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Pharm Seizures > Seizures > Flashcards

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
Q

What is the pro-drug of Phenytoin?

A

Fosphenytoin

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26
Q

The pro-drug of Phenytoin is Fosphenytoin, what is its claim to fame?

A

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

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27
Q

?

A

?

28
Q

What labs need to drawn for carbamazepine?

A

Pregnancy

HLA-B*1502

CBC - worry of anemia

CMP - worry of liver function and Na+ for hyponaturemia

29
Q

What is carbamazepine also for besides seizures?

A

Bipolar and neuropathic pain

30
Q

What is the pros and cons of Phenobarbital long half life?

A

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
Q

What anti-seizure med should be avoided in women of child bearing years?

A

Valproic Acid

Also called Depakene and Depakote

32
Q

What other meds are highly protein bound that can affect the absorption of Valproic acid and Phenytoin?

A

Bactrim

ASA

Warfarin

33
Q

What anti-seizure med has the lowest side effects?

A

Lamotrigine

34
Q

Can Lamotrigine be used for Acute, maintenance or both?

A

Just maintenance

It takes up to 6 weeks to titrate

35
Q

What med affects Lamotrigine?

A

Estrogen (phasic OCP)

Increases clearance of Lamotrigine and lowers the Lamotrigine level

36
Q

What are the only two anti-seizure meds that you have to test the HLA-B*1502?

A

Carbamazepine

Phenytoin

37
Q

When do you need to re-titrate after missed doses of Lamotrigine? And Why?

A

72 hours

Otherwise there is a higher rate of Stevens-Johnson syndrome

38
Q

Does Gabapentin have many drug interactions?

A

No. It has no drug interactions

39
Q

How is Gabapentin cleared and do you need to dose differently for that?

A

Renal clearance. Yes, you need to renally dose

40
Q

Besides seizures for elderly, what else does it treat? (Gabapentin)

A

Neuropathic pain

41
Q

Gabapentin, what symptom do you need to monitor for?

A

Peripheral edema

42
Q

How often is Gabapentin dosed a day?

A

3-4 times a day

43
Q

What dose Gabapentin do?

A

Decreases glutamate release

44
Q

Pregabalin is all the same as Gabapentin except what?

A

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
Q

Why do you titrate Topiramate?

A

To minimize CNS effects: such as difficulty concentrating, memory impairment, confusion

46
Q

What medical history would get you to not prescribe Topiramate to someone?

A

Hx of parenthesis and kidney stones.

47
Q

What else is Topiramate good for?

A

Weight loss and migraines

48
Q

What schedule is Topiramate with pregnancy? What can it cause

A

D, it can cause cleft lip and palate

49
Q

Prior to giving Lacosamide what should you do?

A

ECG

50
Q

Can Lacosamide be given acute? What forms does it come in?

A

Yes. It comes as an IV and PO

51
Q

What schedule is Lacosamide

A

V

52
Q

What is Levetiracetam associate with?

A

Behavioral changes: Agitation, irritability, depression

53
Q

What forms can you get Levetracetam?

A

Oral (IR and ER) and IV

54
Q

Levetiracetam, drug interactions? Major side effects?

A

Nope

55
Q

Which one of the carbazepine is the newest?

A

Eslicarbazepine - It’s a prodrug

56
Q

What side effects can you find in 40% of the people taking Ethosuximide? Because of this how do you change the dosing

A

N/V - So give smaller more frequent dosing

57
Q

Tiagabine: How should you take it?

A

Take with food to slow the absorption. Otherwise it can cause CNS side effects

58
Q

What weird thing can Vigabatrin cause

A

BB warning of Vision loss

59
Q

What can perampanel induce

A

Depression and severe psych issues

60
Q

What allergy can someone have that they could not take Zonisamide?

A

Sulfa allergy

61
Q

What 3 meds can pregnant women or women of child-baring years take for seizures?

A

Lamotrigine

Levetiracetam

Gabapentin

62
Q

What anti-seizure med is last line for women of child-baring years

A

Valproic acid

63
Q

What three meds are preferred during breastfeeding with seizures?

A

Carbamazepine

Phenytoin

Valproate

64
Q

When can a person drive again after a seizure

A

6 months to a year

65
Q

What two meds had the highest risk of suicidality?

A

Lamotrigine

Topriamate

66
Q

When can you withdraw seizure meds? And How?

A

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
Q

How much do you start with decreasing to taper off anti-seizure meds? What if they are on two meds?

A

Decrease 25%

One med at a time

Pharm Seizures (8 decks)

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