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NAPLEX Prep > Seizures/Epilepsy > Flashcards

Seizures/Epilepsy Flashcards

1
Q

Epilepsy = chronic seizure disorder

seizures can be ________ or ________

A

uncontrolled jerking movements or momentary loss of awareness
(aka tonic clonic or absence)

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2
Q

An _______ is used to diagnose epilepsy

A

EEG (electroencephalogram)

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3
Q

_____ seizures start on one side of the brain

_____ seizures start on both sides of the brain

A

focal - one

generalized - both

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4
Q

if patient has a focal seizure with loss of consciousness it is called?

A

focal seizure with impaired consciousness (previously known as complex partial seizure)

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5
Q

_____ seizure = rigid or tense muscles

A

tonic (toned)

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6
Q

status epilepticus (SE) = seizure lasting longer than _______

A

5 minutes

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7
Q

initial treatment for status epilepticus??

A

benzo

midazolam given IM

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8
Q

3 main phases of treating status epilepticus?

A

stabilization
initial tx phase
2nd tx phase

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9
Q

1st phase of status epilepticus: stabilization phase
__ - __ minutes
start ______
check blood sugar - if low give _______
check AED (antiepiletpical drugs) levels, electrolytes, O2

A

0 - 5 minutes
start EEG
give D25-D50

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10
Q

2nd phase of status epilepticus: initial tx phase
__ - __ minutes
if continues give IV benzos or give ________ or _______ if IV not available

A 
5 - 20 minutes
give Versed (IM midazolam)  or Diastat (rectal diazepam)
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11
Q

_______ needs to be adjusted if albumin is low

A

phenytoin

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12
Q

equation for corrected phenytoin/albumin adjustment?

A

total phenytoin measured / [(0.2 x albumin) + 0.1]

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13
Q

3rd phase of status epilepticus: 2nd tx phase
__ - __ minutes
give regular ______ options

A 
20 - 40 minutes;
AED options (IV fosphenytoin, valproic acid, keppra)
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14
Q

First Aid for Seizures:

some general things to do?

A
  • 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
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15
Q

Diastat Dispensing:

syringes come in what strengths?

A

2.5 mg, 10 mg, or 20 mg

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16
Q

Diastat Dispensing:

what must happen before releasing the drug?

A

pharmacist must dial and lock the syringe in at the specified dose

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17
Q

therapeutic range for tegretol?

A

4 - 12 mcg/mL

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18
Q

what drugs decreases the seizure threshold

A 
acyclovir
cephalosporins
lindane
mefloquine
metoclopramide
valacyclovir
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19
Q

what drugs if in high doses and renal impairment can cause seizures?

A 
carbapenems (esp imipenem)
lithium
meperidine
PCN
quinolones
theophylline
clozapine
bupropion
tramadol
varenicline
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20
Q

what is the brand name for the CBD/marijuana derived medication ?

A

Epidiolex

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21
Q

what kind of diet may be used in refractory seizures?

A

ketogenic; 4:1 ratio of fats to combined proteins/carbs

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22
Q

All AEDs cause _______ due to lower electrical activity in the brain and they also all cause ______ disorders

A

CNS depression (confusion, sedation, ataxia, fall risk)

mood disorders suicide risk

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23
Q

which AED is an enzyme inhibitor and can increase lamotrigine/severe rash risk?

A

valproic acid

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24
Q

what AEDs are enzymes inducers?

A
  • carbamazepine/oxcarbazepine
  • phenytoin/fosphenytoin
  • phenobarbitol/primidone
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25
Q

what AEDs need blood levels checked?

A

phenytoin
valproic acid
carbamazepine
phenobarbitol

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26
Q

the metabolism of phenytoin can become saturated – therefore a ________ can lead to a ________
aka
kinetics are _______ order then _____ order

A

small dose increase; large increase in drug concetration

1st order then 0 order

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27
Q

_______ has a boxed warning for hepatoxicity
and
_______ can cause hyponatremia

A

depakote;

tegretol

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28
Q

Phenytek:

IV to PO conversion?

A

1:1

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29
Q

what is the birth defect that happens when women take topamax while pregnant?

A

cleft lip/palate

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30
Q

Patients on AEDs need Calcium why?

A

increased fracture risk

Ca2+ and vit D supplements esp needed if pregnant

31
Q

which AED has the highest teratogenic risk?

A 
valproic acid
(derivs of phenobarb, phenytoin, carbamazpeine do too)
32
Q

Teratogenic issues seen with valproic acid?

A

decrease IQ and neural tube defects

33
Q

If women is pregnant/childbearing age – what meds/supplements should they take

A
  • oral contraceptive
  • folate
  • calcium/vit D (everyone really needs that)
34
Q

Levels of AED ______ during pregnancy

A

decrease

35
Q

max infusion rate for fosphenytoin?

A

150 mg PE/min

36
Q

ALWAYS taper anticonvulsants to get off them; taper over how long to prevent seizures?

A

2 months

37
Q

what is zarontin and what seizure is it used for?

A

ethosuximide

absence seizure

38
Q

AEDs and Kids:

_______ and _______ can cause reduced/lack of sweating (hypohidrosis) – thus limit sun exposure

A

topiramate and zonisamide

39
Q

AEDs and Kids:

_______ induced rash with fatality – higher chance in kids

A

lamotrigine

40
Q

what AEDs have kids friendly dosage forms?

A

lamotrigine (ODT/chewable)

keppra (ODT/oral soln)

41
Q

Most kids grow out of seizures;

if seizure free for ______ can be tapered off

A

1 - 2 years

42
Q

Phenytoin must be diluted by ______ and given via _____ line inline with a _____ filter

A

normal saline; large vein line;

0.22 micron

43
Q

Topamax causes:
what eye disorder?
metabolic _______
weight ______/______ appetite

A

angle closure glaucoma
metabolic acidosis
weight loss/decreased appetite

44
Q

which AEDs are also approved for migraine prophylaxis?

A

topiramate and divaloproex

45
Q

AED MOAs:

______ and ______ increase GABA

A

benzos; valproic acid

46
Q

AED MOAs:

_______ is a T-Type Ca channel blocker

A

Ethosuximide

47
Q

AED MOAs:

what drugs are sodium channel blockers

A

carbamazepine, phenytoin, topiramate

48
Q

Seizures MOA:

too little of _______ or too much _______ can cause a seizure

A

too little GABA (inhibitor neurotransmitter)

too much glutamate (excitatory neurotransmitter)

49
Q

AED Groups:

Side effects for carbamazepine, oxcarbazepine, eslicarbazepine?

A

hyponatremia
rash
enzyme inducers

50
Q

AED Groups:

Side effects for gabapentin/pregabalin?

A

weight gain
peripheral edema
mild euphoria

51
Q

AED Groups:

Side effects for phenobarbital/primidone (prodrug of phenobarb)?

A 
sedating
dependence
tolerance
overdose risk
enzyme inducer
52
Q

AED Groups:

Side effects for topiramate/zonisamide?

A

weight loss
metabolic acidosis
hyperthermia/oligohidrosis (esp in kids)
nephrolithiasis

53
Q

if someone has alopecia from lamotrigine: what supplements can be given to help?

A

selenium and zinc

54
Q

what supplement may someone need when taking valproic acid?

A

carnitine (because of hyperammonia)

55
Q

lamictal starting kits: what colors are they?

A

orange, blue, green

56
Q

lamictal starting kits:

what color is the standard starting dose

A

orange

57
Q

lamictal starting kits:

what color is the lower starting dose (use if concomitant valproic acid!!!)

A

blue

58
Q

lamictal starting kits:

what color is the higher starting dose (use if concomitant enzyme inducers: carbamazepine, phenytoin)

A

green

59
Q

_______ increases lamotrgine by like two fold

A

valproic acid

60
Q

________ is contraindicated in sulfa allergy

A

zonisamide (zonegran)

61
Q

IV to PO conversion for keppra?

A

1:1

62
Q

topiramiate, carbazepine, oxcarbazepine, phenytoin can decrease _______ effectiveness

A

hormonal contraceptives

63
Q

therapeutic range for valproic acid?

A

50 - 100 mcg/mL

64
Q

monitoring for valproic acid

A

LFTs, platelets

b/c hepatic failure and thrombocytopenia risk

65
Q

carbamazepine therapeutic range?

A

4 - 12 mcg/mL

66
Q

for what AED does the HLA-B1502 allele matter (mainly if of Asian descent)?

A

carbamazepine

67
Q

phenobarbitol therapeutic range?

A

20 - 40 mcg/mL

68
Q

vimpat/lacosamide: increases ______/risk of _______

A

PR interval/arrhythmias

69
Q

Phenytoin IV: do not exceed _____ mg/min

A

50

70
Q

if phenytoin/fosphenytoin given too fast – can cause what?

A

hypotension/arrhythmia

71
Q

phenytoin risks?

A

purple glove syndrome (extravasation)
gingival hyperplasia
hair growth
hepatotoxicity

72
Q

boxed warnings for felbamate (felbatol)

A

hepatic failure, aplastic anemia (need patients informed consent!!)

73
Q

what drug can cause permanent vision loss

A

vigabatrin (sabril)

NAPLEX Prep (19 decks)

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