Seizures/Epilepsy Flashcards by Grace Whitham

Tonic-clonic seizures vs absence seizures

TC: uncontrolled jerking movements
A: momentary loss of awareness

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What test is used to diagnose epilepsy?

Electroencephalogram (EEG)

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Drugs that lower seizure threshold

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

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Focal vs generalized seizures

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

Generalized - start on both sides

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Clonic, atonic, myoclonus, and tonic definitions

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

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Status epilepticus definition

seizure that lasts longer than 5 minutes

long term damage can occur after 30 minutes

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3 phases and treatment options for status epilepticus

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

Dial to appropriate dose and lock syringe

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What medical marijuana medication can be used for epilepsy?

Cannabidiol or CBD (Epidiolex)

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What type of diet may help with refractory seizures?

Keto diet

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What is ethosuximide used for?

Absence seizures

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What AED increase GABA to prevent seizures?

Benzos
Valproic acid
Levetiracetam

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What AEDs enhance/potentiate GABA effect?

Phenobarb

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What AED act as a Ca Channel blocker?

Levetiracetam
Gabapentin
Pregabalin
Oxcarbazepine

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What AEDs are T-type Ca channel blockers?

Ethosuximide

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What AEDs are Na channel blockers

Oxcarbazepine
Carbamazepine
Lamorigin
Phenytoin
Topiramate

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A deficiency in ___ or excess of ___ can cause seizures

Deficiency in GABA

Excess of Glutamate

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What supplements should be taken while on AED?

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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Lamotrigine taper

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

Lamotrigine BBW and SE

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

Lamorigine starting kits and colors

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

What medications decrease/increase lamotrigine concentration?

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

Levetiracetam warnings and notes

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

Topiramate warnings and SE

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

Valproic acid therapeutic range

50-100 mcg/mL (total level)

Valproic acid BBW, warning, SE, monitoring

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

Carbamazepine therapeutic range

4-12 mcg/mL

Carbamazepine BBW, CI, Warnings, and notes

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

Lacosamide (Vimpat) schedule, warnings

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

Oxcarbazepine (Trileptal) warnings, monitoring

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

Phenobarbital therapeutic range

20-40 mcg/mL (adults)

Phenobarbital warnings and SE

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

What AED decrease effectiveness of hormonal contraceptives?

Topiramate Oxcarbazepine Phenobarbital

Phenytoin (Dilantin) and Fosphenytoin (Cerebyx) therapeutic range

10-20 mcg/mL (total level) | 1-2.5 mcg/mL (free level)

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

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

Ethosuximide (Zarontin) warningss

SJS/TEN, blood dyscrasias

Felbamate (Felbatol) BBW

Hepatic failure, aplastic anemia

Gabapentin (Neurontin) warnings and SE

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

Pregabalin (Lyrica) schedule

C-V

Primidone is the prodrug of what?

Phenobarbital and phenylethylmalonamide (PEMA)

Vigabatrin BBW

permanent vision loss (30% or more of patients)

Zonisamide (Zonegran) CI and SE

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

Phenytoin correction formula

Total phenytoin measured - ------------------------------------- (0. 2 x albumin) + 0.1

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

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

What AED are CNS depressants?

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

What AEDs cause bone loss?

All of them | Always supplement calcium and vitamin D

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

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