Seizures

Question 1

One of the most common tools for diagnosing seizure is the ___

Answer 1

EEG

Question 2

When changing antiepilectic drugs, it is important to ___

Answer 2

taper the first drug, while initiating the second

Question 3

A third line treatment option for seizures is ___

Answer 3

surgery

Question 4

_______ affect sodium channels and are a first line treatment for tonic-clonic and partial complex seizures. They are the least sedating drug type used for seizures.

Answer 4

Hydantoins

Question 5

Three examples of hydantoins are ___, __, and ___

Answer 5

phenytoin (Dilantin)
ethotoin (Peganone)
fosphenytoin (Cerebyx)

Question 6

Phenytoin (Dilantin)

Answer 6

anticonvulsant; hydantoin 
affect sodium channels 
**do not abruptly discontinue 
**may result in hepatitis
**CV events when IVP

do not take with antiacids

Question 7

The therapeutic serum concentration of phenytoin is _____in a person with a normal albumin level.

Answer 7

10-20 mcg/mL

Question 8

The therapeutic level of free unbound phenytoin is ___

Answer 8

1-2.5 mcg/mL

Question 9

When serum phenytoin is concentrated at ____ it results in far lateral nystagmus

Answer 9

> 20mcg/mL

Question 10

When serum phenytoin is concentrated at >20mcg/mL it results in ___

Answer 10

far lateral nystagmus

Question 11

When serum phenytoin is concentrated at ______ is results in 45 degree far lateral nystagmus and ataxia

Answer 11

> 30mcg/mL

Question 12

When serum phenytoin is concentrated >30mcg/mL it results in ___

Answer 12

45 degree far lateral nystagmus and ataxia

Question 13

When serum phenytoin levels are concentrated at ____ it results in decreased mentation and lethargy

Answer 13

> 40mcg/mL

Question 14

When serum phenytoin is concentrated at >40mcg/mL it results in ___

Answer 14

decreased mentation and lethargy

Question 15

When serum phenytoin is concentrated at >100mcg/mL it results in___

Answer 15

death

Question 16

Common adverse effects of phenytoin are ___

Answer 16

gingival hyperplasia, hirsutism, rash,
ataxia, nystagmus, osteopenia, hepatitis,
blood dyscrasias, SJS, drug reaction with eosinophilia and systemic syndromes (DRESS) and systemic lupus erythematosus (SLE)

Question 17

Drug reaction with eosinophilia and systemic syndromes (DRESS) can result from ___

Answer 17

use of phenytoin

Question 18

Before prescribing phenytoin (Dilantin) is it important to assess ______ and obtain _____ (blood work).

Answer 18

eyes, gums, skin

CBC

Question 19

Phenytoin levels can be decreased by _______________

Answer 19

alcohol (long term use)
anti-acids, tube feedings
rifampin, folic acid

Question 20

______ is a first-line drug for monotherapy in simple or complex partial seizures with secondary generalization

Answer 20

carbamazepine (Tegretol)

Question 21

Therapeutic plasma concentrated of carbamazepine is ____

Answer 21

4-12 mg/L

Question 22

autoinduction is ___

Answer 22

the ability of some drugs to enhance enzymes that enhance their own metabolism

Question 23

Carbamazepine undergoes autoinduction. Therefore, practitioners should ____

Answer 23

be wary to decrease the dose until ONE MONTH after initiation of the drug

Question 24

One common side effect of carbamazepine is ___

Answer 24

rash

Question 25

_______ is indicated for monotherapy or as adjunctive therapy in treated partial seizures

Answer 25

oxcarbazepine (Trileptal)

Question 26

A clinically significant side effect of oxcarbazepine is _____

Answer 26

low serum sodium <125 mmol/L

Question 27

The therapeutic range of Valproic acid and derivatives (Divalproex) is____

Answer 27

50-100mg/L with some patients requiring levels higher than 100mg/L to achieve seizure control

Question 28

Valproic acid may cause _________________________________ and produces _____ in 1-2% of pregnancies

Answer 28

GI upset hepatotoxicity hyperammonemia/encephalopathy thrombocytopenia pancreatitis spina bifida

Question 29

______ is one of the drugs of choice for absence seizures

Answer 29

Ethosuximide (Zarontin)

Question 30

T o F | Ethosuximide (Zarontin) is an appropriate choice for monotherapy

Answer 30

False | ethosuximide (Zarotin), indicated for use in absence seizures, should always be used in combination with another agent

Question 31

Therapeutic range for ethosuximide (Zarontin) is ___

Answer 31

40-100mg/L

Question 32

Common adverse reactions of ethosuximide (Zarontin) include_____. Ethosuximide use has also been associated with_________________________

Answer 32

GI upset and fatigue | blood dyscrasias, CNS depression, SLE, cutaneous reactions

Question 33

The most commonly used barbiturate-based anticonvulsant is ____

Answer 33

phenobarbital

Question 34

Therapeutic range for phenobarbital is ___

Answer 34

15-40mg/L

Question 35

Overdosage or toxicity of phenobarbital results in ____

Answer 35

confusion, jaundice, slurred speech | sedation, hypotension, respiratory depression, coma

Question 36

Hypotension secondary to phenobarbital use can be treated with ___

Answer 36

IV vasopressors

Question 37

_______ reduces the half-life of phenobarbital and ____promoted its elimination

Answer 37

Activated charcoal | sodium bicarbonate

Question 38

Primidone (Mysoline) is a ____

Answer 38

barbituate based anticonvulsant

Question 39

Serum level of primidone (Mysoline) is ____

Answer 39

5-12 mg/L

Question 40

Ezogabine (Potiga) is a ______ used for ______. It is essential to monitor _____, as well as ______. A Black Box warning is _____.

Answer 40

anticonvulsant, neuronal potassium channel opener seizures ***CrCl liver function retinal detachment

Question 41

T o F | Gabapentin should be not used as monotherapy for seizure disorder.

Answer 41

True | There is insufficient data supporting the use of gabapentin as monotherapy

Question 42

Pregabalin (Lyrica) can be used for _____ seizures as an adjunctive therapy. It must be ____ dosed

Answer 42

partial onset | renally dosed

Question 43

lamotrigine (Lamictal) can cause a serious side effect _____ which can be prevented by _____

Answer 43

Rash, including SJS | slower titration

Question 44

T o F | Levetiracetam (Keppra) is approved as an antiseizure monotherapy

Answer 44

False | levetiracetam is an adjunctive therapy

Question 45

Lacosamide (Vimpat) is approved as a monotherapy and adjunctive therapy for partial-onset seizures. It should be avoided in patients with ____, and ____ should be monitored

Answer 45

severe liver disease | CrCL