Seizures/Epilepsy

Question 1

What key drugs can lower the seizure threshold?

Answer 1

Bupropion

Clozapine

Theophylline

Carbapenems (esp imipenem)

lithium

meperidine

penicillin

quinolones

tramadol

Question 2

seizure that is on one side of the brain

Answer 2

focal

Question 3

seizure that starts on both sides of the brain

Answer 3

generalized

Question 4

if a focal seizure results in no loss of consciousness, it is called

Answer 4

focal aware seizure

Question 5

if a patient experiences loss of consciousness, it is called

Answer 5

focal seizure with impaired awareness

Question 6

generalized seizures with non-motor symptoms are called

Answer 6

absence seizures

Question 7

When is a seizure considered a medical emergency?

Answer 7

if it lasts longer than 5 minutes

Question 8

initial treatment for acute seizure management

Answer 8

benzo injection – midazolam can be given IM

diazepam rectal gel (Diastat AcuDial)

Question 9

Diastat Acudial comes in 2.5, 10 and 20mg. what must the pharmacy do before dispensing this medication?

Answer 9

dialed to right dose and LOCKED - the green band should say “ready”

Question 10

Chronic seizure management first line

Answer 10

AEDs – should not be stopped abruptly

Question 11

Ethosuximide are commonly used for what type of seizure

Answer 11

absence seizures

Question 12

What is a concern with vigabatrin?

Answer 12

vision loss

Question 13

Side effects:

hyponatremia, rash, enzyme inducers

Answer 13

carbamazepine, oxcarbazpeine, esilicarbazepine

Question 14

side effects:

weight gain, peripheral edema, mild euphoria

used primarily for neuropathic pain

Answer 14

gabapentin and pregabalin

Question 15

Side effects:

sedation, dependence and overdose, enzyme inducers

Answer 15

phenobarbital and primidone (prodrug of phenobarbital)

Question 16

side effects:

weight loss, metabolic acidosis

nephrolithiasis and oligogidrosis/hyperthermia in children

Answer 16

topiramate and zonisamide

Question 17

ALL AEDs should be supplemented with

Answer 17

vitamin D and calcium

women of childbearing age: folate

Question 18

Lamotrigine and valproic acid, if alopecia develops, supplement with

Answer 18

selenium and zinc

[[valproic acid: possibly carnitine]]

Question 19

What AEDs increase GABA?

Answer 19

benzo

valproic acid

Question 20

What AED is a T-TYPE ca channel blocker?

Answer 20

ethosuximide

Question 21

What AEDs are na channel blocker?

Answer 21

carbamazepine, phenytoin

Question 22

What is the initial starting dose for lamictal?

Answer 22

weeks 1 and 2: 25mg daily, increase by 25mg

Question 23

What is the color of the lamictal starter kits for initial STANDARD dose?

Answer 23

orange

Question 24

what is the color of the lamictal starter kit for lower starting dose? (use if taking valproic)

Answer 24

blue

Question 25

what is the color of the higher starting dose for lamictal

Answer 25

green

use if taking inducer -carbamazepine, phenytoin, phenobarbital

Question 26

what is the therapeutic range for valproic acid?

Answer 26

50-100mcg (total level)

*oral contraceptives can decrease levels

Question 27

boxed warning for valproic acid

Answer 27

hepatic failure

fetal harm

**want LFTs baseline and first 6 months

Question 28

valproic acid might cause hyperammonemia - how do you treat?

Answer 28

carnitine

Question 29

Therapeutic range for tegretol (carbamazepine)

Answer 29

4-12mcgmL

autoinducer

Question 30

What AED should be tested for HLA-B*1502; aplastic anemia and agranulocytes?

Answer 30

carbamazepine

Question 31

Brand: Vimpat

Answer 31

generic: lacosamide (C-V)

Question 32

What AED prolongs PR interval and increases risk of arrhythmias?

Answer 32

lacosamide

Question 33

therapeutic range for phenobarbital

Answer 33

20-40mcg/mL (adults)

decreases OC, need a non-hormonal form

Question 34

Brand: Cerebyx

Answer 34

generic: fosphenytoin

Question 35

What is the administration rate of IV fosphenytoin?

Answer 35

do not exceed 150mg PE/minute

monitor: BP, respiratory function, ECG

lower risk of purple glove syndrome than phenytoin

Question 36

What is the administration rate of IV phenytoin

Answer 36

do not exceed 50mg//min (slower infusion) [[IV:PO 1:1]]; needs HLA-B* 1502 testing too

monitor: BP, respiratory function, ECG

requires a filter

dilute in NS, stable for 4 hours, do not refrigerate

Question 37

NG tubes and phenytoin.. directions?

Answer 37

enteral feeding (tube feeds) decreases phenytoin absorption; hold feeding 1-2 hours before and after administration

Question 38

Therapeutic range for fosphenytoin total level and free level

Answer 38

total level= 10-20mcg/mL

free level = 1-2.5mcg/mL

Question 39

What AED can cause blood dyscrasias?

Answer 39

ethosuximide

Question 40

Brand: Zarontin

Answer 40

generic: ethosuximide

Question 41

Most AEDs are enzyme inducers - which is an enzyme inhibitor?

Answer 41

Valproic acid (increases lamotrigine – use blue starting box)

Question 42

which AEDs in children can cause reduced or lack of sweating?

Answer 42

topiramate and zonisamide

Question 43

Which AEDs are easiest to administer to children?

Answer 43

lamotrigine - ODT, chewable, tablets

keppra- ODT, oral solution

Question 44

when can a child be tapered off AEDs?

Answer 44

seizure free for 1-2 years

Question 45

take __________ on an empty stomach at least one hour before or two hours after food

Answer 45

Oxtellar XR (oxcarbamazepine)

*can also cause low sodium concentrations in the blood)

Question 46

Phenytoin side effects include

Answer 46

severe rash

gingival hyperplasia

hair growth