Unit 7: CNS Drugs.Seizures

Question 1

define epilepsy

Answer 1

electrical storm in the brain

Question 2

define seizure

Answer 2

paroxysmal abnormal neuronal discharges

Question 3

define convulsion

Answer 3

forceful, involuntary spasm/contraction

the motor manifestation of a seizure

Question 4

define status epilepticus

Answer 4

a medical emergency as the patient could stop breathing

30+ minutes of a seizure w/o regaining consciousness

Question 5

what are the 2 types of partial seizures?

Answer 5

simple and complex

Question 6

define tonic-clonic seizures

Answer 6

classic seizure
formerly “grand mal”
tonic phase < 1 minute: abrupt LOC, muscle rigidity, respiratory arrest
clonic phase 2-3 min: muscle jerking, lip/tongue biting, fecal/urinary incontinence

Question 7

define myoclonic seizures

Answer 7

single or multiple myoclonic jerks
myoclonus = quick, involuntary muscle jerk
e.g. hiccups
e.g. muscle twitch when falling asleep

Question 8

define absence seizures

Answer 8

impaired consciousness
formerly “petit mal”
sometimes with automatisms
easy to miss

Question 9

What anti-seizure drugs need serum bloodwork to assess for therapeutic range?

Answer 9

phenytoin
carbamazepine
valproic acid
ethosuximide
lamotrigine
felbamate

Question 10

What anti seizure drug can also treat nerve pain?

Answer 10

gabapentin

Question 11

What is important to remember about pregnancy and many anti seizure drugs?

Answer 11

many are pregnancy class C or D

Question 12

Carbamazepine has interactions with which drugs?

Answer 12

erythromycin
grapefruit juice
protease inhibitors
allopurinol
oral contraceptives
warfarin

Question 13

Name some serious adverse effects with carbamazepine

Answer 13

blood dycrasias:
aplastic anemia
agranulocytosis

Question 14

define agranulocytosis

Answer 14

severe and dangerous leukopenia (low white blood cell counts)

Question 15

serious adverse effects of valproic acid

Answer 15

pancreatitis

hepatitis

Question 16

adverse effects of valproic acid

Answer 16

N/V
anorexia
weight gain
sedation, stupor
tremor
thrombocytopenia

Question 17

what kind of seizures can valproic acid treat?

Answer 17

absence
generalized
parital
febrile

Question 18

how long does it take to reach a steady state with phenobarbital?

Answer 18

3-4 weeks

Question 19

what antiseizure drugs require a loading dose?

Answer 19

phenytoin

phenobarbital

Question 20

name a black box warning for lamotrigine

Answer 20

SJS

toxic epidermal necrosis

Question 21

adverse effects of lamotrigine

Answer 21

somnolence
diplopia
headache
dizziness
nausea

Question 22

what anti seizure medication is also used to treat migraines

Answer 22

topiramate

Question 23

what is the nickname for topiramate and why?

Answer 23

“dopamax”

due to adverse effects

Question 24

what are the adverse effects of topiramate?

Answer 24

slowed thinking and speech
confusion
difficulty concentrating
word-finding difficulties
headache
fatigue
weight loss

Question 25

generic name of Keppra

Answer 25

levetiracetam

Question 26

Keppra must be adjusted for which kind of patients?

Answer 26

those with renal impairment

Question 27

with what other seizure drugs does Keppra interact?

Answer 27

none

Question 28

adverse effects of levetiracetam

Answer 28

dizziness somnolence behavior disturbances

Question 29

Name some serious adverse effects of oxcarbazepine

Answer 29

SJS toxic epidermal necrosis multi-organ hypersensitivity

Question 30

What anti seizure drugs require adjustments for renal issues?

Answer 30

levetiracetam | oxcarbazepine

Question 31

What anti seizure drugs list SJS and toxic epidermal necroses as adverse effects?

Answer 31

oxcarbazepine | lamotrigine

Question 32

What allergy can zonisamide cause?

Answer 32

sulfa allergy

Question 33

list the adverse effects of zonisamide

Answer 33

``` sedation dizziness cognitive impairment Nausea weight loss sulfa allergy ```

Question 34

how does gabapentin work?

Answer 34

alters amino acid metabolism increases GABA decreases glutamate

Question 35

adverse effects of gabapentin

Answer 35

dizziness somnolence weight gain behavioral changes in children

Question 36

name a last line agent

Answer 36

felbamate