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Pharmacology Summer '22 > Seizures > Flashcards

Seizures Flashcards

1
Q

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

A

EEG

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2
Q

When changing antiepilectic drugs, it is important to ___

A

taper the first drug, while initiating the second

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3
Q

A third line treatment option for seizures is ___

A

surgery

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4
Q

_______ 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.

A

Hydantoins

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5
Q

Three examples of hydantoins are ___, __, and ___

A

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

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6
Q

Phenytoin (Dilantin)

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

do not take with antiacids

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7
Q

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

A

10-20 mcg/mL

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8
Q

The therapeutic level of free unbound phenytoin is ___

A

1-2.5 mcg/mL

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9
Q

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

A

> 20mcg/mL

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10
Q

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

A

far lateral nystagmus

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11
Q

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

A

> 30mcg/mL

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12
Q

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

A

45 degree far lateral nystagmus and ataxia

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13
Q

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

A

> 40mcg/mL

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14
Q

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

A

decreased mentation and lethargy

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15
Q

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

A

death

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16
Q

Common adverse effects of phenytoin are ___

A

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

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17
Q

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

A

use of phenytoin

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18
Q

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

A

eyes, gums, skin

CBC

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19
Q

Phenytoin levels can be decreased by _______________

A

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

20
Q

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

A

carbamazepine (Tegretol)

21
Q

Therapeutic plasma concentrated of carbamazepine is ____

A

4-12 mg/L

22
Q

autoinduction is ___

A

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

23
Q

Carbamazepine undergoes autoinduction. Therefore, practitioners should ____

A

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

24
Q

One common side effect of carbamazepine is ___

A

rash

25
Q

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

A

oxcarbazepine (Trileptal)

26
Q

A clinically significant side effect of oxcarbazepine is _____

A

low serum sodium <125 mmol/L

27
Q

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

A

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

28
Q

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

A

GI upset

hepatotoxicity
hyperammonemia/encephalopathy
thrombocytopenia
pancreatitis

spina bifida

29
Q

______ is one of the drugs of choice for absence seizures

A

Ethosuximide (Zarontin)

30
Q

T o F

Ethosuximide (Zarontin) is an appropriate choice for monotherapy

A

False

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

31
Q

Therapeutic range for ethosuximide (Zarontin) is ___

A

40-100mg/L

32
Q

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

A

GI upset and fatigue

blood dyscrasias, CNS depression, SLE, cutaneous reactions

33
Q

The most commonly used barbiturate-based anticonvulsant is ____

A

phenobarbital

34
Q

Therapeutic range for phenobarbital is ___

A

15-40mg/L

35
Q

Overdosage or toxicity of phenobarbital results in ____

A

confusion, jaundice, slurred speech

sedation, hypotension, respiratory depression, coma

36
Q

Hypotension secondary to phenobarbital use can be treated with ___

A

IV vasopressors

37
Q

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

A

Activated charcoal

sodium bicarbonate

38
Q

Primidone (Mysoline) is a ____

A

barbituate based anticonvulsant

39
Q

Serum level of primidone (Mysoline) is ____

A

5-12 mg/L

40
Q

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

A

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

retinal detachment

41
Q

T o F

Gabapentin should be not used as monotherapy for seizure disorder.

A

True

There is insufficient data supporting the use of gabapentin as monotherapy

42
Q

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

A

partial onset

renally dosed

43
Q

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

A

Rash, including SJS

slower titration

44
Q

T o F

Levetiracetam (Keppra) is approved as an antiseizure monotherapy

A

False

levetiracetam is an adjunctive therapy

45
Q

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

A

severe liver disease

CrCL

Pharmacology Summer '22 (9 decks)

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