Brainscape's Knowledge GenomeTM

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


See full index

Pharm I > Seizures > Flashcards

Seizures Flashcards

1
Q

Most common causes of medication-induced seizures

A 
Tramadol
Bupropion
Venlafaxine
Theophylline
High-dose phenothiazines
Benzodiazapene or AED withdrawal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Partial seizures

A

Cause asymmetric manifestations
Begin in one hemisphere of the brain
Also called focal or localization related

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

General seizures

A

Begin in both hemispheres- diffusely throughout the cerebral cortex
Tonic- rigidity
Clonic- rhythmic jerks
Atonic- loss of muscle tone

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

Partial seizure sx

A

Motor
Sensory- visual, auditory, olfactory, gustatory
Autonomic- pallor, flushing, vomiting, sweating, vertigo, tachycardia
Psychic- hallucinations, emotional changes, dysphasia, cognitive changes

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

Partial seizure subtypes

A

Simple partial- no LOC
Complex- impaired consciousness
Secondarily generalized seizures

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

Types of generalized seizures

A

Myoclonic
Infantile spasms
Absence (petit mal)
Tonic-clonic (grand mal)

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

Myoclonic seizures

A

Brief jerking movements of whole body or upper body, occasionally lower extremities

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

Absence (petite mal) seizures

A

Nonconvulsive
Short LOC (10-30 secs)
Pt seems to stare, motionless, with distant facial expression

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

Tonic-clonic (grand mal) seizures

A

Convulsive motor activity with LOC

5 phases- flexion, extension, tremor, clonic, postictal

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

Non-pharmacologic interventions- seizure

A 
Surgery
Ketogenic diet
-High diet
-Low carbohydrate, low protein
Pt education
-Disease and drug education is crucial
Vagus nerve stimulation
-Implantable, programmable pulse generator
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Criteria for attempting discontinuation of seizure meds

A

2-5 yrs seizure free
Single seizure type
Nl neurologic exam and IQ

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

Process of discontinuation of AEDs

A

Go slow (6 weeks to 3 mos per drug)
Remove one agent at a time
Seizure activity may not indicate failure of withdrawal

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

Interaction of AEDs with OCPs

A

Enzyme inducers decrease estrogens and/or progestins
No interaction seen (yet) with valproate and levetiracetam
OCPs decrease lamotrigine concentration

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

AEDs in women of childbearing age

A

Increased incidence of menstrual dysfunction, infertility, birth defects, perinatal infant death

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

Mechanism of teratogenicity and AEDs

A

Major congenital malformations with AED exposure may be 2-3x the general population
Folic acid metabolism- supplementation is necessary

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

Side effects of carbamazepine

A 
Pregnancy category D
Spina bifida
Facial changes
Nail hypoplasia
Small head circumference
Developmental delay
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Side effects of phenytoin

A 
Category D
Hydantoin syndrome (growth deficiency, craniofacial anomalies, mental retardation, nail/digital hypoplasia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Valproic acid side effects

A

Category D

Spina bifida, craniofacial abnormalities, developmental delay, external ear anomalies

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

Phenobarbital pregnancy side effects

A

Category D

similar to phenytoin

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

Topiramate pregnancy side effects

A

Category D

Growth retardation and limb agenesis in animals

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

Felbamate pregnancy side effects

A

Category C

Negative findings in animals

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

Gabapentin pregnancy side effects

A

Category C

Fetal toxicity in high doses in rodents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Tiagabine pregnancy side effects

A

Category C

Growth retardation in animals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Lamotrigine pregnancy side effects

A

Category C

Does affect folate metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Zonisamide pregnancy side effects

A

Category C

Animal problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How do AEDs work in general?

A

Raise seizure threshold via stabilization of neuronal membranes
Limit seizure propagation via depression of synaptic transmission and/or reduction of nerve conduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

AEDs and serious rash

A

Serious rashes are rare though very severe idiosyncratic reactions
-Fever
-Mucocutaneous lesions
Risk is highest in the first 2 mos and those with HLA-B 1502 allele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Stevens Johnson Syndrome

A

Exfoliative rash with fever and hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

AEDs and bone density

A

Chronic administration of enzyme inducing AEDs of valproate has been associated with decreases in bone mineral density

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Hepatic enzyme inhibitors

A

Valproate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Hepatic enzyme inducers

A 
Phenytoin
Topiramate
Phenobarbital
Oxacarbazepine
Carbamazepine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Initial drugs for partial seizures

A

Lamotrigine
Levetiracetam
Oxcarbazepine
Carbamazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Alternative drugs for partial seizures

A 
Valproate
Ezogabine
Pregabaline
Phenytoin
Topiramate
Gabapentin
Zonisamide
Lacosamide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Initial drugs for primary generalized tonic-clonic seizures

A

Valproate
Lamotrigine
Levetiracetam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Alternate drugs for generalized tonic-clonic seizures?

A

Phenytoin
Topiramate
Zonisamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Initial drugs for generalized absence seizures

A

Valproate

Ethosuximide

37
Q

Alternative drugs for generalized absence seizures

A

Zonisamide
Lamotrigine
Clonazepam
Levetiracetam

38
Q

Drugs to avoid in generalized absence seizures

A

Phenytoin
Vigabatrin
Phenobarbital
Carbamazepine

39
Q

Initial drugs for generalized myoclonic seizures

A

Valproate
Lamotrigine
Levetiracetam

40
Q

Alternative drugs for generalized myoclonic seizures

A

Felbamate
Topiramate
Zonisamide
Clonazepam

41
Q

Pros of first gen AEDs

A

Familiar, known ADRs, low cost, broad seizure coverage

Proven efficacy because of experience/data (but equal efficacy to 2nd gen)

42
Q

Cons of first gen AEDs

A

Overlapping MOAs
PK- lab monitoring for toxicity and efficacy
CNS ADRs: Dizzy, drowsy, ataxia, cognitive dysfunction, slurred speech
Reproductive endocrine disorders: pcos- irregular menses, weight gain, hirsutism/hyperandrogenism

43
Q

Drug interactions with first gen AEDs

A

Inducers and inhibitors with vit D- calcium and vit D supplements
Inducers with oral contraceptives- adjust contraceptives (except with VPA)

44
Q

1st gen AEDs

A 
Valproate
Phenytoin
Ethosuximide
Carbamazepine
Phenobarbital
Primidone
45
Q

Additional uses of carbamazepine

A

Toni-clonic

Bipolar and trigeminal neuralgia

46
Q

Dosing of carbamazepine

A

Initiate at 200-400 mg/day to allow tolerance to develop to CNS side effects and increase by 200 mg increments every 2-4 weeks

47
Q

Side effects of carbamazepine

A

GI
Rash and pruritis
Idiosyncratic- bone marrow suppression (d/c if wbc < 2500/mm cubed or ANC < 1000/mm cubed)
Dose related: drowsiness, double vision, dizziness, ataxia
Monitor CBC, Na, LFT

48
Q

Carbamazepine instructions

A

Store in dry conditions
Must test for HLA-B 1502 in Asians
May exacerbate absence or myoclonic seizures

49
Q

Use for ethosuximide

A

Absence seizures only

50
Q

Dosing of ethosuximide

A

Titrate over 1-2 weeks to a max dose of 20 mg/kg/day given qd-bid

51
Q

Adverse effects of ethosuximmide

A

Low toxicity potential

  • Concentration dependent: N/V, drowsiness, unsteadiness, hiccups
  • Rare, idiosyncratic: rash, blood dyscrasia, lupus-like syndrome, psychosis
52
Q

Drug interactions of Ethosuximide

A

Increased serum levels when given with valproic acid

  • Strong inhibitors of CYP3A4
  • Decreased serum levels when given with carbamazepine
  • Strong inducers of CYP3A4
53
Q

Monitoring with Ethosuximide

A

Periodically monitor serum levels, CBC, urinalysis, LFTs

54
Q

Use of phenytoin

A

Partial, secondarily generalized

55
Q

Dosing of Phenytoin

A

Initial oral dose is 15 mg/kg in 3 divided doses followed by a maintenance dose of 5 mg/kg in 1-2 divided doses
Begin 300 mg/day in 1-3 doses, increase by 30-100 mg/day every 10-21 days using serum levels

56
Q

Dose-related adverse effects of Phenytoin

A

Ocular-diplopia, nystagmus, blurred vision
CNS- lethargy, fatigue, incoordination, drowsiness
Cardiovascular- hypotension, bradycardia, cardiac arrhythmias

57
Q

Toxicity adverse effects of Phenytoin

A

20 mcg/mL: nystagmus, slurred speech, ataxia dizziness
30 mcg/mL: drowsiness, diplopia, behavioral changes, cognitive impairment
> 40 mcg/mL: mental status changes, coma, seizures, status epilepticus

58
Q

Chronic adverse effects of Phenytoin

A

Hirsutism
Gingival hyperplasia
Coarsening of facial features

59
Q

Additional uses of valproic acid/valproate

A

Broadest activity of AEDs
Mood disorders
Behavior disorders- dementia pts

60
Q

Therapeutic serum levels of valproic acid/valproate

A

50-100 mcg/mL

61
Q

Oral dosing of valproic acid/valproate

A

Bedtime administration to minimize effects of CNS depression

Minimize GI irritation by giving with food, slowly increasing the dose, using delayed-release preparation

62
Q

IV dosing of valproic acid/valproate

A

Administer over 60 mins (less than or equal to 20 mg/min)

63
Q

Drug interactions of valproic acid/valproate

A

Enzyme inhibitor
Increases levels of phenytoin, carbamazepine, lamotrigine
Its levels are affected by anticonvulsants
ASA increases the activity of VPA
Does not interfere with OCPs
It is affected by inducers and inhibitors

64
Q

Dose-related adverse effects of valproic acid/valproate

A 
Weight gain
Hair loss
Tremor
Menstrual irregularitiesGI irritation
Insulin resistance
65
Q

Idiosyncratic adverse effects of valproic acid/valproate

A

Liver failure
Pancreatitis
Thrombocytopenia

66
Q

Uses of Gabapentin

A

Adjunctive therapy for partial seizures
Neuropathic pain
RLS and other neurological conditions

67
Q

Side effects of Gabapentin

A

Common: fatigue, somnolence, dizziness, ataxia

Worsening edema

68
Q

Counseling for Gabapentin

A

Do not take with antacids, take with food

69
Q

Other considerations for Gabapentin

A

Can exacerbate myoclonic seizures

70
Q

Use of Lacosamide (Vimpat)

A

Add on therapy for partial seizures in adults

71
Q

Adverse effects of Lacosamide (Vimpat)

A

CNS effects
Euphoria
PR interval prolongation

72
Q

Additional uses of Lamotrigine

A

Pediatrics

Maintenance tx for bipolar disorder

73
Q

Dosing for Lamotrigine

A

Depends on drug interactions
Dose is increased by inhibitors
Dose is decreased by inducers

74
Q

Monitoring for valproic acid/valproate

A

Esp in kids < 2 yo, congenital metabolic disorders, severe seizure disorders, organic brain disease, multiple anticonvulsants,
Monitor for loss of seizure control, malaise, weakness, lethargy, facial edema, anorexia, N/V
Monitor LFTs frequently in first 6 mos

75
Q

Lamotrigine dosing with enzyme-inducing AEDs and no valproic acid

A

Weeks 1 and 2: 50 mg (once a day)
Weeks 3 and 4: 100 mg (two divided doses)
Usual maintenance dose: 300-500 mg/day (two divided doses) Escalate dose by 100 mg/day every week

76
Q

Lamotrigine dosing with enzyme-inducing AEDs and valproic acid

A

Weeks 1 and 2: 25 mg (every other day)
Weeks 3 and 4: 25 mg (once a day)
Usual maintenance dose: 100-150 mg/day (two divided doses) Escalate dose by 25-50 mg/day every 1-2 weeks

77
Q

Drug interactions for Lacosamide (Vimpat)

A

No known clinically significant drug interactions

78
Q

Lamotrigine drug interactions

A

Acetaminophen decreases lamotrigine levels

79
Q

Life-threatening rash in lamotrigine

A

Titrate dose slowly to minimize

More common in pediatrics and with valproic acid

80
Q

Additional uses for levetiracetam

A

Neuropathic pain

81
Q

Adverse effects of levetiracetam

A

CNS: sedation, fatigue, coordination difficulties
Behavioral: Some agitation, irritability, depression
Small risk for dermatological rxns

82
Q

Additional uses for oxcabazepine

A

Bipolar disorder

Neuropathic pain

83
Q

Adverse effects of oxcarbazepine

A

25-30% cross-reactivity of carbamazepine rash
Less CNS effects and allergic skin rxns
More frequent hyponatremia

84
Q

Pregabalin use

A

Adjuvant for partial onset seizures
Neuropathic pain
Fibromyalgia syndrome

85
Q

Adverse effects of pregabalin

A

Classic CNS side effects
Thiazolidinedione: additive fluid retention/weight gain
Classified as a C-V due to risk of euphoria

86
Q

Use of topiramate

A

Second line for partial seizures
Weight loss (in combination)
Prophylaxis of migraine HAs

87
Q

Drug interactions of topiramate

A

Variable effect on phenytoin

It is decreased by carbamazepine and phenytoin

88
Q

Adverse effects of topiramate

A

Dose-related: Speech and language problems, fatigue, dizziness, HA, birth defects (cleft lip and cleft palate)
Chronic: Kidney stones, weight loss
Idiosyncratic: Acute narrow-angle glaucoma, oligohydrosis, metabolic acidosis

Pharm I (10 decks)

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