ott seizures Flashcards
status epilepticus defined as
seizure lasting greater than 5 mins, or 2 + seizures without complete recovery between
drug therapy for status epilepticus
5-20 mins: lorazepam / midazolam IV
20-40 mins: IV phosphenytoin, valproic acid or keppra
why cant we give phenytoin quickly?
hypotension
fosphenytoin dose
20 mg PE/kg IV
what can fosphenytoin cause?
purple glove syndrome
phenytoin therapeutic serum concentration
10-20 mcg/mL
what must we obtain for phenytoin loading dose?
serum albumin and serum phenytoin concentration
valproate IV to PO conversion
1:1
desired serum concentration of valproate
80 mcg/mL
range 50-125
1A2 inducers
carbamazepine
phenytoin
phenobarbital
2C9 inducers
carbamazepine
phenytoin
phenobarbital
3A4 inducers
carbamazepine
phenytoin
phenobarbital
lamotrigine
oxcarbazepine
topiramate
CPP LOT
UGT inhibitor
valproate
lamotrigine box warning se
Stevens Johnson Syndrome
lamotrigine dosing without UGT inhibitor or inducer
25 mg qd x 14 days
50 mg qd x 14 days
100 mg qd x 7 days
200 mg daily
lamotrigine dosing with UGT inhibitor (valproate)
25 mg qOD x 14 days
25 mg qd x 14 days
50 mg qd x 7 days
100 mg qd
lamotrigine dosing with UGT inducer
50 mg qd x 14 deays
100 mg qd x 14 days
200 mg qd x 7 days
400 mg qd
what must you do before getting carbamazepine or oxcarbazepine
HLA-B 1502 allele screening
Asian patients at high risk of what
HLAB1502 and anticonvul hypersensitivity syndrome
positive ____ in northern european and asian descent may confer similar risk for DRESS
HLA 3101
DRESS syndrome mortality
10%
when does DRESS occur
2-6 weeks after starting drug therapy
DRESS can happen from what drugs
carbamezapine
cenobamate
lamotrigine
phenytoin
phenobarbital
valproate
zonisamide
drug concentrations in pregnancy may be increased due to
changes in VD
teratogenic risk drugs
carbamezapine
clonazepam
fosphenytoin
phenobarbital
phenytoin
primidone
topiramate
which drug can cause neural tube defects and decreased IQ
valproate
infant should receive what at birth
vitamin K 1 mg IM to decrease risk of hemorragew
estrogen and ____ interact and decrease eachother concentration
lamotrigine
birth control recomended forms
high dose estrogen
progestin only - IUDs good
which drug has risk of arrythmia
lamotrigine
phenytoin / fosphenytoin
which drug has PR interval changes
lacosamide, pregabalin
which drug has heart block
lacosamide
which drug increase risk valvular heart disease
fenfluramine
which drugs lead to SIADH, hyponatremia
carbemazepine, oxcarbemazepine
which drug mess with vitamin d so increase risk osteoporosis
phenytoin
which drug lead to kidney stones, metabolic acidosis, heat intolerance
topirimate
which drug psychosis, suicidal thoughs, worsening depression
lamotrigine
which drug life threatening neuro events
perampanel
which drug hypermmonemia, acute mental status changes
valproate, give at night
which drug cognitive dysfunction and visual abnormalities
topiramate
which drug contraindicated if you have vision risk factors
vigabitran
drug with risk of respiratory depression
gabapentin and pregabalin
which drug could cause thrombocytopenia, PCOS, weight gain
valproate
which drug gingival hyperplasia and hirsutism
phenytoin
zonisamide contraindicated i
sulfa allergy
Epidiolex is what
cannabidoil oral solution
Epidiolex used for what conditions
Dravet Syndrome
Lennox Gastaut Syndrome
keotgenic diet
3-4:1 fats to protein/carb
risk kidney stones hyperlipidemia, weight loss, constipation, decreased bone mass
only works in adults
