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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
what AEDs need blood levels checked?
phenytoin valproic acid carbamazepine phenobarbitol
26
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
27
_______ has a boxed warning for hepatoxicity and _______ can cause hyponatremia
depakote; tegretol
28
Phenytek: | IV to PO conversion?
1:1
29
what is the birth defect that happens when women take topamax while pregnant?
cleft lip/palate
30
Patients on AEDs need Calcium why?
increased fracture risk | Ca2+ and vit D supplements esp needed if pregnant
31
which AED has the highest teratogenic risk?
``` valproic acid (derivs of phenobarb, phenytoin, carbamazpeine do too) ```
32
Teratogenic issues seen with valproic acid?
decrease IQ and neural tube defects
33
If women is pregnant/childbearing age -- what meds/supplements should they take
- oral contraceptive - folate - calcium/vit D (everyone really needs that)
34
Levels of AED ______ during pregnancy
decrease
35
max infusion rate for fosphenytoin?
150 mg PE/min
36
ALWAYS taper anticonvulsants to get off them; taper over how long to prevent seizures?
2 months
37
what is zarontin and what seizure is it used for?
ethosuximide | absence seizure
38
AEDs and Kids: | _______ and _______ can cause reduced/lack of sweating (hypohidrosis) -- thus limit sun exposure
topiramate and zonisamide
39
AEDs and Kids: | _______ induced rash with fatality -- higher chance in kids
lamotrigine
40
what AEDs have kids friendly dosage forms?
lamotrigine (ODT/chewable) | keppra (ODT/oral soln)
41
Most kids grow out of seizures; | if seizure free for ______ can be tapered off
1 - 2 years
42
Phenytoin must be diluted by ______ and given via _____ line inline with a _____ filter
normal saline; large vein line; | 0.22 micron
43
Topamax causes: what eye disorder? metabolic _______ weight ______/______ appetite
angle closure glaucoma metabolic acidosis weight loss/decreased appetite
44
which AEDs are also approved for migraine prophylaxis?
topiramate and divaloproex
45
AED MOAs: | ______ and ______ increase GABA
benzos; valproic acid
46
AED MOAs: | _______ is a T-Type Ca channel blocker
Ethosuximide
47
AED MOAs: | what drugs are sodium channel blockers
carbamazepine, phenytoin, topiramate
48
Seizures MOA: | too little of _______ or too much _______ can cause a seizure
too little GABA (inhibitor neurotransmitter) | too much glutamate (excitatory neurotransmitter)
49
AED Groups: | Side effects for carbamazepine, oxcarbazepine, eslicarbazepine?
hyponatremia rash enzyme inducers
50
AED Groups: | Side effects for gabapentin/pregabalin?
weight gain peripheral edema mild euphoria
51
AED Groups: | Side effects for phenobarbital/primidone (prodrug of phenobarb)?
``` sedating dependence tolerance overdose risk enzyme inducer ```
52
AED Groups: | Side effects for topiramate/zonisamide?
weight loss metabolic acidosis hyperthermia/oligohidrosis (esp in kids) nephrolithiasis
53
if someone has alopecia from lamotrigine: what supplements can be given to help?
selenium and zinc
54
what supplement may someone need when taking valproic acid?
carnitine (because of hyperammonia)
55
lamictal starting kits: what colors are they?
orange, blue, green
56
lamictal starting kits: | what color is the standard starting dose
orange
57
lamictal starting kits: | what color is the lower starting dose (use if concomitant valproic acid!!!)
blue
58
lamictal starting kits: | what color is the higher starting dose (use if concomitant enzyme inducers: carbamazepine, phenytoin)
green
59
_______ increases lamotrgine by like two fold
valproic acid
60
________ is contraindicated in sulfa allergy
zonisamide (zonegran)
61
IV to PO conversion for keppra?
1:1
62
topiramiate, carbazepine, oxcarbazepine, phenytoin can decrease _______ effectiveness
hormonal contraceptives
63
therapeutic range for valproic acid?
50 - 100 mcg/mL
64
monitoring for valproic acid
LFTs, platelets | b/c hepatic failure and thrombocytopenia risk
65
carbamazepine therapeutic range?
4 - 12 mcg/mL
66
for what AED does the HLA-B1502 allele matter (mainly if of Asian descent)?
carbamazepine
67
phenobarbitol therapeutic range?
20 - 40 mcg/mL
68
vimpat/lacosamide: increases ______/risk of _______
PR interval/arrhythmias
69
Phenytoin IV: do not exceed _____ mg/min
50
70
if phenytoin/fosphenytoin given too fast -- can cause what?
hypotension/arrhythmia
71
phenytoin risks?
purple glove syndrome (extravasation) gingival hyperplasia hair growth hepatotoxicity
72
boxed warnings for felbamate (felbatol)
hepatic failure, aplastic anemia (need patients informed consent!!)
73
what drug can cause permanent vision loss
vigabatrin (sabril)

NAPLEX Prep (19 decks)

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