Neuro - Epilepsy

Question 1

Is someone conscious or unconscious during a generalized seizure?

Answer 1

LOC

Question 2

Seizure = increased levels of excitatory NTs, like ______, or deficiency in inhibitory NTs, like _______.

Answer 2

glutamate - excitatory

GABA - inhibitory

Question 3

Name RF of seizures

Answer 3

1. trauma
2. surgery
3. lyte disturbances
4. drug toxicity/withdrawal
5. stroke
6. infection
7. fever
8. genetic predisposition
9. idiopathic

Question 4

What is epilepsy? Who gets it?

Answer 4

chronic condition of recurring sz, commonly in young and old

Question 5

What is the most common sz?

Answer 5

tonic clonic

Question 6

In general, most patients with epilepsy use one/multiple therapies? Do you add or swap drugs when changing meds?

Answer 6

monotherapy

change them

Question 7

Which two drugs “cast the widest net”?

Answer 7

VPA and lamotrigine

Question 8

When is it okay to D/C a seizure med? How is it D/C’d?

Can you switch from generic to brand name without caution?

Answer 8

6-12 months after sz free interval
Slowly weaned
No, the bioavailability difference may lead to sz

Question 9

How do you check to make sure the dose is therapeutic?

Answer 9

check trough level – before the next dose

Question 10

Whats the problem with sz meds and pregnancy?

Answer 10

sz meds are typically teratogenic – folate wasting

Question 11

how do you treat ecampsia seizures?

Answer 11

mag sulfate

Question 12

phenobarbital is reserved for what type of sz? what is an AE of the PO form?

Answer 12

refractoral generalized sz

hangover because its highly sedative

Question 13

What is the tx for status epilecticus?

Answer 13

Benzo, then anti-epileptic maintenance

Question 14

Short acting benzo (Lorazepam? Long acting benzo (Diazepam)?

Answer 14

short - ativan

long - Valium

Question 15

How does phenytoin work?

Answer 15

It promotes Na efflux from neurons thus stabilizing cells and reducing hyperexcitability

Question 16

Which sz drug may actually worsen absence sz?

Answer 16

phenytoin

Question 17

Would phenytoin and ASA interact?

Answer 17

Yes, phenytoin is highly PPB.

Question 18

What are some dose related AEs of phenytoin?

Answer 18

nausea, HA, rash, confusion, NYSTAGMUS

Question 19

what is a sign of phenytoin OD?

Answer 19

nystagmus

Question 20

What are some non-dose related AEs of phenytoin? These make teens less likely to adhere.

Answer 20

gingival hyperplasia, acne, coarsening of facial features

Question 21

Phenytoin has some weird interactions. Name some.

Answer 21

ethanol, vitamin D–osteoporosis, folate wasting, OCPs will not work, VPA levels, warfarin

Question 22

Why is IV phenytoin risky?

Answer 22

poor stability (short half life), and you have to give it with a diluent (high volume load) that causes hypotension.

Question 23

Can phenytoin break a seizure? What can?

Answer 23

Risky.

Fosphenytoin can. its safer than IV phenytoin - less hypotension, volume load, and allows rapid administration. $$$

Question 24

What are the therapeutic levels of phenytoin?

Answer 24

10-20 mcg/ml

Question 25

When would you get a free phenytoin level?

Answer 25

when you suspect that the patient is hypoalbuminemic from malnourishment or hepatic damage.

Question 26

What pregnancy category is phenytoin? Why?

Answer 26

D - folate wasting

Question 27

Valproic Acid (Depakote...) increases the bioavailability within the CNS, enhances the activity and mimics the action of ______ at post synaptic sites.

Answer 27

GABA

Question 28

What other indications does VPA have?

Answer 28

migraine PPX, bipolar disorder, agitation!

Question 29

AEs of VPA?

Answer 29

hepatotoxicity, pancreatitis, thrombocytopenia

Question 30

T or F. VPA is only available IV and PO.

Answer 30

F. sprinkle caps, tablets, capsules, delayed release capsules, extendend release tablets, syrup, injection

Question 31

VPA pregnancy category?

Answer 31

D

Question 32

Carbamazepine (Tegretol) are like what other drugs? What does this mean for CBZ ODs?

Answer 32

TCAs | treat with IV bicarb

Question 33

CBZ is the DOC for what other condition?

Answer 33

trigeminal neuralgia

Question 34

Therapeutic level of CBZ?

Answer 34

4-12 mcg/ml

Question 35

3 AEs of CBZ?

Answer 35

SJS, SIADH (too much ADH), hepatotoxicity

Question 36

Which sz drug is an autoinducer? and what does this mean?

Answer 36

it increases its own metabolism at random times -- no need to get trough level until 2-3 weeks

Question 37

CBZ analogue that has fewer hepatic AEs?

Answer 37

oxycarbazepine (Trileptal)

Question 38

what is the brand name of gabapentin? what is its main indication?

Answer 38

Neurontin | neuropathic pain - DM, HIV, spine injury

Question 39

does gabapentin have may interactions?

Answer 39

no, its renally eliminated

Question 40

how are gabapentin and lyrica related?

Answer 40

gabapentin is a precursor to pregabalin (Lyrica)

Question 41

What preg category is gabapentin?

Answer 41

C -- less folate wasting effects

Question 42

Tompiramate has what MOA?

Answer 42

enhances Na channels, enhances GABA, weak carbonic anyhydrase inhibitor

Question 43

what are some off label uses of Tompiramate?

Answer 43

infantile spasms, weight loss

Question 44

AEs of tompiramate (Topomax)?

Answer 44

anorexia, psychomotor slowing (DOPO) and nephrolithiasis.

Question 45

what preg category is topomax?

Answer 45

C

Question 46

what do you use for lethal injection?

Answer 46

1. barb 2. paralytic 3. high dose K

Question 47

CBZ, phenytoin and VPA are __ generation drugs.

Answer 47

1st - more AEs

Question 48

What risk does Lamotrigine run?

Answer 48

Rash - sjs

Question 49

What risk does Levetiracetam run?

Answer 49

behavioral changes...issue for pediatrics

Question 50

What is the brand name of phenytoin?

Answer 50

Dilantin

Question 51

What is the brand name of VPA?

Answer 51

Depakote, Depacon, Depakene