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psych 1166 > Seizures > Flashcards

Seizures Flashcards

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1
Q

IV phen admin instructions

A
  1. DO not exceed 50 mg/min
  2. Monitoring same as fos, BP, respiratory function, ECG
  3. Requires filter
  4. Dilute in NS, stable for 4 hours
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2
Q

Patient counseling for all AEDs?

A
  1. All can cause suicidal thoughts
  2. Dont stop taking this medication
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3
Q

Warnings for topamax? 7

A
  1. Gap: Met acidosis
  2. Oligohidrosis
  3. reduced perspiration
  4. Nephrolithiasis
  5. Angle closure glaucoma
  6. hyperammonemia
  7. Fetal harm
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4
Q

How is Diastat dispensed?

A

Must be dialed to dose and locked before dispensing

Once locked the green band should say ready

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5
Q

Boxed warning for Tegretol? 4

A

`SJS/TEN

  1. Asian decent should be tested for HLA-B1502
  2. Aplastic anemia
  3. agranulocytosis
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6
Q

Phenobarbital and Primidone (prodrug of pheno) SEs, 5

A
  1. Sedation
  2. Dependence
  3. tolerance
  4. risk of overdose
  5. enzme inducer
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7
Q

What to do during initial phase of SE? 5-20 minutes 5 things

A
  1. If seizure continues
    1. Give IV BZD, IV lorazepam
    2. Alt if IV not available
      1. IM Midazolam
      2. Rectal diazepam (Diastat)
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8
Q

What drugs come in easy to swallow formulations for children 2

A

Lamotrigine and Levetiracetam

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9
Q

What can topiramate and zonisamide cause in children?

A

Reduce or lack of sweating

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10
Q

Women of child bearing age on AEDs should get?

A

Daily folate sup

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11
Q

Warnings for gabapentin?

A

Peripheral edema

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12
Q

Valproic acid MOA?

A

Increase GABA

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13
Q

Lamotrigine drug interaction 1 specifically

A

Valproic, increases lam concentrations

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14
Q

Carbamazepine MOA?

A

Na channel blocker

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15
Q

Therapeutic range for tegretol?

A

4-12 mcg/mL

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16
Q

Initial dosing for lamotrigine?

A

Wks 1 and 2, 25 mg

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17
Q

What drug needs a filter?

A

Phenyoin

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18
Q

What schedule is Vimpat?

A

Lacosamide

CV

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19
Q

Tegretol

A

Carbamazepine

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20
Q

Kepra

A

Levetiracetam

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21
Q

BZD MOA?`

A

Increase GABA

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22
Q

WHat is purple glove syndrome?

A

Extravasation: characterized by edema, pain, and blush color

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23
Q

How is an absence seizure described?

A

Momentary loss of awareness

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24
Q

Lamotrigine can increase the risk of what?

A

Serious rash when taken with lamotrigine

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25
Q

Warnings for Phenobarb??

A
  1. Habit forming
  2. Physiological dependence
  3. Hangover effect
  4. Tolerance
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26
Q

Phenobarb DI?

A

Can decrease the effect of hormonal contraceptives

non-hormonal contra rec’d

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27
Q

Ethosuximide MOA?

A

T-type Ca channel blocker

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28
Q

Note about Trileptal?

A

Not an autoinducer

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29
Q

Zonisamide and Topirimate SEs? 5

A
  1. Wt loss
  2. Metabolic acidosis
  3. Nephrolithiasis
  4. Oligohidrosis
  5. hyperthermia (in children)
    1. Bring bottles of water stay hydrated, limit sun
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30
Q

Lamotrigine Black Box

A

Serious skin reactions, including SJS/TEN

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31
Q

What is ethosuximide used for?

A

Isolated conditions absence seizures

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32
Q

Warnings fro Trilepta

A

Oxcarb

  1. Asian decent HLA 1502 prior of positive dont use
  2. Hyponatremia
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33
Q

What other risk do AEDs have?

A

Suicide risk monitor mood

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34
Q

How is a tonic clonic seizure described?

A

Uncontrolled jerky movements

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35
Q

Vimpat

A

Lacosamide

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36
Q

Drugs for neuroleptic pain? 2

A

Pregabalin and gabapentin

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37
Q

AEDs and teratogenicity?

A

Contraception is required

Enzyme inducing AEDs decrease hormonal contraceptives

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38
Q

IV fosphen admin instructions? 3

A
  1. Do not exceed 150 mg PE/min
  2. Monitor BP, respiratory function and ECG
  3. Lower risk of purple close
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39
Q

4 SEs of Gabapentin?

A
  1. Somnolence
  2. Peripheral edema
  3. et gain
  4. mild euphoria
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40
Q

Boxed warning for Valproic acid? 3

A
  1. Hepatotoxicity
  2. Fetal harm: neuronal tube defects decrease IQ
  3. Pancreatitis
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41
Q

Trileptal

A

Oxcarb

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42
Q

IV PO ratio for phenytoin?

A

1:1

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43
Q

Phenobarb therapeutic range?

A

20-40 mcg/mL in adults

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44
Q

What do increase lamotrigine levels do?

A

Increase risk of severe rash

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45
Q

Many AEDs and pregnancy?

A

Decrease efficacy of hormonal contraceptives

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46
Q

G-tube phen admin insruction?

A

Enteral feedings tube feeds decrease absorption

Hold feedings 1-2 hours before and after

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47
Q

What are generalized seizures?

A

Start on both sides

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48
Q

What to do during the stabilization phase? 7 things to do

A
  1. Time seizure
  2. Start EEG
  3. Check BG if low
  4. Treat with D25-D50
  5. Check AED level
  6. and electrolytes
  7. May need oxygen
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49
Q

WHen can a kid be tapered off AEDs?

A

seizure free for 1 -2 years

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50
Q

Drug that is also used for bipolar and migraine prophylaxis?

A

Valproic acid

51
Q

What two drugs have the MOA of Na channel blocker?

A

Carbamazepine

Phen/fos

others do though lamotrigine, phenytoin, fosphenytoin

52
Q

Monitoring for Trileptal?

A

Oxcarb

Monitoring Na

53
Q

Primidone?

A

Pro drug of phenobarbital

54
Q

What AEDs have blood levels you can check? 4

A
  1. Carb
  2. Phen
  3. Phenobarb
  4. Valproic
55
Q

What doses does diastat acudial come in? 3

A

2.5, 10, 20

56
Q

Key drugs that can lower seizure threshold

High doses and renal impairment increase risk 6

A
  1. High doses and renal impair increase risk in
    1. Carbapenems especially imipenem
    2. Lithium
    3. Meperidine
    4. PCN
    5. Quinolones
    6. Theophylline
57
Q

Contraindication to Carbamazepine?

A
  1. Myelosuppression
58
Q

Status epilepticus tx

What are the phases?

A

Stabalization phase: 0-5

Initial Tx: 5-20

second treatment phase 20-40

59
Q

2 main valpro SEs

A

Alopecia

Wt gain

60
Q

What AED has the highest teratogenic risk?

A

Valproic acid

61
Q

Phenobarb DIs?

A

Strong inducer of most enzymes

62
Q

What is a seizuring lasting more than 5 minutes?

A

Status epilepticus SE

63
Q

Monitoring for Tegretol?

A
  1. CBC: with differential and plats
  2. Electrolytes especiialy Na
64
Q

What are patients on AEDs at risk for?

A

Bone loss

All pt on AEDs should get Calcium and Vit D

65
Q

Whats the most common test to dx epilepsy?

A

ECG

66
Q

Zarontin Warniings 2

A

SJS/TENs, Blood dyscrrasia

67
Q

What kinetics does phenytoin follow and what is the corrected equation?

A

Michalis mentin:

Pheny level/(0.2*alb)+0.1

68
Q

2 SEs of Valproic acid?

A
  1. Hyperammonemia treat with carnitine
  2. dose related thrombocytopenia
69
Q

Valproic acid counseling?

A

Take with food to limit GI upst

70
Q

What lamictal starter pack should be given to a pt taking valproic acid?

A

Blue the lower starting dose pack

71
Q

Valproic acid DI: can increase the levels of what 5 drugs?

A

Inhibitor of 2C9, weak and substrate of 2C19 and 2E1

  1. Lamotrigine
  2. Phenobarb
  3. phenytoin
  4. warfarin
  5. Zidovudine
72
Q

3 main SEs of Topamax?

A
  1. Somnolence
  2. Wt loss
  3. Anorexia
73
Q

Warnings for Kepra 4

A
  1. Psychiatric reactions
    1. Including pscyhotic symptoms, solmonlence, fatigue
74
Q

How are SEs initially treated?

A

BZDs

75
Q

What drug is also used for migraine prophylaxis?

A

Topamax

76
Q

Important note about keppra?

A

No signficant DIs

CrCl<=80 decrease dose

77
Q

Other drugs that lower seizure threshold? 5

A
  1. Clozapine
  2. Bupropion
  3. Tramadol
  4. Varinicline
78
Q

What happens to AEDs during pregnancy?

A

AED levels decrease

79
Q

AEDs enzyme inducers? 6

A
  1. Carbamazepine
  2. Ox carb
  3. Phenytoin
  4. Fosphen
  5. Phenobarb
  6. Primidone
80
Q

Felbamate Black box? 2

A
  1. Hepactic failure
  2. Aplastic anemia
81
Q

Other DI for lamotrigine?

A

Estrogen containing contraceptives decrease lam efficacy

82
Q

What is valproic acid?

A

Enzyme inhibitor not really an issue except for lamotrigine

83
Q

Diastat Acudial dispensing

Each pack contains?

A

2 rectal syringes

84
Q

IV PO rations of keppra?

A

1:1

85
Q

Depakene, Depacon

A

Valproic acid

86
Q

Interesting note about tegretol?

A

Inducer and autoinducer decreases concentrations of other drugs and itsef

87
Q

Monitoring for Valpro

A
  1. LFTs: Baseline and frequently in the first 6 months
  2. Platelet
88
Q

What to do for secondary tx? 20-40 5 things

A
  1. If seizure continues give regular AED option
    1. IV fosphenytoin
    2. Valpro
    3. Levetiracetam
    4. Or phenobarb if others are unavailable
89
Q

Lamotrigine formulations? 3

A

Tablet, Chew, ODT

90
Q

Zarontin?

A

Ethosuximide

91
Q

AEDs decrease abnormal electrical acitivity by what two main things?

A

Increase gaba

Decrease glutamate

92
Q

What can a ketogenic diet be used for?

A

Refractory seizures 4:1 combined fats to protein and carbs

93
Q

What do all AEDs do?

A

Cause CNS depression

94
Q

Warning fro tegretol?

A
  • Hyponatremia (SIADH)
  • Fetal harm
95
Q

What is eslicarbazepine?

A

Produrg of oxcarb

96
Q

SEs of Zonisamide

A

Oligohidrosis, hyperthermia

nephrolithiasis

97
Q

Phenytoin and Fosphenytoin MOA?

A

Na channel blocker

98
Q

Supplements that need to be taken with all AEDs?

A
  1. Vit D and Calcium
  2. Women of child bearing age folate
  3. Valproic acid possibly carnitine
  4. Lamotrigine if alopecia consider selenium and zinc
99
Q

Topamax

A

Topirmate

100
Q

What is the therapeutic range for valproic acid?

A

50-100

Effected by albumin <3.5 use phen calc

101
Q

Warnings for Phenytoin?

A
  1. Extravasation: characterized by edema, pain, and blush color
  2. Avoid with positive HLAB1502
  3. Fetal harm
102
Q

What is epilepsy?

A

A chronic seiure disorder

103
Q

Warniings for Vimpat

A

Prolonged PR interval and increased risk of arrythmias

104
Q

Boxed warning for phenytoin

A
  1. Pheny IV admin rate should not exceed 50mg/min and fosphen IV should not exceed 150 mg PE/min if faster hypotension and cardiac arrhythmias
105
Q

Main Topamax interaction?

A
  1. Weak 2C19 inhibitor and inducer of 3A4
  2. Can decrease efficacy of non-hormonal contraeptives
  3. Can decrease INR
106
Q

Tegretol DIs

A

Strong inducer of many (1A2, 2C19, 2C8/9, 3A4) and p-glycoprotein

Use of alternative non hormonal contraception recommneded

107
Q

Therapeutic level for phenytoin

A

10-20 mcg/mL total

108
Q

3 common SEs of Carb, Oxcarb, and Exslicarb?

A
  1. Hyponatremia
  2. Rash
  3. Enzyme INducers
109
Q

Valpro formulations

A
  1. Capsule and syrup depakene
  2. Depakote: delayed release decrease GI upset
  3. ER
  4. Sprinkle: on food
110
Q

Dilantin, Dilantin Infatab

A

Phenytoin

111
Q

Phen 3 DI things

A
  1. Strong inducer of several
  2. Non hormonal contra is recommened
  3. High protein bound can be displaced with other high protein bound
112
Q

What occurs more commonly with lamotrigine in children?

A

Life threatening rash

113
Q

What are focal seizures?

A

Start on one side

114
Q

Vimpat dose changes

A

CrCl<30

max dose of 300 per day

115
Q

Diastat?

A

Rectal Diazepam

116
Q

Zonisamide contraindications?

A

Hypersens to sulfonamides

117
Q

Lamictal starter kits 3 sets to know

When are they used?

A
  1. Orange:
    1. Standard dosing
    2. Use if no interacting meds
  2. Blue
    1. Lower starting
    2. Use if taking valproic acid
  3. Green
    1. Higher starter dose
    2. Use if taking enzyme inducers
118
Q

WHat can be given IM?

A

Midazolam

119
Q

Vigabatrin (Sabril)

Boxed warning

A

Permanent vision loss

120
Q

When should AEDs be stopped?

A

Not abruptly can cause seizures

121
Q

Formulations fo Keppra? 3

A

Tablet

Oral Solution

Injection

122
Q

What two things need to happen to correct phenytoin levels?

A

Alb<3.5 g/dL

CrCl >= 10

123
Q

3 SEs of Pregabalin and Gabapentin

A

Wt gain, peripheral edema, mild euphoria

psych 1166 (20 decks)

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