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Pass Naplex Now Book II > Seizures > Flashcards

Seizures Flashcards

1
Q

Treatment for:

  • Partial
  • Absence
  • Myoclonic
  • Atonic
  • Atypical Absence
  • Grand Mal (Tonic Clonic)
  • Lennox-Gastuat Syndrome
  • Status epilepticus
A

Partial sz 1st line:

  • Carbamazepine
  • Phenytoin
  • Oxcabazepine
  • Valproic acid

Absence: most common in children = starring/blank

  • Ethosuximide
  • Valproic acid

Myoclonic = cause jump/Atonic = drop attacks

  • Lamotrigine
  • Topiramate
  • Valproic acid

Grand Mal (Tonic clonic)

  • Carbamazepine, phenytoin
  • Valproic acid, topiramate
  • Adjunct: lomotrigine

Lennox-Gastuat syndrome = Cognitive dysfunction, mental retardation, and frequent status epilepticus

  • Valproic acid
  • Benzodiazepine

Status epilepticus

  • Thiamine 100mg or vit B complex
  • Lorazepam IV or IM
  • Phenytoin 18mg/kg IV or fosphenytoin
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2
Q

Luminal

  • MOA
  • Indication
  • SEs
  • Forms
  • DDI
  • Monitor
A

Phenobarbitual

  • Form: Injection
  • MOA: Enhances GABA
  • Indication: sedation, anticonvulsant

SEs: BARBiturates:

  • Bone marrow suppression
  • Ataxia, Rash
  • Respiratory depression
  • Behavior changes (CNS excitation/depression), Bradycardia (hypoTN)
  • Form: IV (avoid >50mg/min), IM, SQ, PO
  • DDI: strong inducer

Monitor:

  • [ ] = 15-40 mcg/mL
  • BCB
  • LFTs
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3
Q

Mysoline

  • MOA
  • Indication
  • SEs
  • Max dose
  • Therapeutic level
A

Primidone (PRM)

  • MOA: metabolized to phenobarbital n PEMA
  • Indication: Epilepsy
  • SEs: same as above
  • Max dose: 2g/d
  • Therapeutic level: 5-12 mcg/mL
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4
Q

Dilantin Injection
Dilantin ER

  • Dilution
A

Phenytoin

  • Dilution: in NS adm
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5
Q

Cerebyx

  • Phenytoin conversion
  • Storage
  • Dilution
  • SEs for both drugs
  • Fosphenytoin C/I
A

Fosphenytoin

  • Rapidly converted to phenytoin. Given short term IV when phenytoin is unavailable or no IV access
  • Phenytoin conversion: 1.5 fos = 1 phenytoin
  • Storage: refrigerate
  • Dilution: NS or DW

SEs

  • Ataxia
  • Rash
  • Gingival hyperplasia
  • Hirsutism
  • Osteomalacia

Fosphenytoin CI
- Sinus bradycardia, 2nd or 3rd degree AV block

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6
Q

Stavzor

  • Indication
  • Form: DR
  • MOA
  • SE
  • Therapeutic levels
  • Preg Cat
  • BBW
  • Monitor
A

Valproic acid

  • Indication: Absence sz, adjunct tx of complex partial sz, mania, migraine
  • Form: DR
  • MOA: increase brain GABA

SEs

  • GI upset, hepatotoxicity, pancreatitis
  • Thrombocytopenia, encephalopathy, deafness
  • Tinnits, SIADH
  • Therapeutic level: 50-100 ug/mL
  • Preg Cat: D

BBW

  • Hepatic failure: monitor LFT Q6M
  • Pancreatitis
  • Teratogenic

Monitor
- LFT, CBC, PT/PTT, serum ammonia

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7
Q

Depakote

A

Divalproex ER

Divalproex

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8
Q

Tegretol
Tegretol XR

  • DDI
  • Max dose
  • MOA
  • Level
  • SE
  • C/I
  • Monitor
  • Genetic test
  • Preg Cat
A

CArbAmAzepine

  • Form: Chewable Tab, suspension
  • DDI: Auto-induction = 3A4 inducer
  • Max dose: 1200 - 1600 mg/d
  • MOA: block use dependent Na channel inhibit Na influx
  • Level: 4-12 ug/mL

SEs

  • Aplastic anemia
  • Anticholinergic
  • Antiarrhythmic
  • SJS rash
  • SAIDH

C/I

  • Fatal blood cell abnormalities
  • Prior bone marrow suppression
  • Monitor: LFTs, CBC, level,
  • Genetic test before start: Asian HLA-B 1502 = SJS or TEN
  • Preg Cat: D
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9
Q

Trileptal

  • Therapeutic range:
  • MOA
  • SEs
  • DDI
A

OXcarbazepine

  • Therapeutic range: 12-30 ug/mL
  • MOA: Block Na channel
  • SEs: SJS, hypoNa
  • DDI: Inducer
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10
Q

Zarontin

  • Indication
  • SEs
  • Pt counseling
  • Level
A

EtHosuximide

  • Indication: Absence sz
  • SEs: hiccups, anemia, drowsness
  • Pt counseling: contact MD if fever, sore throat, mouth sores, bleeding gums, bruising, sign of aplastic anemia
  • Level: 40-400 mcg/mL
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11
Q

Celontin

  • Indication
A

METhsuximide

  • Indication: refractory absence sz
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12
Q

FeLbAtrol

  • Max dose:
  • MOA
  • Indication
  • SEs
A

FeLbAmate

  • Max dose: 3600mg/d
  • MOA: inhibits Na channels
  • Indication: Not rec 1st line. Rec only if do not respond to any other med whose epilepsy is so severe that risk of aplastic anemia or liver failure is acceptable in light of benefits
  • SEs: hepatotoxicity, aplastic anemia, HA, N/V
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13
Q

Neurontin

  • MOA
  • SEs
  • Max dose
A

Gabapentin

  • MOA: incr GABA synthesis
  • SEs: dizziness, peripheral edema, visual effect, wt gain
  • Max dose: 3600mg/d
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14
Q

Horizant

  • Indication
  • Administration
A

Gabapentin ER tab

  • Indication: restless leg syndrome
  • Swallow whole with FOOD @ ~ 5PM
  • Not interchange with other gabapentin
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15
Q

Lyrica

  • Indication
  • Max dose
  • SE
A

Pregabalin

  • Indication: diabetic peripheral neuropathy, post herpetic neuralgia, fibromyalgia, partial sz
  • Max dose: 600mg/d
  • Lyrica seems to be similar to gabapentin in both efficacy and SE. But can be titrate more quickly and might have a faster onset
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16
Q

Lamictal

  • Dose:
  • Form
  • Indication
  • MOA
  • SEs
  • Blue kit
  • Green kit
  • Orange kit
A

Lamotrigine

  • Dose: 25-50mg QHS
  • Form: IR, XR, chewable, ODT
  • Indication: SZ, bipolar I
  • MOA: Inhibits Na chanel
  • SEs: rash (occurs 5days - 8wks), photosensitivity, sedation, hematologic

Blue Kit
- Pt taking VA will start: 25mg QOD x 2 wks then inc to MD = 100 to 200mg/day

Green Kit
- Pt on CBZ, phenytoin, primidone, phenobarbital, rifampin: start 50mg QD x 2wks, then 50mg BID x 2 wks, up to 150-250mg BID

Orange Kit
- Pt not taking any of the above: start 25mg QD x 2wks, then 50mg QD x 2 wks, incr by 50mg/d every 1-2 wks to 225-375mg/d

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17
Q

Keppra

  • Max dose:
  • SEs
A

Levetiracetam

  • Max dose: 3g/d
  • SEs: somnolence, psychiatric sx
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18
Q

Gabitril Filmatabs

  • Dose
  • MOA
  • Indication
  • SEs
A

TiaGABIne

  • Dose: start 4mg/d for 1 wk then incr by 4-8mg QW up to max 56mg/d. Take with FOODs
  • MOA: inhibits presynaptic neuronal GABA reuptake
  • Indication: Partial Sz
  • SEs: speech/language problem, confusion
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19
Q

Zonegran

  • MOA
  • Indication
  • SEs
  • Pt counseling
A

ZoniSAMide

  • MOA: Block Na channels
  • Indication: adjunct tx for partial sz
  • SEs: Kidney Stone, SJS, Aplastic anemia, Weight loss

Pt counseling

  • Sulfa allergy => contact MD
  • Drink plenty of fluid: decre risk of stone
20
Q

Topamax

  • MOA
  • Indication
  • Max dose
  • SEs
  • Pt counseling
A

Topiramate

  • MOA: Block Na channels
  • Indication: sz, migraine ppx
  • Max dose: 200mg/d
  • SEs: Difficulty [ ], psychomotor slowing, speech problem, wt loss, nephrolithiasis, hyperthermia, metabolic acidosis
  • Pt counseling: don’t break tabs = bitter taste, drink plenty of water
21
Q

Vimpat

  • Dose
  • Indication
  • SEs
  • CS
A

LACOSamide

  • Dose: 50mg BID. Max 200mg BID
  • Indication: adjunct tx of partial onset sz
  • SEs: heart block, PR prolongation, dizziness, ataxia
  • CS: V => euphoria
22
Q

Sabril

  • Dose/indication
  • Dose adj
  • Special program
  • SEs
A

VIGabatrin

Dose/Indication

  • Last line for complex partial sz: 500mg BID. Max 3g/d
  • Infant spasms: 150mg/kg/d
  • Renal dose adj:
  • Special: Only prescribed by MD who participated in SHARE program (monitor visual field defects). This drug is ship directly to pt
  • SEs: Vision lost => test vision at baseline then at least Q3M and 3-6M after d/c drug
    Suicidal behavior
23
Q

POTiga

  • Indicaiton
  • MOAs
  • SEs
A

EZOgabine

  • Indication: partial onset sz
  • MOA: K channel opener
  • SEs: urinary retention (REMS)
24
Q

Fycompa

  • Indicaiton
  • MOAs
  • SEs
A

PERAMpanel

  • Indication: partial onset sz
  • MOA: selective noncompetitive antagonist of AMPA receptors.
  • SEs: dizziness, sedation
25
Q

Klonopin

  • MOA
A

Clonazpam

  • MOA: potentiation of GABA
26
Q

Valium

  • MOA
  • Indication
  • SEs
A

Diazepam (diastat = per rectal)

  • MOA: Potentiation of GABA
  • Indication: status epilepticus
  • SEs: CNS depression, respiratory depression
27
Q

Onfi

A

Clobazam

28
Q

Ativan

A

Lorazepam

  • Indication: Status epilepticus
29
Q

Medications Cause SZ

A

Medications

  • Theophyllines
  • TCAs
  • Cocaine, Lidocaine
  • Meperidine (demerol)
  • W/d from EtOH, benzos, barbiturate
  • Tramadol (ultram)
  • Bupropion (Wellbutrin, Zyban)
30
Q

Cause of SZ

A

Cause of SZ

  • Mostly idiopathic
  • Electrolyte imbalance: hypoNa/Ca/Mg
  • Hypoglycemia
  • Hyperthyroid
  • Liver failure
  • Inborn metabolic error
  • Vit B6 deficiency
31
Q

Solfoton

  • Form
A

Phenobarbitual

  • Form: Capsules
32
Q

Diastat

  • Form
A

Diazepam

  • Form: per rectal
33
Q

Versed

A

Midazolam

34
Q

Onfi

A

Clobazam

35
Q

Phenytek

  • Form
A

Phenytoin

  • Form: ER Cap
36
Q

Infatab

  • Form
A

Phenytoin

  • Form: Chew tab
37
Q

Peganone

A

Ethotoin

38
Q

Depakene

A

Valproic acid

  • Form: IR
39
Q

Depacon

  • Form
A

Valproic acid

  • Form: IV
40
Q

Carbatrol

A

Carbamazepine

  • Form: ER
41
Q

Epitol

A

Carbamazepine

42
Q

Equetro

  • Form
  • Indication
A

Carbamazepine

  • Form: ER
  • I: Mania of bipolar
43
Q

Oxtellar

A

Oxcarbamazepine

44
Q

Trokendi

  • Form
A

Topiramate

  • Form: ER
45
Q

Qudexy

A

Topiramate

  • Form: ER

Pass Naplex Now Book II (39 decks)

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