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CDM 4 Exam 3 > Lecture 2 - Seizures 1 > Flashcards

Lecture 2 - Seizures 1 Flashcards

1
Q

Non-pharm seizure treatments

A

Surgery =
Ketogenic Diet
Vagus Nerve stim
Seizure dogs

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2
Q

When is neurosurgery indicated

A

Failed 2-3 trials of meds
Has high efficacy with complex partial seizures of temporal lobe

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3
Q

Ketogenic Diet for seizures

A

High fat: Low protein + carb diet (4 to 1 calories)
no sugar

indicated for primarily young children with drug refactor seizures (Lennox-Gastaut
Potential for growth retardation n long term hyperlipidemia effects

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4
Q

Vagus Nerve Stimulation

A

implanted generator, intermittently stimulates left vagus nerve

about 1/2 pts see 50% reduction in seizures

infection risk at site, but fairly low

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5
Q

Vagus Nerve stimulation adverse effects

A

hoarseness
cough
throat pain
tingling at electrode site

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6
Q

Seizure dogs

A

dogs can predict seizure 15-45min before seizure

trained to alert seizure before happening, help prevent harm during seizure

usually in those that have >1 per month

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7
Q

Ideal AED properties

A

effective
QD or BID dosing
Low cost
Minimal side effects or major organ toxicity
Few or no DIs
Linear PK
Little or no allergic or idiosyncratic reactions
IV form

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8
Q

AED safety alert

A

inc risk of suicidal behavior

All pts currently taking or starting on any AED should be closely monitored for changes in behavior that could indicate emergence or worsening of suicidal thought or behavior or depression

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9
Q

General AED monitoring

A

QOL, Seizure freq, serum drug conc

toxic: specific drug Sessions, suicidal ideation/depression

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10
Q

General AED counseling

A
  1. explain use of drug n regimen
  2. stress adherence
  3. minimize alc and stress
  4. never abruptly stop, inc status epilepticus risk
  5. monitoring periodic blood lvls
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11
Q

Carbamazepine (Tegretol, carbatrol) MOA

A

Blocks Na+ and L-type Ca channels
blocks firing of AP, dec release of excitatory NMT

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12
Q

Carbamazepine (Tegretol, carbatrol) Side Effects

A

Agranulocytosis**
Aplastic Anemia**
SJS**

N/V
Dizziness
Headache
Nystagmus
Hyponatremia*
Osteoporosis*

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13
Q

Carbamazepine (Tegretol, carbatrol) Kinetics

A

Good absorption, food doesnt alter

Autoinduction, low lvls may not be non-adherence, ~4wks then take lvls

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14
Q

Carbamazepine (Tegretol, carbatrol) DDI

A

AEDs, oral contraceptives, warfarin. = dec lvls

Caffeine, Phenytoin = dec CBZ lvls

Clarithromycin, Diltiazem, Valproate, Verapamil = inc CBZ lvls

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15
Q

Carbamazepine (Tegretol, carbatrol) Monitoring

A

Therapeutic lvls = 4-12mg/dl
CBC (Na+)
Rash, SJS
BMD/fractures if on it for years

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16
Q

Carbamazepine (Tegretol, carbatrol) Common dose

A

600mg PO BID, adjusted based on drug lvls

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17
Q

Phenytoin (Dilantin) Side effects

A

Gingival hyperplasia
Behavior changes
Folate deficiency
Agranulocytosis*
SJS*
Lupus*

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18
Q

Phenytoin (Dilantin) Kinetics

A

Non-linear, zero order at therapeutic lvls
90% bound, 10% free and therapeutic effect
CYP450 inducer

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19
Q

Phenytoin (Dilantin) lvl if Hypoalbuminemia (< 4)

A

PHT(observed) / (0.2 X alb) + 0.1

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20
Q

Phenytoin (Dilantin) lvl if Hypoalbuminemia (<4) + Click < 20 or ESRD

A

PHT (observed) / (0.1 X alb) + 0.1

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21
Q

Phenytoin (Dilantin) toxicity

A

watch for inc N/V, Nystagmus, CNS depression

can occur at therapeutic lvls

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22
Q

Drugs that Phenytoin (Dilantin) will dec

A

Other AEDs
Warfarin
Digoxin
Oral contraceptives

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23
Q

Drugs that will inc Phenytoin (Dilantin) lvls

A

amiodarone
Fluc

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24
Q

Drugs that will dec Phenytoin (Dilantin) lvls

A

Antacids

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25
Q

Phenytoin (Dilantin) lvls

A

10-20 = therapeutic
SE > 15mg/L

Loading dose = 15-18mg/kg, dose on weight

usually 300mg per day good starting place

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26
Q

Fosphenytoin (Cerebyx) info

A

less toxic than IV phenytoin

Dose 300-400mg PE equiv per day

Max infusion rate - 150mg/min

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27
Q

Valproate (Depakote, Depakene) SE

A

a lot of weight gain
sedation
Folate deficiency
Hepatic failure*
Pancreatitis*
Teratogenic*
Rash/SJS*

28
Q

Valproate (Depakote, Depakene) is both…

A

Anti seizure and Anti-epileptogenic

29
Q

Does Valproate inc oral contraceptives?

A

nah

30
Q

Drugs that decrease Valproate lvls

A

Carbamazepine
Phenobarbital
Phenytoin

31
Q

Valproate (Depakote, Depakene) dosing

A

~ 500mg BID, done based on lvls

32
Q

Ethosuximide is only effective in what kind of seizures?

A

absence seizures

most common in kids

33
Q

Ethosuximide Side effects

A

Blood dyscrasia*
Liver failure*
Lupus*
Hiccups

34
Q

Ethosuximide dosing

A

250mg QD Peds 3-6yrs old, inc q 4-7 days

500mg QD >6yrs old, inc q4-7 days

35
Q

Primidone (Mysoline) info

A

pro drug converted into phenobarbital

36
Q

Phenobarbital info

A

take at HS due to sedation
not really used, last line

37
Q

Felbamate (Felbatol) rare used due to…

A

side effects

Aplastic anemia and hepatic failure**

38
Q

Gabapentin (Neurontin) dosing

A

400-600 TID
can titrate quickly, Clcr < 60 = adjust
not many drug interactions
dont really monitor lvls

39
Q

Gabapentin side effects

A

wt gain
dizziness
somnolence

40
Q

Lamotrigine (Lamictal) side effects

A

SJS*
Weight gain

41
Q

Lamotrigine dosing

A

dont monitor lvls
~ 150mg PO BID
inc bi-monthly by 50mg/day until seizures controlled

42
Q

Leviteracetam (Keppra) SE

A

fairly good
HA, somnolence, asthenia, behavior change common

43
Q

Leviteracetam (Keppra) dosing

A

no serum monitoring
Common dose 500-750mg BID, 500mg start, inc by 1000mg/day at wkly interval
MDD = 3000mg/day

44
Q

Leviteracetam (Keppra) Renal Dosing

A

CrCl < 80, have to start renal dosing

45
Q

Oxcarbazepine (Trileptal) SE

A

SJS*

46
Q

Oxcarbazepine Dosing

A

600mg BID

Click < 30ml/min, give 300mg/day start then titrate up

47
Q

Oxcarbazepine effect on oral contraceptives

A

will dec lvls, weak inducer

48
Q

Tiagabine (Gabitril) dosing

A

8-16mg BID-QID

not used often, $$ and hard to dose QID

49
Q

Topiramate (Topamax) SE

A

Nephrolithiasis = kidney stone = drink enough water
Weight loss + common ones

50
Q

Topiramate (Topamax) Dosing

A

100-200mg BID

ClCr < 70 = dose adjust

51
Q

Topiramate (Topamax) effect on oral contraceptives

A

dec lvls

52
Q

Zonisamide (Zonegran) SE

A

SJS* + common ones

53
Q

Zonisamide (Zonegran) dosing

A

100-200mg BID
not really commonly used

54
Q

Brivaracetam (Briviact) info

A

similar to keppra, maybe better tolerated for SE
IV form available

55
Q

Cannabidiol (Epidiolex) used for

A

Lennox-Gastaut or Dravet Syndrome which is usually in kids

56
Q

Clobazam (Onfi) used for….

A

Lennox-Gastaut syndrome
C4
start 5mg BID, inc to ~20-40mg QD

57
Q

Eslicarbazepine (Aptiom) info

A

prodrug oxcarbazepine
MDD 1200mg
Click < 50 adjustment, 600mg MDD

58
Q

Everolimus (Afinitor Disperse) indicated for…

A

Tuberous sclerosis complex associated focal seizures in pts 2yrs or older

$$$$

59
Q

Everolimus (Afinitor Disperse) SE

A

> 10% mouth ulceration
Stomatitis
fever

60
Q

Lacosamide (Vimpat) dosing

A

50mg BID, target 200-400mg/day
Take w/ or w/o food
100% Po Bioavail
Crcl < 30ml/min = adjust

61
Q

Perampanel (Fycompa) info

A

1st drug for glutamate receptors
C3, 2mg QD, 12mg MDD

62
Q

Pregabalin (Lyrica) dosing

A

Crcl < 60 adjust
initial dose = 150mg QD
MDD = 600mg BID/TID

63
Q

Pregabalin (Lyrica) SE

A

weight gain

64
Q

Rufinamide (Banzel) primarily used in…

A

Lennox-Gastaut

65
Q

Rufinamide (Banzel) SE

A

May shorten QTc
Leukopenia

can Dec Oral contraceptives

66
Q

Rufinamide (Banzel) dosing

A

200-400mg BID to start, 3200mg MDD
Give with food

CDM 4 Exam 3 (11 decks)

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