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Pharm test 3 > Neuro - Epilepsy > Flashcards

Neuro - Epilepsy Flashcards

1
Q

Is someone conscious or unconscious during a generalized seizure?

A

LOC

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2
Q

Seizure = increased levels of excitatory NTs, like ______, or deficiency in inhibitory NTs, like _______.

A

glutamate - excitatory

GABA - inhibitory

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3
Q

Name RF of seizures

A
  1. trauma
  2. surgery
  3. lyte disturbances
  4. drug toxicity/withdrawal
  5. stroke
  6. infection
  7. fever
  8. genetic predisposition
  9. idiopathic
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4
Q

What is epilepsy? Who gets it?

A

chronic condition of recurring sz, commonly in young and old

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5
Q

What is the most common sz?

A

tonic clonic

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6
Q

In general, most patients with epilepsy use one/multiple therapies? Do you add or swap drugs when changing meds?

A

monotherapy

change them

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7
Q

Which two drugs “cast the widest net”?

A

VPA and lamotrigine

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8
Q

When is it okay to D/C a seizure med? How is it D/C’d?

Can you switch from generic to brand name without caution?

A

6-12 months after sz free interval
Slowly weaned
No, the bioavailability difference may lead to sz

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9
Q

How do you check to make sure the dose is therapeutic?

A

check trough level – before the next dose

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10
Q

Whats the problem with sz meds and pregnancy?

A

sz meds are typically teratogenic – folate wasting

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11
Q

how do you treat ecampsia seizures?

A

mag sulfate

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12
Q

phenobarbital is reserved for what type of sz? what is an AE of the PO form?

A

refractoral generalized sz

hangover because its highly sedative

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13
Q

What is the tx for status epilecticus?

A

Benzo, then anti-epileptic maintenance

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14
Q

Short acting benzo (Lorazepam? Long acting benzo (Diazepam)?

A

short - ativan

long - Valium

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15
Q

How does phenytoin work?

A

It promotes Na efflux from neurons thus stabilizing cells and reducing hyperexcitability

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16
Q

Which sz drug may actually worsen absence sz?

A

phenytoin

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17
Q

Would phenytoin and ASA interact?

A

Yes, phenytoin is highly PPB.

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18
Q

What are some dose related AEs of phenytoin?

A

nausea, HA, rash, confusion, NYSTAGMUS

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19
Q

what is a sign of phenytoin OD?

A

nystagmus

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20
Q

What are some non-dose related AEs of phenytoin? These make teens less likely to adhere.

A

gingival hyperplasia, acne, coarsening of facial features

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21
Q

Phenytoin has some weird interactions. Name some.

A

ethanol, vitamin D–osteoporosis, folate wasting, OCPs will not work, VPA levels, warfarin

22
Q

Why is IV phenytoin risky?

A

poor stability (short half life), and you have to give it with a diluent (high volume load) that causes hypotension.

23
Q

Can phenytoin break a seizure? What can?

A

Risky.

Fosphenytoin can. its safer than IV phenytoin - less hypotension, volume load, and allows rapid administration. $$$

24
Q

What are the therapeutic levels of phenytoin?

A

10-20 mcg/ml

25
Q

When would you get a free phenytoin level?

A

when you suspect that the patient is hypoalbuminemic from malnourishment or hepatic damage.

26
Q

What pregnancy category is phenytoin? Why?

A

D - folate wasting

27
Q

Valproic Acid (Depakote…) increases the bioavailability within the CNS, enhances the activity and mimics the action of ______ at post synaptic sites.

A

GABA

28
Q

What other indications does VPA have?

A

migraine PPX, bipolar disorder, agitation!

29
Q

AEs of VPA?

A

hepatotoxicity, pancreatitis, thrombocytopenia

30
Q

T or F. VPA is only available IV and PO.

A

F. sprinkle caps, tablets, capsules, delayed release capsules, extendend release tablets, syrup, injection

31
Q

VPA pregnancy category?

A

D

32
Q

Carbamazepine (Tegretol) are like what other drugs? What does this mean for CBZ ODs?

A

TCAs

treat with IV bicarb

33
Q

CBZ is the DOC for what other condition?

A

trigeminal neuralgia

34
Q

Therapeutic level of CBZ?

A

4-12 mcg/ml

35
Q

3 AEs of CBZ?

A

SJS, SIADH (too much ADH), hepatotoxicity

36
Q

Which sz drug is an autoinducer? and what does this mean?

A

it increases its own metabolism at random times – no need to get trough level until 2-3 weeks

37
Q

CBZ analogue that has fewer hepatic AEs?

A

oxycarbazepine (Trileptal)

38
Q

what is the brand name of gabapentin? what is its main indication?

A

Neurontin

neuropathic pain - DM, HIV, spine injury

39
Q

does gabapentin have may interactions?

A

no, its renally eliminated

40
Q

how are gabapentin and lyrica related?

A

gabapentin is a precursor to pregabalin (Lyrica)

41
Q

What preg category is gabapentin?

A

C – less folate wasting effects

42
Q

Tompiramate has what MOA?

A

enhances Na channels, enhances GABA, weak carbonic anyhydrase inhibitor

43
Q

what are some off label uses of Tompiramate?

A

infantile spasms, weight loss

44
Q

AEs of tompiramate (Topomax)?

A

anorexia, psychomotor slowing (DOPO) and nephrolithiasis.

45
Q

what preg category is topomax?

A

C

46
Q

what do you use for lethal injection?

A
  1. barb
  2. paralytic
  3. high dose K
47
Q

CBZ, phenytoin and VPA are __ generation drugs.

A

1st - more AEs

48
Q

What risk does Lamotrigine run?

A

Rash - sjs

49
Q

What risk does Levetiracetam run?

A

behavioral changes…issue for pediatrics

50
Q

What is the brand name of phenytoin?

A

Dilantin

51
Q

What is the brand name of VPA?

A

Depakote, Depacon, Depakene

Pharm test 3 (9 decks)

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