26 - Seizures/Epilepsy Flashcards Preview

PEBC > 26 - Seizures/Epilepsy > Flashcards

Flashcards in 26 - Seizures/Epilepsy Deck (46):
1

non-pharms for seizure

-avoid sleep deprivation
-keep alcohol consumption to a minimum
-avoid cocaine and amphetamines
-ketogenic or atkins diet may decrease seizure frequency
-yoga or mildfulness-based therapy may help

2

if sensitive to phenytoin, avoid _____

carbamazepine

3

first line for absence seizures

ethosuximide

4

What is primidone's active metabolite?

phenobarbital

5

Definition of epilepsy?

-either 2 unprovoked seizures occurring more than 24 hours apart, 1 unprovoked seizure at a high (>60%) probability of further seizures over the next 10 years or 1 unprovoked seizure and a clearly identifiable epilepsy syndrome

6

An aura indicates the onset of what type of seizure?

focal (partial) seizure

7

What is a simple partial seizure?

-focal seizures without impairment of awareness
-usually brief, less than 60 seconds

8

What is a complex partial seizure?

focal seizures with impairment of awareness
-usually last 1-2 mins

9

List the 4 types of generalized seizures

-Absence
-Generalized tonic-clonic
-Atonic
-Myoclonic

10

Describe an absence seizure (petit-mal)

-usually lasts only 5-10 seconds
-can recur daily
-no warning signs
-onset in childhood

11

Describe a generalized tonic-clonic seizure (grand-mal)

-tonic/clonic phases
-can begin as a focal seizure or can involve entire brain at onset

12

Describe an atonic seizure

-abrupt loss of consciousness and muscle tone
-return to awareness in seconds

13

Describe myoclonic seizures

-"shock-like" jerks

14

Which AEDs can we measure serum levels for

phenytoin, phenobarbital, primidone, CBZ, VPA

15

First choice monotherapy for generalized tonic-clonic

-CBZ
-lamotrigine
-levetiracetam
-phenytoin
-VPA/divalproex

16

First choice montherapy for absence seizures

ethosuximide

17

First choice monotherapy for myoclonic and atonic seizures

VPA/divalproex

18

First choice monotherapy for focal (partial) seizures with or without secondary generalization

-CBZ
-lamotrigine
-levetiracetam
-phenytoin

19

Women of childbearing age taking an AED should receive what daily supplementation to prevent neural tube defects?

folic acid 1 mg daily

20

_____ may be better tolerated than CBZ and have similar effectiveness in obtaining long-term seizure freedom

lamotrigine

21

____ may be superior to lamotrigine and topiramate

VPA

22

For childhood absence epilepsy, ____ and _____ are similarly effective in preventing seizures and both meds are superior to lamotrigine

ethosuximide and BPA

23

Ethosuximide is associated with lower rates of ______ difficulties than VPA so it is first choice for childhood absence epilepsy

attention

24

For patients with traumatic brain injury, AEDs prevent seizures in the first ___ days after the injury but have no effect on development of later seizures

7

25

What are some dose-related adverse effects of AEDS?
How do you manage them?

-dizziness, sedation, fatigue, cognitive and psychiatric symptoms, nausea
-try reducing the dose or slow release formulation or more frequent administration with lower doses of IR AED

26

What is an idiosyncratic reaction to AED?

skin rash

27

Which AEDs are most likely to cause skin rash

phenytoin, CBZ, lamotrigine

28

When is rash most likely to occur?

within 6 weeks but can occur at any time

29

If a definite drug rash develops, how do you manage this?

stop AED. Continuation can result in SJS

30

What type of people are at higher risk for CBZ-associated rash?

Han Chinese descent with certain human leukocyte antigen (HLA) status

*consider checking HLA status in these patients before starting CBZ therapy

31

AEDs can also cause other idiosyncratic reactions such as ?

hematopoiesis or hepatic toxicity

32

Long-term use of enzyme-inducing AEDs and VPA have been associated with what?

increased risk fo low bone density and fracture

33

Pre-pregnancy considerations:
Ideally if patient on COC, how much estrogen should it have if they're on enzyme inducing AED?

> 50 mcg EE but no COC products currently available with EE > 35 mcg

34

Pre-pregnancy considerations:
What are some options for women to prevent pregnancy on enzyme inducing AEDs?

-depot shot
-IUD (hormonal and non-hormonal)
-barrier contraception (less effective)

35

Pre-pregnancy considerations:
Which AED is actually decreased by COCs?

lamotrigine

*levels can be expected to drop by at least 50% after starting COC
*consider doubling lamotrigine dose after starting a COC

36

If they are pregnant and on an anti-epileptic drug that will not be stopped, how much folic acid and when do they need it?

-Ideally 1mg folic acid daily at least 3 months prior to conception until 12 weeks gestation
-Then from 12 weeks gestation continuation through pregnancy and for 4-6 weeks postpartum or as long as breastfeeding continues, they need folic acid 0.4-1mg daily.

37

Which AEDs are associated with low rates of teratogenicity?

lamotrigine, levetiracetam and oxcarbazepine

38

Levels of AEDs can ____ when pregnancy due to increased clearance

decrease

39

If a pregnant person is controlled on an AED that may cause teratogenic effects do you switch?

No, the risk of congenital malformations is highest in 1st trimester when many women don't even know they are pregnant

A change in controlled therapy puts person at risk of another seizure which can harm the mom and fetus

40

What vitamin is routinely given to all newborns of a mom on an AED?

vitamin K bc enzyme-inducing AEDs can potentially increase the degradation of vitamin K in the fetus

41

Do you still recommend breastfeeding while on AED?

Yes

42

Infants whose mothers are taking _____ may be sedated

barbiturates

43

AED levels may _____ after delivery

increase

44

If a patient is controlled but they are below the serum target range, do you increase the drug.

no - "treat the patient, not the serum level"

45

Is CBZ a pro drug?

yes

46

100 mg phenytoin sodium = ___ mg phenytoin base

92

Decks in PEBC Class (130):