Antiseizure/Status Epilepticus

Question 1

When do you initiate anti seizure drug therapy in patients?

Answer 1

2+ unprovoked seizures

Question 2

When do you consider discontinuing ASD therapy

Answer 2

1. Seizure free for 2-4 years
2. Complete seizure control within one year of onset
3. Onset of seizure between 2-35 years of age
   AND normal neurologic exam/EEG

Question 3

List the 3 MOA of ASDs

Answer 3

1. Increase GABAeric inhibitory transmission
2. Decrease Glutamatergic excitatory transmission
3. Modify ionic conductance-nerve impulse propagation

Question 4

List the presynaptic voltage gated Na+ channel drugs

Answer 4

1. Phenytoin
2. Carbamazepine
3. Lamotrigine
4. Lacosamide

Question 5

List the presynaptic voltage gated Ca++ channel drugs

Answer 5

1. Ethosurimide
2. Lamotrigine
3. Gabapentin
4. Pregabalin

Question 6

List the presynaptic voltage gated K+ channel drug

Answer 6

Retigabine

Question 7

list the synaptic vesicle protein (SV24) drug

Answer 7

Levetiractam

Question 8

List the two postsynaptic drugs

Answer 8

1. AMPA Receptors

2. NMDA receptors

Question 9

What drugs block the AMPA receptor

Answer 9

1. Phenobarbital
2. Topiramate
3. Lamotrigine
4. Perampanel

Question 10

List the GABA A receptor drug

Answer 10

Benzodiazepines

• Diazepam
• Lorazepam

Question 11

Absence treatment

Answer 11

1. Ethosuximide
2. Lamotrigine
3. Valproic acid

Question 12

Ethosuximide MOA

Answer 12

1. Decrease VG-Ca++ currents

2. Decrease glutamate

Question 13

Ethosuximide clinical application (what sz tx?)

Answer 13

Generalized Absence

Question 14

Ethosuximide SEs

Answer 14

1. Headache

2. Blood dyscrasias

Question 15

Lamotrigine (Lamictal) MOA

Answer 15

1. Blocks Na+ and Ca++ channels

2. Decreases glutamate

Question 16

Lamotrigine (Lamictal) MOA clinical applications

Answer 16

1. Generalized tonic-clonic
2. Focal aware/impaired
3. Focal or Generalized 4.Myoclonic
4. Generalized Absence

Question 17

Lamotrigine (Lamictal) SE’s

Answer 17

1. Black box warning: Serious skin rash-start low and go slow
2. Diplopia

Question 18

Valporic acid (Depakote) MOA

Answer 18

Alters synthesis and degradation of GABA

Question 19

Valporic acid (Depakote) clinical application

Answer 19

1. Generalized tonic-clonic
2. Focal aware/impaired
3. Focal or Generalized 4.Myoclonic
4. Generalized Absence

Question 20

Valporic acid (Depakote) SEs

Answer 20

1. Heptatotoxicity
2. Pancreatitis
3. Teratogenic-Don’t give to women of child bearing age
4. Alopecia

Question 21

Clonazepam MOA

Answer 21

Enhance GABAA receptor responses

Question 22

Clonazepam clinical application

Answer 22

1. Generalized Absence
2. Focal or Generalized
3. Myoclonic
4. Infantile spasms

Question 23

Clonazepam SEs

Answer 23

Sedation

Question 24

Topiramate (Topamax) clinical application

Answer 24

1. Generalized tonic-clonic
2. Generalized absence
3. Focal aware/impaired
4. Migraine

Question 25

Topiramate (Topamax) SE's

Answer 25

1. Cognitive slowing | 2. Confusion

Question 26

Drugs to avoid in absence seizures

Answer 26

1. Carbamazepine 2. Vigabatrin 3. Gagapentin 4. Tiagabin

Question 27

Ineffective drugs in absence seizures

Answer 27

1. Phenytoin | 2. Phenobarbital

Question 28

What are the 3 FDA approved meds to treat tonic-clonic seizures?

Answer 28

1. Lamotrigine 2. Levatriacetam 3. Perampanel

Question 29

tonic-clonic seizure US guideline treatment

Answer 29

Topiramate (Topimax)

Question 30

Levatriacetam (Keppra) MOA

Answer 30

Binds synaptic protein

Question 31

Levatriacetam (Keppra) SE's

Answer 31

1. Behavioral problems | 2. HA

Question 32

Carbamazepime (Tegretol) MOA

Answer 32

1. Blocks voltage-gated Na+ channels | 2. Decreases glutamate release

Question 33

Carbamazepime (Tegretol) Box warning

Answer 33

1. Serious dermatologic reaction: TEN & SJS | 2. Asians: Aplastic anemia and agranulocytosis

Question 34

Carbamazepime (Tegretol) ADEs

Answer 34

1. Hyponatremia 2. Metabolic Bone Dz (MBD) 3. Ataxia 4. Diplopia

Question 35

Lacosamide ADE's

Answer 35

EKG changes- small increase in PR interval

Question 36

Phenytoin (Dilantin) MOA

Answer 36

Blocks voltage-gated Na+ channels

Question 37

Phenytoin (Dilantin) Box warning

Answer 37

CV risk associated with rapid infusion

Question 38

Phenytoin (Dilantin) ADEs

Answer 38

1. Nystagmus-often the first sx of toxicity 2. Gingival hyperplasia 3. Hirsutism 4. Folate deficiency (supplement with folate) 5. Neuropathy

Question 39

Phenobarbitol ADEs

Answer 39

1. Intellectual blunting 2. MBD 3. Behavior changes

Question 40

What is unique about the Phenobarbitol drug reaction?

Answer 40

Idiosyncratic- reactionspecific to pt

Question 41

What will happen if you continue to increase the Phenobarbitol dose?

Answer 41

Patient will die

Question 42

Gabapentin (Neurontin) ADEs

Answer 42

1. Somnolence-"Brain fog' 2. Ataxia 3. Weight gain

Question 43

Pregablin (Lyrica) ADE's

Answer 43

1. Somnolence-"Brain fog' 2. Ataxia 3. Weight gain

Question 44

Vigabatrin (sabril) box warning

Answer 44

Permanent vision loss

Question 45

Perampanel (Fycompa) Box warning

Answer 45

Serious psychiatric and behavioral rxn

Question 46

Tiagabine (Gabitril) ADEs

Answer 46

1. Concentration and attention difficulties 2. Behavioral disturbances 3. Increased appetite

Question 47

Zonisamide MOA

Answer 47

blocks Na+ channel

Question 48

Zonisamide ADEs

Answer 48

1. Cognitive slowing 2. Rash-Sulfa based drug 3. Paresthesia 4. Kidney stones 5. Oligohydrosis

Question 49

What do you want to consider using in a female who takes Phenytoin d/t its drug interactions?

Answer 49

Interacts with oral contraceptives | -Consider IUD or patch

Question 50

If a patient comes in who takes Carbamazepine and is having a seizure, what do you want to check first? why?

Answer 50

Check serum level of Carbamazepine because this drug is induces it's own metabolism

Question 51

What drug has rare or minimal drug interactions?

Answer 51

Lamotrigine