epilepsy

Question 1

1st gen anticonvulsants

Answer 1

• Phenytoin/fosphenytoin
• Valproic Acid
• Carbamazepine
• Ethosuximide
barbituates
benzos

Question 2

3 AEs that would req discontinuation of 1st gen anticonvulsants

Answer 2

rash, blood disorders, hepatotoxicity

Question 3

class: Phenobarbital, pentobarbital, mysoline

Answer 3

barbituates

Question 4

most concerning SE of phenobarbital

Answer 4

decrease in cognitive function (IQ, attention, memory dysfunction)

Question 5

AEs (dose related): ataxia, memory impairment, sedation, slowed thinking, abuse potential,
dependence/withdrawal, residual hangover effects

Answer 5

benzos

Question 6

Phenytoin/Fosphenytoin enzyme metabolism

Answer 6

3A4 inducer (increased plasma concentration w/ estrogen, warfarin)

Question 7

AEs:
o Nystagmus, dizziness, diplopia, ataxia
o Hirsutism, gingival hyperplasia, anemia, severe rash
§ HLA-B1502 allele at increased risk of cutaneous rxn (SJS, TEN)
o Potential teratogen

Answer 7

Phenytoin/Fosphenytoin (First Generation AED)

Question 8

which1st gen anticonvulsant has the most interactions

Answer 8

Phenytoin/Fosphenytoin (First Generation AED)

Question 9

First line for absence seizures

Answer 9

Ethosuximide

Question 10

AEs:
o N/V, anorexia, rash, drowsiness, hyperactivity
o Possible agranulocytosis, aggressive behavior

Answer 10

Ethosuximide

Question 11

pt counseling for ethosuximide

Answer 11

take w/ food/milk to decrease GI upset

Question 12

Valproic Acid contra

Answer 12

kids <2 yrs

Question 13

main Valproic Acid interactions

Answer 13

VPA + lamotrigine = increased lamotrigine levels
o Carbamazepine and phenytoin

Question 14

AEs:
o GI (loss of appetite, nausea, dyspepsia, diarrhea)
§ Reduced by administration w/ food and XR formulation
o Thrombocytopenia (reversible)
o Tremor – alleviated by BB (propranolol)
o Sedation
o Alopecia
o Hepatotoxicity – hepatic necrosis
o Pancreatitis (severe)
o Hyperammonemia

Answer 14

Valproic Acid (

Question 15

most common AEs of Valproic Acid

Answer 15

GI (loss of appetite, nausea, dyspepsia, diarrhea)
§ Reduced by administration w/ food and XR formulation
o Thrombocytopenia (reversible)
o Tremor – alleviated by BB (propranolol)
o Sedation

Question 16

valproic acid monitoring

Answer 16

monitoring: thrombocytopenia, LFTs, derm (alopecia)

Question 17

AEs: hyponatremia, agranulocytosis, aplastic anemia
common: drowsiness, dizziness, ataxia, lethary, confusion, GI upset, hyponatremia

Answer 17

Carbamazepine

Question 18

Carbamazepine BBW

Answer 18

epidermal necrolysis, SJS, TEN
o Related to gene HLA B1502

Question 19

monitoring for Carbamazepine

Answer 19

CBC, BMP, dermatologic exams

Question 20

(2nd Generation)
• Analog of carbamazepine
o Does not cause hematologic adverse effects
o Less drug-drug interactions

Answer 20

Oxcarbazepine

Question 21

AEs (dose related): diplopia, dizziness, somnolence, hyponatremia

Answer 21

Oxcarbazepine

Question 22

Mainly used in Lennox-Gastaut Syndrome

Answer 22

Felbamate

Question 23

AEs (dose related/idiosyncratic): aplastic anemia, hepatotoxicity
o Written consent before giving

Answer 23

Felbamate

Question 24

AEs: somnolence, abnormal thinking, dizziness, ataxia, weight gain

Answer 24

gabapentin, lyrica

Question 25

First line in pregnancy

Answer 25

Lamotrigine, Keppra (monitoring req for both)

Question 26

AEs: o Maculopapular rash (common) § Progresses into SJS § Increased risk w/ rapid dose titration, when given w/ VPA, or in peds

Answer 26

lamotrigine

Question 27

lamotrigine dosing considerations

Answer 27

start low, go slow

Question 28

counseling for lamotrigine

Answer 28

Lamotrigine reduces efficacy of combined OCPs

Question 29

AEs: somnolence, dizziness, cognitive slowing, paresthesia, mild blurry vision, altered sense of taste (esp w/ carbonated drinks), inc risk of kidney stones, metabolic acidosis, glaucoma

Answer 29

topamax

Question 30

indication: infantile spasms

Answer 30

(Vigabatrin)

Question 31

BBW for Vigabatrin

Answer 31

BBW: PERMANENT VISION LOSS

Question 32

AEs: o Common: somnolence, fatigue, dizziness, URI o Less common: ataxia, asthenia o Rare: agranulocytosis, SJS, aggressive behavior

Answer 32

Keppra

Question 33

Zonisamide contra

Answer 33

Sulfonamide derivative (avoid w/ sulfa allergy)

Question 34

Perampanel abuse potential?

Answer 34

yes, sched 3

Question 35

Brivaracetam safe in pregnancy?

Answer 35

yes

Question 36

Avoid the following in absence and myoclonic seizures – can worsen seizure

Answer 36

Carbamazepine o Oxcarbamazepine o Gabapentin/pregabalin o Tigabine

Question 37

most likely to cause failure of combined OCPs

Answer 37

Carbamazepine

Question 38

highest risk for malformations in fetus

Answer 38

valproate

Question 39

Initial Tx of Status Epilepticus

Answer 39

• Lorazepam IV (alternative: diazepam) o Wait 3 to 5 minutes for response, then additional lorazepam PRN • If no IV access – midazolam IM • In second IV: Fosphenytoin OR VPA OR levetiracetam OR Phenytoin