Seizures/Epilepsy Flashcards
What key drugs can lower the seizure threshold?
Bupropion
Clozapine
Theophylline
Carbapenems (esp imipenem)
lithium
meperidine
penicillin
quinolones
tramadol
seizure that is on one side of the brain
focal
seizure that starts on both sides of the brain
generalized
if a focal seizure results in no loss of consciousness, it is called
focal aware seizure
if a patient experiences loss of consciousness, it is called
focal seizure with impaired awareness
generalized seizures with non-motor symptoms are called
absence seizures
When is a seizure considered a medical emergency?
if it lasts longer than 5 minutes
initial treatment for acute seizure management
benzo injection – midazolam can be given IM
diazepam rectal gel (Diastat AcuDial)
Diastat Acudial comes in 2.5, 10 and 20mg. what must the pharmacy do before dispensing this medication?
dialed to right dose and LOCKED - the green band should say “ready”
Chronic seizure management first line
AEDs – should not be stopped abruptly
Ethosuximide are commonly used for what type of seizure
absence seizures
What is a concern with vigabatrin?
vision loss
Side effects:
hyponatremia, rash, enzyme inducers
carbamazepine, oxcarbazpeine, esilicarbazepine
side effects:
weight gain, peripheral edema, mild euphoria
used primarily for neuropathic pain
gabapentin and pregabalin
Side effects:
sedation, dependence and overdose, enzyme inducers
phenobarbital and primidone (prodrug of phenobarbital)
side effects:
weight loss, metabolic acidosis
nephrolithiasis and oligogidrosis/hyperthermia in children
topiramate and zonisamide
ALL AEDs should be supplemented with
vitamin D and calcium
women of childbearing age: folate
Lamotrigine and valproic acid, if alopecia develops, supplement with
selenium and zinc
[[valproic acid: possibly carnitine]]
What AEDs increase GABA?
benzo
valproic acid
What AED is a T-TYPE ca channel blocker?
ethosuximide
What AEDs are na channel blocker?
carbamazepine, phenytoin
What is the initial starting dose for lamictal?
weeks 1 and 2: 25mg daily, increase by 25mg
What is the color of the lamictal starter kits for initial STANDARD dose?
orange
what is the color of the lamictal starter kit for lower starting dose? (use if taking valproic)
blue
what is the color of the higher starting dose for lamictal
green
use if taking inducer -carbamazepine, phenytoin, phenobarbital
what is the therapeutic range for valproic acid?
50-100mcg (total level)
*oral contraceptives can decrease levels
boxed warning for valproic acid
hepatic failure
fetal harm
**want LFTs baseline and first 6 months
valproic acid might cause hyperammonemia - how do you treat?
carnitine
Therapeutic range for tegretol (carbamazepine)
4-12mcgmL
autoinducer
What AED should be tested for HLA-B*1502; aplastic anemia and agranulocytes?
carbamazepine
Brand: Vimpat
generic: lacosamide (C-V)
What AED prolongs PR interval and increases risk of arrhythmias?
lacosamide
therapeutic range for phenobarbital
20-40mcg/mL (adults)
decreases OC, need a non-hormonal form
Brand: Cerebyx
generic: fosphenytoin
What is the administration rate of IV fosphenytoin?
do not exceed 150mg PE/minute
monitor: BP, respiratory function, ECG
lower risk of purple glove syndrome than phenytoin
What is the administration rate of IV phenytoin
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
NG tubes and phenytoin.. directions?
enteral feeding (tube feeds) decreases phenytoin absorption; hold feeding 1-2 hours before and after administration
Therapeutic range for fosphenytoin total level and free level
total level= 10-20mcg/mL
free level = 1-2.5mcg/mL
What AED can cause blood dyscrasias?
ethosuximide
Brand: Zarontin
generic: ethosuximide
Most AEDs are enzyme inducers - which is an enzyme inhibitor?
Valproic acid (increases lamotrigine – use blue starting box)
which AEDs in children can cause reduced or lack of sweating?
topiramate and zonisamide
Which AEDs are easiest to administer to children?
lamotrigine - ODT, chewable, tablets
keppra- ODT, oral solution
when can a child be tapered off AEDs?
seizure free for 1-2 years
take __________ on an empty stomach at least one hour before or two hours after food
Oxtellar XR (oxcarbamazepine)
*can also cause low sodium concentrations in the blood)
Phenytoin side effects include
severe rash
gingival hyperplasia
hair growth
