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Pharmacology > Week 11 Seizures > Flashcards

Week 11 Seizures Flashcards

1
Q

What are the causes of seizures?

A 
congenital defects (cerebral palsy)
hypoxia
trauma (brain surgery)
Cancer
alcohol or drugs (or withdrawal)
elevated body temp (febrile seizures)
electrolyte disturbances, glucose abnormalities
Meperidine (Demerol)
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2
Q

Why is it important to determine seizure type?

A

initial drug choice is type dependent

wrong choice may precipitate (increase) seizures

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3
Q

What is the primary treatment for all partial seizures?

A

valproate (Depakene)

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4
Q

What is the primary treatment for generalized tonic clonic, absence, myocolinc and atonic?

A

Valproate (Depakene)

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5
Q

What percentage of patients are controlled with mono therapy of anti-epileptic drugs?

A

50-70%

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6
Q

What percentage of pts require combination therapy of anti-epileptic drugs?

A

30%

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7
Q

What percentage of patients have poorly controlled despite AED therapy?

A

5%

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8
Q

What are causes of pseudo resistance?

A 
wrong diagnosis
wrong drug (s)
wrong dose
lifestyle issues
must be ruled out to consider treatment failure
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9
Q

What is the goal of AED therapy?

A

prevent seizures

maintain normal function and improve quality of life with fewest side effects

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10
Q

What does discontinuation of AED Therapy depend on?

A 
seizure type
seizure freee duration
EEG
and other factors 
**Never DC abruptly
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11
Q

Optimal treatment for seizures requires _____.

A

individualization

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12
Q

When should you start AED therapy for seizures?

A

rarely needed after a single seizure
start in pts at risk for recurrent seizures
generally start after 2 or more unprovoked strokes

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13
Q

Is AED therapy lifelong?

A

not necessarily

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14
Q

How an AED withdrawal be prevented?

A

withdrawal should be gradual (tapered)
sudden withdrawal may precipitate status epilepticus
relapse is more likely if done over 1-3 months
relapse is lefff likely if done over 6 months

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15
Q

What are some of the common significant interactions of AED treatment?

A

oral contraceptives and warfarin

CYP 450 inducers

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16
Q

What CYP450 inducers have very significant interactions to AED treatment?

A

Phenytoin (Phenobarbitol)
Carbamazepine
Primidone

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17
Q

What are the CYP 450 inducers that have less significant interactions to AED treatment?

A

Oxycarbazepine
Topiramate

Newer 2nd generation much less significant

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18
Q

What are common side effects of AED therapy?

A

suicidal ideation (2 fold risk)
CNS : sedation, slowed thinking, dizziness and ataxia
Osteomalacia & osteoporosis
Vision changes

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19
Q

What is important to remember when altering mediation for AED therapy?

A

correlate drug levels to symptoms before abandoning the medication

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20
Q

Why is mono therapy preferred?

A 
increases adherence
proves wider therapeutic index
more cost effective
combos promote drug interactions
no controlled studies compared combo treatments
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21
Q

What is important to remember if giving combo therapy for seizures?

A

choose an add-on with a different MOA
AND/OR
different side effect profile

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22
Q

What are the big 3 AED medications?

A

Phenytoin
Carbamazepine
Valproic Acid

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23
Q

What are the common side effects of Penytoin (dilantin)?

A 
gingival hyperplasia
rash
acne
nystagmus
hirsutism
osteomalacia
folate deficiency
24
Q

What is a common side effect of Carbamazepine (tegretol)?

A

hyponatremia

25
Q

What is the advantage of Carbamazepine (tegretol)?

A

less cognitive impairment

26
Q

What are the common side effects of valproic acids and derivatives?

A

fatal hepatotoxicity

27
Q

What medication is 1:1 dimer in an enteric coated tablet that claimed to have fewer GI effects?

A

Divalproex (Depakote, Depakote ER)

28
Q

What medication is rarely used now for seizures except for pregnancy because other drugs are as effective with fewer side effects?

A

Phenobarbitol

29
Q

What is important with discontinuation of phenobarbital?

A

taper slowly, abrupt stoppage may cause seizures

30
Q

What mediation is metabolized into phenobarbital?

A

Primidone (Mysoline)

31
Q

What medications for seizures are not practical for long term use due to development of tolerance?

A

Clonazepam (Klonopin)
Diazepam (Valium)
Lorazepam (Ativan)

32
Q

What is the drug of choice for absent seizures?

A

Ethosuximide (Zarontin)

33
Q

Why use caution with Felbamate (Felbatol)?

A

fatal aplastic anemia

hepatotoxicity

34
Q

What is a common side effect of topiramate (topamax)?

A

temporary or permanent vision loss

decrease sweating

35
Q

What medication has chronic side effects similar to topiramate?

A

Zonisamide (Zonegran)

36
Q

What are the newer agents for seizures?

A

Levetiracetam (keppra)

Gabapentin (Neurontin) and Pregabalin (Lyrica)

37
Q

What medications are a GABA analog with no drug interactions that are NOT first line in ACD?

A

Gabapentin (Neurontin) and Pregabalin (Lyrica)

38
Q

What is the anticonvulsant of choice in pregnancy?

A

Phenobarbital

39
Q

What is significant about generic substitution of anticonvulsant drugs?

A

Need physician approval

40
Q

What AED are used for neuropathic pain?

A

Gabapentin (Neurontin) and Pregabalin (Lyrica)

41
Q

What are other uses of AEDs?

A

Neuropathic pain
bipolar disorder
migraine

42
Q

What is a life threatening emergency and mortality is about 20%?

A

status epilepticus

43
Q

What is the etiology of status epilepticus?

A

anti epileptic drug noncompliance or discontinuation
withdrawal syndromes
brain injury
metabolic abnormalities
drug use/overdose that lower seizure threshold

44
Q

What are drugs that lower the seizure threshold? (3)

A

Imipinem (Primaxin)
High dose Penicillin G
Lidocaine

45
Q

What is the treatment for status epilepticus? (5)

A 
Diazepam (valium)
Lorazepam (Ativan)
Phenytoin (Dilantin)
Fosphenytoin (Cerebyx)
Phenobarbital (Luminal)
46
Q

How is diazepam administered?

A

Inject directly! diluting causes precipitation

47
Q

Diazepam provides _______ minute seizure free interval. Often less than ____ minutes due to ______

A

30-40 minutes
less than 20 minutes
redistribution into adipose

48
Q

According to a recent study what medication if more effective than phenytoin and easier to use than diazepam + phenytoin and phenobarbital?

A

Lorazepam (Ativan)

49
Q

What medication is most effective in terminating seizures within 20 minutes and maintaining a seizure free state in the first 60 minutes after treatment?

A

Lorazepam (Ativan)

50
Q

What medication is longer lasting then diazepam and may be diluted with equal volumes of 0.9% NaCL

A

Lorazepam (Ativan)

51
Q

What is the maximum infusion rate of phenytoin (dilantin) due to hypotension?

A

no faster than 50mg/minute

52
Q

What are the advantages of Fosphenytoin (cerebyx)?

A

pro-drug of penytoin
highly water soluble and unlikely to precipitate (less hypotension and allows for IM administration)
can infuse faster (150mg/min)
can be mixed in any solution

53
Q

What medication is dosed in terms of phenytoin equivalents?

A

Fosphenytoin (Cerebyx)

1.5mg fosphenytoin = 1mg phenytoin

54
Q

Why is phenobarbital (Luminal) not used first line in status epilepticus?

A

slow administration
prolonged sedation (half life is 80-100 hours)
greater risk of hypotension and hypoventilation
little used controlled substance- not quickly available

55
Q

What is the dosage of phenobarbital if used for refractory epilepticus?

A

IV 15-20mg/kg at 50mg/minute

Pharmacology (17 decks)

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