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adult seizure Flashcards

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1
Q

Which ASM to use for treatment-resistant epilepsy level A

A

pregabalin, perampanel

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2
Q

Which ASM to use for treatment-resistant epilepsy level B

A

lacosamide, eslicarbazepine

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3
Q

Which ASM to use for treatment-resistant epilepsy level C

A

clobazam, oxcarbazepine

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4
Q

ASMs that lower folic acid and vitamin K

A

CBZ, PB, PHT, primidone, VPA

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5
Q

ASMs that lower estrogen

A

CBZ, OXB, PHT, PB, TPM

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6
Q

Aromatic ASMs

A

CBZ, OXB, PB, PHT

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7
Q

When can a pt D/C ASM

A

-seizure free for 2-5 yr
-Hx of single type of focal or primary generalized seizure
-Normal neurologic exam and IQ
-EEG has normalized with treatment

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8
Q

ASMs likely to exacerbate generalized seizures

A

CBZ, OXB, GBP, pregablin, LTG, PHT, tiagabine, vigabatrin

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9
Q

ASMs likely to exacerbate Lennox-Gastaut syndrome

A

lacosamide, phenobarbital +same as generalized

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10
Q

Carbamazepine CI

A

TCA or CBZ allergy
hx myelosuppression
concomitant nefazodone

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11
Q

Carbamazepine Warnings/ADRs

A

-hyponatremia, SIADH, cardiac, osteoporosis
-hepatotoxicity linked to aliphatic epoxide
-SJS/TEN in HLA-B*1502 Asian descent
-Aplastic anemia/agranulocytosis
-Drug reaction with eosinophilic/systemic symptoms

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12
Q

Which ASMs are autoinducers

A

carbamazepine (titrate over 3-4 weeks to target dose)

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13
Q

Which ASMs are autoinhibitors

A

VPA (autoinhibits its own glucuronidation)

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14
Q

Which ASMs are teratogenic

A

phenytoin, topiramate, carbamazepine

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15
Q

Carbamazepine target serum levels

A

4-12 mcg/mL

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16
Q

Phenytoin target serum levels (total)

A

10-20 mcg/mL

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17
Q

Phenytoin target serum levels (free)

A

1-2 mcg/mL

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18
Q

Oxcarbazepine Warnings/ADRs

A

-Cross hypersensitivity with CBZ
-Hyponatremia
-less hepatotoxic than CBZ

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19
Q

Oxcarbazepine metabolism

A

inducer of 3A4, 3A5
Inhibitor of 2C19

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20
Q

Phenytoin CI

A

-delavirdine
-IV admin in pts with bradycardia, sinoatrial block, 2/3rd degree AV block, Adams-stokes

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21
Q

Phenytoin Warnings/ADRs

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A

Porphyria exacerbation
renal/hepatic impairment
hypoalbuminemia
hyperglycemia
hirsutism, gingival hyperplasia, acne
folate deficiency
cardiovascular events (BBW)

22
Q

Phenobarbital CI

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A

porphyria
impaired hepatic function
respiratory disease w/ obstruction/dyspnea
substance abuse

23
Q

Phenobarbital Warnings/ADRs

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A

-Paradoxical stim response (children)
-Respiratory depression
-Habit forming (C IV)

24
Q

Phenobarbital target serum level

25
Phenobarbital MoA
GABA modulator
26
Gabapentin MoA
Ca channel inhibitor (alpha-2-delta subunit)
27
Gabapentin Warnings/ADRs
-Tumorigenic potential -peripheral edema, weight gain
28
Which ASMs have no CYP450 interactions
Gabapentin, pregabalin, levetiracetam
29
Which ASMs are controlled substances
Pregabalin (CV) Phenobarbital (CIV) Lacosamide (CV)
30
Pregabalin MoA
Ca channel inhibitor (alpha-2-delta subunit)
31
Pregabalin CI
angioedema
32
Pregabalin Warnings/ADRs
-peripheral edema -thrombocytopenia/dec. platelet count -prolonged PR interval -Rhabdomyolysis -weight gain -tumorigenic potential -blurred vision
33
VPA MoA
Sodium channel blocker Calcium channel blocker GABA modulator
34
VPA CI
hepatic disease urea cycle disorders women of childbearing age not using contraception
35
VPA Warnings/ADRs
-severe hepatotoxicity and pancreatitis -structural birth defects -hyperammonemia (errors of ammonia metabolism) -hypothermia -thrombocytopenia -weight gain -false + for urine ketone and altered thyroid tests
36
VPA target serum level
50-150 mg/L
37
VPA: if switching from ___ to ___ formulation, consider a slight dose increase due to differences in F
delayed release to extended release
38
Zonisamide MoA
sodium channel blocker Calcium channel blocker Increases dopamine
39
Zonisamide Warnings/ADRs
-Metabolic acidosis -Nephrolithiasis -Oligohydrosis/hyperthermia -Renal dysfunction -depression, psychosis, cognitive dulling -weight loss -paresthesias
40
Lamotrigine MoA
block sodium block calcium decreases glutamine release
41
Lamotrigine Warnings/ADRs
-phenylketonurics -HLH -aseptic meningitis -blinding in eye, blurred vision -false + for PCP -hepatic failure
42
Topiramate MoA
block sodium channel GABA modulator block carbonic anhydrase block AMPA/kinase subtypes of glutamate receptors
43
Topiramate Warnings/ADRs
-Metabolic acidosis -Nephrolithiasis -Oligohydrosis/hyperthermia -acute myopia, glaucoma, increase intraocular pressure -hyperammonemia -encephalopathy -weight loss -dyspepsia
44
Levetiracetam MoA
unknown - binds SV2A and inhibits presynaptic calcium channels
45
Levetiracetam CI
angioedema and anaphylaxis
46
Levetiracetam Warnings/ADRs
-Angioedema -anaphylaxis -mood changes: psychosis, anger, aggression, depression
47
Levetiracetam elimination
70% renal 30% hepatic dose adjust with CrCl
48
Ethosuximide ADRs
SJS, leukopenia, eosinophilia, thrombocytopenia, systemic lupus, headache
49
Drugs reported to cause convulsions
clozapine, meperidine, antimicrobials, bupropion, venlafaxine, amphetamines, cocaine, MDMA/ecstasy, drug withdrawal (ASMs, alcohol, sedative-hypnotics)
50
DDI: VPA decreases
PHT total, CBZ total, TPM and TGB
51
DDI: VPA increases
PHT unbound, CBZ unbound, CBZ epoxide, PB, felbamate, LTG, ethosuximide, tiagabine unbound, ZNS
52
DDI: VPA is increased by inducers like
CBZ, PHT, PB

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