module 3 seizure

Question 1

seizure patho

Answer 1

abnormal function of ion channels and neural networks

- rapid, synchronous, uncontrolled spread of electrical activity

Question 2

anticonvulsant class warnings

Answer 2

inc. risk of suicidal thoughts
monitor for worsening depression/mood changes
withdrawal seizures

Question 3

Na channel inhibitors: anticonvulsant Rx

Answer 3

phenytoin 
fosphenytoin 
carbamazepine
oxcarbazepine
eslicarbazepine
lamotrigine
lacosamide

Question 4

phenytoin, fosphenytoin MOA

Answer 4

slows rate of channel recovery fro inactivated to close state
- channel use dependent

Question 5

phenytoin, fosphenytoin AE

Answer 5

IV BB: severe hypoTN, cardiac arrhythmia
steven johnson
toxic epidermal necrolysis
hepatotoxicity/abnormalities 
hirsutism 
gingival hyperplasia
acne
altered vit. D metabolism -> osteoporsis
CNS depression 
N/V/C

Question 6

phenytoin, fosphenytoin administration

Answer 6

fosphenytoin: progrug

protein bound: 90-95%

Question 7

phenytoin, fosphenytoin precaution

Answer 7

hepatically metabolized

inducer of : 3A4, 2C9, 2C19

Question 8

phenytoin, fosphenytoin monitoring

Answer 8

drug levels
- total: 10-20
- free: 1-2
Albumin
CrCl

Question 9

phenytoin, fosphenytoin and zero order kinetics

Answer 9

constant amount of drug eliminated per unit of time

- independent of dose concentration

Question 10

carbamazepine MOA

Answer 10

Na channel inhibitor
slows rate of channel recovery from inactivated to closed state
- channel use dependent

Question 11

carbamazepine administration

Answer 11

protein bound: 75-90%
metabolized -> active metabolite
first order kinetics

Question 12

first order kinetics

Answer 12

constant fraction of the concentration of drug is eliminated.
- dependent on dose concentration

Question 13

carbamazepine AE

Answer 13

BB: dermatologic reactions
- steven johnsons
- toxic epidermal necrolysis
hypersensitivity
DRESS
jaundice
hyponatremia
CNS depression
N/V

Question 14

carbamazepine precautions

Answer 14

hepatically metabolized
autoinducer
potent inducer of 3A4, 1A2, 2C9/19

Question 15

carbamazepine monitoring

Answer 15

CBC

drug levels: 6-12

Question 16

oxcarbazepine

Answer 16

NA channel inhibitor

similar structure to carbamazepine with less DI and AE

Question 17

Eslicarbazepine

Answer 17

active metabolite of oxcarbazepine

Question 18

lamotrigine MOA

Answer 18

Na channel inhibitor
slows rate of channel recovery from inactive to closed state
- channel use dependent

Question 19

lamotrigine AE

Answer 19

BB: serious rash
- Steven Johnson
- toxic epidermal necrolysis
- DRESS
-- can be r/t rapid titration
blood dyscrasias: 
- neutropenia
- thrombocytopenia
- aplastic anemia
CNS depression
N/V

Question 20

lamotrigine administration

Answer 20

protein bound: 55%

Question 21

lamotrigine precaution

Answer 21

hepatically metabolized

Question 22

lamotrigine monitoring

Answer 22

CBC

Question 23

Lacosamide MOA

Answer 23

Na channel inhibitor

enhances slow inactivation of voltage gated Na channels

Question 24

lacosamide AE

Answer 24

cardiac rhythm and conduction abnml 
dizzy
ataxia
HA
nausea

Question 25

lacosamide precaution

Answer 25

hepatically metabolized

Question 26

lacosamide administration

Answer 26

protein bound: <15%

schedule V drug

Question 27

Ca channel inhibitors

Answer 27

Ethosuximide
gabapentin
pregabalin

Question 28

K channel inhibitor

Answer 28

ezogabine

Question 29

GABA

Answer 29

benzodiazepines
clobazam
barbiurates
vigabatrin
tiagabine

Question 30

Glutamate (NMDA, AMPA)

Answer 30

felbate
rufinamide
perampanel

Question 31

mixed action meds

Answer 31

valroic acid
levtiracetam
topiramate
zonisamide