Seizure/Epilepsy Flashcards
VC is a 34 year-old female (height: 5’6”, weight: 156 lbs) who is admitted to the hospital with seizure activity.
Diagnoses Focal aware seizures GERD Hypertension Diabetes type 2
Medications Phenytek 300 mg PO daily Tegretol 400 mg PO daily Depakote ER 1,500 mg PO daily Zantac 75 mg PO PRN Cozaar 100 mg PO daily Metformin 1,000 mg PO BID
Labs on 4/14: Na (mEq/L) = 129 (135 – 145) K (mEq/L) = 3.5 (3.5 – 5) Cl (mEq/L) = 100 (95 – 103) HCO3 (mEq/L) = 26 (24 – 30) Glucose (mg/dL) = 148 (100 – 125) SCr (mg/dL) = 1.0 (0.6 – 1.2) Ca (mg/dL) = 8.7 (8.5 – 10.5) Mg (mEq/L) = 1.9 (1.3 – 2.1) PO4 (mg/dL) = 2.5 (2.3 – 4.7) AST (IU/L) = 12 (10 – 40) ALT (IU/L) = 23 (10 – 40) Albumin (g/dL) = 2.2 (3.5 – 5) A1C (%) = 8.3 Phenytoin, total = 7.8 mcg/mL
Labs on 6/17: Na (mEq/L) = 139 (135 – 145) K (mEq/L) = 3.5 (3.5 – 5) Cl (mEq/L) = 100 (95 – 103) HCO3 (mEq/L) = 26 (24 – 30) Glucose (mg/dL) = 158 (100 – 125) AST (IU/L) = 212 (10 – 40) ALT (IU/L) = 223 (10 – 40) Albumin (g/dL) = 2.5 (3.5 – 5) Question
Which of VC’s medications is most likely causing the laboratory results on 4/14?
Answer
A Tegretol B Depakote ER C Zantac D Cozaar E Metformin
Tegretol can cause hyponatremia.
What is the therapeutic range for Tegretol?
Answer
A 5-15 mcg/mL B 4-8 mcg/mL C 4-12 mcg/mL D 20-40 mcg/mL E 50-100 mcg/mL
C
4-12 mcg/mL
VC is a 34 year-old female (height: 5’6”, weight: 156 lbs) who is admitted to the hospital with seizure activity.
Diagnoses Focal aware seizures GERD Hypertension Diabetes type 2
Medications Phenytek 300 mg PO daily Tegretol 400 mg PO daily Depakote ER 1,500 mg PO daily Zantac 75 mg PO PRN Cozaar 100 mg PO daily Metformin 1,000 mg PO BID
Labs on 4/14: Na (mEq/L) = 129 (135 – 145) K (mEq/L) = 3.5 (3.5 – 5) Cl (mEq/L) = 100 (95 – 103) HCO3 (mEq/L) = 26 (24 – 30) Glucose (mg/dL) = 148 (100 – 125) SCr (mg/dL) = 1.0 (0.6 – 1.2) Ca (mg/dL) = 8.7 (8.5 – 10.5) Mg (mEq/L) = 1.9 (1.3 – 2.1) PO4 (mg/dL) = 2.5 (2.3 – 4.7) AST (IU/L) = 12 (10 – 40) ALT (IU/L) = 23 (10 – 40) Albumin (g/dL) = 2.2 (3.5 – 5) A1C (%) = 8.3 Phenytoin, total = 7.8 mcg/mL
Labs on 6/17: Na (mEq/L) = 139 (135 – 145) K (mEq/L) = 3.5 (3.5 – 5) Cl (mEq/L) = 100 (95 – 103) HCO3 (mEq/L) = 26 (24 – 30) Glucose (mg/dL) = 158 (100 – 125) AST (IU/L) = 212 (10 – 40) ALT (IU/L) = 223 (10 – 40) Albumin (g/dL) = 2.5 (3.5 – 5) Question
VC is not tolerating orals. What is the equivalent total daily dose of Phenytek if given intravenous?
Answer
A 300 mg B 450 mg C 600 mg D 900 mg E 1,200 mg
Phenytek IV:PO ratio is 1:1. Therefore, the dose of Phenytek given IV should be 300 mg per day.
Labs on 6/17: Na (mEq/L) = 139 (135 – 145) K (mEq/L) = 3.5 (3.5 – 5) Cl (mEq/L) = 100 (95 – 103) HCO3 (mEq/L) = 26 (24 – 30) Glucose (mg/dL) = 158 (100 – 125) AST (IU/L) = 212 (10 – 40) ALT (IU/L) = 223 (10 – 40) Albumin (g/dL) = 2.5 (3.5 – 5) Question
Besides the labs obtained on 6/17, what other laboratory values should be monitored since VC is taking Tegretol?
Answer
A CBC with differential B PFTs C Chest X-ray D CT scan E aPTT
Correct
Patients taking Tegretol should have their CBC with differential monitored.
Which of the following pairs of terms is not correctly matched?
Answer
A
Focal seizures - start on one side of the brain
B
Focal aware seizure - previously called generalized partial seizure
C
Focal seizure with impaired awareness - previously called complex partial seizure
D
Generalized seizures - start on both sides of the brain
E
Generalized seizure - loss of consciousness or awareness during the seizure
B
Focal aware seizure - previously called generalized partial seizure
Focal aware seizure is the updated term for what was previously called a simple partial seizure
Which of the following are boxed warnings for valproate and divalproex? (Select ALL that apply.)
Answer
A Pulmonary fibrosis B Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis C Teratogenicity D Hepatic failure E Pancreatitis
C Teratogenicity D Hepatic failure E Pancreatitis
Incorrect
Boxed warnings include hepatic failure, pancreatitis and teratogenicity.
Side effects of divalproex sodium may include the following: (Select ALL that apply.)
Answer
A Thrombocytopenia B Tachypnea C Extrapyramidal symptoms D Weight gain E Hair loss
A Thrombocytopenia D Weight gain E Hair loss
Weight gain and hair loss (alopecia) are associated with divalproex. Dose-related thrombocytopenia is a warning for valproate products.
A 28 year-old male has been diagnosed with seizures. He continues to have seizures despite receiving multiple antiepileptic drugs. His doctor has prescribed a specific diet that can help reduce seizures in patients who are refractory. Which of the following diets is used for this purpose?
Answer
A Low sodium B Mediterranean C Low cholesterol D Ketogenic E High carbohydrate
D
Ketogenic
The ketogenic diet is high in fats and low in carbohydrates (4:1 fat to carb+protein) and induces a state of ketosis that can decrease seizure frequency.
Which of the following side effects/adverse drug reactions are possible with the use of zonisamide? (Select ALL that apply.)
Answer
A Pancreatitis B Contraindicated in sulfa allergy C Weight loss D Decreased sweating E Kidney stones
B Contraindicated in sulfa allergy C Weight loss D Decreased sweating E Kidney stones
Incorrect
Zonisamide is a sulfonamide and is contraindicated in sulfonamide allergy.
Which of the following anticonvulsants are associated with oligohydrosis?
Answer
A Topiramate B Phenytoin C Carbamazepine D Lamotrigine E Lacosamide
A
Topiramate
Topiramate and zonisamide can cause oligohydrosis (decreased sweating). Oligohydrosis is most prominent in children.
JW comes to pick up her seizure medication, Lamictal. Which of the following statements concerning Lamictal is true?
Answer
A
This medication can cause neuroleptic malignant syndrome.
B
This medication can cause reductions in vitamin D.
C
This medication requires monthly monitoring of platelet counts.
D
This medication requires a slow dose titration.
E
The brand name is Keppra.
D
This medication requires a slow dose titration.
Lamictal requires a slow dose titration to reduce the risk of rash.
A patient who started taking antiepileptic drugs 2 years ago commented to her prescriber that she has seen an increase in body hair. Which antiepileptic drug is associated with this effect?
Answer
A Carbamazapine B Lamotrigine C Phenobarbital D Phenytoin E Valproate
D
Phenytoin
Long-term complications of phenytoin therapy can include hirsutism (increased hair growth), gingival hyperplasia, osteoporosis, and peripheral neuropathy.
A hospital pharmacist is preparing a phenytoin injection. The pharmacist should use the following diluent:
Answer
A Lactated ringers B Sterile water C D5W D D20W E NS
E
NS
Phenytoin should be diluted in NS only. It is administered in a large vein (extravasation can cause tissue necrosis), with an inline 0.22 micron filter.
Which of the following best describes the kinetics of phenytoin?
Answer
A
Phenytoin exhibits kinetics consistent with the Frank-Starling curve.
B
Phenytoin exhibits first order kinetics only.
C
Phenytoin exhibits second order kinetics only.
D
Phenytoin exhibits first order, then zero order kinetics.
E
Phenytoin exhibits zero order, then first order kinetics.
D
Phenytoin exhibits first order, then zero order kinetics.
Incorrect
Phenytoin exhibits first order, followed by zero order kinetics (also known as saturable or Michaelis-Menten kinetics)
Which of the following statements concerning oxcarbazepine is correct?
Answer
A
The brand name is Tegretol.
B
Serum sodium levels need to be monitored for the first 3 months of therapy.
C
If patients have a hypersensitivity reaction on carbamazepine, there is little-to-no risk of the same reaction if switched to oxcarbazepine.
D
IV to oral ratio is 1:1.
E
This medication is not associated with osteoporosis.
B
Serum sodium levels need to be monitored for the first 3 months of therapy.
Due to the risk of hyponatremia, serum sodium needs to be monitored for the first 3 months of oxcarbazepine therapy.
