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NAPLEX > Seizure/Epilepsy > Flashcards

Seizure/Epilepsy Flashcards

1
Q

Seizure Causes

A
  • Fever (Children/Infants!)
  • Alcohol withdrawal
  • Hypoglycemia
  • Electrolyte abnormalities
  • (CNS) infections!
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2
Q

Epilepsy Causes

A
  • Brain tumors
  • Dementia
  • Brain damage
  • Genetic
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3
Q

Epilepsy vs Seizure

A
  • Seizure can be one time event
  • Epilepsy: chronic seizure disorders
  • One seizure isn’t necessarily epilepsy
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4
Q

Diagnosis

A
  • EEG mainly
  • CT/MRI (damage)
  • Spinal tap/CSF (infectious)
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5
Q

Focal

A
  • Focused area

- One side of the brain

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6
Q

Awareness

A
  • Subtype of focal seizure
  • Aware seizure: maintain awareness (simple in the past)
  • Impaired awareness: loss/reduced awareness (complex in the past)
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7
Q

Generalized

A

Both sides of the Brain

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8
Q

Movement Types

A
  • Subtypes of generalized seizure
  • Tonic: rigid muscles
  • Clonic: rhythmical/jerking movements
  • Atonic: limp muscles
  • Myoclonus: muscle twitching
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9
Q

First Aid for Seizure

A
  • Lower to floor gently
  • Lie patient on the side
  • Keep track of the time (>5 min = medical emergency)
  • Remove tight clothing, don’t put anything in mouth
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10
Q

Status Epilepticus Tx

A
  • 0-5 min: Check BG, electrolytes, AED levels IF possible
  • 5-20 mins: IV benzo (lorazepam) OR IM midazolam or rectal diazepam if IV access not available
  • 20-40 mins: IV AEDs
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11
Q

IV AED Options

A
  • Fosphenytoin
  • Levetiracetam
  • Valproic Acid
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12
Q

Diastat AcuDial Dispensement

A
  • Dial to correct dose before giving to patient (lock once set)
  • Instruct pts/caregivers to confirm that dose is correct when they leave pharmacy
  • Green “ready band” should be showing when locked
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13
Q

Chronic Seizure Management

A
  • AEDs are first line
  • Avoid meds that lower seizure threshold
  • Don’t abruptly stop any seizure medication
  • Non-Rx Tx: Medical marijuana, ketogenic diet (4:1 fat:other diet, usually recommended in refractory pts)
  • Decreases hormonal birth control efficacy
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14
Q

Drugs that Lower Seizure Threshold

A
  • Carbapenems (imipenem esp!)
  • Lithium
  • Meperidine
  • Penicillin
  • Quinolones
  • Theophylline
  • *^^High doses/renal impairment increase risk in meds above**
  • Clozapine
  • Bupropion
  • Tramadol
  • Varenicline
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15
Q

General AED Risk/Monitoring

A
  • ALL increase risk for fracture
  • ALL have increased risk in suicidal ideation/risk (CNS depression)
  • Most have fetal harm to some degree
  • Monitor seizure freq (efficacy), mental status, blood levels (if applicable)
  • Supplement with vitamin D/calcium
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16
Q

AEDs that Increase GABA

A
  • Benzos
  • Valproic Acid
  • Levetiracetam (2 MoA)
  • Deficiency in GABA can cause seizures
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17
Q

Ca-Channel Blocker AEDs

A
  • Ethosuximide: T-Type Ca Channel Blocker
  • Levetiracetam (2 MoA)
  • Reducing Ca+ reduces neuronal firing
18
Q

Na-Channel Blocker AEDs

A
  • Carbamazepine
  • Phenytoin/Fosphenytoin
  • Lamotrigine
  • Topiramate
  • Reducing Na+ reduces neuronal firing rate
19
Q

AED Inhibitor vs Inducer

A
  • Valproic acid is the only notable INHIBITOR

- Otherwise, assume they are an inducer

20
Q

AEDs Requiring Blood Levels

A
  • Phenytoin**
  • Valproic Acid
  • Carbamazepine
  • Phenobarbital
21
Q

Phenytoin Doses

A
  • Michaelis-Mentin kinetics
  • Small increases in doses can cause large increases in drug level
  • Only increase in 30-50 mg dose adjustments
  • IF albumin low, correct total phenytoin level: total measured/[(0.2*Albumin) + 0.1]
22
Q

Valproic Acid

A

-Severe fetal harm (category X): neural tube defects, decreased IQ (prevent with folate)

23
Q

Kids + AED

A
  • CNS depression is a concern (need to be awake/pay attention in school
  • Topiramate/Zonisamide: hypohydrosis ( reduced sweating, limit outside play, hydrate)
  • Lamotrigine: increases risk of severe rash
24
Q

Carbamazepine Cousins

A
  • Oxcarbazepine
  • Eslicarbazepine
  • Hyponatremia, rash, enzyme inducers
25
Q

Topiramate Cousin

A

Zonisamide

  • Weigh loss, metabolic acidosis
  • Kidney stones, oligohidrosis/hyperthermia (esp. kids)
26
Q

Lamotrigine

A
  • SERIOUS skin reactions (SJS, TEN)
  • SE: aespetic meningitis, nausea
  • Dose: Start low and slowly titrate up
  • Give BLUE starting dose pack if also using valproic acid
  • GREEN starter pack: if taking with enzyme inducers and/or not taking valproic acid
  • ORANGE: standard starting dose, no DDI
27
Q

Keppra

A
  • Levetiracetam
  • No significant DDI
  • Less toxicity/SE
  • SE: psych. rxns, irritability, dizzy, weakness
  • IV: PO is 1:1
28
Q

Topamax

A
  • Topiramate
  • Warning: kidney stones, oligohidrosis, acute angle closure glaucoma, metabolic acidosis (nonanion), hyperammonia, hetal harm
  • SE: Weight LOSS, anorexia, CNS depression (cognitive problems, “Stupamax”)
29
Q

Depakote

A
  • Valproic Acid
  • Box Warning: hepatic failure, fetal harm, pancreatitis
  • Warning: HYPERammonia
  • Can treat hyperammonia with carnitine in severe cases*
  • SE: alopecia (use selenium/zinc), weight GAIN
  • Therapeutic levels: 50-100 mcg/mL
  • *Can correct the same way as phenytoin if albumin is low**
30
Q

Tegretol Information

A
  • Carbamazepine: NARROW SPECTRUM
  • Hyponatremia
  • Rash: SJS/TEN (test for HLA-B*1502)
  • Strong inducer (AUTOinducer)
  • Can also be used for bipolar disorder (Equetro) and trigeminal neuralgia
  • Therapeutic Levels: 4-12 mcg/mL
31
Q

Trileptal

A
  • Oxcarbazepine: NARROW spectrum
  • Hyponatremia
  • Rash 25-30% cross-sensitivity (HLA*B-1502 testing recommended, but not req. like carbamazepine)
  • Inducer
32
Q

Gabapentin Cousin

A
  • Pregabalin
  • Weight gain, peripheral edema, euphoria
  • More common for neuropathic pain
33
Q

Phenobarbital Cousin

A
  • Primidone (prodrug of Phenobarbital)

- Sedating, dependence/tolerance/overdose risk, enzyme inducer

34
Q

Vimpat

A
  • Lacosamide
  • Prolongs PR level: baseline ECG and cont. to monitor
  • CV
  • Risk of arrhythmias
  • Otherwise similar to other AEDs
35
Q

Phenobarbital

A
  • CI: hepatic impairment, previous addiction, intraarterial administration (extravasation)
  • Warning: habit forming, resp. depression, fetal harm
  • SE: dependence/tolerance/hangover effects
  • Strong inducer
  • Therapeutic Range: 20-40 mcg/mL
36
Q

Dilantin

A
  • Phenytoin
  • 1 mg PE = 1 mg phenytoin (used to dose Fosphenytoin - Cerebyx, IV prodrug)
  • Strong inducer
  • Therapeutic: 10-20 mcg/mL total; 1-2.5mcg/mL free levels
37
Q

Phenytoin AE

A
  • Time related: gingival hyperplasia, hirsutism, hepatotoxicity
  • Dose-related: ataxia, nystagmus, diplopia/blurred vision
  • *Due to kinetics, only increase by 30-50 mg at a time**
38
Q

Phenytoin Vs Fosphenytoin

A
  • Phenytoin max: 50 mg/min; Fosphenytoin: 150 mg PE/min or 2 mg PE/kg/min
  • Arrhythmia risk at fast inf., purple glove syndrome
  • Less purple glove syndrome in fosphenytoin
  • Phenytoin: requires filter, dilute with NS, stable for 4 hours
  • Separate tube feedings from phenytoin by 1-2 hours (decreases absorption)
39
Q

Zarontin

A
  • Ethosuximide

- Indication: absence seizures

40
Q

Felbatol

A
  • Felbamate
  • Hepatic failure
  • Aplastic anemia
41
Q

Sabril

A
  • Vigabatrin
  • Vision loss (30%)
  • REMS

NAPLEX (59 decks)

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