Seizure/Epilepsy Flashcards
1
Q
Seizure Causes
A
- Fever (Children/Infants!)
- Alcohol withdrawal
- Hypoglycemia
- Electrolyte abnormalities
- (CNS) infections!
2
Q
Epilepsy Causes
A
- Brain tumors
- Dementia
- Brain damage
- Genetic
3
Q
Epilepsy vs Seizure
A
- Seizure can be one time event
- Epilepsy: chronic seizure disorders
- One seizure isn’t necessarily epilepsy
4
Q
Diagnosis
A
- EEG mainly
- CT/MRI (damage)
- Spinal tap/CSF (infectious)
5
Q
Focal
A
- Focused area
- One side of the brain
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)
7
Q
Generalized
A
Both sides of the Brain
8
Q
Movement Types
A
- Subtypes of generalized seizure
- Tonic: rigid muscles
- Clonic: rhythmical/jerking movements
- Atonic: limp muscles
- Myoclonus: muscle twitching
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
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
11
Q
IV AED Options
A
- Fosphenytoin
- Levetiracetam
- Valproic Acid
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
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
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
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
16
Q
AEDs that Increase GABA
A
- Benzos
- Valproic Acid
- Levetiracetam (2 MoA)
- Deficiency in GABA can cause seizures
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
