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therapeutics 2 > Ott Seizures > Flashcards

Ott Seizures Flashcards

1
Q

what are the two main types of seizures

A

partial and generalized

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2
Q

what are the two kinds of partial seizures

A

simple and complex

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3
Q

what are the types of generalized seizures

A

tonic
clonic
tonic-clonic
absence
atonic
myoclonic

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4
Q

what medications at usual doses can lower the seizure threshold

A

bupropion
clozapine
theophylline
varenicline
phenothiazine antipsychotics
CNS stimulants

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5
Q

what medications at high doses can lower seizure threshold

A

carbapenems
lithium
meperidine
penicillin
quinolones
tramadol

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6
Q

what quality of life monitoring should be taken for seizure patients

A

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

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7
Q

what are the risk factors for seizure recurrence

A

<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

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8
Q

what are possible reasons for treatment failure

A

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

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9
Q

management of drug resistant epilepsy

A

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

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10
Q

definition of status epilepticus

A

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

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11
Q

what is first line for status epilepticus

A

IV benzodiazepines (lorazepam or midazolam)

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12
Q

what is phenytoin’s biggest risk

A

hypotension - limits infusion rate

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13
Q

fosphenytoin compared to phenytoin

A

prodrug and better IV tolerance

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14
Q

fosphenytoin equivalents

A

20mg PE/kg IV

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15
Q

what is required for phenytoin and fosphenytoin

A

cardiac monitoring and purple glove syndrome

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16
Q

oral phenytoin dosing considerations

A

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

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17
Q

what is the goal serum concentration of oral phenytoin

A

10-20mcg/ml

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18
Q

Valproate loading dose IV to PO conversion

A

1:1 mg/kg

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19
Q

Valproate goal serum concentration

A

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

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20
Q

1A2 inducer

A

carbamazepine
phenobarbital
phenytoin

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21
Q

2C9inducer

A

carbamazepine
phenobarbital
phenytoin

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22
Q

3A4 Inducers

A

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

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23
Q

UGT inhibitors

A

Valproate

24
Q

Lamotrigine without concomitant UGT drug interactions

A

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

25
Q

Lamotrigine with UGT inhibitor (valproate)

A

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

26
Q

Lamotrigine dosing with UGT inducers (carbamazepine, phenytoin)

A

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

27
Q

what is the boxed warning for lamotrigine

A

stevens-johnson syndrome/toxic epidermal necrolysis

28
Q

what is the black box warning for carbamazepine or derivatives

A

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

29
Q

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

A

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

30
Q

what is strongly correlated with HLA

A

AHS in patients of Asian descent

31
Q

what is DRESS syndrom

A

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

32
Q

when does DRESS syndrome occur

A

2-6 weeks after drug initiation

33
Q

what drugs are associated with DRESS syndrome

A

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

34
Q

what patients are at an increased risk of DRESS syndrome

A

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

35
Q

what is antiseizure withdrawal syndrome associated with

A

abrupt discontinuation of antiseizure meds

36
Q

what is the danger of antiseizure drug withdrawal syndromes

A

recurrence of seizures

37
Q

why are drug serum concentrations altered in pregnancy

A

changes in volume of distribution

38
Q

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

A

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

39
Q

what antiseizure drug is not recommended in pregnancy and why

A

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

40
Q

what should be given with antiseizure drugs in pregnancy

A

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

41
Q

what is the contraceptive drug interaction mediated by

A

P450 3A4 induction

42
Q

how can contraceptive drug interactions be minimized

A

use higher-dose estrogen contraceptives - warning for increased thromboembolism

43
Q

what contraceptives are recommended

A

IUDs and depot

44
Q

how does estrogen affect lamotrigine

A

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

45
Q

what drug is associated with arrhythmias

A

lamotrigine
phenytoin/fosphenytoin

46
Q

what drugs cause PR interval changes

A

lacosamide
pregabalin

47
Q

what drug causes heart block

A

lacosamide

48
Q

what drug is associated with valvular hear disease

A

fenfluramine

49
Q

what are the AEs of carbamazepine/eslicarbazepine/oxcarbazepine

A

hyponatremia, SIADH

50
Q

what are the AEs of phenytoin

A

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

51
Q

what side effects does topiramate have

A

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

52
Q

what are the psych AEs of levetiracetam

A

psychosis
suicidal thoughts
unusual mood change
worsening depression

53
Q

what are the psych AEs of perampanel

A

boxed warning: dose related serious psych events

54
Q

what are the psych AEs of valproate

A

acute mental status changes related to hyperammonemia

55
Q

what are the psych AEs of topiramate

A

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

56
Q

what drug can cause visual abnormalities

A

topiramate

57
Q
A

therapeutics 2 (24 decks)

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