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Neurological Conditions > Seizures/Epilepsy > Flashcards

Seizures/Epilepsy Flashcards

1
Q

Valproic Acid:

BBW
Warnings
ADE

A

Hepatic failure
Pancreatitis
Pregnancy category X

Hyperammonemia
Thrombocytopenia

Alopecia
Weight gain

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2
Q

Why is Brivaracetam better than Levetiracetam?

A

It has less incidence of mood, psychotic ADE

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3
Q

Seizure pathophysiology

A

Deficiency of Gamma-aminobutyric acid (GABA)

Excess of Glutamate, NA, and Ca channels

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4
Q

When do we treat epilepsy with meds?

A

Consider early treatment if a seizure is clearly unprovoked and :

  • an epileptiform EEG
  • structural lesions
  • history of status epileptics
  • variable known to prove a seizure that cannot be modified due to clinical necessity

(note: Patients are allowed to have 1 seizure without having to be treated long term if there is no reoccurrence)

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5
Q

What are the common ADE of all anti-epileptic drugs?

A 
Anti-epileptic drugs are depressants.
Cause:
Dizziness
Confusion
Sedation 
Ataxia/Coordination difficulties
Bone loss
Suicide risk
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6
Q

Why is Clobezam better than Clonazepam?

A

Less sedating

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7
Q

What drug is closely related to Topamax

A

Zonisamide

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8
Q

Carbamazepine
Oxcarbazepine
Eslicarbazepine

ADE

A

Hyponatremia

Rash

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9
Q

Phenobarbital clinical peral

A

Has a few days of half life and therefore may need a loading dose
Also used in neonates

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10
Q

Which anti-epileptic drugs are inducers and which are inhibitors?

A

Enzyme inhibitor : Valproic acid

Enzyme inducers : All other anti-epileptic drugs

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11
Q

Which anti-epileptic drugs cause an increase in GABA?

A

Benzodiazepines
Valproic acid
Phenobarbital

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12
Q

Lacosamide warning

A

Prolongs PR interval

Increase risk of arrhythmias

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13
Q

What is the brand name of Lacosamide and what is the schedule?

A

Vimpat

Class V

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14
Q

In the treatment of Status Epileptics, what is the usually dose for IV loading dose of anti-epileptic drugs?

A

20mg/kg

Except for Keppra

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15
Q

Which anti-epileptic drugs can cause SJS/TEN?

A

Lamotrigen
Carbamazepine
Oxcarbazepine
Eslicarbazepine

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16
Q

Which anti-epileptic drugs have a high risk of causing neural tube defects in utero?

A

Valproic acid

Carbamazepine

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17
Q

Status Epileptics (SE) treatment?

A

0-5 min: Stabilization Phase

  • Time the seizure
  • Start EEG, O2 prn
  • Check AED levels, electrolytes, BG

5 - 20 min: Initial treatment phase (if seizure continues)

  • Give IV Lorazepam (perferred)
  • Or IV Medazolam
  • OR PR Diazepam

20 - 40 min: Second treatment phase (if seizure continues)
- Give regular AED, IV fosphenytoin, Valproic acid, Levetiracetam (or phenobarbital if others are unavailable)

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18
Q

What is the BBW and special ADE of Lamotrigine?

A

Serious skin reaction (SJS/TEN)

Alopecia (treatment: supplement selenium and zinc)

Remember: D-D interaction with Valproic acid

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19
Q

What is the guideline in starting meds in treating epilepsy?

A

Start with mono therapy
Titrate up slowly.

If patient is experiencing too much ADE or not working then slowly titrate down while titrating up on another mono therapy.
Titrate up on the 2nd mono therapy.

If still uncontrolled, start add on agents

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20
Q

What is it called when patient has a focal seizure with awareness and without awareness?

A

With awareness:
Focal aware seizure aka Simple Partial seizure

Without awareness:
Focal seizure with impaired awareness aka Complex Partial seizure

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21
Q

Which anti-epileptic drugs are Ca channel blockers?

A

Pregabalin

Gabapentin

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22
Q

What electrolyte can cause seizures

A

Sodium (hypo or hyper )

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23
Q

What is the prodrug of Phenobarbital?

A

Primidone (Mysoline)

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24
Q

Clinical peril of Topamax

A

Dopamax

make people dumb

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25
Q

What kind of seizure is characterized with brief, subtle momentary loss of awareness?

A

Absence Seizure

Always are categorized as general
Can sometimes be misdiagnosed for ADHD

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26
Q

Phenobarbital

Warning
ADE

A

Habit forming
Respiratory depression
Pregnancy category X

Physiological dependence
Tolerance
Hangover effect

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27
Q

What kind of seizure is characterized with rigid or tense muscle and rhythmical uncontrolled jerking movement?

A

Tonic-Clonic Seizure

the violent seizures with falls and jerks

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28
Q

Phenytoin/Fosphenytoin

BBW
Warnings
ADE

A

These drugs are non-linear
IV administration of Phenytoin should not exceed 50mg/minute
and
Fosphenytoin should not exceed 150 PE/minute
Fast infusion can cause cardiac arrhythmias

Extravastion leading to Purple Glove Syndrome
HLA-B*1502 in Asian due to metabolism changes
Pregnancy category X

Dose related:
Nystagmus
Ataxia
Diplopia/blurred vision

Long term use:
Gingival hyperplasia
Hair growth
Hepatotoxicity

29
Q

What are some non med, alternative treatments for seizures?

A

Marijuana
Ketogenic diet
Vagal nerve stimulation
Surgical intervention

30
Q

Which anti-epileptic drugs cause Hyperammonemia?

A

Valproate

Topiramate

31
Q

Which anti-epileptic drugs are considered broad-spectrum?

A

Lamotrigine
Levetiracetam
Topiramate
Valproic Acid

32
Q

Phenytoin/Fosphenytoin therapeutic range?

A

1 - 2.5 mcg/ml (free level)

10 -20 mcg/ml (total level)

33
Q

What is the dose adjustment formula for phenytoin?

A

Phenytoin correction = total phenytoin measured/ ((0.2 * albumin) + 0.1)

34
Q

What kind of seizure is characterized with muscle twitching or jerking ?

A

Myoclonus

35
Q

Valproic Acid therapeutic range?

A

50 - 100 mcg/ml

36
Q

Dose Phenytoin or Fosphenytoin have a lower risk of purple-glove syndrome?

Which one can be infused faster?

A

Fosphenytoin for both

37
Q

What with the difference b/w Cabamezapine and Oxcarbazepine?

A

Oxcarbazepine doesn’t auto-induce.

Not a prodrug

38
Q

What drug has a very narrow spectrum of activity and is only used in the treatment of one type of seizure?

A

Ethosuximide = Absence seizures

39
Q

Which anti-epileptic drugs cause alopecia and what is the treatment?

A

Lamotrigine
Valproic Acid

Treatment: supplement selenium and zinc

40
Q

What is Epilepsy?

A

A chronic seizure disorder

Def for diagnosis:

  • 2 unprovoked seizures separated by 24 hours
  • 1 unprovoked seizure if the chance of reassurance is over 60% per physician
41
Q

What is the starting and maintenance dose of Lamotrigine?

A

Initial: 25mg PO QD

Maintenance: 300 - 400mg PO QD or divided BID

Starter kit color coding:
Orange: standard dose with no d-d interaction

Blue: lower dose with d-d interaction with valproic acid

Green: Higher dose with enzyme inducers

42
Q

Which anti-epileptic drugs are Na channel blockers (usually used for focal seizure)?

A 
Carbamezepine 
Lacosamide 
Lamotrigine
Phenytoin/Fosphenytoin
Topiramate
43
Q

Which anti-epileptic drugs are considered narrow-spectrum?

A 
Carbamazepine 
Oxcarbazepine 
Lacosamide (Vimpat)
Phenobarbital
Phenytoin/Fosphenytoin
44
Q

How are epilepsy diagnosed?

A

EEG

45
Q

What kind of seizure is characterized with limp or weak muscles?

A

Atonic

46
Q

What vitamins or supplements do we need to consider taking when on anti-epileptic drugs?

A

With all AED: Calcium and Vitamin D

Women of childbearing age: Folate

Valproic acid: possibly carnitine

Lamotrigine and Valproic acid: if alopecia, supplement with selenium and zinc

47
Q

Levetiracetam warning?

A

***Mood is one big problem to watch for with Keppra
Psychiatric reactions, including psychotic symptoms, somnolence,
fatigue

48
Q

What are Status Epileptics (SE) seizures?

A

Seizures which last more than 5 minutes

If more than 30 min, can cause brain injury

49
Q

Phenobarbital therapeutic range?

A

20 - 40 mcg/ml

50
Q

Carbamazepine therapeutic range?

A

4 - 12 mcg/ml

51
Q

What are Focal seizures?

A

Seizures which start on one dose of the brain but can spread to the other side.

52
Q

Oxcarbazepine warning

A

Serious skin reaction (SJS/TEN)
HLA-B*1502 in Asian due to metabolism changes (which can cause SJS/TEN)
Hyponatremia

53
Q

What anti-epileptic drugs is an auto- inducer?

A

Cabamezapine

54
Q

Which anti-epileptic drugs cause permanent vision loss?

A

Vigabatrin (Sabril, Vigadrone)

55
Q

Topiramate , Zonisamide

ADE

A

Weight loss
Metabolic acidosis
Nephrolithiasis
Oligohidrosis/hyperthermia (in children)

56
Q

Clinical peril with Gabapentin?

A

Needs renal dose adjustments
and
can cause peripheral edema

57
Q

Which anti-epileptic drugs cause blocking of both Na and Ca channels?

A

Oxcarbazepine

58
Q

Which anti-epileptic drugs cause both an increase in GABA and blocks Ca channels?

A

Levetiracetam

59
Q

What are Generalized seizures?

A

Seizures which start on both sides of the brain

Always has a loss of conciseness

60
Q

What are some drugs which can decrease the threshold of seizure? (10)

A 
Bupropion
Clozapine 
Theophylline 
Varenicline 
Carbepenems (esp. Imipenem)
Lithium 
Meperidine 
Penicillin 
Quinolones 
Tramadol
61
Q

Other than for epilepsy, what other condition is Topiramate used for?

A

Migraine prophylaxis

62
Q

Topiramate

Warnings
ADE

A 
Metabolic acidosis 
Oligohidrosis (reduced perspiration/hyperthermia
Nephrolithiasis (kidney stones)
Angle-closure glaucoma 
Hyperammonemia 
Fetal harm

Memory/concentration/attention loss
Weight loss
Anorexia

63
Q

What are generalized seizures with non motor symptoms called?

A

Absence seizures

64
Q

Pregabalin
Gabapentin

ADE

A

Weight gain
Peripheral edema
Mild euphoria

Usually used for neurotic pain

65
Q

Which anti-epileptic drugs has a sulfa allergy attached to it?

A

Zonisamide (Zonegran)

66
Q 
Phenobarbital
Primidone (prodrug of Phenobarbital)

ADE

A

Dependence/tolerance/overdose risk

67
Q

At what point can anti-epileptic drugs be discontinued?

A

If patient is without a seizure for 1 to 2 years

68
Q

Carbamazepine

BBW
Contraindication
Warning

A

Serious skin reaction (SJS/TEN)
HLA-B*1502 in Asian due to metabolism changes (which can cause SJS/TEN)
Aplastic anemia
Agranulocytosis

Myelosuppression

Hyponatremia (SIADH)
Pregnancy category X

Neurological Conditions (4 decks)

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