Seizure therapy + Antiepileptic Drugs

Question 1

What is the DOC for treatment of a rabbit with seizures?

Answer 1

Gabapentin

Question 2

What is a simple partial seizure?

Answer 2

Lateralizing motor activity, no loss of consciousness

Question 3

What is the DOC for acute management of seizures?

Answer 3

1. Diazepam
2. Midazolam

(benzodiazepines)

Question 4

What routes of admin can Midazolam be given to control an acute seizure?

Answer 4

IV, IM, TM, IN, per rectum

Question 5

What routes of admin can Diazepam be given to control an acute seizure?

Answer 5

IV, TM, IN, per rectum

Question 6

Which drug can be given as a loading dose, allowing a steady state to be reached?

Answer 6

Phenobarbital

Question 7

Which antiepileptics require routine plasma level monitoring?

Answer 7

1. Phenobarbital
2. KBr

Question 8

__________ is the DOC in patients requiring chronic/maintenance therapy

Answer 8

Phenobarbital

Question 9

Which of the following anticonvulsants works by altering chloride transport across neuronal cell membranes?

A. Phenobarbital
B. KBr
C. Alfaxalone
D. Zonisamide

Answer 9

B. KBr / Bromide / NaBr

Question 9

Which of the following anticonvulsants works by inhibiting voltage gated sodium channels?

A. Phenobarbital
B. KBr
C. Alfaxalone
D. Zonisamide

Answer 9

D. Zonisamide

Question 10

Bromide has a _________ half life

Answer 10

Extremely long

Question 10

In what species is the use of Bromide contraindicated?

Answer 10

• Contraindicated in cats
• Causes asthma-like pulmonary changes and respiratory distress

Question 11

What changes can be seen on blood chemistry with a patient on Bromide therapy?

Answer 11

1. Falsely high Cl- levels

Question 12

What can cause increased renal excretion of Bromide, resulting in a faster metabolism of the drug?

Answer 12

High salt (Na+) diet

Question 13

How can you treat “bromism” overdose?

Answer 13

0.9% NaCl to promote excretion

Question 14

MOA on phenobarbital?

Answer 14

GABA agonist, barbiturate

Question 15

What is not an adverse side effect of phenobarbital?

A. Elevated ALP
B. Urinary retention
C. Bone marrow suppression
D. Enzyme induction

Answer 15

B. Urine retention

Causes PU/PD/PP

Question 16

Levetiracetam (Keppra) has a ________ half life

Answer 16

Short, have to give TID

Question 17

What is the DOC for seizures due to hepatic encephalopathy?

Answer 17

Levetiracetam (Keppra)

Question 18

Adverse effects of phenobarbital?

Answer 18

1. PU/PD/PP
2. Tolerance due to enzyme induction
3. Contraindicated if hepatic dysfunction
4. Bone marrow suppression
5. Interferes with thyroid testing
6. Requires plasma conc. monitoring

Question 19

Which anticonvulsant can be used as “pulse therapy” for breakthrough seizures?

Answer 19

Levetiracetam (Keppra)

Question 20

Adverse effects of Levetiracetam (Keppra)?

Answer 20

1. Caution in patients with decreased GFR (CKD, AKI)
2. “Honeymoon effect” lasts 7 months then builds tolerance
3. Some sedation/ataxia

Question 21

Adverse effects of Zonisamide?

Answer 21

1. Hepatopathy
2. Urinary calculi
3. GI signs
4. Idiosyncratic agranulocytosis

Question 22

Why must a urinalysis and CBC be monitored during Zonisamide use?

Answer 22

• Causes urinary calculi
• Causes idiosyncratic agranulocytosis

Question 23

How can Zonisamide be administered?

Answer 23

Oral formulation only

Question 24

Which AED has no injectable formulation?

Answer 24

Zonisamide

Question 25

When is zonisamide indicated for treatment of seizures?

Answer 25

Adjunct AED (2nd or 3rd line add on drug)