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NAPLEX review 2024 RXPrep Book > Neurologic Conditions: Seizures/Epilepsy > Flashcards

Neurologic Conditions: Seizures/Epilepsy Flashcards

1
Q

Focal seizures

A

start on one side of brain and can spread to the other

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2
Q

Generalized seizures

A

start on both sides of the brain

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3
Q

Unknown seizures

A

beginning is unknown, occur at night or unwitnessed

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4
Q

Focal aware seizure

A

no loss of consciousness

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5
Q

Focal seizure with impaired awareness

A

pt experiences loss of consciousness

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6
Q

Status epilepticus

A

seizure that lasts more than 5 minutes

if lasts 30min, long term damage can occur and is medical emergency

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7
Q

Status epilepticus txm

A

0-5min = stabilization phase = time seizure, start ECG, check AED lvls/electrolytes

5-20 min = initial txm phase = IV loraz or IM midaz, rectal Diastat or nasal/buccal midday if cant do IV

20-40 min = 2nd txm phase = give regular AED, IV fosphenytoin, valproic acid, keppra, if lasts longer than no clear txm

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8
Q

Dispensing Diastat

A

pharmacist has to lock syringes into appropriate dose prior to dispensing
should double check when counseling patient before med leaves pharmacy

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9
Q

Ketogenic for refractory seizures

A

high fats
normal protein
low carbs

4:1 ratio of fats to combined protein/carbs

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10
Q

Seizures can occur due to….

A

deficiency of inhibitory NT (GABA)
too much excitatory NT (Glutamate)

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11
Q

Which AEDs inc GABA

A

Benzo
Valproic Acid

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12
Q

Which AED enhance/potentiate GABA effect

A

Phenobarbital

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13
Q

Which AED inc GABA and CA channel blocker

A

Levetiracetam

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14
Q

Which AED is type T Ca channel blocker

A

Ethosuximide

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15
Q

Which AED are Ca channel blockers

A

Pregabalin
Gabapentin

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16
Q

Which AED block Na and Ca channels

A

Oxcarbazepine

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17
Q

Which AED block Na channels

A

Carbamazepine
Lamotrigine
Phenytoin/Fosphenytoin
Topiramate

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18
Q

Broad spectrum AED

A

Lamotrigine = Lamictal
Levetiracetam = Keppra
Topiramate = Topamax
Valproic acid
Divalproex = Depakote

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19
Q

Lamotrigine (Lamictal) boxed warnings

A

serious skin reactions, including SJS/TEN, risk inc if using high starting dose

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20
Q

Lamotrigine (Lamictal) side effects

A

Alopecia (supplement w/ selenium/zinc)
N/V
Somnolence
rash
tremor

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21
Q

How long after stopping do you have to restart dose titration for Lamotrigine

A

If stop for > 6 days, have to do initial dose titration

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22
Q

Lamictal starter kits

A

Orange = standard
Blue = lower dose
Green = higher dose

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23
Q

When to sue which Lamictal start kits

A

Orange = no interacting meds
Blue = if taking valproic acid, enzyme inhibitor
Green = taking enzyme inducer (carbamazepine, phenytoin, phenobarbital, primidone, ritonavir, rifampin)

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24
Q

Levetiracetam (Keppra) IV:PO ration

A

1:1

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25
Q

Levetiracetam (Keppra) warnings

A

psychiatric reactions
somnolence
fatigue
suicidal behavior
anaphylaxis
inc BP
severe skin reactions

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26
Q

Significant drug interactions for Keppra

A

No significant interactions

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27
Q

Topiramate (Topamax) Contraindications

A

Trokendi XR only = using alc 6hr before/after dose

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28
Q

Topiramate (Topamax) warnings

A

metabolic acidosis
reduced perspiration (Oligohidrosis)
kidney stones
angle-closure glaucoma
hyperammonemia
visual problems = reversible
fetal harm

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29
Q

Topiramate (Topamax) side effects

A

somnolence
memory/concentration/attention difficulty
weight loss
anorexia

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30
Q

Topiramate (Topamax) monitoring

A

Electrolytes = sodium bicarb
eye exam = intraocular pressure

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31
Q

Which contraception should be used with Topiramate (Topamax)

A

non-hormonal contraception

32
Q

Valproic Acid Boxed warnings

A

Hepatic failure, usually during first 6 months of txm
fetal harm and dec IQ in pregnancy

33
Q

Valproic Acid Contraindications

A

hepatic disease
urea cycle
ppx migraine pregnancy
known POLG disorder or suspected

34
Q

Valproic Acid warnings

A

Hyperammonemia = tx w/ carnitine in symptomatic adults
dose related thrombocytopenia
DRESS reactions

35
Q

Valproic Acid side effects

A

Alopecia = supplement selenium/zing
weight gain
N/V
HA

36
Q

Valproic Acid monitoring

A

LFTS at BL and freq in 1st 6 months
CBC
platelets

37
Q

Common narrow spectrum AED

A

Lacosamide = Vimpat
Carbamazepine = Tegretol
Oxcarbazepine = Trileptal
Phenytoin = Dilantin
Fosphenytoin = Cerebyx
Phenobarbital = Sezaby

38
Q

Lacosamide (Vimpat) max daily dose CrCl < 30

A

300mg/day

39
Q

Lacosamide (Vimpat) warnings

A

prolong PR interval and inc risk of arrhythmias

40
Q

Lacosamide (Vimpat) side effects

A

dizziness
HA
blurred vision
ataxia
tremor
euphoria

41
Q

Carbamazepine (Tegretol) boxed warnings

A

Serious skin reactions = test for HLAB*1502 allele in asians
aplastic anemia
agranulocytosis

42
Q

Carbamazepine (Tegretol) contraindications

A

Myelosuppression
using MAOi within last 14 days

43
Q

Carbamazepine (Tegretol) warnings

A

hyponatremia (SIADH)
fetal harm
hypothyroidism

44
Q

Carbamazepine (Tegretol) side effects

A

Dizziness
drowsiness
ataxia
N/V
pruritus
photosensitivity
blurred vision
rash
inc LFTS
alopecia

45
Q

Carbamazepine (Tegretol) monitoring

A

CBC w/ differential and platelets
LFTs
eye exam
thyroid function test
Electrolytes = Na

46
Q

Oxcarbazepine (Trileptal) warnings

A

inc risk for serious skin reaction if HLA-B*1502 gene = test asians
Hyponatremia

47
Q

Oxcarbazepine (Trileptal) side effects

A

Somnolence
dizziness
N/V
abdominal pain
diplopia
visual disturbances
ataxia
tremor

48
Q

Oxcarbazepine (Trileptal) monitoring

A

serum Na lvls
thyroid functon
CBC

49
Q

Oxcarbazepine (Trileptal) notes

A

for oral suspension, use within 7 wks of opening original container

50
Q

Phenytoin (Dilantin) & Fospehnytoin (Cerebyx) boxed warnings

A

Phenytoin IV = no more than 50mg/min
Fosphenytoin = no more than 150 mg/min

if faster can get hypotension and cardiac arrhythmias

51
Q

Phenytoin (Dilantin) & Fospehnytoin (Cerebyx) contraindications

A

Previous hepatotoxicity due to phenytoin

52
Q

Phenytoin (Dilantin) & Fospehnytoin (Cerebyx) warnings

A

extravasation = lead to purple glove syndrome
avoid in HLA-B*1502 positive patients
DRESS rxn, fetal harm, bradycardia, SJS/TEN

53
Q

Phenytoin (Dilantin) & Fospehnytoin (Cerebyx) side effects

A

dose related toxicity = nystagmus, ataxia, diplopia/blurred vision, slurred speech

chronic = gingival hyperplasia, hair growth, hepatotoxicity, skin thickening

54
Q

Phenytoin (Dilantin) & Fospehnytoin (Cerebyx) monitoring

A

serum phenytoin concentrations, LFTs, CBC w/ differential
IV: continuous cardiac and respiratory monitoring

55
Q

Phenobarbital (Sezaby) therapeutic range

A

20-40 mcg/mL in adults
15-40 mcg/mL in children

56
Q

Phenobarbital warnings

A

caution in SUD = potential drug dependence, respiratory depression, fetal harm

57
Q

Phenobarbital side effects

A

physiological dependence
tolerance
hangover effect
somnolence
cognitive impairment
dizziness
ataxia
depression
folate deficiency

58
Q

Which AED is used for absence seizures

A

Ethosuximide (Zarontin)

59
Q

Ethosuximide (Zarontin) warnings

A

serious skin rash (SJS/TEN)
blood dyscrasias
DRESS rxns

60
Q

Felbamate (Felbatol) boxed warnings

A

aplastic anemia
hepatic failure

61
Q

Felbamate (Felbatol) monitoring

A

LFTs
CBCs
serum lvls of other AEDs

62
Q

Fenfluramine (Fintepla) boxed warnings

A

valvular heart disease
pulmonary htn = given through REMS

63
Q

Fenfluramine (Fintepla) warnings

A

dec appetite & weight loss
serotonin syndrome
inc BP
angle closure glaucoma

64
Q

Gabapentin (Neurontin) side effects

A

somnolence
peripheral edma
weight gain
ataxia
blurred vision
mild euphoria

65
Q

Perampanel (Fycompa) boxed warning

A

neuropsychiatric events (dose related), including irritability, aggression, anger an paranoia, mostly in first 6 weeks

66
Q

Prodrug of phenobarbital

A

Primidone (Mysoline)

67
Q

Rufinamide (Banzel) contraindications

A

pts with familial short QT syndrome due to QT shortening = dose related

68
Q

Stiripentol (Diacomit) warnings

A

loss of appetite/weight loss
delirium/hallucinations = rare

69
Q

Tiagabine (Gabitril) warnings

A

worsening of seizures/new-onset seizures when used off-label for other indicators, serious skin reactions SJS/TEN

70
Q

Vigabatrin (Sabril, Vigadrone) boxed warnings

A

causes permanent vision loss > 30% of patients

71
Q

Vigabatrin (Sabril, Vigadrone) monitoring

A

eye exam at baseline, every 3 months during therapy and 3-6 months after d/c

can only get through REMS

72
Q

Zonisamide (Zonegran, Zonisade) contraindications

A

hypersensitivity to sulfonamides

73
Q

Zonisamide (Zonegran, Zonisade) side effects

A

similar to topiramate

including oligohidrosis/hyperthermia and risk of nephrolithiasis

74
Q

Adjusting Phenytoin doses

A

Has Michaelis-Menten kinetics, aka saturable kinetics

if enzymes saturated, small inc in dose can cause large inc in drug lvl

75
Q

Higher lvls of lamotrigine will inc the risk of….

A

severe rash

76
Q

Concerns with AEDs

A

seizure frequency monitoring
many drug interactions
CNS depression
Bone loss
Suicide Risk and Rash
risks in pregnancy

77
Q
A

NAPLEX review 2024 RXPrep Book (71 decks)

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