Seizures/Epilepsy Flashcards
Epilepsy = chronic seizure disorder
seizures can be ________ or ________
uncontrolled jerking movements or momentary loss of awareness
(aka tonic clonic or absence)
An _______ is used to diagnose epilepsy
EEG (electroencephalogram)
_____ seizures start on one side of the brain
_____ seizures start on both sides of the brain
focal - one
generalized - both
if patient has a focal seizure with loss of consciousness it is called?
focal seizure with impaired consciousness (previously known as complex partial seizure)
_____ seizure = rigid or tense muscles
tonic (toned)
status epilepticus (SE) = seizure lasting longer than _______
5 minutes
initial treatment for status epilepticus??
benzo
midazolam given IM
3 main phases of treating status epilepticus?
stabilization
initial tx phase
2nd tx phase
1st phase of status epilepticus: stabilization phase
__ - __ minutes
start ______
check blood sugar - if low give _______
check AED (antiepiletpical drugs) levels, electrolytes, O2
0 - 5 minutes
start EEG
give D25-D50
2nd phase of status epilepticus: initial tx phase
__ - __ minutes
if continues give IV benzos or give ________ or _______ if IV not available
5 - 20 minutes give Versed (IM midazolam) or Diastat (rectal diazepam)
_______ needs to be adjusted if albumin is low
phenytoin
equation for corrected phenytoin/albumin adjustment?
total phenytoin measured / [(0.2 x albumin) + 0.1]
3rd phase of status epilepticus: 2nd tx phase
__ - __ minutes
give regular ______ options
20 - 40 minutes; AED options (IV fosphenytoin, valproic acid, keppra)
First Aid for Seizures:
some general things to do?
- clear space (rid of sharp or hard things); clear space on floor – soft object underneath head
- put person on their side
- remove glasses/anything around the neck that makes it hard to breathe
- time seizure (call 911 if > 5 mins/not getting better or trouble breathing)
- do NOT hold people down
Diastat Dispensing:
syringes come in what strengths?
2.5 mg, 10 mg, or 20 mg
Diastat Dispensing:
what must happen before releasing the drug?
pharmacist must dial and lock the syringe in at the specified dose
therapeutic range for tegretol?
4 - 12 mcg/mL
what drugs decreases the seizure threshold
acyclovir cephalosporins lindane mefloquine metoclopramide valacyclovir
what drugs if in high doses and renal impairment can cause seizures?
carbapenems (esp imipenem) lithium meperidine PCN quinolones theophylline clozapine bupropion tramadol varenicline
what is the brand name for the CBD/marijuana derived medication ?
Epidiolex
what kind of diet may be used in refractory seizures?
ketogenic; 4:1 ratio of fats to combined proteins/carbs
All AEDs cause _______ due to lower electrical activity in the brain and they also all cause ______ disorders
CNS depression (confusion, sedation, ataxia, fall risk)
mood disorders suicide risk
which AED is an enzyme inhibitor and can increase lamotrigine/severe rash risk?
valproic acid
what AEDs are enzymes inducers?
- carbamazepine/oxcarbazepine
- phenytoin/fosphenytoin
- phenobarbitol/primidone
what AEDs need blood levels checked?
phenytoin
valproic acid
carbamazepine
phenobarbitol
the metabolism of phenytoin can become saturated – therefore a ________ can lead to a ________
aka
kinetics are _______ order then _____ order
small dose increase; large increase in drug concetration
1st order then 0 order
_______ has a boxed warning for hepatoxicity
and
_______ can cause hyponatremia
depakote;
tegretol
Phenytek:
IV to PO conversion?
1:1
what is the birth defect that happens when women take topamax while pregnant?
cleft lip/palate
Patients on AEDs need Calcium why?
increased fracture risk
Ca2+ and vit D supplements esp needed if pregnant
which AED has the highest teratogenic risk?
valproic acid (derivs of phenobarb, phenytoin, carbamazpeine do too)
Teratogenic issues seen with valproic acid?
decrease IQ and neural tube defects
If women is pregnant/childbearing age – what meds/supplements should they take
- oral contraceptive
- folate
- calcium/vit D (everyone really needs that)
Levels of AED ______ during pregnancy
decrease
max infusion rate for fosphenytoin?
150 mg PE/min
ALWAYS taper anticonvulsants to get off them; taper over how long to prevent seizures?
2 months
what is zarontin and what seizure is it used for?
ethosuximide
absence seizure
AEDs and Kids:
_______ and _______ can cause reduced/lack of sweating (hypohidrosis) – thus limit sun exposure
topiramate and zonisamide
AEDs and Kids:
_______ induced rash with fatality – higher chance in kids
lamotrigine
what AEDs have kids friendly dosage forms?
lamotrigine (ODT/chewable)
keppra (ODT/oral soln)
Most kids grow out of seizures;
if seizure free for ______ can be tapered off
1 - 2 years
Phenytoin must be diluted by ______ and given via _____ line inline with a _____ filter
normal saline; large vein line;
0.22 micron
Topamax causes:
what eye disorder?
metabolic _______
weight ______/______ appetite
angle closure glaucoma
metabolic acidosis
weight loss/decreased appetite
which AEDs are also approved for migraine prophylaxis?
topiramate and divaloproex
AED MOAs:
______ and ______ increase GABA
benzos; valproic acid
AED MOAs:
_______ is a T-Type Ca channel blocker
Ethosuximide
AED MOAs:
what drugs are sodium channel blockers
carbamazepine, phenytoin, topiramate
Seizures MOA:
too little of _______ or too much _______ can cause a seizure
too little GABA (inhibitor neurotransmitter)
too much glutamate (excitatory neurotransmitter)
AED Groups:
Side effects for carbamazepine, oxcarbazepine, eslicarbazepine?
hyponatremia
rash
enzyme inducers
AED Groups:
Side effects for gabapentin/pregabalin?
weight gain
peripheral edema
mild euphoria
AED Groups:
Side effects for phenobarbital/primidone (prodrug of phenobarb)?
sedating dependence tolerance overdose risk enzyme inducer
AED Groups:
Side effects for topiramate/zonisamide?
weight loss
metabolic acidosis
hyperthermia/oligohidrosis (esp in kids)
nephrolithiasis
if someone has alopecia from lamotrigine: what supplements can be given to help?
selenium and zinc
what supplement may someone need when taking valproic acid?
carnitine (because of hyperammonia)
lamictal starting kits: what colors are they?
orange, blue, green
lamictal starting kits:
what color is the standard starting dose
orange
lamictal starting kits:
what color is the lower starting dose (use if concomitant valproic acid!!!)
blue
lamictal starting kits:
what color is the higher starting dose (use if concomitant enzyme inducers: carbamazepine, phenytoin)
green
_______ increases lamotrgine by like two fold
valproic acid
________ is contraindicated in sulfa allergy
zonisamide (zonegran)
IV to PO conversion for keppra?
1:1
topiramiate, carbazepine, oxcarbazepine, phenytoin can decrease _______ effectiveness
hormonal contraceptives
therapeutic range for valproic acid?
50 - 100 mcg/mL
monitoring for valproic acid
LFTs, platelets
b/c hepatic failure and thrombocytopenia risk
carbamazepine therapeutic range?
4 - 12 mcg/mL
for what AED does the HLA-B1502 allele matter (mainly if of Asian descent)?
carbamazepine
phenobarbitol therapeutic range?
20 - 40 mcg/mL
vimpat/lacosamide: increases ______/risk of _______
PR interval/arrhythmias
Phenytoin IV: do not exceed _____ mg/min
50
if phenytoin/fosphenytoin given too fast – can cause what?
hypotension/arrhythmia
phenytoin risks?
purple glove syndrome (extravasation)
gingival hyperplasia
hair growth
hepatotoxicity
boxed warnings for felbamate (felbatol)
hepatic failure, aplastic anemia (need patients informed consent!!)
what drug can cause permanent vision loss
vigabatrin (sabril)
