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Seizures Flashcards

1
Q

1st line treatment for Generalized absence seizures?

A

Ethosuximide

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2
Q

What are the four 1st line meds for adults who have focal seizures?

A

Carbamazepine (carba-maz-a-peen)

Levetiracetam (leva-tr-ass-a-tam)

Phenytoin (phen-a-toin)

Zonisamide (za-nic-a-mide)

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3
Q

What are the two 1st line meds for Elderly with focal seizures?

A

Gabapentin

Lamotrigine

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4
Q

What is the 1st line med for children with focal seizures?

A

Oxcarbazepine (ox-car-bay-za-pean)

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5
Q

What is the first line treatment for Tonic clinic seizures in Adults and Elderly?

A

La-motrigine (La-moat-truh-jean)

Levetiracetam (Leh-vuh-tr-A-suh-tam)

Topiramate - (Tuh-peer-a-mate)

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6
Q

How long do we taper when discontinuing a seizure medication?

A

3-6 months

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7
Q

What would you educate about brand name or generic with seizure meds?

A

Stick to the same generic or brand name manufacture

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8
Q

When do you draw a trough for seizure meds?

A

12 hours after the bedtime dose

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9
Q

What drives treatment and dose changes with seizure meds, even if there are labs to monitor?

A

The Patient, not the numbers

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10
Q

When do you check therapeutic drug monitoring with seizure meds. There are several of them

A
  1. Initiating
  2. Changing
  3. Adding
  4. Stopping
  5. Concern for toxicity
  6. Concern for inadequate response
  7. Verify absorption
  8. Evaluate adherence
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11
Q

When should you draw free therapeutic levels?

A

Elderly

CKD

Low Albumin

Pt taking other highly protein bound meds

Unexpected Adverse reactions

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12
Q

What two meds can you draw Free levels?

A

Phenytoin

Valproate acid products

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13
Q

What is the Free:Total ratio?

A

1:10

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14
Q

What are the most common side effects with anti-seizure meds?

A

GI: N/V/Diarrhea

CNS: Somnolence, fatigue, dizziness, ataxia

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15
Q

What is the most common idiosyncratic Adverse reaction with anti-seizure meds?

A

Rash

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16
Q

The idiosyncratic ADR of rash: What is the rare risk type rashes?

A

Stevens Johnson

Which can lead into Toxic Epidermal nercolysis (TEN)

Also, Drug reaction with eosinophilia and systemic symptoms (DRESS)

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17
Q

Who is at biggest risk of SJS and TEN? And what test can they take to evaluate the risk factor?

A

People of Asian decent

HLA-B* 1502

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18
Q

What anti-seizure meds can cause idiosyncratic rashes?

A 
Carbamazepine
Eslicarbazepine
Ethosuximide
Phenytoin
Oxcarbazepine
Lamotrigine

CEE POL

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19
Q

Because an idiosyncratic ADR is blood dyspraxia, except in Gabpentin, pregabalin, and Lamotrigine, what lab is routine for all seizure meds?

A

CBC

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20
Q

What 4 meds do we monitor LFT’s because of the risk of hepatotoxicity with anti-seizure meds?

A

carbamazepine

Phenobarbital

Phenytoin

Valproate acid

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21
Q

Why can you feel safe to give Valproic acid to adults without risk of hepatotoxicity?

A

The BB warning is with children under 2 years old on multi anti seizure meds

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22
Q

What lab test should be done prior to starting Phenytoin (Dilantin)?

A

Pregnancy test

HLA-B*1502

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23
Q

What is the starting maintenance dose per day with Phenytoin (Dilantin)?

A

300mg/day for Maintenance

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24
Q

What is the Loading dose of Phenytoin?

A

1 gram

Divided into three doses (300/300/400)

Or <70kg 15/mg/kg/dose for three doses

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25
What is the pro-drug of Phenytoin?
Fosphenytoin
26
The pro-drug of Phenytoin is Fosphenytoin, what is its claim to fame?
Can be IV loaded 3x faster than Phenytoin and also can be given IM This is great for the initial bolus because phenytoin has to be give IV very slowly and there is no IM version
27
?
?
28
What labs need to drawn for carbamazepine?
Pregnancy HLA-B*1502 CBC - worry of anemia CMP - worry of liver function and Na+ for hyponaturemia
29
What is carbamazepine also for besides seizures?
Bipolar and neuropathic pain
30
What is the pros and cons of Phenobarbital long half life?
Pro: If the forget a dose, there is a low risk of seizure Con: If there are side effects, than it takes a long time to resolve Also it takes 3-4 weeks to reach a steady state
31
What anti-seizure med should be avoided in women of child bearing years?
Valproic Acid Also called Depakene and Depakote
32
What other meds are highly protein bound that can affect the absorption of Valproic acid and Phenytoin?
Bactrim ASA Warfarin
33
What anti-seizure med has the lowest side effects?
Lamotrigine
34
Can Lamotrigine be used for Acute, maintenance or both?
Just maintenance It takes up to 6 weeks to titrate
35
What med affects Lamotrigine?
Estrogen (phasic OCP) Increases clearance of Lamotrigine and lowers the Lamotrigine level
36
What are the only two anti-seizure meds that you have to test the HLA-B*1502?
Carbamazepine Phenytoin
37
When do you need to re-titrate after missed doses of Lamotrigine? And Why?
72 hours Otherwise there is a higher rate of Stevens-Johnson syndrome
38
Does Gabapentin have many drug interactions?
No. It has no drug interactions
39
How is Gabapentin cleared and do you need to dose differently for that?
Renal clearance. Yes, you need to renally dose
40
Besides seizures for elderly, what else does it treat? (Gabapentin)
Neuropathic pain
41
Gabapentin, what symptom do you need to monitor for?
Peripheral edema
42
How often is Gabapentin dosed a day?
3-4 times a day
43
What dose Gabapentin do?
Decreases glutamate release
44
Pregabalin is all the same as Gabapentin except what?
Same in peripheral edema, used for neuropathic pain, cleared renally, adjust for renal impairment, It is just Federally a schedule V, when Gabapentin is a schedule V just state wise
45
Why do you titrate Topiramate?
To minimize CNS effects: such as difficulty concentrating, memory impairment, confusion
46
What medical history would get you to not prescribe Topiramate to someone?
Hx of parenthesis and kidney stones.
47
What else is Topiramate good for?
Weight loss and migraines
48
What schedule is Topiramate with pregnancy? What can it cause
D, it can cause cleft lip and palate
49
Prior to giving Lacosamide what should you do?
ECG
50
Can Lacosamide be given acute? What forms does it come in?
Yes. It comes as an IV and PO
51
What schedule is Lacosamide
V
52
What is Levetiracetam associate with?
Behavioral changes: Agitation, irritability, depression
53
What forms can you get Levetracetam?
Oral (IR and ER) and IV
54
Levetiracetam, drug interactions? Major side effects?
Nope
55
Which one of the carbazepine is the newest?
Eslicarbazepine - It’s a prodrug
56
What side effects can you find in 40% of the people taking Ethosuximide? Because of this how do you change the dosing
N/V - So give smaller more frequent dosing
57
Tiagabine: How should you take it?
Take with food to slow the absorption. Otherwise it can cause CNS side effects
58
What weird thing can Vigabatrin cause
BB warning of Vision loss
59
What can perampanel induce
Depression and severe psych issues
60
What allergy can someone have that they could not take Zonisamide?
Sulfa allergy
61
What 3 meds can pregnant women or women of child-baring years take for seizures?
Lamotrigine Levetiracetam Gabapentin
62
What anti-seizure med is last line for women of child-baring years
Valproic acid
63
What three meds are preferred during breastfeeding with seizures?
Carbamazepine Phenytoin Valproate
64
When can a person drive again after a seizure
6 months to a year
65
What two meds had the highest risk of suicidality?
Lamotrigine Topriamate
66
When can you withdraw seizure meds? And How?
Seizure free for 2-4 years Complete seizure control within one year of onset Onset after 2 years of age but before 35 How: There needs to be a Normal neuro exam and Normal EEG Should always be gradual
67
How much do you start with decreasing to taper off anti-seizure meds? What if they are on two meds?
Decrease 25% One med at a time

Pharm Seizures (8 decks)

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