Seizures/Epilepsy Flashcards
What is used to diagnose Epilepsy?
Electroencephalogram (EEG)
Focal seizures start on what side?
one side
generalized seizures start on what side?
Both sides
Focal aware seizure (aka simple partial seizure)
no loss of consciousness
if you experience loss of consciousness, what type of seizure?
focal seizure with impaired awareness
(AKA complex impaired seizure)
generalized seizures with non motor symptoms are called
absence seizure
motor symptoms for seizeures are
jerking movement (clonic)
limp or weak muscles (atonic)
non motor symptoms
changes in sensations, emotions,, thinking or cognition
Status Epilepticus seizure lasts?
beyond 5 min
status epilecticus stabilization phase
occurs witin 0-5 min
time seizure
start ECG Oxygen may be needed
chack AED levels, electrolytes
if BG low- treat with D25-D50
status epilepticus initial treatment phase
5-20 min
IV Lorazepam (Ativan) OR IM midazolam (Versed)
if not available use Rectal diazepam (Diastat)
instranasal/buccal midazolam
status epilepticus Second treatment Phase
20-40 min
give AED
IV fosphenytoin, Valproic Acid, Levetiracetam
Diastat Acudial syringes come in
2.5, 10, 20 mg
must be dialed and locked before dispensing
non-drug/alternative treatment for chronic seizure
cannabis
canabiidiol/CBD (epidiolex)
keto diet - refractory seizures
Vigabatrin (AED) boxed warning of
permanent vision loss
(Sasbril/Vigadrone)
benzodiazepines MOA
increase GABA
valproic Acid MOA
increases GABA
Phenobarbital MOA
enhances/ potentiates GABA
Levetiracetam MOA
CCB & increases GABA
Ethosuximide MOA
T-type CCB
Pregabalin /Gabapentin MOA
CCB
Oxcarbazepine MOA
NA & CCB
Carbamazepine MOA
Na channel Blocker
Lamotrigene MOA
Na channel Blocker
phenytoin/fosphenytoin MOA
NAcB
topiramate MOA
NAcB
what vitamins are required when taking AED medications
vitamin D & Ca
pregnant: Folate
valproic: Carnitine
lamotrigene & valproic : if alopecia- selenium and Zinc
Carbamazepine & Oxcarbazepine & Eslicarbazepine
similar Side Effects
Rash (SJS/TEN)
hypoNatremia
enzyme induction
gabapentin/ pregabalin
similar Side Effects
weight Gain
peripheral edema
mild euphoria
primarily used for neuropathic pain
phenobarbital & Primidone (prodrug of phenobarbital)
similar Side Effects
sedation
dependence/tolerance/overdose risk
enzyme induction
topiramate & Zonisamide
similar Side Effects
nephrolithiasis
oligo hidrosis
hyperthermia (in children)
Lamotrigine (Tab, chewable, ODT)
Brand Name/ BW/SE
Lamictal
weeks 1 & 2 25 mg daily
BW: serious skin reactions (SJS/TEN)
SE: alopecia
other: N/V, somnolence, tremor, ataxia, diplopia, blurred vision
Valproic Acid can increase lamotrigine concentrations what color starter kit must be used?
Blue (low starting dose)
use with valproic acid
what kit must be used with lamotrigine when needing a higher dose due to an enzyme inducer?
Green
Combined Oral contraceptives can decrease lamotrigine levels
what must be done
use a higher maintenance dose of 300-400 mg
levetiracetam
Brand Name/ W/SE
Tab, ODT, oral sol, Inj
Keprra
psychiatric reactions
psychotic symptoms
somnolence
fatigue
NO SIGNIFICANT DRUG Interactions
Topiramate
Brand Name/ W/SE
Cap, ER cap, Tab
Topamax
Topamax sprinkle
also used for migraine prophylaxis
Metabolic Acidosis
Oligohhidrosis (reduced perspiration)
nephrolithiasis
Hyperammonemia
angle closure glaucoma
FETAL HARM
-cyp3A4 inducer
can decrease INR,
phenytoin, VA, lamotrigine carbazepine=al decrease levels
Valproic Acid
Divalproex
Brand Name/ BW/W/SE
Depokene/ Depakote
Therapeutic Range: 50-100 (Total Level)
BW: Fetal Harm (neural tube defects decrease IQ)
hepatic failure
HyperAmmonemia (tx caritine)
thrombocytopenia (increase bleeding risk)
alopecia
Weight Gain
monitor LFT increases in the first 6 months
topiramate Side effects
somnolence
memory/concentration/attention/
weight Loss
anorexia
what can valproic acid/Divalproex be also used for
also used for migraine prophylaxis & Bipolar disorder
what drugs can Valproic acid increase
lamotrigene
phenobarbital
phenytoin
warfarin
zidovudine
what antibiotic can decrease levels of valproic acid
carbapenems
carbamazepine
Cap,Tab, chewable, Oral sus
Brand/BW/W/CI
Tegretol
serious skin reactions test HLA-B1502
aplastic anemia
agranulocytosis
W: HypOnatremia (SIADH), Fetal Harm
CI: myelosuppression, MAOi, NNRTI
monitor CBC and platelets, Na
autoinducer1A2/2C19/3A4
Therapeutic range 4-12
induces P-gp
Lacosamide
tab, oral sol, inj
brand/ W
Vimpat
prolongs PR interval
increase of arrythmias
oxcarbazepine
brand/W
trileptal
serious skin reaction test HLA-B 1502 prior to initiating
hypOnatremia
not an autoinducer
phenobarbital
W/SE
habit forming
respiratory depression
fetal harm
psychological dependence
tolerance
hangover effect
phenytoin
cap, chewable, oral sus, Inj
boxed Warning
side effects
Dilantin
IV DNE 50 mg/min
faster leads to cardiac arrhythmias
Nystagmus
ataxia
diplopia
gingival hyperplasia
hair growth
hepatotoxic
req filter and NS only, stable 4 hours
fosphenytoin (prodrug of phenytoin)
Boxed warning
Side effects
Cerebyx
IV DNE 150 mg PE/min
faster leads to cardiac arrhythmias
Nystagmus
ataxia
diplopia
gingival hyperplasia
hair growth
hepatotoxic
phenytoin & fosphenytoin
warnings
extravasation leads to purple glove syndrome (characterized as edema, pain bluish discoloration of skin)
Test HLA 1502
Fetal Harm
ethosuximide
Zarontin
used for absence seizures
serious skin rash (SJS/TEn)
blood dycrasias
felbamate
Felbatol
BW: hepatic failure
aplastic anemia
zonisamide
Zonergan
contraindicated hypersensitivity for sulfonamides
oligo hidrosis`, hyperthermia, nephroliathiasus
phenytoin exerts what type o kinetics
michaelis menten=saturable
if albumin is low <3.5
must adjust level
phenytoin correction formula
measured phenytoin / ( 0.2 x albumin +0.1
free levels do not req adjusting
primidone
Mysolamine
is a prodrug of phenobarbital
what drugs are enzyme inducers
carbazepine
oxcarbazepine
phenytoin
fosphenytoin
phenobarbital
primidone
what drugs are enzyme inhibitors
valproic acid
All AEDs can cause
CNS depression
dizzines, confusion, ataxia, coordination issues, dizziness
Suicide risk-& Rash mon mood
what AED has highest risk of fetal harm
valproic acid with neural tube defects
