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Rx Prep Chapters >4 hours > Seizures/Epilepsy > Flashcards

Seizures/Epilepsy Flashcards

1
Q

What is used to diagnose Epilepsy?

A

Electroencephalogram (EEG)

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2
Q

Focal seizures start on what side?

A

one side

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3
Q

generalized seizures start on what side?

A

Both sides

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4
Q

Focal aware seizure (aka simple partial seizure)

A

no loss of consciousness

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5
Q

if you experience loss of consciousness, what type of seizure?

A

focal seizure with impaired awareness
(AKA complex impaired seizure)

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6
Q

generalized seizures with non motor symptoms are called

A

absence seizure

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7
Q

motor symptoms for seizeures are

A

jerking movement (clonic)
limp or weak muscles (atonic)

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8
Q

non motor symptoms

A

changes in sensations, emotions,, thinking or cognition

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9
Q

Status Epilepticus seizure lasts?

A

beyond 5 min

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10
Q

status epilecticus stabilization phase

A

occurs witin 0-5 min
time seizure
start ECG Oxygen may be needed
chack AED levels, electrolytes
if BG low- treat with D25-D50

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11
Q

status epilepticus initial treatment phase

A

5-20 min
IV Lorazepam (Ativan) OR IM midazolam (Versed)
if not available use Rectal diazepam (Diastat)
instranasal/buccal midazolam

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12
Q

status epilepticus Second treatment Phase

A

20-40 min
give AED
IV fosphenytoin, Valproic Acid, Levetiracetam

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13
Q

Diastat Acudial syringes come in

A

2.5, 10, 20 mg
must be dialed and locked before dispensing

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14
Q

non-drug/alternative treatment for chronic seizure

A

cannabis
canabiidiol/CBD (epidiolex)
keto diet - refractory seizures

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15
Q

Vigabatrin (AED) boxed warning of

A

permanent vision loss
(Sasbril/Vigadrone)

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16
Q

benzodiazepines MOA

A

increase GABA

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17
Q

valproic Acid MOA

A

increases GABA

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18
Q

Phenobarbital MOA

A

enhances/ potentiates GABA

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19
Q

Levetiracetam MOA

A

CCB & increases GABA

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20
Q

Ethosuximide MOA

A

T-type CCB

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21
Q

Pregabalin /Gabapentin MOA

A

CCB

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22
Q

Oxcarbazepine MOA

A

NA & CCB

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23
Q

Carbamazepine MOA

A

Na channel Blocker

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24
Q

Lamotrigene MOA

A

Na channel Blocker

25
Q

phenytoin/fosphenytoin MOA

A

NAcB

26
Q

topiramate MOA

A

NAcB

27
Q

what vitamins are required when taking AED medications

A

vitamin D & Ca
pregnant: Folate
valproic: Carnitine
lamotrigene & valproic : if alopecia- selenium and Zinc

28
Q

Carbamazepine & Oxcarbazepine & Eslicarbazepine
similar Side Effects

A

Rash (SJS/TEN)
hypoNatremia
enzyme induction

29
Q

gabapentin/ pregabalin
similar Side Effects

A

weight Gain
peripheral edema
mild euphoria
primarily used for neuropathic pain

30
Q

phenobarbital & Primidone (prodrug of phenobarbital)
similar Side Effects

A

sedation
dependence/tolerance/overdose risk
enzyme induction

31
Q

topiramate & Zonisamide
similar Side Effects

A

nephrolithiasis
oligo hidrosis
hyperthermia (in children)

32
Q

Lamotrigine (Tab, chewable, ODT)
Brand Name/ BW/SE

A

Lamictal
weeks 1 & 2 25 mg daily
BW: serious skin reactions (SJS/TEN)
SE: alopecia
other: N/V, somnolence, tremor, ataxia, diplopia, blurred vision

33
Q

Valproic Acid can increase lamotrigine concentrations what color starter kit must be used?

A

Blue (low starting dose)
use with valproic acid

34
Q

what kit must be used with lamotrigine when needing a higher dose due to an enzyme inducer?

A

Green

35
Q

Combined Oral contraceptives can decrease lamotrigine levels
what must be done

A

use a higher maintenance dose of 300-400 mg

36
Q

levetiracetam
Brand Name/ W/SE
Tab, ODT, oral sol, Inj

A

Keprra
psychiatric reactions
psychotic symptoms
somnolence
fatigue
NO SIGNIFICANT DRUG Interactions

37
Q

Topiramate
Brand Name/ W/SE
Cap, ER cap, Tab

A

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

38
Q

Valproic Acid
Divalproex
Brand Name/ BW/W/SE

A

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

39
Q

topiramate Side effects

A

somnolence
memory/concentration/attention/
weight Loss
anorexia

40
Q

what can valproic acid/Divalproex be also used for

A

also used for migraine prophylaxis & Bipolar disorder

41
Q

what drugs can Valproic acid increase

A

lamotrigene
phenobarbital
phenytoin
warfarin
zidovudine

42
Q

what antibiotic can decrease levels of valproic acid

A

carbapenems

43
Q

carbamazepine
Cap,Tab, chewable, Oral sus
Brand/BW/W/CI

A

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

44
Q

Lacosamide
tab, oral sol, inj
brand/ W

A

Vimpat
prolongs PR interval
increase of arrythmias

45
Q

oxcarbazepine
brand/W

A

trileptal
serious skin reaction test HLA-B 1502 prior to initiating
hypOnatremia

not an autoinducer

46
Q

phenobarbital
W/SE

A

habit forming
respiratory depression
fetal harm

psychological dependence
tolerance
hangover effect

47
Q

phenytoin
cap, chewable, oral sus, Inj
boxed Warning
side effects

A

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

48
Q

fosphenytoin (prodrug of phenytoin)
Boxed warning
Side effects

A

Cerebyx
IV DNE 150 mg PE/min
faster leads to cardiac arrhythmias

Nystagmus
ataxia
diplopia
gingival hyperplasia
hair growth
hepatotoxic

49
Q

phenytoin & fosphenytoin
warnings

A

extravasation leads to purple glove syndrome (characterized as edema, pain bluish discoloration of skin)
Test HLA 1502
Fetal Harm

50
Q

ethosuximide

A

Zarontin
used for absence seizures
serious skin rash (SJS/TEn)
blood dycrasias

51
Q

felbamate

A

Felbatol
BW: hepatic failure
aplastic anemia

52
Q

zonisamide

A

Zonergan
contraindicated hypersensitivity for sulfonamides
oligo hidrosis`, hyperthermia, nephroliathiasus

53
Q

phenytoin exerts what type o kinetics

A

michaelis menten=saturable
if albumin is low <3.5
must adjust level

54
Q

phenytoin correction formula

A

measured phenytoin / ( 0.2 x albumin +0.1
free levels do not req adjusting

55
Q

primidone

A

Mysolamine
is a prodrug of phenobarbital

56
Q

what drugs are enzyme inducers

A

carbazepine
oxcarbazepine
phenytoin
fosphenytoin
phenobarbital
primidone

57
Q

what drugs are enzyme inhibitors

A

valproic acid

58
Q

All AEDs can cause

A

CNS depression
dizzines, confusion, ataxia, coordination issues, dizziness
Suicide risk-& Rash mon mood

59
Q

what AED has highest risk of fetal harm

A

valproic acid with neural tube defects

Rx Prep Chapters >4 hours (6 decks)

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