Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SHPCPJEN3 > Seizures > Flashcards

Seizures Flashcards

1
Q

Status Epilepticus

A

Life threatening seizure thats over 5 mins. If more than 30 mins could result in CNS damage. We worry about airway and IV access.

Generally patient will 100 mg thiamine and 25 gm of glucose in 50 ml of 50% dextrose should be considered.
Tx:
- lorazepam IV or IM ( if no IV access )
- phenytoin IV ( must have IV access )
- Fosphenytoin IV or IM
- Midazolam or propofol ( if we do all this and they still have seizures )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

1st line tx in status epilepticus

A

Benzos 1st line
- lorazepam 0.1mg/kg IV / IM at a max rate of 2 mg /min, allowing 1 min to see if more doses are necessary prn.
Alternative: diazepam 0.2 mg /kg IV or Midazolam IV/IM

Fosphenytoin ( preferred and IM ok) or phenytoin( cannot be in same bag as benzos. Separate bag)

If still seizing Midazolam or propofol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Medications that may seizures

A

Any stimulant at high enough dosages
• Theophylline ( caffeine structure similar) :
•PNC , ampicillin, oxacillin, ticarcillin, Imipenem, isoniazid, metronidazole
• abx: imipenem, cilastin, carbapenums
• TCAs, Bupropion( Wellbutrin, aplenzin, zyban )
• cocaine
•lidocaine
• meperidine ( Demerol ), Tramadol ( ultram ) , Nucenta ( tapendatol very similar to tramadol )
•lithium
•withdrawal from ethanol , benzos, barbiturates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Barbiturates

A

Phenobarbital MOA: enhance gaba
forms: tabs elixir, soln injection. IV
Problem: severe cognitive impairment / sedation.
Max IV : avoid IV > 50 mg / min
Indication: sedation & anticonvulsant

May cause hyperactivity in young kids.

BARB
B: bone disease, bone marrow suppression
A: ataxia
R: Rash
B: bradycardia, behavior changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Vitamin D deficiency and phenobarbital

A

Take supplement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

DDI phenobarbital

A

Phenobarbital is a inducer

Avoid OC. Can decrease effectiveness of estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Phenobarbital monitoring

A

Levels of phenobarb: kids 15-20 , adults 20 -40.
Mental status
CBC
LFT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Primidone

A

Metabolized to phenobarbital ( enhances gaba)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Fosphenytoin/ phenytoin -L

A

Fosphenytoin: starts with F. In fridge. IV and IM formulation.
MOA: decrease the amplitude of Na+ dependent action potential
phenytoiN: cap N for NS

IV chewable, oral : phenytoin
Fosphenytoin comes in IM

Goes through liver.
Inducers** DDI

DILANTIN

Therapeutic levels of phenytoin are 10-20. It’s protein bound. If protein levels drop, phenytoin will be displaced and levels increase. Low levels of albumin mean increase phenytoin levels. Burn patient means protein levels drop = high phenytoin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Phenytoin dose dependent kinetics

A

T
First order to zero order ( higher doses ) because the enzymes become saturated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Fospheytoin

A

Cerebyx
IV and IM only. IM is convenient
In Fridge
Mix in NS and D5W ( Phenytoin was only in NS )
Rate: Fosphenytoin infusion rate was 150 mg/min, phenytoin was only 50 mg/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Rash from phenytoin

SE:

A

Immunologic reaction. HLA-B*1502 ( like carbamazepine and oxcarbamazepine)

SE: gingival hyperplasia, hirsutism, arrhythmia/ bradycardia ( IV) [ recall used for arrhythmia class 1b. Anything that can be used for arrhythmia can cause arrhythmia ]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Valproic acid/ divalproex sodium

A

Valproic acid: depakene

Divalproex sodium: Depakote

Stavzor: delayed release caps depakote

Sodium valproate ( depacon- IV ) room temp

Used for absence seizures absanz fda approved , migraine prevention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Valproic acid and divalproex
SE
DDI
Protein displacement
Range
Pregnancy

A

SE: hepatotoxicity( BBW) . GI, thrombocytopenia, hyperammonemia , encephalopathy, deafness, tinnitus, SIADHe

DDI: Valproic acid is a weak inhibitor. DDI with lamictal. Increases blood levels of Lamotrigine.

Protein : phenytoin and Asa ( VPA is tightly protein bound ) : Asa displaces VA from protein

Antacids: will increase pH of the stomach —> dissolution of depakote EC in stomach. Separate by 2 h

Therapeutic range : 50 -100

Teratongenic ( D )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Carbamazepine

A

Anticholinergic ( recall structurally looks like a TCA and Cyclobenzaprine ) : avoid MAOIs
SE: hyponatremia, tachycardia arrhythmias,
RASH: if asn pt do genetic testing HLAB1502

MOA: binds to volatage dependent sodium channels
SE: Steven Johnson’s rash, arrhythmia , aplastic anemia agranulocytosis, anticholinergic ( tachycardia, dry mouth, ), SIADH, photosensitivity ( sun burns ). Monitor LFT
Tegretol
Cabatrol

Indications: tonic clonic focal not fo absence or myoclonic seizures

Bone marrow suppression ( aplastic anemia ) most seizure meds worry about bone marrow
Range: 4-12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Carbamazepine is a cyp 3a4 substrate

A

T

Drugs that increase carbamazepine are inhibitors of cyp 3a4
Grapefruit juice
Azoles: flu, keto, itraconazole,
Protease inhibitors : Ritonavir ( strongest )
C: clarithromycin, erythromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Carbamazepine and Valproic acid are both pregnancy category

A

D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Carbamazepine looks like TCA and Cyclobenzaprine

A

T

SE: anticholinergic side effects and hyponatremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Oxcarbazepine
Brand
MOA
SE
Level:

A

Trileptal
MOA: block Na channel
SE: less than carbamazepine. Most common: sedation ( slowing the sudden release of activity ). Rash( rare but still worry. Test Asians genetically HLAB*1502), ataxia, hyponatremia ( like carbamazepine), hypothyroidism.
Level:12-30

DDI : less than carbamazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

2 meds only used for absence seizures

A

Valproic acid and ethosuximide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Ehtosuximide

A

Zero tin
MOA: may be a t type calcium channel blocker / decrease Na current

Level 40-100

Methsuximide another form used for absence seizures. Used for patients refractory to other agents

23
Q

FeLbAmate

A

L lft
A aplastic anemia check CBC

MOA: not well understood.

24
Q

Gabapentin

A

Neurontin
100% goes through renal.
No DDI through liver.

Not a long half life so divided doses. But really sedating

Weight gain and edema : SE
( worry about additive Thiazidolidiones or CCBs )

Horizant: ER gabapentin. FDA approved for post hermetic neuralgia( post shingles) , RLS

25
Q

Pregabalin

A

Lyrica CV C5 ( euphoria )
100% renal
Dose adjust if crcl< 60

Max 600 mg /day

approved for adjunct for seizures. Indication: diabetic peripheral neuropathy, post hermetic neuralgia, fibromyalgia, adjunctive partial seizures

SE: dizziness, somnolence, dry mouth, bilateral edema ( % edema more than gabapentin [ worry about CHF patients ]) , occular effects. Myopathy ( tell patient to see doc )

26
Q

Lamotrigine

A

Lamictal

MOA: inhibits Na+ channels
SE: Rash ( D/C ) Steven Johnson’s, bone marrow suppression

Tabs, IR XR, ODT, chewable

Substrate watch for inducers / inhibitors ( increase Lamotrigine )
DDI : estrogen has shown lamictal [ ] by 50%.

27
Q

Rifampin can decrease Lamotrigine

A

Yes bc rifampin is an inducer and Lamotrigine is a cyp3a4 substrate

28
Q

Levetiracetam

A

Keppra, keppra XR, elepsia XR, Spritam
Renal 100%
MOA: not well understood

SE: somnolence ( all seizure meds do ) , weight loss, psychiatric sx ( agitation, anxiety , depression, psychosis)

29
Q

Taigabine

A

Gabitril Filmatabs
Take with food
MOA: potent enhancer of GABA, inhibits presynaptic neuronal GABA reuptake

Indication: partial seizure
SE: sedation, slows down speech

Substrate

30
Q

Zonisamide

A

Zonegran- sulfa -

MOA: blocks Na+ channels ( adjunct for partial seizures )
Topamax and zonisamide are the two medications that have ecarbonic anhydrase inhibition and can cause kidney stones.
Sulfa allergy?

SE: kidney stones, aplastic anemia, steven Johnson’s syndrome, weight loss, decrease sweating ( like topamax)
Drink water to decrease chance of stone formation.

31
Q

Both zonisamide and topamax have carbonic anhydrase inhibition. What does that tell you?

A

L/R

Can cause kidney stones

And it has sulfa in it. Worry about sulfa allergy

32
Q

Topiramate

A

Topamax
MOA: block Na+ channel / increase GABA / block NMDA glutamate receptor
Renal
Trokendi : ER capsule ( never open capsule )
Qudexy ER : capsule you may open and sprinkle on food
Indicated : >2 y/o for seizures/ migraine prophylaxis
SE: carbonic anhydrase inhibition ( kidney stones, sulfa allergy ( no actual concern about sulfa allergy only zonisamide) ) , weight loss( Qsymia : topamax +phentermine ) , Nephrolitiasis, metabolic acidosis, decreasing sweating and fever

Caution: may decrease serum bicarbonate concentrations leading to metabolic acidosis

Pregnancy category D

33
Q

Metabolic acidosis

A

Excreting or getting rid of sodium bicarbonate

34
Q

Lacosamide

A

Vimpat CV C5, V for IV , for AV blockage,

MOA: inactivates volatage dependent sodium channels
SE: hypersensitivity reaction, heart block, PR prolongation, dizziness, ataxia

35
Q

Vigabatrin

A

Sabril
Can cause BLINDNESS high % BBW
MOA: irreversible inhibitor of GABA-T increasing levels of GABA

Last line. Can cause blindness. Seizures can be so bad and ongoing

Renal
SHARE: support help and resources for epilepsy.

36
Q

Ezogabine

A

Discontinued
Pottage CV c5

MOA: potassium channel opener

Caution: urinary Retention. REMS drug.
BBW: skin discoloration.
Indication: partial onset seizures.

37
Q

Per a panel

A

Fycoma CIII C3

Once daily really long half life

MOA : glutamate R antagonists.
indication : partial onset seizures.

SE: agitation. Sedation.

Substrate

38
Q

Eslicarbazepine

A

Aptiom
MOA: Na channel blocker similar to carbazepine

Once daily
Induces cyp3a4
SE: somnolence, dizziness, Rash ( but no genetic testing done ) hyponatremia ( like carbazepine and oxcarbazepine )

39
Q

Rufinamide

A

Banzel

MOA: prolongs inactive sate of sodium channels
Indication : Lennox gastaut syndrome ( adjunct )

SE: sedation

40
Q

If your patient needs OC which anti-epileptic drugs do we worry about ?

A

1) carbamazepine
2) oxcarbazepine
3) phenytoin
4) phenobarbital
5) primidone

These are all inducers

41
Q

Which anti-epileptics are available as chewable tablets?

A

Phenytoin, Carbamazepines, and Lamotrigine

42
Q

Name the anticonvulsants that increase GABA

Which inhibit Na+ influx?

A

Phenobarbital
Primidone
Benzo’s
Divalproex
TiaGABin
ViGABatrin
* these all increase GABA’s effects

2) inhibitors Na+ influx
Phenytoin
Fosphenytoin
Carbamazepine

43
Q

HLA*1502 is what?

A

HLA*1502 Allele to test for SJ rxn for carbamazepine and oxcarbazepine

•HLA*5701 - abacavir

• HLA*5801 for allopurinol

44
Q

BBW for valproate

A

Divalproex

Pancreatitis hepatotoxicity

45
Q

BBW Carbamazepine

A

Aplastic anemia/agranulocytosis + serious dermatological reactions ( SJ’s)

46
Q

BBW Natilzumab

A

Tysabri used for MS patients

Multifocal leukalencephalopathy

47
Q

Lamotrigine is not available in injectable formulations

A

T

No IV or IM

48
Q

Keppra is available in what formulations

A

IV
PO tabs
And Solution

49
Q

Lancosamide formulations

A

IV
PO tab; soln

VIMPAT

50
Q

SHARE for what drug?

A

Vigabatrin ( causes blindness ) last line

iPLEDGE- isotretinoin
TOUCH- tysabri ( natalizumab ): risk of progressive multifocal leukoencephalopathy ( PML )

REMS program : clozapine ( risk evaluation and mitigation

SHARE: support, help and resources for epilepsy

51
Q

Corrected Phenytoin equation

Ex) phenytoin level is 15mcg/mL and albumin level is 2.0 g/dL

A

Measured phenytoin / [ ( 0.2 x Alb ) + 0.1 ]

15/ [ ( 0.2 x 2.0 ) + 0.1 ]

15/ 0.5 = 30 mcg/ mL

Therapeutic range is 10-20

52
Q
A

,

53
Q
A

SHPCPJEN3 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions