Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

RxPrep > Seizures/Epilepsy > Flashcards

Seizures/Epilepsy Flashcards

1
Q

How is epilepsy diagnosed?

A

electroencephalogram (EEG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What drugs can cause seizures?
* high-doses and/or renal impairment increase risk

A
  1. Opioids (tramadol, meperidine)*
  2. Quinolones/mefloquine
  3. Carbapenems*
  4. Cephalosporins*
  5. PCNs*
  6. Bupropion/ TCAs*
  7. antipsychotics (clozapine)
  8. Lithium*
  9. baclofen*
  10. diphenhydramine*
  11. metoclopramide
  12. metronidazole
  13. varenicline
  14. stimulants (methylphenidate)*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a focal seizure?

A

starts on 1 side of the brain, may spread to the other

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is a generalized seizure?

A

starts on both sides of the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a focal aware seizure?

A

no loss of consciousness; simple partial seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a focal seizure with impaired awareness?

A

loss of consciousness; complex partial seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How are rigid or tense movements described?

A

tonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is muscle twitching described?

A

myoclonus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is status epilepticus?

A

seizure lasts 5 min or more (medical emergency)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is status epilepticus treated?

A

0-5 min: stabilize airway/circulation/breathing; time seizure and start ECG; check anti seizure drug levels/electrolytes/treat glucose with dextrose
5-20 min (treatment 1): IV lorazepam/diazepam, IM midazolam; rectal diazepam, intranasal/buccal midazolam if seizure continues (alt)
20-40 min (treatment 2): IV fosphenytoin/valproic acid/levetiracetam/phenobarbital
>40 min (treatment 3): repeat treatment 2 or midazolam/pentobarbital/propofol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When and what non-injectable options for non-emergency seizure control?

A
  1. diazepam rectal gel (Diastat AcuDial)
  2. buccal/intranasal midazolam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What patients are Diastat AcuDial prescribed for?

A

at risk for long-lasting seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What must the pharmacist do before dispensing Diastat AcuDial?

A

dial each syringe to the correct dose (2.5, 10, 20mg) and lock before dispensing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the instructions for dialing the Diastat AcuDial to the correct dose?

A
  1. hold the barrel of the syringe with the cap facing down and dose window visible, don’t remove the cap
  2. grab the cap and turn to adjust the dose
  3. confirm dose in window, hold the cap and push up on both sides of the lock ring; green band should say READY; cannot be unlocked
  4. repeat with second syringe and check dose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Can anti-seizure medications (ASM) be stopped?

A

stopping abruptly increases seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are adjuvant treatments for chronic seizures?

A
  1. CBD (Epidiolex)
  2. ketogenic diet (4:1 fats:protein/carbs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What ASMs are used for focal and generalized seizures?

A

Broad spectrum ASMs (lamotrigine, levetiracetam, topiramate, valproic acid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are generalized seizures with non-motor symptoms called?

A

absence seizure (staring spell)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which agent is used specifically for absence seizures?

A

ethosuxamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are narrow spectrum ASMS used for?

A

focal-onset seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are safety concerns with all ASMs?

A
  1. Increased risk of CNS depression (sedation, cognitive impairment, ataxia/difficult coordination, falls)
  2. Suicide risk warning
  3. Bone loss/increased fracture risk
  4. SJS/TENS rash
  5. DRESS multiorgan HSR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What supplements should be taken with ASMs?

A
  1. Ca and Vitamin D (all)
  2. Folate (pregnancy)
  3. Carnitine (Valproic acid)
  4. Biotin, Selenium and Zinc (alopecia with valproic acid and lamotrigine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which ASMs have the MOA of enhancing GABA effect?

A
  1. Benzos
  2. Phenobarbital
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which ASMs have the MOA of increasing GABA by blocking Na channels?

A

Valproate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which ASMs have the MOA of inhibiting vesicle fusion by binding SV2A proteins?

A

Levetiracetam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which ASMs have the MOA of blocking Na channels?

A
  1. carbamazepine
  2. phenytoin/fosphenytoin
  3. topiramate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Which ASMs have the MOA of decreasing glutamate by blocking Na channels?

A

lamotrigine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Which ASMs have the MOA of blocking t-type Ca channels?

A

ethosuxamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How does blocking Ca channels decrease seizure?

A

slows/stops transmission of electrical signal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How does blocking Na channels decrease seizure?

A

decreases neuronal firing rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Lamotrigine

A

Lamictal
Lamictal ODT
Lamictal XR
Lamictal Starter Kit
Subvenite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How is lamotrigine dosed for seizure?

A

Week 1 and 2: 25mg QD
Week 3 and 4: 50mg QD
Week 5 and on: increase by 50mg every 1-2 weeks
Maintenance dose: IR 225-375 BID, XRn300-400mg QD; dose varies based on DIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are BBW for lamotrigine?

A

Serious skin reactions (SJS/TEN) peds>adults; increased risk with starting doses higher than recommended or use with valproate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are warnings with lamotrigine?

A
  1. Multiorgan HSR (DRESS)
  2. aseptic meningitis
  3. blood dyscrasias (disorder of cells in the blood)
  4. cardiac rhythm abnormalities
  5. hemophagocytic lymphohistiocytosis (HLH) rare immune reaction that can be fatal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are SEs with lamotrigine?

A
  1. Alopecia (supplement with Biotin, Selenium, and Zinc)
  2. N/V
  3. somnolence
  4. rash
  5. tremor
  6. ataxia
  7. impaired coordination
  8. dizziness
  9. diplopia (double vision)
  10. blurred vision
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What should be monitored with lamotrigine therapy?

A
  1. Rash (discontinue if any HSR or rash)
  2. fever
  3. Adherence (if not taken for >/= 5 half-lives (>6 days) restart initial dosing titration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are DIs with lamotrigine?

A
  1. drugs that induce/inhibit uridine diphosphate glucuronosyltransferase (UGT)
  2. valproic acid increases lamotrigine conc
  3. oral estrogen containing contraceptives decrease lamotrigine conc
  4. carbamazepine, phenytoin, phenobarbital, primidone, lopinavir/ritonavir, atazanavir/ritonavir, rifampin decrease lamotrigine conc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How does Lamictal Starter Kit work?

A

Color coded kit:
Blue- lower starting dose (used if also taking valproic acid)
Orange- Standard starting dose
Green- Higher starting dose (used if also taking carbamazepine, phenytoin, phenobarbital, primidone, lopinavir/ritonavir, atazanavir/ritonavir, rifampin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Levetiracetam

A

Keppra
Keppra XR
Elepsia XR
Spritam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How is levetiracetam dosed?

A

Initial: 500 mg BID IR or 1000mg QD XR
Maintenance: max dose 3000mg/day
CrCl </=80: decrease dose
IV:PO=1:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are warnings with levetiracetam?

A
  1. Psychiatric reactions (Psychotic symptoms, Somnolence, Fatigue, aggression, anxiety, suicidal behavior)
  2. anaphylaxis/angioedema
  3. coordination difficulties
  4. severe skin reactions (SJS/TENS)
  5. multiorgan HSR (DRESS)
  6. hematologic abnormalities (mainly anemias)
  7. loss of seizure control during pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are SEs with levetiracetam?

A
  1. somnolence
  2. dizziness
  3. weakness
  4. asthenia (weakness)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are DIs with levetiracetam?

A

None

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What drugs are considered broad spectrum ASM?

A
  1. Lamotrigine
  2. Levetiracetam
  3. Topiramate
  4. Valproate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Topiramate

A

Topamax
Topamax Sprinkle
Eprontia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Topiramate extended-release

A

Qudexy XR
Trokendi XR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

How is topiramate dosed?

A

Week 1: 25mg BID IR or 50mg QD XR
Week 2-4: increase by 25mg BID IR or 50mg QD XR each week
Week 5 and on: increase by 100mg weekly until max dose/theraputic effect
Max dose: 400mg/day
CrCl<70: decrease dose by 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are CIs with topiramate?

A

Trokendi XR: alcohol use 6 h before/after dose
Qudexy XR: patients with metabolic acidosis taking metformin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are warnings with topiramate?

A
  1. Hyperchloremic non-anion gap Metabolic Acidosis
  2. Ogliohidrosis (reduced perspiration)/hyperthermia (mostly children)
  3. Nephrolithiasis (kidney stones)
  4. acute myopia
  5. secondary Angle-closure Glaucoma
  6. Hyperammonemia
  7. Visual problems (reversible)
  8. Fetal Harm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are SEs with topiramate?

A
  1. Somnolence
  2. Difficulty with Memory, Concentration, Attention
  3. Weight loss/ Anorexia
  4. paresthesia (skin sensation)
  5. dizziness
  6. psychomotor slowing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What should be monitored with topiramate?

A
  1. electrolytes (Bicarb)
  2. renal function
  3. hydration status
  4. eye exam (Intra Ocular Pressure)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are specific administration instructions for Topamax Sprinkle?

A

swallow whole or open and sprinkle on a small amount of soft food (swallow whole; do not chew)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are DIs with topiramate?

A
  1. weak inhibitor CYP2C19 and inducer of CYP3A4
  2. phenytoin, carbamazepine, valproate, and lamotrigine can decrease topiramate levels
  3. topiramate can decrease effective ness of oral contraceptives (especially >200mg/day) Non-hormonal BC recommended
  4. can decrease INR if on warfarin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What other indication does topiramate have?

A

migraine prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What are BBWs with valproate?

A
  1. Hepatic failure: usually during first 6 months of therapy, children < 2 years and those with mitochondrial disorders increased risk
  2. Fetal harm: Neural tube defects and Decreased IQ scores
  3. Pancreatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are CIs with valproate?

A
  1. Hepatic disease
  2. urea cycle disorders
  3. prophylaxis of migraine in pregnancy
  4. certain mitochondrial disorders if <2 years of age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What are warnings with valproate?

A
  1. Hyperammonemia (tx with Carnitine in symptomatic adults only)
  2. hypothermia
  3. dose-related thrombocytopenia (increase bleeding risk)
  4. multiorgan HSR (DRESS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What are SEs with valproate?

A
  1. Alopecia (supplement biotin, selenium, zinc)
  2. N/V
  3. Weight changes (gain >loss)
  4. Somnolence/dizziness
  5. Tremor
  6. headache
  7. anorexia
  8. abdominal pain
  9. edema
  10. diplopia/blurred vision
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What should be monitored with valproate?

A
  1. LFTs (baseline and frequently for first 6 months)
  2. CBC with differential (esp. Platelets)
  3. serum valproate levels (50-100 mcg/mL)
  4. serum ammonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is the difference between valproate vs. valproic acid?

A

“valproate” is used to refer to any formulation of valproic acid, valproate sodium, or divalproex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Valproate

A

Valproic Acid (capsule/syrup)
Valproate sodium (IV)
Divalproex (Depakote)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Divalproex

A

Depakote (DR tablet)
Depakote ER (ER tablet)
Depakote Sprinkle (capsules can be opened and sprinkled on food)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

How is valproate dosed?

A

Initial: 10-15 mg/kg/day
Max: 60 mg/kg/day
Therapeutic range: 50-100mcg/mL
Albumin <3.5: may need to decrease dose
DR to ER: increase TDD 8-20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What are other indications for valproate?

A
  1. Bipolar disorder
  2. Migraine prophylaxis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What are DIs with valproate?

A
  1. Increases levels of Lamotrigine, Warfarin, phenobarbital, and zidovudine
  2. Risk of serious rash when used with Lamotrigine (use lower lamictal dose)
  3. Salicylates displace valproate from protein (more valproate)
  4. Carbapenems and estrogen containing contraceptives decrease valproate
  5. use with topiramate can lead to hyperammonemia with or without encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Which agents are narrow-spectrum ASMs?

A
  1. Lacosamide
  2. Carbamazepine
  3. Oxcarbazepine
  4. Phenytoin/Fosphenytoin
  5. Phenobarbital
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Lacosamide

A

Vimpat (CV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

How is lacosamide dosed?

A

Initial: 50-100mg BID
Max: 400mg/d
CrCl<30: max 300mg/d
IV:PO=1:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What are warnings with lacisamide?

A
  1. Prolongs PR interval increasing risk of Arrhythmias (obtaine ECG prior to use and after titrated to steady state in those with or at risk of cardiac conduction problems)
  2. Multiorgan HSR (DRESS)
  3. syncope/dizziness
  4. ataxia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What are SEs with lacosamide?

A
  1. dizziness
  2. headache
  3. ataxia
  4. tremor
  5. diplopia/blurred vision
  6. ataxia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is monitored with lacosamide?

A

ECG (baseline and steady state) in at risk pts

72
Q

What are DIs with lacosamide?

A
  1. medications that prolong PR interval (beta blockers, CCBs, digoxin risk of AV block and brady)
  2. inhibitors of CYP 2C19,2C9, and 3A4 can increase lacosamide conc
73
Q

Carbamazepine

A

Tegretol
Tegretol XR
Carbatrol
Epitol
Equetro (for bipolar disorder)

74
Q

What are BBWs for carbamazepine?

A
  1. Serious Skin Reactions (SJS/TENS)
  2. HLA-B*1502 allele testing required for patients of Asain descent prior to starting
  3. Aplastic anemia
  4. Agranulocytosis
  5. D/C if significant myelosuppression occurs
75
Q

What are warnings with carbmazepine?

A
  1. increased risk of HSR with HLA-A*3101 allele
  2. multiorgan HSR (DRESS)
  3. hyponatremia (SIADH)
  4. Fetal harm
  5. hypothyroidism
  6. increased IOP
  7. liver damage
  8. cardiac conduction abnormalities
76
Q

What are CIs with carbamazepine?

A
  1. Myelosuppression
  2. HSR to TCAs
  3. MAOi within 14 days
  4. use with nefazodone or NNRTIs that are substrates of CYP3A4
77
Q

What are SEs with carbamazepine?

A
  1. dizziness/drowsiness
  2. ataxia
  3. N/V
  4. pruritis
  5. photosensitivity
  6. blurred vision
  7. rash
  8. alopecia
  9. increased LFTs
  10. renal impairment
78
Q

What should be monitored with carbamazepine?

A
  1. CBC with differential including platelets prior to and during therapy
  2. drug levels 3-5 days after initiation and after 4 weeks due to autoinduction
    3.LFTs
  3. rash
  4. eye exam
  5. thyroid function
  6. serum NA
  7. renal function
79
Q

What are DIs with carbamazepine?

A
  1. Autoinducer will decrease its own levels
  2. Strong CYP3A4 and Pgp inducer (can decrease levels of warfarin, levothyroxine, and hormonal contraceptives)
  3. major CYP3A4 substrate inhibitors or inducers can effect levels
  4. carbamazepine suspension should not be taken with other liquid meds can precipitate
80
Q

How is carbamazepine dosed?

A

Initial: 200mg BID (100mg QID suspension)
Max: ~1600/d
Therapeutic range: 4-12mcg/mL

81
Q

What is a therapeutic carbamazepine drug level?

A

4-12 mcg/mL

82
Q

Oxcarbazepine

A

Trileptal
Oxtellar XR

83
Q

How is oxcarbazepine dosed?

A

Initial: 300mg BID (Trileptal) or 600mg QD Oxtellar XR
Max: 2400mg/d
CrCl<30: start 300mg QD
Carbamazepine to Oxcarbazepine = 1.5 x carbamazepine dose
XR tablet: take on empty stomach 1 hour before or 2 hours after a meal
Suspension: use within 7 weeks of opening original container

84
Q

What are CIs with oxcarbazepine?

A

HSR to eslicarbazepine

85
Q

What are warnings with oxcarbazepine?

A
  1. increased risk of serious skin reactions (SJS/TENS)
  2. consider screening for HLA-B*1502 prior to initialing therapy if Asian
  3. multiorgan HSR (DRESS)
  4. Hyponatremia
  5. hypothyroidism
  6. worsening of generalized seizures
86
Q

What are SEs with oxcarbazepine?

A
  1. somnolence/dizziness
  2. N/V
  3. abdominal pain
  4. diplopia/visual disturbances
  5. ataxia
  6. tremor
87
Q

What should be monitored with oxcarbazepine?

A
  1. Serum Na (esp. during first 3 months)
  2. thyroid function
  3. CBC
88
Q

What are DIs with oxcarbazepine?

A
  1. decrease hormonal contraception; non-hormonal contraception preferred
  2. weak CYP3A4 inducer and CYP2C19 inhibitor; not an auto inducer
89
Q

Phenytoin

A

Dilantin
Dilantin Infatabs
Phenytek

90
Q

How is phenytoin dosed?

A

Loading dose: 15-20 mg/kg (can be divided doses)
Maintenance: 300-600 mg/day
Therapeutic range: 10-20 mcg/mL (total), 1-2 mcg/mL (free)
IV:PO=1:1

91
Q

What are BBWs with phenytoin?

A
  1. Phenytoin IV rate should not exceed 50mg/min
  2. Fosphenytoin IV rate should not exceed 150mg phenytoin equivalents (PE)/min or 2mg PE/kg/min (use slower rate)
  3. Faster administration results in hypotension and cardiac arrhythmias
92
Q

What are warnings with phenytoin/fosphenytoin?

A
  1. Extravasation (purple glove syndrome)
  2. Avoid if HLA-B*1502 positive or hx of severe rash with carbamazepine
  3. Fetal harm
  4. Multiorgan HSR (DRESS)
  5. bradycardia
  6. risk of SJS/TENS
  7. blood dycrasis
  8. cardiac arrest
  9. hepatic/renal impairment
  10. hypothyroidism
93
Q

What is purple glove syndrome?

A

edema, pain, and bluish discoloration of skin which can lead to tissue necrosis

94
Q

What are chronic SEs with phenytoin/fosphenytoin?

A
  1. Gingival hyperplasia
  2. Hepatotoxicity
  3. hair growth
  4. morbilliform rash (measles-like)/rash
  5. peripheral neuropathy
  6. high BP
  7. metallic taste
  8. connective tissue hyperplasia
95
Q

What are dose-related toxicities with phenytoin/fosphenytoin?

A
  1. Nystagmus (rapid eye movement)
  2. Ataxia
  3. Diplopia/blurred vision
  4. slurred speech
  5. dizziness
  6. somnolence
  7. lethargy
  8. confusion/delirium
96
Q

What should be monitored with phenytoin/fosphenytoin?

A
  1. Serum phenytoin concentration (metabolism can become saturated, small dose increase leads to large serum increase)
  2. LFTs
  3. CBC
  4. Continuous ECG and respiratory function (IV)
97
Q

What is the difference between phenytoin/ fosphenytoin?

A

fosphenytoin is the prodrug of phenytoin

98
Q

How is phenytoin converted to fosphenytoin?

A

1 PE= 1mg phenytoin=1.5 mg fosphenytoin

99
Q

What are DIs with phenytoin/fosphenytoin?

A
  1. strong inducers of CYP 2C19, 3A4, Pgp, UGT1A1 can decrese conc of other ASMs
  2. hormonal contraceptives
  3. high protein binding
100
Q

How is phenytoin administered IV?

A
  1. Dilute in NS, stable for 4 hours, do not refrigerate
  2. monitor BP, respiratory rate, and ECG
  3. requires a filter
  4. do not exceed 50mg/min
101
Q

How is fosphenytoin administered IV?

A
  1. Dilute in NS, stable for 4 hours, do not refrigerate
  2. monitor BP, respiratory rate, and ECG
  3. no filter
  4. do not exceed 150 PEmg/min
  5. lower risk of purple glove syndrome vs. phenyotin
102
Q

How is phenytoin administered via NG-tube?

A
  1. hold feedings 1-2 hours before and after administration
  2. enteral feeding decrease conc
103
Q

How should phenytoin/fosphenytoin dose be adjusted when albumin <3.5 and CrCL>/=10?

A

Total phenytoin mcg/mL / (0.2 x albumin g/dL) +0.1

104
Q

What is a CI to using phenytoin/fosphenytoin?

A

hx hepatotoxicity from phenytoin

105
Q

Fosphenytoin

106
Q

Phenobarbital

A

Sezaby (injectable formulation for neonatal seizures that is preservative free)

107
Q

What are CIs with phenobarbital?

A
  1. Severe hepatic impairment, dyspnea, or airway obstruction
  2. hx addiction to sedative hyponotics
  3. intraarterial administration
108
Q

What are warnings with phenobarbital?

A
  1. Potential for drug dependency
  2. Fetal harm
  3. Respiratory depression
  4. hyperactive or aggressive behavior (acute pain/peds)
  5. hypotension given IV
  6. serious skin reactions SJS/TENS
109
Q

What is the therapeutic range for phenobarbital?

A

Adults: 20-40 mcg/mL
Peds: 15-40 mcg/mL

110
Q

What are SEs with phenobarbital?

A
  1. Physiologic dependence/tolerance
  2. Residual sedation (hangover)
  3. somnolence/dizziness
  4. cognitive impairment
  5. ataxia
  6. depression
  7. folate deficiency
111
Q

What should be monitored with phenobarbital?

A
  1. LFTs
  2. CBC with differential
112
Q

What are DIs with phenobarbital?

A
  1. Strong inducer of 3A4 and Pgp
  2. hormonal contraceptives
113
Q

What is the prodrug of phenobarbital?

114
Q

What is in common with phenobarbital and primidone?

A
  1. sedation
  2. dependence/tolerance/OD risk
  3. enzyme induction
  4. primidone is the prodrug of phenobartital
115
Q

What is in common with carbamazepine, oxcarbazepine, and eslicarbazepine?

A
  1. Hyponatremia
  2. Rash
  3. enzyme induction
116
Q

What is in common with gabapentin and pregabalin?

A
  1. weight gain
  2. peripheral edema
  3. mild euphoria
  4. used for neuropathic pain primarily
117
Q

What is in common with topiramate and zonisamide?

A
  1. weight loss
  2. metabolic acidosis
  3. nephrothialasis and ogliohidrosis/hyperthermia in children
118
Q

Clobazam

A

Onfi
Sympazan

119
Q

Diazepam

A

Diastat AcuDial
Valtoco

120
Q

Midazolam

121
Q

What are BBWs with benzos?

A

Use with opioids results in profound sedation, Respiratory depression, and Death

122
Q

What are warnings with benzos?

A
  1. severe skin reactions (SJS/TEN)
  2. paradoxical reactions including hyperactive/aggressive behavior
  3. anterograde amnesia
  4. C-IV
123
Q

What are SEs with nasally administered benzos?

A
  1. drooling
  2. pyrexia (increased body temp)
  3. nasal/throat irritation
124
Q

When is clobazam used?

A

Lennox-Gastaut syndrome or refractory epilepsy

125
Q

Brivaracetam

126
Q

What are warnings with bivaracetam?

A
  1. behavioral reactions including psychotic symptoms, irritability, depression, aggressive behavior, or anxiety
  2. bronchospasm
  3. angioedema
  4. no therapeutic benefit when used with levetiracetam
  5. CV
127
Q

What should be monitored with bivaracetam?

A
  1. somnolence
  2. fatigue
  3. caution driving/operating machinery
128
Q

Cannabidiol

A

Epidiolex (oral solution)

129
Q

What are warnings with cannabidiol?

A
  1. somnolence/sedation (more risk when used with clobazam)
  2. hepatotoxicity (monitor LFTs)- more risk when used with valproic acid/clobazam
  3. can decrease appetite
  4. used in Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex
  5. C-V
130
Q

Cenobamate

131
Q

What are warnings with cenobamate?

A
  1. multiorgan HSR (DRESS)
  2. shortening of QT interval
  3. somnolence
  4. gait disturbance
  5. visual changes
  6. C-V
132
Q

What should be monitored with cenobamate?

A
  1. eye exam
  2. serum K (can become elevated)
133
Q

Eslicarbazepine

134
Q

What are warnings SEs with eslicarbazepine?

A
  1. Active metabolite of oxcarbazepine so same
  2. drug-induced liver injury (monitor LFTs)
  3. inducer of CYP3A4
  4. monitor Na
135
Q

Ethosuxamide

136
Q

What are warnings with ethosuxamide?

A
  1. serious skin reaction (SJS/TENS)
  2. multiorgan HSR (DRESS)
  3. blood dyscrasis
  4. used for absence seizures
137
Q

What are SEs with ethosuxamide?

A
  1. N/V
  2. abdominal pain
  3. weight loss
  4. hiccups
  5. dizziness/somnolence
138
Q

What should be monitored with ethosuxamide?

A
  1. LFTs
  2. CBC with differential
  3. urinalysis
  4. platelets
  5. trough serum
  6. rash
139
Q

Felbamate

140
Q

What are BBWs for felbamate?

A
  1. Aplastic Anemia
  2. hepatic failure
  3. informed consent needs to be signed by patient and prescriber prior to dispensing
141
Q

What should be monitored with felbamate?

A
  1. LFTs
  2. CBC
  3. serum levels of other ASM
142
Q

Fenfluramine

143
Q

What are BBWs with fenfluramine?

A
  1. Valvular heart disease
  2. Pulmonary HTN (REMS program)
144
Q

What are warnings with fenfluramine?

A
  1. Decreased appetite/weight loss
  2. serotonin syndrome (CI with MAOis)
  3. high BP
  4. angle-closure glaucoma
145
Q

What should be monitored with fenfluramine?

A
  1. ECG before, during, after treatment
  2. weight
  3. BP
146
Q

Gabapentin

A

Neurontin
Gralise (postherpetic neuralgia)
Horizant- gabapentin enacarbil (postherpetic neuralgia and restless leg syndrome)

147
Q

What are warnings with gabapentin?

A

angioedema

148
Q

What are SEs with gabapentin?

A
  1. Somnolence/dizziness
  2. Peripheral edema (monitor)
  3. Weight gain (monitor)
  4. ataxia
  5. diplopia/blurred vision
  6. dry mouth
  7. mild euphoria
149
Q

Perampanel

150
Q

What are warnings with perampanel?

A

BBW: Neuropsychiatric events (dose related)including irritability, aggression, anger, paranoia (mainly first 6 weeks)
1. CYP3A4 substrate
2. C-III

151
Q

Pregabalin

152
Q

What are warnings and SEs with pregablin?

A

same as gabapentin

153
Q

Primidone

154
Q

What is important to not about SEs and warnings with primidone?

A

prodrug of phenobarbital; same

155
Q

Rufinamide

156
Q

What are CIs with rufinamide?

A

Patients with familial short QT syndrome due to QT shortening (dose-related)

157
Q

How should rufinamide be administered?

158
Q

Stripentol

159
Q

What are warnings with stripentol?

A
  1. loss of appetite/weight loss
  2. delirium/hallucinations (rare)
  3. to be taken with clobazam to treat Darvet syndrome
160
Q

What should be monitored with stripentol?

A
  1. CBC
  2. hepatic function
  3. weight
  4. mood
161
Q

Tiagabine

162
Q

What are warnings with tiagabine?

A
  1. worsening of seizures/new onset seizures when used off-label for other indications
  2. serious skin reactions (SJS/TENS)
163
Q

How should tiagabine be administered?

164
Q

Vigabatrin

A

Sabril
Vigadrone

165
Q

What are BBWs with vigabatrin?

A

Permanent vision loss (>/=30% of patients)

166
Q

What should be monitored with vigabatrin?

A
  1. eye exam baseline, every 3 months, and every 3-6 months after D/c
  2. REMS
167
Q

Zonisamide

A

Zonegran
Zonisade

168
Q

What is a CI to using zonisamide?

A

HSR to sulfonamides

169
Q

What are warnings with zonisamide

A
  1. Hyperchloremic non-anion gap Metabolic Acidosis
  2. Ogliohidrosis (reduced perspiration)/hyperthermia (mostly children)
  3. Nephrolithiasis (kidney stones)
  4. acute myopia
  5. secondary Angle-closure Glaucoma
  6. SJS/TENS/DRESS
  7. Visual problems (reversible)
  8. Fetal Harm
170
Q

What are SEs with zonisamide?

A
  1. Ogliohidrosis (reduced perspiration)/hyperthermia (mostly children)
  2. Nephrolithiasis (kidney stones)
171
Q

Which ASM requiring drug level range monitoring?

A
  1. phenytoin
  2. valproic acid
  3. carbamazepine
  4. phenobarbital
172
Q

Which ASMs are enzyme inducers?

A
  1. carbamazepine
  2. oxcarbazepine
  3. phenytoin
  4. fosphenytoin
  5. phenobarbital
  6. primidone
173
Q

Which ASMs are enzyme inhibitors?

A

valproic acid (increases levels of lamotrigine)

174
Q

What should be supplemented in women of childbearing age on ASMs?

A
  1. folate to decrease risk of neural tube defects
  2. calcium and vitamin D to prevent bone loss
175
Q

Which ASMs have the lowest risk of neural tube defects and other teratogenic effects?

A

levetiracetam and lamotrigine

176
Q

Which ASMs are best to avoid in children?

A
  1. Topiramate and zonisamide reduce sweating in children (must reduce sun exposure)
  2. lamotrigine (highest risk of rash with fatality)

RxPrep (67 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions