Seizure

Question 1

ALL AED have a _____ risk

Answer 1

suicide

Question 2

Many AED have ________ monitoring

Answer 2

drug level

Question 3

Stopping anti epileptic med cold turkey is a good idea

Answer 3

FALSE- wean slowly over 6 week- months

Question 4

Why do 50% of people fail at epilepsy treatment?

Answer 4

non-adherence to meds

Question 5

All seizure meds are good for all seizures. T or F

Answer 5

F

Match drug w/ seizure = trial and error effort

Question 6

4 traditional seizure meds

Answer 6

phentoin (Dilantin)
fosphenytoin
carbamezepine (Tegretol)
valproic acid (Depakote)

Question 7

2 newer agents of seizure med

Answer 7

gabapentin (Neurontin)

pregabalin (Lyrica)

Question 8

Whats better about the newer agents for treating seizure?

Answer 8

Newer agents = better tolerated in long term

Newer agents = less drug interactions, safer for preg

Question 9

What sucks about the newer agents for epilepsy?

Answer 9

cost more $$$

Question 10

Most widely used traditional antiseizure agent

Answer 10

Phenytoin (Dilantin)

Question 11

how does Phenytoin (Dilantin) fxn ?

Answer 11

blocks Na channels in brain to decrease action potential

-Narrow therapeutic index

Question 12

Which traditional anti-seizure med has a super narrow therapeutic index and what is it?

Answer 12

Phenytoin (Dilantin)

10-20 mcg/mL= therapeutic drug level

Question 13

How do we admin IV Phenytoin (Dilantin) ? (4)

Answer 13

SLOW - 50mg/min

• w/ normal saline
• in a large vein to prevent purple glove syndrome
• flush after admin to prevent drug interaction/precipitate

Question 14

What system are we closely monitoring during IV Phenytoin (Dilantin) admin and why?

Answer 14

Risk of cardiovascular collapse —> block Na channels in heart > heart stops

–>Monitor VS during administration, monitor for bradycardia/hypotension/arrhythmias

Question 15

3 regular side effects of Phenytoin (Dilantin)

Answer 15

• Drowsiness
• Gingival hyperplasia: oral hygeine, folic acid
• GI~ give with food to decrease

Question 16

2 freaky adverse effects of Phenytoin (Dilantin)

Answer 16

• Toxic epidermal necrolysis

- Stevens Johnson Syndrome

Question 17

Phenytoin (Dilantin) toxicity s/s

Answer 17

nystagmus, sedation, ataxia, blurred/double vision

Question 18

Don’t give antiseizure meds to which patient populations?

Answer 18

pregz in the eggz

–> teratogenic :(

Question 19

Wtf is FOSPhenytoin?

Answer 19

Prodrug that is converted to phenytoin

Question 20

how is FOSPhenytoin dosed?

Answer 20

Dosed in phenytoin equivalents (PE)

Question 21

Random side effect from IV FOSPhenytoin

Answer 21

• Temporary paresthesia and itching (groin)

- –>Resolves when infusion complete

Question 22

IV FOSPhenytoin- what are we doing here?

Answer 22

• SLOW (a little fast then phenytoin but still slow!)

- Watch for CV collapse

Question 23

Route for FOSPhenytoin?

Answer 23

IV OR IM

Question 24

Which 2 antiseizure meds break your blood?

Answer 24

Carbamezepine (Tegretol)

Valproic acid (valproate)

Question 25

Side effects of Carbamezepine (Tegretol)

Answer 25

• 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

Question 26

Which antiseizure drug will increase its own metabolism? what does it result in?

Answer 26

Carbamezepine (Tegretol)

- decreases 1/2 life over time

Question 27

Carbamezepine (Tegretol) does not mix with

Answer 27

-Grapefruit + lots of drugs (antifungals, erythromycin, antivirals, verapamil, niacin, loratadine)

Question 28

Imagine you are old and you can’t swallow your Valproic acid (valproate) acid. What are you gonna do about it

Answer 28

• 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

Question 29

Common side effects of Valproic acid (valproate)?

Answer 29

GI Upset: n/v/d

Question 30

Rare side effects of Valproic acid (valproate)

Answer 30

Hepatotoxicity & pancreatitis

*Blood dyscrasias

Question 31

Which antiseizure med is the most teratogenic of them all?

Answer 31

Valproic acid (valproate)

Question 32

Gabapentin. I’ve seen you before, what are you doing here in antiseizure meds?! How do I give you for seizure prevention? (hint: dosing)

Answer 32

higher doses for seizure then multimodal pain management

Question 33

side effects of Gabapentin (Neurontin)

Answer 33

somnolence, dizziness, ataxia, fatigue, nystagmus

Question 34

Which antiseizure meds are scheduled?

Answer 34

class V:

Gabapentin (Neurontin) (sort of)
Pregabalin (Lyrica)

Question 35

Pregabalin (Lyrica)- what do you treat?

Answer 35

anti seizure, fibromyalgia, diabetic neuropathy

Question 36

side effects of Pregabalin (Lyrica)

Answer 36

dizziness, somnolence, blurred vision, weight gain (7%), *euphoria–> schedule 5 drug?

Question 37

3 benzos for active seizure in the hospital (route/rate)

Answer 37

lorazepam (Ativan) 4mg IV
2mg/min administration rate

diazepam (Valium) 5-10mg
5mg/min administration rate

midazolam (Versed) IM

Question 38

active seizure outside of the hospital?

Answer 38

lorazepam SL or diazepam rectal gel

Question 39

Patient teachings for anti seizure meds

Answer 39

• 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