Ott Seizures

Question 1

what are the two main types of seizures

Answer 1

partial and generalized

Question 2

what are the two kinds of partial seizures

Answer 2

simple and complex

Question 3

what are the types of generalized seizures

Answer 3

tonic
clonic
tonic-clonic
absence
atonic
myoclonic

Question 4

what medications at usual doses can lower the seizure threshold

Answer 4

bupropion
clozapine
theophylline
varenicline
phenothiazine antipsychotics
CNS stimulants

Question 5

what medications at high doses can lower seizure threshold

Answer 5

carbapenems
lithium
meperidine
penicillin
quinolones
tramadol

Question 6

what quality of life monitoring should be taken for seizure patients

Answer 6

frequency
functional status
social functioning
mental health status
cognition
# of doses of drugs per day
cost of drug therapy

Question 7

what are the risk factors for seizure recurrence

Answer 7

<2 years seizure free
onset of seizures after 12
history of febrile seizures
2-6 years before good seizure control
more than >30 seizures before control
partial seizures
abnormal EEG
organic neurological disorder
withdrawal of phenytoin or valproate

Question 8

what are possible reasons for treatment failure

Answer 8

failure to reach CNS target
alteration of drug targets in the CNS
drugs missing real target

Question 9

management of drug resistant epilepsy

Answer 9

rule out wrong drug or diagnosis
combination therapy
electrical/surgical intervention

Question 10

definition of status epilepticus

Answer 10

continuous seizure activity lasting 5 minutes or more or 2 or more discrete seizures with incomplete recovery between seizures

Question 11

what is first line for status epilepticus

Answer 11

IV benzodiazepines (lorazepam or midazolam)

Question 12

what is phenytoin’s biggest risk

Answer 12

hypotension - limits infusion rate

Question 13

fosphenytoin compared to phenytoin

Answer 13

prodrug and better IV tolerance

Question 14

fosphenytoin equivalents

Answer 14

20mg PE/kg IV

Question 15

what is required for phenytoin and fosphenytoin

Answer 15

cardiac monitoring and purple glove syndrome

Question 16

oral phenytoin dosing considerations

Answer 16

MUST obtain both phenytoin serum concentration and serum albumin in same blood draw

Question 17

what is the goal serum concentration of oral phenytoin

Answer 17

10-20mcg/ml

Question 18

Valproate loading dose IV to PO conversion

Answer 18

1:1 mg/kg

Question 19

Valproate goal serum concentration

Answer 19

80mcg/mL (50-125 mcg/ml)

Question 20

1A2 inducer

Answer 20

carbamazepine
phenobarbital
phenytoin

Question 21

2C9inducer

Answer 21

carbamazepine
phenobarbital
phenytoin

Question 22

3A4 Inducers

Answer 22

Carbamazepine
Cenobamate
Clobazam
Eslicarbazepine
Felbamate
Lamotrigine
Oxacarbazepine
Phenobarbital
Phenytoin
Primidone
Rufinamide
Stiripentol
Topiramate
Oral Contraceptives

Question 23

UGT inhibitors

Answer 23

Valproate

Question 24

Lamotrigine without concomitant UGT drug interactions

Answer 24

25mg qd x 14 days
50mg qd x 14 days
100mg qd x 7 days
200mg qd

Question 25

Lamotrigine with UGT inhibitor (valproate)

Answer 25

halve the dosing 25mg every other day x 14 days 25 mg qd x 14 days 50mg qd x 7 days 100mg qd

Question 26

Lamotrigine dosing with UGT inducers (carbamazepine, phenytoin)

Answer 26

double the dosing 50mg qd x 14 days 100mg qd x 14 days 200mg qd x 7 days 400mg qd

Question 27

what is the boxed warning for lamotrigine

Answer 27

stevens-johnson syndrome/toxic epidermal necrolysis

Question 28

what is the black box warning for carbamazepine or derivatives

Answer 28

genetic screen for HLA-B*1502 allele prior to starting

Question 29

what should happen with patients who test positive for the HLA allele

Answer 29

should not be treated with carbamazepine or derivates unless benefit outweighs risk

Question 30

what is strongly correlated with HLA

Answer 30

AHS in patients of Asian descent

Question 31

what is DRESS syndrom

Answer 31

potentially life-threatening drug reaction with eosinophilia and systemic symptoms of drug induced hypersensitivity

Question 32

when does DRESS syndrome occur

Answer 32

2-6 weeks after drug initiation

Question 33

what drugs are associated with DRESS syndrome

Answer 33

carbamazepine, cenobamate, lamotrigine, phenobarbital, phenytoin, valproate, zonisamide

Question 34

what patients are at an increased risk of DRESS syndrome

Answer 34

positive for HLA-A*3101 allele (asian or northern european descent)

Question 35

what is antiseizure withdrawal syndrome associated with

Answer 35

abrupt discontinuation of antiseizure meds

Question 36

what is the danger of antiseizure drug withdrawal syndromes

Answer 36

recurrence of seizures

Question 37

why are drug serum concentrations altered in pregnancy

Answer 37

changes in volume of distribution

Question 38

what should seizure patients who are child bearing age be aware of

Answer 38

most seizure drugs are teratogenic and contraceptives should be used (keeping in mind OC drug interactions)

Question 39

what antiseizure drug is not recommended in pregnancy and why

Answer 39

valproate because it causes neural tube defects and is associated with a decreased IQ in offspring

Question 40

what should be given with antiseizure drugs in pregnancy

Answer 40

supplemental folic acid (5mg daily) supplemental vitamin K 10mg daily during last month of pregnancy infant get vit K 1 mg IM at birth

Question 41

what is the contraceptive drug interaction mediated by

Answer 41

P450 3A4 induction

Question 42

how can contraceptive drug interactions be minimized

Answer 42

use higher-dose estrogen contraceptives - warning for increased thromboembolism

Question 43

what contraceptives are recommended

Answer 43

IUDs and depot

Question 44

how does estrogen affect lamotrigine

Answer 44

significantly decrease lamotrigine serum concentration 50% and lamotrigine decreases estrogen concentrations

Question 45

what drug is associated with arrhythmias

Answer 45

lamotrigine phenytoin/fosphenytoin

Question 46

what drugs cause PR interval changes

Answer 46

lacosamide pregabalin

Question 47

what drug causes heart block

Answer 47

lacosamide

Question 48

what drug is associated with valvular hear disease

Answer 48

fenfluramine

Question 49

what are the AEs of carbamazepine/eslicarbazepine/oxcarbazepine

Answer 49

hyponatremia, SIADH

Question 50

what are the AEs of phenytoin

Answer 50

altered vit d metabolism and decreased calcium concentrations leading to osteoporosis with long-term use

Question 51

what side effects does topiramate have

Answer 51

decreased bicarb leaded to metabolic acidosis nephrolithiasis decreased sweating heat intolerance oligohydrosis

Question 52

what are the psych AEs of levetiracetam

Answer 52

psychosis suicidal thoughts unusual mood change worsening depression

Question 53

what are the psych AEs of perampanel

Answer 53

boxed warning: dose related serious psych events

Question 54

what are the psych AEs of valproate

Answer 54

acute mental status changes related to hyperammonemia

Question 55

what are the psych AEs of topiramate

Answer 55

associated with cognitive dysfunction if the dose is increased too rapidly so use slow titration

Question 56

what drug can cause visual abnormalities

Answer 56

topiramate