Epilepsy Flashcards by Nicole Castoro

Partial seizure

start at focus

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Simple partial seizure

type of partial
spread is limited
stay awake, memory intake

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Complex partial seizure

type of partial
alteration of consciousness - appear confused

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Generalized seizures

not linked to single foci
involves entire cerebrum

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Absence seizures

Petit Mal
type of generalized
disruption in intentional behavior effects consciousness and memory

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Simple ansence seizures

type of generalized
usually grow out of it

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Tonic clonic seizures

Grand mal
type of generalized
have 3 phases

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3 phases of tonic clonic seizures

initial tonic phase
clonic phase
terminal phase

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Epilepsy

2 seizures unattributed to some other disease process

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Goal of therapy

least seizures least AEs

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Phenobarbital abbrev.

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Phenytoin abbrev.

PHT

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Phenytoin brand

Dilantin

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Primidone abbrev.

PRM

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Primidone brand

Mysoline

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Ethosuximide abbrev.

ETX

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Ethosuximide brand

Zarontin

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Carbamazepine abbrev.

CBZ

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Carbamazepine brand

Tegretol

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Valproic acid abbrev.

VPA

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Valproic acid brand

Depakene, Depakote

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Felbamate abbrev.

FBM

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Felbamate brand

Delbatol

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Gabapentin abbrev.

GBP

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Gabapentin brand

Neurotin

Topiramate abbrev.

TPM

Topiramate brand

Topamax

Lamotrigine abbrev.

LTG

Lamotrigine brand

Lamictal

Levetiracetam abbrev.

LEV

Levetiracetam brand

Keppra

Oxcarbazepine abbrev.

OXC

Oxcarbazepine brand

Trileptal

Zonisamide abbrev.

ZNS

Zonisamide brand

Zonegran

Pregabalin abbrev.

PBG

Pregabalin brand

Lyrica

Tigabine abbrev.

TGB

Tigabine brand

Gabitril

LAcosamide abbrev.

LAC

Lacosamide brand

Vimpat

Rufinamide abbrev.

RUF

Rufinamide brand

Banzel

Vigabatrin abbrev.

VGT

Vigabatrin brand

Sabril

Clobazam abbrev.

CLB

Clobazam brand

Obfi

Ezogabine abbrev.

EZG

Ezogabine brand

Potiga

Perampanel abbrev.

PRP

Perampanel brand

Fycompa

Eslicarbazepine abbrev.

ECBZ

Esilcarbazepine brand

Aptiom

Brivaracetam abbrev.

BRV

Brivaracetam brand

Briviact

Keppra MOA

glutamate receptor antagonist

Keppra monitoring

dose adjust based on GFR

Keppra AEs

Weight gain enhances CNS depressants

Oxcarbazepine use

adjunctive in partial seizures in children 6 and older

Oxcarbazepine monitoring

sodium, sometimes hepatic, no routine bloodwork

Oxcarbazepine AEs

more common in kids HA, dizzy, N/V RASH

Oxcarbazepine benefit

lower potential for DDI

Lamotrigine use

Partial onset, absence, generalized

Lamotrigine MOA

Na channel blockade, H current enhancement, glutamate receptor antagonist

Oxcarbazepine MOA

Na channel blockade, GABA enhancement

Lamotrigine AEs

SJS more common with fast titrate and with VPA

Lamotrigine Advantage

Broad spectrum, low teratogenic, non sedative

Gabapentin use

partial seizures - mono or add on

Gabapentin MOA

Ca channel blockade, H current enhancement, glutamate receptor antagonist

Gabapentin AEs

dizzy, ataxia, weight gain, abuse Higher dose = less % absorbed

Gabapentin Advantage

no PK DDI, low neurotoxic, use for bipolar and neuropathic

Phenytoin use

Generalized seizures

Phenytoin MOA

Na channel blockade, glutamate receptor antagonist

Phenytoin monitoring

when giving IV monitor cardiac and BP

Phenytoin AEs

capacity limited metabolism, concentration dependent nystagmus, double vision idiosyncratic: aplastic anemia, granulocytopenia, SJS Chronic: gum hypertrophy, osteoporosis, fetal vitamin K depletion

Fosphenytoin purpose

Prodrug for phenytoin, for IV and IM

Valproate MOA

Na channel blockade, Ca channel blockade, GABA enhancement

Valproate monitoring

baseline LFTs, platelets coagulation prior to surgery, periodic serums

Valproate AEs

N/V/D, increase LFTs, spina bifida, drowsy, hair loss, weight gain

Valproate C/Is

Hepatic dysfunction or disease

Valproate DDIs

decreased by CBZ, LTG, PHT, rifampin increased by ASA, chlorpromazine, cimetidine, felbamate

Carbamazepine use

Partial seizures, secondarily generalized seizures

Carbamazepine MOA

Na channel blockade, GABA enhancement

Carbamazepine monitoring

baseline CBC and monitor if decrease in WBC, LFTs occasionally serum monitoring weekly during first

Carbamazepine AEs

dizzy, HA, N/V, hyponatremia and water intoxication, diarrhea, diarrhea, transient leukopenia or aplastic anemia

Carbamazepine C/Is

d/c if leukopenia ANC < 1500 d/c MAOi's 14 days before

Carbamazepine DDIs

stimulates 3A4s - metabolize anticoags, OCs, cyclosporine, doxy, theophylline metabolism inhibited by cimetidine, clarithro, erythro, fluoxetine

AEDs that increase chance of pregnancy

enzyme inducing Phenobarb, pheny, primidone, carbamazepine inc. clearance of OC's

AEDs to avoid in pregnancy

VPA + CBZ LTG PB - neonatal withdrawal

Breastfeeding C/Is

Ethosuximide, zonisamide, clonazepam, diazepam