Exam 3 Seizure

Question 1

DOC focal seizure

Answer 1

Carbamazepine

Question 2

DOC for seizure in infants (not infantile spasms)

Answer 2

Phenobarbital

Question 3

MOA phenobarbital

Answer 3

Increase GABA/decreases excitatory transmission

Question 4

MOA for phenytoin

Answer 4

Alters all ion channeled. Primarily Na.

Question 5

MOA ethosuxide

Answer 5

Inhibits calcium channel

Question 6

MOA valproic acid

Answer 6

Increase GABA, increase membrane conductance of potassium(with high levels), effects sodium.

Question 7

DOC absent seizures

Answer 7

Ethosuximide

Question 8

MOA gaba analogs

Answer 8

Increased GABA activity.

Question 9

MOA carbamazepine

Answer 9

Similar to phenytoin. Alters sodium

Question 10

How is phenytoin distributed in body under normal conditions.

Answer 10

90% bound to albumin.

Question 11

Drugs that compete for albumin

Answer 11

Carbamazepine, valproic acid, phenytoin and sulfonamides.

Question 12

Considerations for adding valproic acid in conjunction with phenytoin

Answer 12

Consider decreasing phenytoin dose since valproic acid will displace phenytoin from albumin.

Question 13

Therapeutic and toxic levels of phenytoin

Answer 13

Therapeutic: 10-20 mcg/mL
Toxic: 30-50 mcg/mL

Question 14

Toxic side effects phenytoin

Answer 14

Ataxia, nystagmus, diplopia, rash, skin lesions, sedation, decreased pursuit of ocular movement.

Question 15

Chronic side effects of phenytoin

Answer 15

Hirsuitism, gingival hyperplasia, coarsening of facial features

Question 16

Status epilepticus treatment

Answer 16

Almost always requires iv anti seizure med (diazepam, lorazepam).
ACLS- it is a medical emergency.
Fps phenytoin or phenobarbital if unresponsive to fosphenytoin.

Question 17

How long must a seizure occur to be considered status epilepticus

Answer 17

30 mins

Question 18

Drug that is beneficial in trigeminal neuralgia

Answer 18

Carbamazepine

Question 19

Trigeminal neuralgia s/s

Answer 19

Lightning, shocking, aching, burning, tingling, stabbing, crushing, throbbing.

Question 20

Carbamazepine induced hepatic enzymes. How does this affect its half life

Answer 20

It cuts half life in half.
1 dose: t1/2 36 hours
Continuous Tx: t1/2 20 hours

Question 21

Lacosamide (Vimpat) MOA

Answer 21

Blocks sodium channels

Question 22

Benzodiazepines MOA

Answer 22

Depress all levels of CNS
Likely from increased GABA activity.

Question 23

Lacosamide (Vimpat) side effects

Answer 23

Dizziness, HA, diplopia, nausea

Question 24

Phenobarbital useful in which types of seizures

Answer 24

Focal/general clonic tonic
Tried in all types

Question 25

Phenobarbital not useful in which types of seizures

Answer 25

Generalized, absence, atomic attacks, or infantile spasms.

Question 26

Phenobarbital side effects

Answer 26

Sedation
Overdose: gait and speech impairment, confusion, resp distress, coma.

Question 27

Automatisms seen with seizure

Answer 27

Lip smacking, swallowing, fumbling, scratching, walking about.

Question 28

Side effects ethosuximide

Answer 28

GI distress: pain and n/v
CNS: Lethargy

Question 29

Valproic acid side effects

Answer 29

GI: n/v, pain heartburn
Inhibits metabolism of phenobarbital, carbamazepine, phenytoin.

Question 30

Treatment of infantile spasms

Answer 30

Palliative: watch and prevent injury.
Corticotropins: (prednisone) suppress infantile spasm until child grows out of it.
Vigabatrin: GABA analog

Question 31

Alt seizure treatments

Answer 31

Ketogenic diet increases FA oxidation. Making brain activity less efficient.
Surgery
Medical marijuana
Vagul stimulation