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Maternal Medicine > Seizures > Flashcards

Seizures Flashcards

Creasy, EB MFM

1
Q

Brand name: Phenytoin

A

Dilantin

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2
Q

Brand name: Carbamazepine

A

Tegretol

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3
Q

Brand name: Valproic acid

A

Depakote

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4
Q

Brand name: Levetiracetam

A

Keppra

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5
Q

General therapeutic recommendations for treatment of epilepsy in pregnancy

A

Smallest effective dose, monotherapy preferable
Folate supplementation of 4 mg daily

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6
Q

History to document in the epileptic patient

A

Aura - present or absent
Seizure description by eyewitness, including duration
Postictal phase - description, duration
Exacerbating factors
Birth history, esp if seizure onset was neonatal or early childhood
History of febrile convulsions, CNS infections, or head trauma w/ LOC
Family history

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7
Q

Fetal complications of epilepsy

A

Fetal loss
Perinatal death
Congenital malformations (4-8%, or twice baseline risk)
Low birth weight
Prematurity
Developmental delay
Childhood epilepsy

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8
Q

Preconception counseling of the epileptic patient

A

There is a small risk of having a child with a malformation because of the sz disorder or the drugs used in its treatment. This risk is probably about double that for the nonepileptic patient (4-8%, compared with 2-3% for the general population), but there is still more than 90% chance that she will have a normal child.
Preconception folic acid (4 mg) may be considered to reduce the risk of major congenital malformations.

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9
Q

Preconception counseling: when can an anticonvulsant be stopped, and when should the patient attempt conception

A

Consider neuro consultation regarding tapering off AEDs if the patient has been seizure free for > 2 years and has a nl EEG. The patient should be observed for 6-12 months off AED before attempting conception.

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10
Q

Seizure freedom for at least __ months before pregnancy is associated with a high likelihood of remaining seizure-free during pregnancy

A

9 months

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11
Q

Risk of epilepsy in offspring

A

2-3%

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12
Q

Prenatal care of the epileptic patient

A

Folic acid 4 mg/day
Anatomic US at 11-13w to identify severe defects
AFP at 15-18w gestation for NTDs
Targeted US at 16-20w
Fetal echo at 22w
+/- growth US at 32w
Neonates should receive 1 mg IM Vit K at birth

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13
Q

Which anticonvulsants should have levels monitored during pregnancy?

A

Lamotrigine
Carbamazapine
Phenytoin
Levetiracetam
Oxcarbazepine

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14
Q

Anticonvulsants that interfere with oral contraceptives

A

Enzyme-inducing AEDS:
Phenytoin
Phenobarbital
Carbemazepine
Topiramate (>200 mg/day)
Primidone

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15
Q

Drugs that may interfere with absorption of anticonvulsants

A

Folic acid may lower plasma phenytoin level
Antacids
Antihistamines

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16
Q

Anticonvulsants that should be avoided in pregnancy, at least in first trimester

A

Valproic acid
Phenytoin
Carbamazepine
Phenobarbital
Topiramate
Primidone
Trimethadione

17
Q

Overall rate of major fetal malformations with phenobarbital

A

6%

18
Q

Overall rate of major fetal malformations with lamotrigine

A

3%

19
Q

Overall rate of major fetal malformations with carbamazepine

A

3%

20
Q

Fetal malformations associated with carbamazepine

A

Craniofacial
Fingernail hypoplasia
Developmental delay
Neural tube defects

21
Q

Overall rate of major fetal malformations with valproic acid

A

10%

22
Q

Fetal malformations associated with valproic acid

A

Neural tube defects (1-2%)
Cleft lip/palate
Developmental delay
Hypospadias
Cardiac malformations
Endocrine disorders

23
Q

Fetal malformations associated with phenytoin

A

Fetal hydantoin syndrome:
Prenatal & postnatal growth deficiency
Microcephaly
Dysmorphic facies
Mental deficiency
Cleft lip/palate

24
Q

How common is fetal hydantoin syndrome

A

May be seen in 11% of infants exposed to phenytoin in utero, but 30% may have lesser degrees of impairment

25
Q

Fetal malformations associated with topiramate

A

Oral clefts
Increased risk of low birth weight

26
Q

Fetal malformations associated with lamotrigine

A

Facial clefts

27
Q

Which is more teratogenic: valproic acid or carbamazepine?

A

Valproic acid

28
Q

Valproic acid + ___ is particularly teratogenic.

A

Lamotrigine

29
Q

Does prenatal vitamin K in women with epilepsy reduce the risk of newborn hemorrhagic complications?

A

Evidence is inadequate to determine

30
Q

Postpartum considerations for mothers with epilepsy

A

Do not bathe child while home alone
Avoid stair climbing while carrying the baby
Portable changing bad on floor should be used
Avoid using front or back carrier
Women taking enzyme-inducing anticonvulsants who desire OCPs should take one w/ >50 mcg of ethinyl estradiol

31
Q

Is breastfeeding contraindicated in women taking anticonvulsants?

A

No. Monitor infants for sedation. Valproic acid, phenobarbital, phenytoin, and carbamazepine may be considered as not transferring into breast milk as much as levetiracetam, gabapentin, lamotrigine, and topiramate.

32
Q

Treatment of status epilepticus

A

IV diazepam (10-30 mg)
IV lorazepam (4-8 mg)

Maternal Medicine (20 decks)

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