Seizures/Epilepsy

Question 1

Drugs that can cause seizures (10 drugs/classes)

Answer 1

Opioids (tramadol, meperidine)*
Quinolones
Carbapenems*
Cephalosporins*
Penicillins*
Mefloquine
Bupropion
Antipsychotics (esp. clozapine)
Lithium*
Tricyclic antidepressants

*At high doses/renal impairment

Question 2

Diastat Acudial Dispensing

Answer 2

Each package contains two rectal syringes prefilled with diazepam rectal gel
Each syringe must be dialed to the right dose and locked before dispensing

Question 3

Vitamins to take while on an ASM (4 categories)

Answer 3

ALL ASMs: calcium and vitamin D
Women of childbearing age: folate
Valproic acid: possibly carnitine
Lamotrigine and valproic acid: if alopecia develops, supplement with biotin, selenium, and zinc

Question 4

Antiseizure medications with enzyme induction (6 meds)

Answer 4

Carbamazepine
Oxcarbazepine
Phenytoin
Fosphenytoin
Phenobarbital
Primidone

Question 5

Antiseizure medications with enzyme inhibition (1 med)

Answer 5

Valproic acid (increases lamotrigine)

Question 6

Lamictal Starter Kits by Color

Answer 6

Blue: Lower starting dose, use if taking valproic acid (enzyme inhibitor)
Orange: Standard starting dose, use if no interacting medications
Green: Higher starting dose, use if taking an enzyme inducer and not taking valproic acid

Question 7

IV Phenytoin Administration pearls

Answer 7

Do not exceed 50 mg/min (slow infusion)
Monitor BP, respiratory function, and ECG
Requires a filter
Dilute in NS, stable for 4 hours, do not refrigerate

Question 8

NG-tube Phenytoin Administration pearls

Answer 8

Enteral feedings decreases phenytoin absorption
Hold feedings 1-2 hours before and after administration

Question 9

IV Fosphenytoin Administration pearls

Answer 9

Do not exceed 150 mg PE/min
Monitor BP, respiratory function, and ECG
Lower risk of purple glove syndrome than phenytoin

Question 10

Phenytoin correction calculation

Answer 10

Total phenytoin measured/(0.2 x albumin + 0.1)