Seizures Flashcards
What is epilepsy?
When there are 2 or more unprovoked seizures occuring at least 24 hours apart, 1 seizure with a high probability (>60%) likelihood of a second seizure within 10 years, or 1 seizure with EEG evidence of epileptic disorder
What are likely factors that precipitate loss of seizure control in people on AED?
lack of sleep, alcohol, street drugs, adherence issues, acute infection, electrolyte abnormalities, hypoglycaemia, addition of a drug that promotes seizures or interacts with AEDs, sudden withdrawal from alcohol or benzos
Which 5 AEDs require serum monitoring?
carbemazepine, phenytoin, phenobarbital, valproic acid, primidone
What are non-pharms for seizure prevention?
Adequate sleep
Minimize alcohol intake
Keto diet or atkins diet sometimes used for people with epilepsy
What is first line in absence seizures?
Ethosuximide
What is first line in tonic-clonic seizures?
Lamotrigine, Levetiracetam, Carbemazepine, Valproic acid/divalproex
What should be done when initiating or discontinuing AED therapy?
Careful dose titration up or down.
What should be done if someone on AED is still seizing?
Slowly titrate the medication up to max dose. If already at max dose, add a second agent and then taper the initial medication.
Polytherapy is indicated when people fail on 2-3 drugs for monotherapy
Which AED’s have the potential for rash?
Carbemazepine, Phenytoin, and Lamotrigine are most likely, although this is possible with any of the AEDs
When is a rash from an AED most likely to develop, and what is the management?
AED can develop at any time in therapy, but can most commonly develop in first 6 weeks.
If a definite drug rash develops, the AED should be stopped immediately.
After how long is a consideration toward discontinuing AED’s made?
About 3-5 years seizure free, a neurologist may consider d/c the medication. S/he must consider risks and benefits to long term therapy.
Which contraception methods are likely to be affected by AEDs?
Nuvaring, Patch, COC, POC
What contraception methods are less likely to be affected by AEDs?
IUDs, Progestin injection
What 6 AEDs that are commonly seen are enzyme inducers?
Carbemazepine, topiramate, phenytoin, phenobarbital, primidone, oxcarbazepine
What two drugs to AED’s commonly interact with?
birth control pills and DOACs
