Seizures Flashcards
One of the most common tools for diagnosing seizure is the ___
EEG
When changing antiepilectic drugs, it is important to ___
taper the first drug, while initiating the second
A third line treatment option for seizures is ___
surgery
_______ 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.
Hydantoins
Three examples of hydantoins are ___, __, and ___
phenytoin (Dilantin)
ethotoin (Peganone)
fosphenytoin (Cerebyx)
Phenytoin (Dilantin)
anticonvulsant; hydantoin affect sodium channels **do not abruptly discontinue **may result in hepatitis **CV events when IVP
do not take with antiacids
The therapeutic serum concentration of phenytoin is _____in a person with a normal albumin level.
10-20 mcg/mL
The therapeutic level of free unbound phenytoin is ___
1-2.5 mcg/mL
When serum phenytoin is concentrated at ____ it results in far lateral nystagmus
> 20mcg/mL
When serum phenytoin is concentrated at >20mcg/mL it results in ___
far lateral nystagmus
When serum phenytoin is concentrated at ______ is results in 45 degree far lateral nystagmus and ataxia
> 30mcg/mL
When serum phenytoin is concentrated >30mcg/mL it results in ___
45 degree far lateral nystagmus and ataxia
When serum phenytoin levels are concentrated at ____ it results in decreased mentation and lethargy
> 40mcg/mL
When serum phenytoin is concentrated at >40mcg/mL it results in ___
decreased mentation and lethargy
When serum phenytoin is concentrated at >100mcg/mL it results in___
death
Common adverse effects of phenytoin are ___
gingival hyperplasia, hirsutism, rash,
ataxia, nystagmus, osteopenia, hepatitis,
blood dyscrasias, SJS, drug reaction with eosinophilia and systemic syndromes (DRESS) and systemic lupus erythematosus (SLE)
Drug reaction with eosinophilia and systemic syndromes (DRESS) can result from ___
use of phenytoin
Before prescribing phenytoin (Dilantin) is it important to assess ______ and obtain _____ (blood work).
eyes, gums, skin
CBC
Phenytoin levels can be decreased by _______________
alcohol (long term use)
anti-acids, tube feedings
rifampin, folic acid
______ is a first-line drug for monotherapy in simple or complex partial seizures with secondary generalization
carbamazepine (Tegretol)
Therapeutic plasma concentrated of carbamazepine is ____
4-12 mg/L
autoinduction is ___
the ability of some drugs to enhance enzymes that enhance their own metabolism
Carbamazepine undergoes autoinduction. Therefore, practitioners should ____
be wary to decrease the dose until ONE MONTH after initiation of the drug
One common side effect of carbamazepine is ___
rash
_______ is indicated for monotherapy or as adjunctive therapy in treated partial seizures
oxcarbazepine (Trileptal)
A clinically significant side effect of oxcarbazepine is _____
low serum sodium <125 mmol/L
The therapeutic range of Valproic acid and derivatives (Divalproex) is____
50-100mg/L with some patients requiring levels higher than 100mg/L to achieve seizure control
Valproic acid may cause _________________________________ and produces _____ in 1-2% of pregnancies
GI upset
hepatotoxicity
hyperammonemia/encephalopathy
thrombocytopenia
pancreatitis
spina bifida
______ is one of the drugs of choice for absence seizures
Ethosuximide (Zarontin)
T o F
Ethosuximide (Zarontin) is an appropriate choice for monotherapy
False
ethosuximide (Zarotin), indicated for use in absence seizures, should always be used in combination with another agent
Therapeutic range for ethosuximide (Zarontin) is ___
40-100mg/L
Common adverse reactions of ethosuximide (Zarontin) include_____. Ethosuximide use has also been associated with_________________________
GI upset and fatigue
blood dyscrasias, CNS depression, SLE, cutaneous reactions
The most commonly used barbiturate-based anticonvulsant is ____
phenobarbital
Therapeutic range for phenobarbital is ___
15-40mg/L
Overdosage or toxicity of phenobarbital results in ____
confusion, jaundice, slurred speech
sedation, hypotension, respiratory depression, coma
Hypotension secondary to phenobarbital use can be treated with ___
IV vasopressors
_______ reduces the half-life of phenobarbital and ____promoted its elimination
Activated charcoal
sodium bicarbonate
Primidone (Mysoline) is a ____
barbituate based anticonvulsant
Serum level of primidone (Mysoline) is ____
5-12 mg/L
Ezogabine (Potiga) is a ______ used for ______. It is essential to monitor _____, as well as ______. A Black Box warning is _____.
anticonvulsant, neuronal potassium channel opener
seizures
***CrCl
liver function
retinal detachment
T o F
Gabapentin should be not used as monotherapy for seizure disorder.
True
There is insufficient data supporting the use of gabapentin as monotherapy
Pregabalin (Lyrica) can be used for _____ seizures as an adjunctive therapy. It must be ____ dosed
partial onset
renally dosed
lamotrigine (Lamictal) can cause a serious side effect _____ which can be prevented by _____
Rash, including SJS
slower titration
T o F
Levetiracetam (Keppra) is approved as an antiseizure monotherapy
False
levetiracetam is an adjunctive therapy
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
severe liver disease
CrCL
