Seizures & Epilepsy Flashcards
1
Q
What are seizures and what are some ways that they are caused?
A
- excitatory neurons suddenly produces a surge of uncontrollable electrical activity
- Caused by: fever (common in kids), infections, alcohol withdrawls, hypoglycemia, electrolyte imbalances
2
Q
What are epilepsys?
A
- chornic seisure disorders with various seizures
3
Q
What is the most common test used to help diagnose epilepsy?
A
- EEG (electroencepholgram) - looks at brain activity
4
Q
What are some drugs that could causes seizures?
A
- Opioids (Tramadol, Meperidine)
- Quinolones, Carbapenems, Cephalosporins, Penicillins, Mefloquine (higher doses = higher risks)
- Burpopion, Clozapine, Lithium, TCAs
5
Q
What are the different types of seizures?
A
- Focal (starts on one side and movement to other)
- Generalized (starts on both sides)
- Unknown Onset
6
Q
What are the 2 subsets of focal seizures?
A
- Focal Aware: NO loss of consciousness
- Focal with impaired awareness: LOSS of consciousness
7
Q
What are some of the motor symptoms associated with seizures?
A
- Jerking Movements (Clonic)
- Limp or Weak Muscles (Atonic)
- Muscle Twitching (Myoclonus)
- Rigid or Tense Muscles (Tonic)
8
Q
How long do seizures normally last?
A
- ~ 2 mintues (longer than 5 mins = Status Epilepticus)
9
Q
What is the treatment algorithm for someone experiencing status epilepticus?
time frames
A
- 0 - 5 Mins: stablization (breathing, airway, circulations) and timing of seizure
- 5 - 20 Mins: IV Lorazepam, IM Midazolam, or IV Diazepam
- 20 - 40 Mins: Non benzo (IV fosphenytoin, valproic acid, levcetiracetam)
- Refactory: repeat step 3 or midazolam, pentobarbital or propofol
10
Q
What is given to patients that are at high risk of long lasting seizures?
A
- Diastat AcuDial (Pharmacist MUST set the dose before giving to patient)
11
Q
What are some adujvant treatments for seizures/epilepsys
A
- Medical Marjiuana (Epidiolex and CBD are approved for RARE forms of Epilepsy)
- Keto Diet (4:1 ratio of Fats with protein/carbs forces the body to break down fats into ketones - decrease seizures)
12
Q
What are some common concerns with the antiseizure medications?
A
- CNS/Psych effects: CNS Depression, Cognitivie Impairment, Falls, Suicidal Risk
- Bone Loss: Increased Fracture Risk (MUST be given Ca or Vit D sup)
- Rash: SJS or TENs
13
Q
What are some of the supplements that should be taken while on antiseizure medications?
A
- ALL ASMs: Ca or Vit D
- Women of Childbearing Age: Folate
- Valproic Acid: Carnitine?
- Lamotrigine & Valproic Acid: if alopecia = biotinm selenium or zinc
14
Q
What are some of the drugs/classes that are used for antiseizures?
A
- Benzos
- Phenobarbital
- Valproate
- Levetiracetam
- Carbamazepine (Oxcarb)
- Phenytoin/Fosphenytoin
- Torpiramate
- Lamotrigine
- Ethosuximide
15
Q
What is the MOA for Lamotrigine (Lamictal)?
A
- Blocks sodium channels and decreases glutamate
16
Q
What is important to know about the dosing for lamotrigine?
A
- Initial dosing: weeks 1 - 2 = 25 mg daily
- weeks 3 - 4 = 50 mg daily
17
Q
What are some boxed warnings for Lamotrigine?
A
- Serious Skin Reactions (SJS ot TENs)
18
Q
What are some warnings for lamotrigine?
A
- Multiorgan Hypersensitivity Reactions (DRESS)
19
Q
What are some side effects for Lamotrigine?
A
- Alopecia, N/V, Somnolence, Rash, Tremor, Ataxia, Dizziness, Blurred Vision
20
Q
What are some addition notes for lamotrigine?
A
- Use starter kits when beginning treatments
- If DC’d, then restart titrations
21
Q
What is important to know about the starter kit for lamotrigine?
BLUE, ORANGE, GREEN
A
- BLUE: LOW dose if taking Valproic Acid
- ORANGE: NORMAL dose
- GREEN: HIGH dose if taking Carbamazepine, Phenytoin, Phenobarbital, Primidone and NOT Valproic Acid
22
Q
What is the MOA for Levetiracetam (Keppra)?
A
- Inhibits vesicles fusion by binding SV2A proteins
23
Q
What are some warnings for levetiracetam?
A
- Psychiatric Reactions (psychotic symptoms, somnolence, fatigue, arrgression…)
- SJS, TENS, or DRESS
24
Q
What are some side effects for levetiracetam?
A
- Somnolence, dizziness, weakness, asthenia
25
What are some **additional notes** for **levetiracetam**?
- NO significant drug interactions
26
What is the **MOA** for **Topiramate (Topamax)?
- Blocks sodium channels
27
What are some **warnings** for **topiramate**?
- Metabolic acidosis
- Oligohidrosis (reduced perspiration)
- Nephrolithiasis (kidney stones)
- Angle-closure glaucmoa
- Hyperammonemia
- Visual Problems
- Fetal Harm
28
What are some **side effects** for **topiramate**?
- Somnolence, Dizziness, Psychomotor slowing, **memory/concentration/attention difficulties**, weight loss, anorexia
29
What is the **MOA** for **Valproate**?
- blocks sodium channels and **increases GABA**
30
What are the **2 valproate antiseizure medications**?
- Valproic Acid
- Divalproex (Depakote)
31
What are some **boxed warnings** for **Valproate**?
- Hepatic Failure (more common during first 6 months of treatment, kids < 2 yo)
- Fetal Harm (neural tube defects and decrease IQ)
32
What are some **warnings** for **valproate**?
- Hyperammonemia (treat with **carnitine**)
- Dose related Thrombocytopenia
- DRESS
33
What are some **side effects** for **Valproate**?
- Alpecia, N/V, Weight gain > loss, headache, anorexia, dizziness, somnolance, tremor
34
What are some **warnings** for **lacosamide (vimpat)**?
- Prolongs PR interval
- Increased arrhythmia risk
- DRESS
35
What is the **MOA** for **carbamazepine (tegretol)**?
## Footnote
also oxcarb
- Block sodium channels
36
What are some **boxed warnings** for **Carbamazepine**?
- Serious skin reactions (**SJS or TENS**) - should test **HLA-B * 1502** if Asain descent (same with Oxcarb)
- Aplastic Anemia and Anganulocytosis
37
What are some **contraindications** for **Carbamazepine**?
- Myelosuppression
38
What are some **warnings** for **Carbamazepine**?
- Increased risk of hypersensitivity reactions with HLA-A * 3101 allele
- DRESS
- Hyponatremia
- Fetal Harm
39
What are some **side effects** for **Carbamazepine**?
- Dizziness, Drowsiness, ataxia, N/V, blurred vision, rash
## Footnote
same with Oxcarb
40
What are some things to **monitor** for **carbamazepine**?
- CBC with differential
- Na (same with Oxcarb)
41
What is the **MOA** for **Phenytoin/Fosphenytoin [Dilantin/Cerebyx]**?
- Blocks sodium channels
42
What are some **boxed warnings** for **phenytoin/fosphenytoin**?
- Phenytoin IV rate should **NOT** exceed 50 mg/min
- Fosphenytoin IV rate should **NOT** exceed 150 mg/min
## Footnote
**Higher rates = increased risk for cardiac arrhythmias**
43
What are some **warnings** for **phenytoin/fosphenytoin**?
- Extravasation (purple glove syndrome) - leads to necrosis
- HLA-B * 1502 Testing: if + **&** rash with carba then DO NOT use
- DRESS, **Fetal Harm**
44
What are some of the **dose related (toxicitiy) side effects** for **Phenytoin/Fosphenytoin**?
- Nystagmus, Ataxia, Diplopia
45
What are some of the **chroinc side effects** for **phenytoin/fosphenytoin**?
- Gingival Hyperplasia
- Hepatoxicity
46
Why is it important to **monitor phenytoin** levels?
- Metabolism of phenytoin becomes saturated when no enyzmes are available
- Small dose increases could greatly increase the concentrations
47
What is the **MOA** of **Phenobarbital**?
## Footnote
-
- Enhances GABA effects
48
What are some **warnings** for **Phenobarbital**?
- **Caution in substance use disorder** (potential for drug dependency)
- **Resipratory Depression**
- **Fetal Harm**
49
What are some **side effects** for **Phenobarbital**?
- **Physiological dependence**
- **Tolerance**
- **Residual Sedation**
- Fatigue, dizziness, ataxia, depression, folate deficiency
50
When is **ethosuximide (Zarontin)** used for seizures/epilepsy?
- Absense Seizures
51
What are some **warnings** for **ethosuximide**?
- Serious skin reactions (SJS, TENs)
- Blood dyscrasias (Blood disorders)
52
Other then for seizures/epilepsy, what else are **gabapentin/pregabalin** used for?
- Neuropathic Pain
53
What are some **side effects** for **gabapentin**?
- Somnolence
- Peripheral Edema
- Weight Gain
