Seizure Flashcards
ALL AED have a _____ risk
suicide
Many AED have ________ monitoring
drug level
Stopping anti epileptic med cold turkey is a good idea
FALSE- wean slowly over 6 week- months
Why do 50% of people fail at epilepsy treatment?
non-adherence to meds
All seizure meds are good for all seizures. T or F
F
Match drug w/ seizure = trial and error effort
4 traditional seizure meds
phentoin (Dilantin)
fosphenytoin
carbamezepine (Tegretol)
valproic acid (Depakote)
2 newer agents of seizure med
gabapentin (Neurontin)
pregabalin (Lyrica)
Whats better about the newer agents for treating seizure?
Newer agents = better tolerated in long term
Newer agents = less drug interactions, safer for preg
What sucks about the newer agents for epilepsy?
cost more $$$
Most widely used traditional antiseizure agent
Phenytoin (Dilantin)
how does Phenytoin (Dilantin) fxn ?
blocks Na channels in brain to decrease action potential
-Narrow therapeutic index
Which traditional anti-seizure med has a super narrow therapeutic index and what is it?
Phenytoin (Dilantin)
10-20 mcg/mL= therapeutic drug level
How do we admin IV Phenytoin (Dilantin) ? (4)
SLOW - 50mg/min
- w/ normal saline
- in a large vein to prevent purple glove syndrome
- flush after admin to prevent drug interaction/precipitate
What system are we closely monitoring during IV Phenytoin (Dilantin) admin and why?
Risk of cardiovascular collapse —> block Na channels in heart > heart stops
–>Monitor VS during administration, monitor for bradycardia/hypotension/arrhythmias
3 regular side effects of Phenytoin (Dilantin)
- Drowsiness
- Gingival hyperplasia: oral hygeine, folic acid
- GI~ give with food to decrease
2 freaky adverse effects of Phenytoin (Dilantin)
- Toxic epidermal necrolysis
- Stevens Johnson Syndrome
Phenytoin (Dilantin) toxicity s/s
nystagmus, sedation, ataxia, blurred/double vision
Don’t give antiseizure meds to which patient populations?
pregz in the eggz
–> teratogenic :(
Wtf is FOSPhenytoin?
Prodrug that is converted to phenytoin
how is FOSPhenytoin dosed?
Dosed in phenytoin equivalents (PE)
Random side effect from IV FOSPhenytoin
- Temporary paresthesia and itching (groin)
- –>Resolves when infusion complete
IV FOSPhenytoin- what are we doing here?
- SLOW (a little fast then phenytoin but still slow!)
- Watch for CV collapse
Route for FOSPhenytoin?
IV OR IM
Which 2 antiseizure meds break your blood?
Carbamezepine (Tegretol)
Valproic acid (valproate)
Side effects of Carbamezepine (Tegretol)
- Usual SE–>CNS
- Rare SE–>Bone marrow suppression
- –>Leukopenia, anemia, thrombocytopenia
- Skin rash
- –>-Report any rash to provider!
- —>Severe-> stop the drug
- —>Asian patients test for HLA-B*1502
- sunburn
Which antiseizure drug will increase its own metabolism? what does it result in?
Carbamezepine (Tegretol)
- decreases 1/2 life over time
Carbamezepine (Tegretol) does not mix with
-Grapefruit + lots of drugs (antifungals, erythromycin, antivirals, verapamil, niacin, loratadine)
Imagine you are old and you can’t swallow your Valproic acid (valproate) acid. What are you gonna do about it
- do NOT crush or chew the tablets
- Get capsules to sprinkle on your butterscotch pudding while you fall asleep to a PBS masterpiece theatre episode
Common side effects of Valproic acid (valproate)?
GI Upset: n/v/d
Rare side effects of Valproic acid (valproate)
Hepatotoxicity & pancreatitis
*Blood dyscrasias
Which antiseizure med is the most teratogenic of them all?
Valproic acid (valproate)
Gabapentin. I’ve seen you before, what are you doing here in antiseizure meds?! How do I give you for seizure prevention? (hint: dosing)
higher doses for seizure then multimodal pain management
side effects of Gabapentin (Neurontin)
somnolence, dizziness, ataxia, fatigue, nystagmus
Which antiseizure meds are scheduled?
class V:
Gabapentin (Neurontin) (sort of)
Pregabalin (Lyrica)
Pregabalin (Lyrica)- what do you treat?
anti seizure, fibromyalgia, diabetic neuropathy
side effects of Pregabalin (Lyrica)
dizziness, somnolence, blurred vision, weight gain (7%), *euphoria–> schedule 5 drug?
3 benzos for active seizure in the hospital (route/rate)
lorazepam (Ativan) 4mg IV
2mg/min administration rate
diazepam (Valium) 5-10mg
5mg/min administration rate
midazolam (Versed) IM
active seizure outside of the hospital?
lorazepam SL or diazepam rectal gel
Patient teachings for anti seizure meds
- Don’t stop taking your medication!!
- Sedation is common when starting, but generally improves over time
- Don’t take with other CNS depressants !!
- Pregnancy =Teratogenic Risk
- Decreased effectiveness of birth control
