Seizures Flashcards
Treatment for:
- Partial
- Absence
- Myoclonic
- Atonic
- Atypical Absence
- Grand Mal (Tonic Clonic)
- Lennox-Gastuat Syndrome
- Status epilepticus
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
Luminal
- MOA
- Indication
- SEs
- Forms
- DDI
- Monitor
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
Mysoline
- MOA
- Indication
- SEs
- Max dose
- Therapeutic level
Primidone (PRM)
- MOA: metabolized to phenobarbital n PEMA
- Indication: Epilepsy
- SEs: same as above
- Max dose: 2g/d
- Therapeutic level: 5-12 mcg/mL
Dilantin Injection
Dilantin ER
- Dilution
Phenytoin
- Dilution: in NS adm
Cerebyx
- Phenytoin conversion
- Storage
- Dilution
- SEs for both drugs
- Fosphenytoin C/I
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
Stavzor
- Indication
- Form: DR
- MOA
- SE
- Therapeutic levels
- Preg Cat
- BBW
- Monitor
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
Depakote
Divalproex ER
Divalproex
Tegretol
Tegretol XR
- DDI
- Max dose
- MOA
- Level
- SE
- C/I
- Monitor
- Genetic test
- Preg Cat
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
Trileptal
- Therapeutic range:
- MOA
- SEs
- DDI
OXcarbazepine
- Therapeutic range: 12-30 ug/mL
- MOA: Block Na channel
- SEs: SJS, hypoNa
- DDI: Inducer
Zarontin
- Indication
- SEs
- Pt counseling
- Level
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
Celontin
- Indication
METhsuximide
- Indication: refractory absence sz
FeLbAtrol
- Max dose:
- MOA
- Indication
- SEs
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
Neurontin
- MOA
- SEs
- Max dose
Gabapentin
- MOA: incr GABA synthesis
- SEs: dizziness, peripheral edema, visual effect, wt gain
- Max dose: 3600mg/d
Horizant
- Indication
- Administration
Gabapentin ER tab
- Indication: restless leg syndrome
- Swallow whole with FOOD @ ~ 5PM
- Not interchange with other gabapentin
Lyrica
- Indication
- Max dose
- SE
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
Lamictal
- Dose:
- Form
- Indication
- MOA
- SEs
- Blue kit
- Green kit
- Orange kit
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
Keppra
- Max dose:
- SEs
Levetiracetam
- Max dose: 3g/d
- SEs: somnolence, psychiatric sx
Gabitril Filmatabs
- Dose
- MOA
- Indication
- SEs
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
Zonegran
- MOA
- Indication
- SEs
- Pt counseling
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
Topamax
- MOA
- Indication
- Max dose
- SEs
- Pt counseling
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
Vimpat
- Dose
- Indication
- SEs
- CS
LACOSamide
- Dose: 50mg BID. Max 200mg BID
- Indication: adjunct tx of partial onset sz
- SEs: heart block, PR prolongation, dizziness, ataxia
- CS: V => euphoria
Sabril
- Dose/indication
- Dose adj
- Special program
- SEs
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
POTiga
- Indicaiton
- MOAs
- SEs
EZOgabine
- Indication: partial onset sz
- MOA: K channel opener
- SEs: urinary retention (REMS)
Fycompa
- Indicaiton
- MOAs
- SEs
PERAMpanel
- Indication: partial onset sz
- MOA: selective noncompetitive antagonist of AMPA receptors.
- SEs: dizziness, sedation
Klonopin
- MOA
Clonazpam
- MOA: potentiation of GABA
Valium
- MOA
- Indication
- SEs
Diazepam (diastat = per rectal)
- MOA: Potentiation of GABA
- Indication: status epilepticus
- SEs: CNS depression, respiratory depression
Onfi
Clobazam
Ativan
Lorazepam
- Indication: Status epilepticus
Medications Cause SZ
Medications
- Theophyllines
- TCAs
- Cocaine, Lidocaine
- Meperidine (demerol)
- W/d from EtOH, benzos, barbiturate
- Tramadol (ultram)
- Bupropion (Wellbutrin, Zyban)
Cause of SZ
Cause of SZ
- Mostly idiopathic
- Electrolyte imbalance: hypoNa/Ca/Mg
- Hypoglycemia
- Hyperthyroid
- Liver failure
- Inborn metabolic error
- Vit B6 deficiency
Solfoton
- Form
Phenobarbitual
- Form: Capsules
Diastat
- Form
Diazepam
- Form: per rectal
Versed
Midazolam
Onfi
Clobazam
Phenytek
- Form
Phenytoin
- Form: ER Cap
Infatab
- Form
Phenytoin
- Form: Chew tab
Peganone
Ethotoin
Depakene
Valproic acid
- Form: IR
Depacon
- Form
Valproic acid
- Form: IV
Carbatrol
Carbamazepine
- Form: ER
Epitol
Carbamazepine
Equetro
- Form
- Indication
Carbamazepine
- Form: ER
- I: Mania of bipolar
Oxtellar
Oxcarbamazepine
Trokendi
- Form
Topiramate
- Form: ER
Qudexy
Topiramate
- Form: ER
