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NAPLEX Review > Seizures/Epilepsy > Flashcards

Seizures/Epilepsy Flashcards

1
Q

Tonic-clonic seizures vs absence seizures

A

TC: uncontrolled jerking movements
A: momentary loss of awareness

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2
Q

What test is used to diagnose epilepsy?

A

Electroencephalogram (EEG)

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3
Q

Drugs that lower seizure threshold

A 
Bupropion
Clozapine
Theophylline
Varenicline
Carbapenems (esp imipenem)
Lithium
Meperidine
PCN
Quinolones
Tramadol
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4
Q

Focal vs generalized seizures

A

Focal - start on one side but can spread to other side

Generalized - start on both sides

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5
Q

Clonic, atonic, myoclonus, and tonic definitions

A

Clonic - sustained rhythmical jerking movements
Atonic - weak or limp muscles
Myoclonus: muscle twitching
Ronic - rigid or tense muscles

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6
Q

Status epilepticus definition

A

seizure that lasts longer than 5 minutes

long term damage can occur after 30 minutes

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7
Q

3 phases and treatment options for status epilepticus

A

Stabilization phase (0-5 min): time seizure, start EEG, oxygen, check labs (dextrose/electrolytes)
Initial treatment phase (5-10 min): IV lorazepam (preferred) or IM midazolam or rectal diazepam
Second treatment phase (20-40 min): IV fosphenytoin, valproic acid, levetiracetam, phenobarb last option

If none of this works throw the kitchen sink at them

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8
Q

What must the pharmacist do before dispensing rectal diazepam (Diastat)

A

Dial to appropriate dose and lock syringe

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9
Q

What medical marijuana medication can be used for epilepsy?

A

Cannabidiol or CBD (Epidiolex)

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10
Q

What type of diet may help with refractory seizures?

A

Keto diet

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11
Q

What is ethosuximide used for?

A

Absence seizures

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12
Q

What AED increase GABA to prevent seizures?

A

Benzos
Valproic acid
Levetiracetam

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13
Q

What AEDs enhance/potentiate GABA effect?

A

Phenobarb

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14
Q

What AED act as a Ca Channel blocker?

A

Levetiracetam
Gabapentin
Pregabalin
Oxcarbazepine

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15
Q

What AEDs are T-type Ca channel blockers?

A

Ethosuximide

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16
Q

What AEDs are Na channel blockers

A 
Oxcarbazepine
Carbamazepine
Lamorigin
Phenytoin
Topiramate
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17
Q

A deficiency in ___ or excess of ___ can cause seizures

A

Deficiency in GABA

Excess of Glutamate

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18
Q

What supplements should be taken while on AED?

A

Calcium and vitamin D
Folate for women of childbearing age
Carnitine if on valproic acid
Selenium and zinc if alopecia while on lamotrigine and valproic acid

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19
Q

Lamotrigine taper

A

25mg x 2 wk
50mg x 2 wk
Increase by 50mg q1-2 wk

20
Q

Lamotrigine BBW and SE

A

BBW: SJS, TEN
SE: alopecia (supplement selenium and zinc)

21
Q

Lamorigine starting kits and colors

A

Orange - standard
Blue - lower starting dose (use if on valproic acid)
Green - higher starting dose (use if taking inducer)

22
Q

What medications decrease/increase lamotrigine concentration?

A

Increase: valproic acid
Decrease: carbamazepine, phenytoin, phenobarb, primidone, lopinavir/ritonavir, atazanavir/ritonavir, rifampin, oral estrogen containing contraceptives

23
Q

Levetiracetam warnings and notes

A

Warnings: psych reactions, including psychotic symptoms, somnolence, fatigue
Notes: no significant drug interactions

24
Q

Topiramate warnings and SE

A

Warnings: metabolic acidosis, oligohidrosis, nephrolithiasis, angle-closure glaucoma, hyperammonemia, fetal harm
SE: Somnolence, issues with memory/concentration/attention, weight loss, anorexia

25
Q

Valproic acid therapeutic range

A

50-100 mcg/mL (total level)

26
Q

Valproic acid BBW, warning, SE, monitoring

A

BBW: Hepatic failure, fetal harm (neural tube defects and decreased IQ scores)
Warnings: hyperammonemia, thrombocytopenia
SE: Alopecia, weight gain
Monitoring: LFTs, platelets

27
Q

Carbamazepine therapeutic range

A

4-12 mcg/mL

28
Q

Carbamazepine BBW, CI, Warnings, and notes

A

BBW: SJS/TEN (HLA-B*1502), aplatic anemia and agranulocytosis
CI: myelosuppression
Warnings: hyponatremia (SIADH), fetal harm
Notes: autoinducer - decreases level of other drugs and itself

29
Q

Lacosamide (Vimpat) schedule, warnings

A

Schedule: C-V
Warnings: prolongs PR interval and increases risk of arrhythmias

30
Q

Oxcarbazepine (Trileptal) warnings, monitoring

A

Warnings: SJS/TEN (HLA-B*1502), hyponatremia
Monitor: Na

31
Q

Phenobarbital therapeutic range

A

20-40 mcg/mL (adults)

32
Q

Phenobarbital warnings and SE

A

Warnings: Habit forming, respiratory depression, fetal harm
SE: Psychological dependence, tolerance, hangover effect

33
Q

What AED decrease effectiveness of hormonal contraceptives?

A

Topiramate
Oxcarbazepine
Phenobarbital

34
Q

Phenytoin (Dilantin) and Fosphenytoin (Cerebyx) therapeutic range

A

10-20 mcg/mL (total level)

1-2.5 mcg/mL (free level)

35
Q

Phenytoin (Dilantin) and Fosphenytoin (Cerebyx) BBW, warnings, SE, monitoring

A

BBW: Phenytoin IV rate - do not exceed 50mg/min; fosphenytoin IV rate - do not exceed 150mg PE/min
Warnings: extravasation (HLA-B*1502), fetal harm
SE: Nystagmus, ataxia, diplopia, gingival hyperplasia, hair growth, hepatoxicity
Monitor: serum concentration, LFTs, cardiac and respiratory monitoring

36
Q

Ethosuximide (Zarontin) warningss

A

SJS/TEN, blood dyscrasias

37
Q

Felbamate (Felbatol) BBW

A

Hepatic failure, aplastic anemia

38
Q

Gabapentin (Neurontin) warnings and SE

A

Warnings: Peripheral edema
SE: somnolence, peripheral edema, weight gain, mild euphoria

39
Q

Pregabalin (Lyrica) schedule

A

C-V

40
Q

Primidone is the prodrug of what?

A

Phenobarbital and phenylethylmalonamide (PEMA)

41
Q

Vigabatrin BBW

A

permanent vision loss (30% or more of patients)

42
Q

Zonisamide (Zonegran) CI and SE

A

CI: hypersensitivity to sulfonamides
SE: oligohidrosis/hyperthermia and risk of nephrolithiasis

43
Q

Phenytoin correction formula

A

Total phenytoin measured

(0. 2 x albumin) + 0.1

44
Q

What AED are enzyme inducers/inhibitors and have a lot of drug interactions?

A

Inducers: Carbamazepine, oxcarbazepine, phenytoin, fosphenytoin, phenobarb, primidone
Inhibitor: valproic acid

45
Q

What AED are CNS depressants?

A

All of them
They depress electrical activity in the brain and can cause dizziness, confusion, sedation, and ataxia/coordination difficulties

46
Q

What AEDs cause bone loss?

A

All of them

Always supplement calcium and vitamin D

47
Q

What AEDs have known teratogenic risk? Which is the highest risk?

A 
Clonazepam
Phenobarb
Primidone
Phenytoin/fosphenytoin
Carbamazepine
Valpric acid --> highest risk

NAPLEX Review (79 decks)

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