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Pharm Unit 4 > Wk 11 > Flashcards

Wk 11 Flashcards

1
Q

Causes of seizures

A 
Congenital defects (CP)
Hypoxia (decreased cerebral oxygen) 
Cancer
Alcohol/drugs (withdrawal) 
Elevated body temp
Electrolyte/glucose disturbances
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2
Q

Drugs that cause seizures

A

Meperidine

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3
Q

Initial drug of choice for seizures is ___

A

type dependent

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4
Q

Wrong choice in drugs for seizures may increase ___

A

seizures

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5
Q

Primary drug for partial seizures

A

Valproate
Carbamazepine
Phenytoin

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6
Q

Primary drugs for tonic-clonic seizures

A

Valproate
Carbamazepine
Phenytoin

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7
Q

Primary drug for absence seizures

A

valproate

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8
Q

primary drug for myoclonic

A

valproate

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9
Q

primary drug for atonic seizures

A

valproate

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10
Q

Most seizure patients respond to ___ AEDs

A

1-2

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11
Q

Rarely, patients require >2 ___

A

AEDs

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12
Q

50-75% of patients are controlled with ___

A

monotherapy

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13
Q

30% of patients require ___

A

combination therapy

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14
Q

5% poorly controlled despite ___

A

AED therapy

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15
Q

Pseudoresistance can be caused by:

A

wrong dx
wrong drug
wrong dose
lifestyle issues

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16
Q

___ must be ruled out to consider treatment failure

A

pseudo resistance

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17
Q

Goal of AED therapy

A

prevent seizures, maintain normal functioning inprove quality of life with fewest side effects.

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18
Q

select an AED recommended for the ____

A

identified seizure type

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19
Q

when augmenting therapy, chose a drug with an ____

A

alternative mechanism

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20
Q

discontinuation depends on ___

A

seizure type
seizure free duration
EEG
other factors

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21
Q

NEVER ____ an AED

A

abruptly discontinue

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22
Q

optimal treatment requires

A

individualizatoin

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23
Q

AED therapy is highly ___

A

individualized

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24
Q

immediately therapy rarely needed after ____

A

single seizure

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25
Q

start AED therapy for patients at risk for ____

A

recurrent seizures

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26
Q

generally start AED therapy after _____ seizures

A

2+ unprovoked seizures

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27
Q

AED therapy is not necessarily ___

A

life long

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28
Q

AED withdrawal should be ___

A

gradual (tapered)

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29
Q

sudden withdrawal may precipitate ____

A

status epilepticus

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30
Q

relapse is more likely if done over ____ months

A

1-3 months

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31
Q

relapse is less likely if done over ___ months

A

6

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32
Q

common significant interactions with AEDs

A

OCPs and warfarin

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33
Q

very significant CYP450 inducers

A

Phenytoin (Phenobarbitol)
Carbamazepine
Primidone

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34
Q

Less significant CYP450 inducers

A

Oxcarbazepine

Topiramateq

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35
Q

much less significant CYP450 inhibitor

A

newer (second generation) agents

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36
Q

common s/e of AED thearpy

A

suicidal ideation
CNS
Osteomalacia & osteoporosis
Vision changes

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37
Q

suicidal ideation of patients on AED tx is ___ risk vs general population

A

2 fold

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38
Q

CNS s/e of AED therapy

A

sedation
slowed thinking
dizziness
ataxia

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39
Q

Correlate drug levels to ___ before abandoning medication

A

symptoms

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40
Q

Whenever possible, _____ is perferred

A

monotherapy

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41
Q

mono therapy is preferred because;

A

increased adherence
provides wider therapeutic index
most cost-effective

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42
Q

combinations promote _____

A

drug-drug interactions

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43
Q

no controlled studies on ______

A

comparing drug combos

44
Q

if adding on, _____

A

add on with a different MOA and/or different S/E profile

45
Q

Big Three of AED therapy

A

Pheytoin
Carbamazepine
Valproic acid

46
Q

Administration of phenytoin

A

IV, PO

47
Q

S/E of phenytoin

A 
gingival hyperplasia
rash
acne
nystagmus
hirtuism
osteomalacia
folate deficiency
48
Q

administration of carbamazepine

A

PO

49
Q

S/E of carbamazepine

A

hyponatremia

50
Q

advantages of carbamazepine

A

less cognitive impairment

51
Q

Administration of valproic acids

A

IV, PO

52
Q

S/E of valproic acid

A

fetal hepatotoxicity

53
Q

brand name of divalproex

A

depakote

depakote ER

54
Q

divalproex is a ______ in an ___ coated tablet

A

1:1 dimer; enteric coated

55
Q

divalproex claims to have ___

A

fewer GI effects

56
Q

___ is rarely used now

A

phenobarbital

57
Q

when is phenobarbital used

A

pregnancy

58
Q

why is phenobarbital rarely used

A

other drugs as effective with fewer s/e

59
Q

abrupt stoppage of phenobarbital may cause ___

A

seizuresa

60
Q

taper phenobarbital ___

A

slowly

61
Q

what drug is metabolized to phenobarbital

A

primidone (mysoline)

62
Q

long term use of Benzos are not practical due to ____

A

development of tolerance

63
Q

benzodiazepines used with seizures

A

clonazepam
diazepam
lorazepam

64
Q

Drug of choice for absence seizures

A

Ethosuximide (zarotin)

65
Q

caution with felbamate

A

fatal aplastic anemia

hepatotoxicity

66
Q

s/e of topiramate

A

temporary or permanent vision loss

decreased sweating

67
Q

chronic side effects of zonisamide are similar to ___

A

topiramate

68
Q

levetiracetam has few ___

A

drug interactions

69
Q

levetiracetam is available ___

A

IV & PO

70
Q

Gabapentin and Pregabalin are ____ analogs

A

GABA

71
Q

Gabapentin and Pregabalin have no __ and are not ___

A

drug interactions; first line

72
Q

Phenobarbital is anticonvsulant of choice in ___

A

pregnancy

73
Q

AAN opposes generic substitution of _____ for the treatment of ___ w/o physician approval

A

anticonvulsant drugs; epilepsy

74
Q

other uses of AEDs

A

neuropathic pain (gabapentin, pregabalin)
bipolar disorder
migraine

75
Q

life threatening emergency

A

status epilepticus

76
Q

mortality of status epilepticus

A

20%

77
Q

causes of status epilepticus

A

anti epileptic drug noncompliance/discontinuation
withdrawal syndromes
brain injury
metabolic abnormalities
drug use/overdose that lowers seizure threshhold

78
Q

brain injury that could cause status epilepticus

A

tumor
stroke
anoxia
hypoxia

79
Q

metabolic abnormalities that cause status epilepticus

A

decreased glucose
decreased Na
decreased Ca
decreased Mg

80
Q

drugs that lower seizure threshold

A

imipenem (primaxin)
high dose penicillin G (IV PCN)
lidocaine

81
Q

imipenem lowers the seizure threshold LESS w/ ))))

A

meropenem merrem

82
Q

Treatment for status epilepticus

A 
diazepam
lorazepam
phenytoin
fosphenytoin
phenobarbital
83
Q

in status epilepticus inject ___ directly

A

diazepam

84
Q

diluting diazepam in status epilepticus causes ___

A

precipitation

85
Q

diazepam typically provides _____

A

30-40 min seizure-free interval

86
Q

sometimes diazepam provides <20 minute seizure free interval due to

A

redistribution into adipose

87
Q

recent study found lorazepam more effective then ____

A

phenytoin

88
Q

lorazepam is easier to use than:

A

diazepam + phenytoin

phenobarbitol

89
Q

lorazepam is most effective in treating seizures w/I _____ and maintaining a seizure free state in the first ______

A

20 mins; 60 mins after treatment

90
Q

lorazepam is ___ than diazepam

A

longer lasting

91
Q

lorazepam may be diluted wiht ____

A

equal volumes of 0.9 NaCl (NS)

92
Q

Phenytoin _____ IV load

A

15-20mg

93
Q

phenytoin has better results in status epilepticus with ___ dosage

A

higher end 18-20mg

94
Q

infuse phenytoin no faster than ___

A

50mg/min

95
Q

may need to slow down phenytoin infusion due to ___

A

hypotension

96
Q

pro-drug of phenytoin

A

fosphenytoin

97
Q

fosphenytoin is highly _____

A

water soluble

98
Q

fosphenytoin is unlikely to ___

A

precipitate

99
Q

fosphenytoin allows for ___ administration

A

IM

100
Q

fosphenytoin has less hypotension than with ___

A

phenytoin

101
Q

you can infuse fosphenytoin ___

A

faster (150mg/min)

102
Q

___mg fosphenytoin = ~ ___mg of phenytoin

A

1.5 mg; 1mg

103
Q

fosphenytoin is dosed in terms of ____

A

phenytoin equivalents (PE)

104
Q

fosphenytoin can be mixed in ___

A

any solution

105
Q

if refractory give phenobarbital at ___ dose

A

IV, 15-20mg/kg @ 50 mg/min

106
Q

Phenobarbital is not used firs line due to

A

slow administration
prolonged sedation
greater risk of hypotension/hypoventilation
little-used controlled substance (not quickly available)

107
Q

half life of phenobarbitol

A

80-100 hours.

Pharm Unit 4 (3 decks)

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