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pharmacy 358 > Seizures > Flashcards

Seizures Flashcards

1
Q

What is diagnosis of a seizure?

A

1 unprovoked (no outside cause) but is at significant risk of recurrence

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2
Q

What type of seizures is most common?

A

Focal

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3
Q

What is status epileptics?

A

seizure lasting >30 minutes but treat if longer than 5 minutes

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4
Q

What is treatment for status epileptics?

A

IV phenytoin if no improve benzos

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5
Q

What are the role of benzos in epilepsy?

A

prn if seizure onset

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6
Q

What are post ical symptoms?

A

tired, memory issues, confusion, anxiety

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7
Q

What meds can lower seizure threshold?

A

opioids, cancer medications, carbapenems and 4th gen cephalosporins, bupropion, AP, stimulants

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8
Q

What do doctors use to classify seizures?

A

EEG to see before and after

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9
Q

What is the chances of becoming seizure free?

A

60% after 1 or 2 tries= 12 months

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10
Q

If mono therapy doesn’t work what should we do?

A

Diff mono= less reaction, better adherence, lower cost
combo= prob not

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11
Q

What is a good ASM taper?

A

at least 6 week taper

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12
Q

Non pharm for seizures?

A

ketogenic diet= high fat low carb, badly tolerated, need strict adherence better for children
surgery= refractory focal onset
VNS= electrical puls in vagus
avoid trigger
lower stress
lower alcohol
improve sleep and nutrition

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13
Q

Common s/e for all ASM?

A

sedation, dizzy, ataxia, blurred vision, gi

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14
Q

If rash with CBZ what can we use?

A

clobazam

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15
Q

If rash with Oxcarb what can we use?

A

gabapentin

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16
Q

If rash with eliscarb what can we use?

A

pregabalin

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17
Q

If rash with Phenobarbital what can we use?

A

lacosamide= maybe still bad

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18
Q

If rash with phenytoin what can we use?

A

topiramate

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19
Q

If rash with lamotrigine what can we use?

A

valproic acid

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20
Q

How can we minimize teratogenicity?

A

folic acid and to try to get seizure free for 1 year prior to pregnancy

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21
Q

What birth control is good ?

A

IUD, depoprovera
continuous with >30 mg of EE

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22
Q

IN regards to CYP what does valproic acid do?

A

inhibits

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23
Q

What ASM are narrow?

A

CBZ, gabapentin,Phenytoin, phenobarbital, pregabalin

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24
Q

What is first line for Focol seizures?

A

CBZ, lamotrigine

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25
Q

What is second line for focal?

A

Valproate, levetiracetam, oxcarbazepine

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26
Q

First line for Generalized tonic clonic?

A

nothing BUT has 3rd line of CBZ, lamotrigine, valproate, topiramate, levetiracetam

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27
Q

What should ONLY be used in myoclonic seizures?

A

Valproate (first line), levetiracetam, topiramate

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28
Q

What is first line for absence seizures?

A

ethosuxamide, valproate
2nd line lamotrigine

29
Q

Meds that target sodium channels primarily?

A

Phenytoin, CBZ, lamotrigine, lacosamide

30
Q

Issue with phenytoin?

A

bad inducer of CYP, 0 order kinetics
bad cosmetic s/e like gingival hyperplasia

31
Q

What relationship means zero order?

A

Michaelis menten

32
Q

Dose dependent s/e of phenytoin?

A

drowsy, confused, nystagmus, nausea

33
Q

What s/e are not dose dependent of phenytoin?

A

hirsutism, gingival, bone softening, SJS

34
Q

Pros and cons of CBZ?

A

Pros- Xr BID (IR is 4 times)
Cons-induces and even itself, SJS with asian population

35
Q

Asian gene that increases risk of SJS?

A

HLA-B1502

36
Q

Most noteable side effect for CBZ?

A

Bad blood dyscrasia and rash

37
Q

Important monitoring for CBZ?

A

Ocular exam, ECG, CBC, real, LFT and thyroid

38
Q

Drugs that increase CBZ?

A

macrolides, Valproic acid, lamotrigine, azoles, diltiazem and verapamil,

39
Q

Drugs that decrease CBZ?

A

Phenytoin, phenobarbital

40
Q

What drugs are decreased by CBZ?

A

warfar8h, phenytoin, VA, Lamotrigine, topiramate, azoles, ESTROGEN

41
Q

How do we overcome CBZ interaction with estrogen?

A

> 50 mg CONTINUOUS

42
Q

Why is eslicarbazepine better than CBZ?

A

MUCH less 3A4 induction and doesn’t induce itself

43
Q

Highlighted s/e of eslicarbazepine?

A

prolong PR interval= no go in 2/3 AV block

44
Q

What is special structurally of oxcarbazepine?

A

prodrug

45
Q

Does oxcarbazepine have same issues with CYP?

A

No

46
Q

IN regards to s/e, how is lamotrigine unique?

A

MUCH more tolerated
less sedate and weight gain
SJS tho

47
Q

Why might lamotrigine be an issue in women?

A

contraceptives (estrogen) decreases it by 50%

48
Q

Can we give VA and lamotrigine?

A

yes but 50% reduction of lamotrigine dose from VA so dose adjust

49
Q

What happens if you miss a dose of lamotrigine?

A

its fine but if >5 days have to retitrrate

50
Q

IN regards to MOA, how is lacosamide unique?

A

slow inactivation of NA channels

51
Q

Unique s/e of lacosamide?

A

PR prolong= bad in bad AV block

52
Q

How is lacosamide with DI?

A

much much less

53
Q

What drugs target calcium/potassium channels?

A

ethosuxamide, gabapentin, prefab, CBZ, VA

54
Q

What ASM impact GABA?

A

Clobazam, phenobarb, topiramate

55
Q

Pros/Cons of Clobazam?

A

Pros: lower tolerance
rapid
Cons: abuse, taper needed

56
Q

Notable s/e of clobazam?

A

sedation and respiratory depression

57
Q

Cons of phenobarbital?

A

sedation bad, inducer of CYP, lethal

58
Q

Why does topiramate suck?

A

ND, bad CNS effects of drowsy, dizzy, low cognition

59
Q

What drugs work on glutamate?

A

lamotrigine, topiramate

60
Q

How does perampanel work?

A

NMDA antagonist

61
Q

Prominent s/e of perampanel?

A

aggressive behaviour

62
Q

Pros/Cons of VA?

A

Pros no interaction with Birth control, low risk of rash,
Cons: Teratogen and inhibits CYP

63
Q

Prominent s/e of VA?

A

hepatotoxic, weight gain

64
Q

What is good levels of VA?

A

350-700

65
Q

How does Levetiracetam work?

A

SV2A inhibitor

66
Q

Pros of Levetiracetam?

A

no DI, tolerated, rapid titration

67
Q

Notable s/e of levetiracetam?

A

psychiatric and behaviour problems

68
Q

Issue with bevaracetam?

A

psych issues and angioedema and brochospasm

pharmacy 358 (16 decks)

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