Topiramate
115
Fatal pancreatits AEDs
VPA
116
Aplastic anemia AEDs
Carbamazepine (and agranulocytosis), Felbamate
117
SJS AEDs
Carbamazepine, Lamictal, Oxcarbazepine, Phenobarb, Tigabine, Zonisamide, Phenytoin/Fosphenytoin
118
Oligohydrosis AEDs (inability to sweat, risk of heat stroke, and highest risk in children)
Topiramate, Zonisamide
119
Nephrolithiasis (kidney stones) AEDs
Topiramate, Zonisamide
120
Weight gain AEDs
VPA, Gabapentin, Pregabalin
121
Weight loss AEDs
Felbamate, Ethosuximide, Topiramate, Zonisamide
122
Hyponatremia AEDs
Carbamazepin, Oxcarbazepine (more common)

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