Seizure Pharm

Question 1

Antiepileptic drugs (AEDs)—aka anticonvulsants

Answer 1

Serious drugs aimed at improving quality of life for pt with seizures; most pt won’t be seizure free with them but can improve QoL; come with many side effects

Question 2

AED cessation

Answer 2

Usually take for the rest of their life, but can dec the dose after 1-2 years seizure free; if you stop taking suddenly it will cause a seizure

Question 3

What factors do you use to choose a seizure drug?

Answer 3

Efficacy, adverse effects, drug interactions, cost, ease of use, pediatric availability

Question 4

Therapeutic monitoring

Answer 4

Regular blood draws to measure therapeutic effects ; evaluate effectiveness and adherence

Question 5

2nd and 3rd gen seizure drugs

Answer 5

Fewer SE and may be better for elderly, but efficacy of brand vs generic drugs is debatable

Question 6

3 major effects of AEDs (MOA)

Answer 6

Inc threshold of motor cortex activity which DECREASES NERVE’S ABILITY TO EXCITE and decreases electrical activity; limit SPREAD of nerve impulse conduction; decrease SPEED of nerve impulse conduction

Question 7

Alternate mechanism for seizure drugs

Answer 7

Work on increasing GABA bc low GABA is associated with seizures

Question 8

Side effects of all seizure drugs

Answer 8

BLACK BOX for worsened depression, increased SI, mood change; teratogenic–inc risk of birth defects; CNS depression–dizzy, drowsy, upset GI

Question 9

phenytoin (Dilantin) class and indications

Answer 9

hydantoins; tonic-clonic seizure, partial (focal seizure)

Question 10

phenytoin SE and NC

Answer 10

Lethargy, abnormal mvt, mental confusion, cognitive changes, GINGIVAL HYPERPLASIA (take care of teeth), hirsutism, osteoporosis, hypertrophy of SQ facial tissue; irritates the vein, needs therapeutic monitoring—toxicity causes nystagmus, atoxic encephalopathy, many drug-drug interactions bc highly protein bound; PO or IV; CYP450 inducer (increases metabolism of other drugs)

Question 11

valproic acid indication and class

Answer 11

no class; for all seizures, bipolar

Question 12

valproic acid SE and NC

Answer 12

GI upset, hepatotoxicity, pancreatitis, urea cycle disease; can get delayed response or sprinkles for kids; not for liver probs bc disease, PO or IV, highly protein bound

Question 13

topiramate (Topamax) class and indications

Answer 13

no class; adjunct therapy for partial and second general seizures, tonic-clonic seizures

Question 14

topiramate SE and NC

Answer 14

Visual changes—close-angle glaucoma; can interact with contraceptives and cause cleft lip—don’t get pregnant on it; only PO

Question 15

levetiracetam (Keppra) indication and class

Answer 15

anticonvulsant; for adjunct therapy with partial seizure w/ w/o generalization

Question 16

leviracetam SE and NC

Answer 16

Not for general maintenance, more for emergencies

Question 17

Rapid seizure management

Answer 17

most stop w/i 2 minutes but need IV access in case, check blood glucose; outpatient–give forms of diazepams like rectal and jelly

Question 18

Gold standard for rapid seizure management

Answer 18

Benzodiazepines; Diazepam, lorazepam