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NAPLEX Prep > Seizure/Epilepsy > Flashcards

Seizure/Epilepsy Flashcards

acute management, chronic management, monitoring, DDI, ADE, pregnancy, peds, counseling points

1
Q

drugs that can lower the seizure threshold

A

bupropion
clozapine
metoclopramide
theophylline
beta lactams
lithium
meperidine
FQs
tramadol
methadone

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2
Q

first line for acute seizure management

A

***if sz lasts >5 min

for 5-20 min
IV ativan or IV midazolam (versed) or rectal diazepam (Diastat)

for 20-40 min
give regular AEDs
keppra
VPA
IV fosphenytoin
IV phenytoin
phenobarbital

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3
Q

what doses does diastat (PR diazepam) come in

A

2.5mg
10mg
20mg

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4
Q

what is the device that can monitor sz in patients >6 yo

A

Embrace 2 smart watch

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5
Q

what type of diet can possible help with epilepsy

A

ketogenic
4:1 fats : carbs + proteins

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6
Q

what are the general coverage AEDs

A

keppra
lamotrigine
VPA
topiramate

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7
Q

how is lamotrigine dosed upon initiation for patients not on CYP inducers or inhibtors

A

week 1-2: 25mg po qd
week 2-4: 50mg po qd
week 5+: increase daily dose by 50mg q1-2 weeks

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8
Q

why is lamotrigine titrated slowly

A

risk of SJS/TEN

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9
Q

ADE of lamictal

A

SJS/TEN, DRESS, blood dyscrasias, arrhythmia, HLH, alopecia, N/V, somnolence, tremor, blurred vision

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10
Q

what color lamotrigine starter kit would be used for a patient on VPA

A

blue with a lower starting dose

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11
Q

what color lamotrigine starter kit would a patient use if they are not on any CYP inducers or inhibitors that affect lamotrigine

A

orange

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12
Q

what color lamotrigine starter kit would a patient be started on if they were taking a drug that induces CYP enzymes that affect lamotrigine concentrations and no VPA

A

green with a higher start dose

(phenobarbital, phenytoin, rifampin, SJW, primidone, carbamazepine)

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13
Q

levetiracetam dosing
start dose
MDD
renal adjustments?
what is the IV:PO ratio

A

start 500mg IR BID
MDD 3000mg
CrCl <80 –> dec dose
1:1

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14
Q

ADE of keppra

A

irritability, HTN, SJS/TEN, psych reactions, somnolence

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15
Q

levetiracetam DDI

A

no significant DDI :)

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16
Q

topiramate dosing
start dose
MDD
renal adjustments?
what is the IV:PO ratio

A

week 1: 25mg IR BID
week 2:-4: inc TDD by 50mg
week 5+: inc by 100mg weekly
MDD 400mg
CrCl <79 –> dec dose 50%
not available IV!

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17
Q

when is topiramate contraindicated

A

Er formulations are CI with alcohol and metformin

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18
Q

topiramate SE and monitoring

A

metabolic acidosis, nephrolithiasis, angle-closure glaucoma, memory issues, psychomotor slowing, anorexia, fetal harm

monitor bicarb, s/sx kidney stones, renal function (dec dose 50% if CrCl <80), hydration, eye exams for glaucoma

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19
Q

topiramate and CYP DDI

A

topiramate is a 3A4 inducer
3A4 inducers also dec topiramate levels

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20
Q

topiramate decreases efficacy of

A

estrogen-containing oral contraceptives and warfarin

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21
Q

what is the starting dose of VPA

A

15-20 mg/kg/day

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22
Q

MDD of VPA

A

60mg/kg/day

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23
Q

VPA concentrations are reported as

A. free
B. bound
C. total

A

C. total

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24
Q

VPA TDM goal

A

50-100mcg/mL of total VPA

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25
Q

what is the nuance with TDM of VPA

A

dec albumin will inc unbound VPA while VPA level stays the same bc it is total VPA

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26
Q

BBW of VPA

A

hepatic failure, fetal harm and neural tube defects

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27
Q

when is VPA contraindicated

A

hepatic disease

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28
Q

VPA SE and monitoring

A

SE: hyperammonemia, thrombocytopenia, DRESS
monitor: LFTs, CBC w diff, plts, TDM

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29
Q

T or F

carbapenems increase VPA concentrations

A

false, carbapenems dec VPA concentrations by induction

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30
Q

T or F

estrogen containing oral contraceptives decrease VPA concentrations

A

true, carbapenems do as well

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31
Q

T or F

VPA inhibits 2C9

A

true

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32
Q

T or F

VPA inhibits 2C19

A

false, VPA is a substrate of 2C19

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33
Q

what are the common inducers of VPA metabolism

A

phenytoin
phenobarbital
rifampin
carbamazepine

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34
Q

T or F

SJ Wort induces VPA metabolism

A

false, does not affect

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35
Q

which AEDs are metabolized by 2C19

A

VPA
lacosamide
phenytoin

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36
Q

esomeprazole and omeprazole will increase or decrease VPA concentrations? Which enzyme is involved?

A

esomeprazole and omeprazole inhibit CYP2C19 and will increase VPA concentrations

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37
Q

VPA will increase plasma concentrations of… via 2C19 inhibition
SATA

A. warfarin
B. lacosamide
C. rifampin
D. phenytoin
E. amiodarone
F. statins

A

A. warfarin
B. lacosamide

D. phenytoin

38
Q

which are the narrow spectrum AEDs

A

phenytoin, fosphenytoin, lacosamide, oxcarbazepine, carbamazepine, phenobarbital

39
Q

lacosamide isa control - _____

A

V

40
Q

pregabalin is a control - ____

A

V

41
Q

lacosamide
brand name
control - ___

A

vimpat
V

42
Q

phenobarbital is a control - ____

A

IV

43
Q

lacosamide starting dose
MDD
renal adjustments?
IV:PO

A

50-100mg BID
MDD 400mg
MDD if CrCl <30 = 300mg
1:1

44
Q

major lacosamide ADE

A

porolongs PR interval –> arrhythmias

*caution with BB, CCB, and other drgs that prolong PR interval

45
Q

carbamazepine brand name
TDM goal

A

tegretol
goal is 4-12 mcg/mL

46
Q

tegretol (carb) ADE and monitoring

A

DRESS SJS/TEN, liver damage, fetal harm, hyponatremia

47
Q

what should be done prior to tegretol or trileptal initiation and for which patient population?

A

patients of asain ancestry should be tested for the HLA-B*1502 allele

48
Q

what is a major concern with tegretol and trileptal

A

hyponatremia (SIADH)

49
Q

how do we convert between oxcarbazepine and carbamazepine

A

carb x 1.2 or 1.5 = oxcarb

50
Q

carbamazepine is CI in

A

myelosuppression
MAO-i in last 14 days
TCA hypersensitivity reaction

51
Q

what is unique about carbamazepine metabolism

A

auto inducer

enzyme inducer and induces its own metabolism

52
Q

oxcarbazepine
dosing
MDD
renal adjustments
warnings

A

300mg BID
MDD 2400mg
CrCl <30 – start at 300mg qd
warnings: SJS/TEN, hyponatremia

53
Q

carbamazepine/tegretol
dosing
MDD
renal adjustments
warnings

A

200mg BID
MDD 1600mg
no renal dose adjustments
warnings: SJS/TEN, hyponatremia

54
Q

phenytoin dosing
target in TDM

A

LD = 15-20mg/kg LD
TDM 10-20 total
1-2.5 free

55
Q

corrected pheny equation

A

corr pheny = pheny measured
(0.2 x alb) + 0.1

56
Q

IV:PO phenytoin

A

1:1

57
Q

admin of IV phenytoin should not exceed

A

50mg/min

58
Q

Fosphenytoin is a ____________ of phenytoin

A

prodrug

59
Q

how to convert btwn Fosphenytoin and phenytoin

A

1.5mg Fosphenytoin = 1mg phenytoin

60
Q

admin of IV Fosphenytoin should not exceed

A

150mg of phenytoin equivalent/min

61
Q

s/sx of phenytoin dose-related toxicity

A

nystagmus, ataxia, diplopia, lethargy

62
Q

s/sx of chronic phenytoin use

A

gingival hyperplasia
hair growth
liver tox
inc BG
metallic taste

63
Q

what should be monitored with phenytoin use

A

ECG (arrhythmias)
CMP
respiratory
TDM
LFTs

64
Q

phenytoin induces/inhibits which enzymes?

A

strong inducer
3A4, 1A2, 2C9, 2C19

65
Q

patients on which AEDs should use non-hormonal contraceptives

A

phenytoin
topiramate
VPA

66
Q

how should phenytoin be administered in patients with an NG tube

A

tube feeds should be held for 1-2 hours before and after

67
Q

phenobarb dosing

A

50-100mg BID-TID

68
Q

phenobarb is contraindicated in

A

hepatic imp, dyspnea, PMH sed/hypnotic addiction, IA adminsitration

69
Q

warnings for phenobarbital

A

drug dependency
resp depression
SJS/TEN
tolerance and hangover effects
fetal harm

70
Q

phenobarb DDI

A

strong inducer
do not use with estrogen-containing OCs

71
Q

what can happen with phenytoin drug concentrations and metabolism with time

A

phenytoin metabolism can become saturated over time where a small inc in dose can cause a large inc in Cp

need to correct for albumin

72
Q

common concerns with AEDs

A

bone loss, CNS dep, suicide risk, SJS/TEN

73
Q

which AEDs are NOT safe in pregnancy and are considered teratogenic

A

phenytoin
oxcarbazepine
carbamazepine
phenobarbital
primidone
clonazepam

74
Q

what supplementation should be given to patients who are on AEDs and are of child bearing potential / aer pregnant

A

folate, vitamin D, Ca

75
Q

what supplementation should be given to all patients on AEDs

A

Ca and Vit D

76
Q

what SE are children more susceptible to and which AEDs cause this

A

more susceptible to hypohidrosis from topiramate and zonisamide
limit sun exposure

77
Q

what supplementation can be given with VPA

A

carnitine

78
Q

what can be given to patients on lamotrigine and VPA if they develop alopecia

A

selenium and zinc

79
Q

which AEDs should not be used with estrogen-containing OCs and are recommended to use with non-hormonal contraceptives instead

A

phenytoin
topiramate
VPA
phenobarbital

80
Q

which AEDs can cause SJS/TEN

A

lamotrigine
levetiracetam
oxcarbazepine
carbamazepine

81
Q

benzo MOA

A

potentiate GABA

82
Q

VPA MOA

A

potentiates GABA

83
Q

phenobarb MOA

A

potentiates GABA

84
Q

levetiracetam (keppra) MOA

A

CA channel blocker and potentiates GABA

85
Q

pregabalin/gabapentin MOA

A

Ca channel blocker

86
Q

oxcarbazepine MOA

A

Na and Ca channel blocker

87
Q

carbamazepine MOA

A

Ca channel blocker

88
Q

lamotrigine MOA

A

Ca channel blocker

89
Q

phenytoin/fosphenytoin MOA

A

Ca channel blocker

90
Q

topiramate MOA

A

Ca channel blocker

NAPLEX Prep (57 decks)

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