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Spring 15 - Pharm Unit II > Seizures > Flashcards

Seizures Flashcards

1
Q

What is the #1 treatment for seizures disorders?

A

AEDs

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2
Q

Partial Seizures

A
  • begin locally; simple or complex
  • simple: no impairment of consciousness
  • complex: consciousness impaired
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3
Q

Generalized Seizures

A

-bilaterally symmetrical and w/o local onset

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4
Q

Pathophysiology of Seizures

A
  • sudden electrical disturbance of cortex

- neurons fire rapidly and repeatedly

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5
Q

Goals of Sz Therapy

A
  • control or reduce frequency of sz
  • ensure med adherence
  • optimize QOL
  • balance between sz control and side effects
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6
Q

General Approach to Sz Treatment

A
  • determine risk of subsequent seizures
  • pick AED based on sz type and AEs
  • begin with monotherapy
  • titrate dose as needed
  • adherence is key (60% non-adherent)
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7
Q

Non-pharm Therapy for Szs

A
  • surgery: temporal lobectomy, CC section, hemispherectomy
  • vagal nerve stimulator implantation
  • ketogenic diet
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8
Q

Ketogenic Diet

A
  • induce ketogenic state by cutting out all carbs

- high fat/high protein diet, very restrictive

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9
Q

MOA of AEDs

A
  • stabilize neuronal membranes
  • enhance inhibitory NTs and decrease excitatory
  • increase seizure threshold
  • inhibit spread of abnormal/sz discharges
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10
Q

Concentration-Related AEs

A
  • most common
  • increased drug levels = increased side effects
  • not permanent
  • see at peak concentration or throughout the day
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11
Q

How are concentration-related AEs managed?

A
  • lower dose/level
  • change schedule or formulation of med
  • discontinue med
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12
Q

Idiosyncratic AEs

A
  • more rare
  • not related to dose/level
  • may be permanent
  • seen throughout the day
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13
Q

How are idiosyncratic AEs managed?

A

discontinue med

treat AE as needed

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14
Q

What are some common concentration dependent acute side effects?

A
  • drowsiness, dizziness, lethargy
  • ataxia, unsteadiness
  • N/V/HA
  • diplopia
  • GI upset
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15
Q

What are some common idiosyncratic side effects?

A
  • blood dyscrasias
  • rash
  • pedal edema
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16
Q

What are common chronic side effects of AEDs?

A
  • osteoporosis/metabolic bone dz
  • weight gain
  • behavior changes
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17
Q

How does suicide risk factor into AED pt education?

A
  • pts on AEDs have 2x risk of suicidal thoughts and behaviors
  • patients should be educated to seek help
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18
Q

What type of drugs may decrease absorption of AEDs? How can this be prevented?

A
  • aluminum or magnesium containing antacids

- separate doses by 2+ hours

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19
Q

When drugs affect protein binding of AEDs, what is the overall effect on the pt?

A
  • highly protein bound drugs compete for protein binding sites
  • transient elevation in free drug, but decrease in total serum concentration
20
Q

What are common inducers of the CYP450 system? What effect do these have on AED therapy?

A
  • carbamazepine
  • phenytoin
  • phenobarbital
  • adding inducers will decrease total serum concentration of AED
21
Q

What is a common inhibitor of the CYP450 system?

A
  • valproate

- adding an inhibitor will increase total serum concentration of AED

22
Q

DOC for Generalized Tonic Clonic Szs (there are 9 - name 3)

A
  • carbamazepine
  • lamotrigine
  • oxcarbazepine
  • phenytoin
  • topiramate
  • valproate
23
Q

DOC for Absence Szs (there are 4 - name 2)

A
  • lamotrigine

- valproate

24
Q

DOC for Myoclonic Szs (there are 5 - name 2)

A
  • lamotrigine
  • topiramate
  • valproate
25
Q

DOC for Atonic Szs (there are 3 - name 2)

A
  • lamotrigine

- valproate

26
Q

DOC for any Partial Szs (there are 9 - name 4)

A
  • carbamazepine
  • gabapentin
  • lamotrigine
  • oxcarbazepine
  • phenytoin
  • topiramate
27
Q

What monitoring needs to be done for most AEDs and when?

A
  • seizures: ongoing

- CBC, LFTs: baseline, 6 mo (x2 sometimes), q12 months

28
Q

How is therapy evaluated in sz pts?

A
  • establish individual therapeutic range
  • ongoing monitoring of sz control, AEs, drug interactions, adherence, toxicity
  • seizure diary: frequency, severity
29
Q

What is the interaction between AEDs and oral contraceptives? How can we help pts with this?

A
  • AEDs decrease estrogen concentrations

- use higher dose OC or alternative form of birth control

30
Q

Can AEDs be used during pregnancy or breastfeeding?

A
  • pregnancy: teratogenic so goal is monotherapy with lowest dose possible; avoid VPA
  • breastfeeding: varies but most are safe
31
Q

Who should be genetically screened and why?

A
  • Asian descent before starting CBZ and PHT
  • Asians w/ a certain gene will develop SJS or TEN when taking CBZ
  • PHT risk unknown
32
Q

What 5 criteria must be met before discontinuing a sz med?

A
  • sz free for 2-5 years
  • normal neuro exam
  • normal intelligence quotient
  • single type of partial or generalized seizure
  • normal EEG with tx
33
Q

How should sz therapy be DC’d?

A
  • slowly decrease polytherapy to mono
  • decrease mono dose over 1-3 months
  • decrease by no more than 1/3 each time
  • tapering too fast can cause withdrawal szs
34
Q

Criteria for Status Epilepticus

A

-sz > 30 minutes or no alert period between seizures

35
Q

Potential Causes of SE

A
  • EtOH withdrawal
  • head trauma, SAH, tumor, stroke
  • non-adherence w/ meds of drug interactions
36
Q

Treatment for SE

A
  • ABCs and IV access
  • benzo (lorazepam) 2-4 mg IV push (max rate 2 mg/min)
  • monitor vitals
  • phenytoin of fosphenytoin loading gose
  • if PHT doesn’t stop szs, give phenobarbital
37
Q

What are the advantages of fosphenytoin over phenytoin?

A

fos can be given faster and has a lower risk of cardiac events than phenytoin

38
Q

What AED has a really long half life?

A

phenobarbital (46-136 hr in adults)

39
Q

AEs of Carbamazepine

A
  • diplopia
  • hyponatremia
  • leukopenia
40
Q

If felbamate is very effective at treating seizures, why is it not used often?

A
  • aplastic anemia

- hepatic failure

41
Q

AEs of Lamotrigine

A
  • rash (start low, titrate slow)
  • ataxia, tremor
  • sedation
  • N/V, weight gain
42
Q

AEs of Phenobarbital

A
  • sedation
  • irritability
  • confusion
  • decreased cognition and motor skills
  • aggression
  • hyperactivity
43
Q

AEs of Pregabalin

A
  • controlled substance (C 5)
  • dizziness, ataxia
  • somnolence, abnormal thinking
  • blurred vision
  • weight gain
44
Q

AEs of Valproic Acid

A
  • N/V
  • tremor, ataxia
  • sedation
  • weight gain
  • hepatic failure, thrombocytopenia
  • preg cat D
45
Q

What drugs are good choices for status epilepticus treatment?

A
  • clonazepam (klonopin)
  • diazepam (valium)
  • lorazepam (ativan)
  • fosphenytoing (cerebyx)
46
Q

AEs of Lorazepam/Ativan

A
  • sedation
  • ataxia
  • confusion
47
Q

AEs of Fosphenytoin

A

-nystagmus, dizziness, ataxia

Spring 15 - Pharm Unit II (9 decks)

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