Antiseizure/Status Epilepticus Flashcards

(51 cards)

1
Q

When do you initiate anti seizure drug therapy in patients?

A

2+ unprovoked seizures

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2
Q

When do you consider discontinuing ASD therapy

A
  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
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3
Q

List the 3 MOA of ASDs

A
  1. Increase GABAeric inhibitory transmission
  2. Decrease Glutamatergic excitatory transmission
  3. Modify ionic conductance-nerve impulse propagation
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4
Q

List the presynaptic voltage gated Na+ channel drugs

A
  1. Phenytoin
  2. Carbamazepine
  3. Lamotrigine
  4. Lacosamide
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5
Q

List the presynaptic voltage gated Ca++ channel drugs

A
  1. Ethosurimide
  2. Lamotrigine
  3. Gabapentin
  4. Pregabalin
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6
Q

List the presynaptic voltage gated K+ channel drug

A

Retigabine

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7
Q

list the synaptic vesicle protein (SV24) drug

A

Levetiractam

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8
Q

List the two postsynaptic drugs

A
  1. AMPA Receptors

2. NMDA receptors

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9
Q

What drugs block the AMPA receptor

A
  1. Phenobarbital
  2. Topiramate
  3. Lamotrigine
  4. Perampanel
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10
Q

List the GABA A receptor drug

A

Benzodiazepines

  • Diazepam
  • Lorazepam
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11
Q

Absence treatment

A
  1. Ethosuximide
  2. Lamotrigine
  3. Valproic acid
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12
Q

Ethosuximide MOA

A
  1. Decrease VG-Ca++ currents

2. Decrease glutamate

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13
Q

Ethosuximide clinical application (what sz tx?)

A

Generalized Absence

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14
Q

Ethosuximide SEs

A
  1. Headache

2. Blood dyscrasias

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15
Q

Lamotrigine (Lamictal) MOA

A
  1. Blocks Na+ and Ca++ channels

2. Decreases glutamate

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16
Q

Lamotrigine (Lamictal) MOA clinical applications

A
  1. Generalized tonic-clonic
  2. Focal aware/impaired
  3. Focal or Generalized 4.Myoclonic
  4. Generalized Absence
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17
Q

Lamotrigine (Lamictal) SE’s

A
  1. Black box warning: Serious skin rash-start low and go slow
  2. Diplopia
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18
Q

Valporic acid (Depakote) MOA

A

Alters synthesis and degradation of GABA

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19
Q

Valporic acid (Depakote) clinical application

A
  1. Generalized tonic-clonic
  2. Focal aware/impaired
  3. Focal or Generalized 4.Myoclonic
  4. Generalized Absence
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20
Q

Valporic acid (Depakote) SEs

A
  1. Heptatotoxicity
  2. Pancreatitis
  3. Teratogenic-Don’t give to women of child bearing age
  4. Alopecia
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21
Q

Clonazepam MOA

A

Enhance GABAA receptor responses

22
Q

Clonazepam clinical application

A
  1. Generalized Absence
  2. Focal or Generalized
  3. Myoclonic
  4. Infantile spasms
23
Q

Clonazepam SEs

24
Q

Topiramate (Topamax) clinical application

A
  1. Generalized tonic-clonic
  2. Generalized absence
  3. Focal aware/impaired
  4. Migraine
25
Topiramate (Topamax) SE's
1. Cognitive slowing | 2. Confusion
26
Drugs to avoid in absence seizures
1. Carbamazepine 2. Vigabatrin 3. Gagapentin 4. Tiagabin
27
Ineffective drugs in absence seizures
1. Phenytoin | 2. Phenobarbital
28
What are the 3 FDA approved meds to treat tonic-clonic seizures?
1. Lamotrigine 2. Levatriacetam 3. Perampanel
29
tonic-clonic seizure US guideline treatment
Topiramate (Topimax)
30
Levatriacetam (Keppra) MOA
Binds synaptic protein
31
Levatriacetam (Keppra) SE's
1. Behavioral problems | 2. HA
32
Carbamazepime (Tegretol) MOA
1. Blocks voltage-gated Na+ channels | 2. Decreases glutamate release
33
Carbamazepime (Tegretol) Box warning
1. Serious dermatologic reaction: TEN & SJS | 2. Asians: Aplastic anemia and agranulocytosis
34
Carbamazepime (Tegretol) ADEs
1. Hyponatremia 2. Metabolic Bone Dz (MBD) 3. Ataxia 4. Diplopia
35
Lacosamide ADE's
EKG changes- small increase in PR interval
36
Phenytoin (Dilantin) MOA
Blocks voltage-gated Na+ channels
37
Phenytoin (Dilantin) Box warning
CV risk associated with rapid infusion
38
Phenytoin (Dilantin) ADEs
1. Nystagmus-often the first sx of toxicity 2. Gingival hyperplasia 3. Hirsutism 4. Folate deficiency (supplement with folate) 5. Neuropathy
39
Phenobarbitol ADEs
1. Intellectual blunting 2. MBD 3. Behavior changes
40
What is unique about the Phenobarbitol drug reaction?
Idiosyncratic- reactionspecific to pt
41
What will happen if you continue to increase the Phenobarbitol dose?
Patient will die
42
Gabapentin (Neurontin) ADEs
1. Somnolence-"Brain fog' 2. Ataxia 3. Weight gain
43
Pregablin (Lyrica) ADE's
1. Somnolence-"Brain fog' 2. Ataxia 3. Weight gain
44
Vigabatrin (sabril) box warning
Permanent vision loss
45
Perampanel (Fycompa) Box warning
Serious psychiatric and behavioral rxn
46
Tiagabine (Gabitril) ADEs
1. Concentration and attention difficulties 2. Behavioral disturbances 3. Increased appetite
47
Zonisamide MOA
blocks Na+ channel
48
Zonisamide ADEs
1. Cognitive slowing 2. Rash-Sulfa based drug 3. Paresthesia 4. Kidney stones 5. Oligohydrosis
49
What do you want to consider using in a female who takes Phenytoin d/t its drug interactions?
Interacts with oral contraceptives | -Consider IUD or patch
50
If a patient comes in who takes Carbamazepine and is having a seizure, what do you want to check first? why?
Check serum level of Carbamazepine because this drug is induces it's own metabolism
51
What drug has rare or minimal drug interactions?
Lamotrigine