Seizures Flashcards
What are the two basic types of seizures?
Focal - electrical impulses in part of the brain
Generalized - electrical impulses in the whole brain
What are the 6 different types of generalized seizures?
Tonic -clonic
Absence - staring into soace
Myoclonic - Brief attacks causing jumps
Clonic - repeated jerking
Tonic - stiff
Atonic - drop attack
What is status epilepticus?
What is first line treatment
> 5 minutes of a seizure
Benzo’s - Lorazepam IV/IM then diazepam
Phenobarbital
Brand
MOA
Indication
ADE
Max IV push
PGx - drug example
Luminal injections, Solfoton caps
Enhance GABA
Sedation and Anticonvulsant
BARB
Bone disease , BMS
Ataxia
Rash , respiratory depression
Behavior changes, bradycardia
Max 50mg/min IV
Strong inducer - does go through the liver - will decrease birth control effectiveness
Monitoring levels of phenobarbital
Infants and children 0 14-40
Adults - 20-40
Primidone
Brand
MOA
Formulation
Therapeutic level
Mysoline
Enhance GABA
Only available in PO
5-12
Can you use clonazepam for status epilepticus?
What about clobazam ?
No to both because it comes in oral only
Diastat counseling
- confirm green ready bank
- position on side
- insert lubricated tip and push over 3 seconds
- hold 3 seconds and remove
- hold buttocks for 3 seconds
Phenytoin
MOA
Formulations
Compatibility
Max dose
Therapeutic range
Kinetics?
Storage
What other level must you check?
Testing
Decrease amplitude if Na+ dependent action potential
Injection , tabs, chewtabs, suspension
ONLY IN NS
500-600mg/day
10-20mg/L
Dose-dependent, zero order
Room temp
Albumin because it is protein bound so if protein is down then free phenytoin levels are up
HLAB1502
Fosphenytoin
Brand
Formulations
Phenytoin equivalent
Storage
Compatibility
Testing
Cerebyx
IV and IM
1.5mg fos = 1mg phenytoin
Fridge
NS or D5W
HLAB1502
Phenytoin/fosphenytoin ADE
Sedation
Rash
Gingical hyperplasia
Hirsutism
Osteomalacia
Arrythmia
Alcohol effects of phenytoin
Acute intake will increase levels
Chronic intake will decrease levels
Valproic acid / divalproex
Brand
MOA
Indication
ADE
Therapeutic dose
BBW
Depakene
Stavzor
Increase brain GABA and block sodium channels
Absence, complex partial seizure , mania, migraine prevention
GI upset, hepatox, pancreatitis, thrombocytopenia, hyperammonemia, encephalopathy, deafness, tinnitus, SIADH
50-100
hepatic failure, pancreatitis, teratogenic
Carbamazepine
Brand
MOA
Formulations
Max dose
Testing
Therapeutic range
ADE
Tegretol , epitol, equetro
Binds VG Na+ channels - is an AUTOINDUCER
Chew tabs, tabs, ER caps, suspension
1200-1600 mg/day
HLAB1502
4-12ug/mL
Aplastic anemia, antiarrythmic, anticholinergic, SJS< SIADH, Liver injury
Oxcarbazepine
Brand
MOA
Forms
Therapeutic range
Testing
Trileptal
Block Na+ channel
Tablets and suspension
12-30ug/mL
HLAB1502
Ethosuximide
Brand
MOA
Forms
Indication
ADE
Therapeutic range
Zarontin
T-type Ca2+ blocker
Capsuls and syrup
ABSENCE
Aplastic anemia (check CBC)
40-100
Felbamate
Brand
Forms
Indications
ADE
Felbatrol
Oral
Not first line
Hepatotox, aplastic anemia
Gabapentin
Excretion
MOA
Max dose
ADE
RENAL
Bind to alpha 2 delta
3600mg divided
Dizziness , edema
Horizant
Generic
Indication
Dose
Gabapentin ER tabs
RLS and postherpetic nerualgia
600mg QD with food
Pregabalin
Brand
Excretion
Max dose
Indications (4)
ADE
Lyrica
RENAL
600mg/d
DM peripheral neuropathy, postherpetic neuralgia, fibromyalgia, focal partial seizures
Dizziness, visual effects, bilateral edema
Lamotrigine
Brand
MOA
Forms
ADE
Drug interaction (1)
Lamictal
Inhibit Na+ channels
IR/ER tabs, chew tabs, ODT
RASH
Estrogen will decrease LAMICTAL’s concentration
Levetiracetam
Brand
Excretion
Form
Max
ADE
Keppra
Spritam (zipdose , similar to ODT)
RENAL
Tab, solution, IV
3g/day
Somnolence, psychiatric symptoms , weight loss
Tiagabine
Brand
Excretion
start and Max dose
Indication
Gabaitril
Liver
stat at 4mg/d to 56mg/d with food
Partial seizures
Zonisamide
Brand
MOA
Forns
ADE
Alleriges?
Zonegran
Block Na+ channels
Capsules
Kidney stones ( because of CAI effects) , aplastic anemia, SJS, weight loss
SULFA
Topiramate
Brand / forms
MOA
Excretion
ADE
Three counseling points
Topamax
Trokendi XR - don’t sprinkle
Quedexy XR - can sprinkle
Block Na+, increase GABA, block NMDAR
Weight loss, hyperthermia, metabolic acidosis, kidney stones (has CAI effect)
- don’t break tabs
- drink fluids to decrease stones
- pregnancy category D
Lacosamide
Brand
MOA
Forms
Max dose
ADE
Vimpat
Inactivate VG Na+ channels
Tabs, solution, injection
200mg BID
Heart block , dizziness , euphoria (C5)
Vigabatrin
Brand
MOA
Forms
Max dose
BBW
Indications
Sabril
Irreversibly inhibits GABA T to increase GABA
Powder packet, tabs
3g/day
Blindness and suicidal behavior - so must be registered through SHARE program
Last line complex seizures, infantile spasms
Perampanel
Brand / schedule
MOA
Indication
ADE
Fycompa C3
Glutamate receptor antagonist
Adjunct to partial onset seizures >12y.o
Anger, euphoria, dizziness
Eslicarbazepine
Brand
MOA
Dose / max
ADE
Aptiom
Na+ channel blocker
800 mg - 1200mg QD
Dizzy, rash, hypoNa+
Rufinamide
Brand
Indication
Dose form
ADE
Banzel
Lennox-gastaut syndrome
Oral suspension
Somnolence and vomiting
Brivaraceta,
Brand
Forms
Indication
Drug interaction
Briviact
tablets, solution, IV
Focal seizures
Double dose with rifampin
Cannabidiol
Brand
Indication
ADE
Epidiolex
Lennox-gastaut syndrome or dravet syndrome >2y.o
ALT/AST elevation
Stiripentol
Brand
Indication
Form
Diacomit
Dravet syndrome
Capsules
Ganaxolone
Brand / schedule
MOA
Indication
Forms
Max
Ztalmy C5
GABA A Receptor modultor
Seizures causes by cyclin-dependent kinase like 5 deficiency
oral -
1.8g/d
Nayzilam
Generic
Dose
Midazolam NASAL SPRAY
5mg (1 spray) in 1 nostril, may repeat in 10 mnutes
What seizure med do you use in pregnancy?
Lamotrigine
Levetiracetam
