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Therapeutics 2 > Seizure Disorder > Flashcards

Seizure Disorder Flashcards

(101 cards)

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1
Q

What are the drug causes of Seizures?

A

-antidepressants (bupropion, SNRI, TCA)
-antipsychotics
-amphetamines
-theophylline
-illicit substances
-tramadol/tapentadol
-withdrawal from alcohol, anticonvulsants, benzos, baclofen

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2
Q

What are the seizure types?

A

-partial or focal seizures: abnormal electrical activity in one hemisphere
-generalized seizures: abnormal electrical activity in both hemispheres

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3
Q

Describe Simple Focal Onset Seizures

A

without dyscognitive features
-no loss of consciousness
-involuntary twitching or jerking in one extremity
-sweating, salivating, vomiting (autonomic symptoms)
-numbness, tingling, feeling of deja vu, visual disturbances, hallucinations, ringing/buzzing sounds

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4
Q

Describe Complex Focal Onset Seizures

A

with dyscognitive features
-loss of consciousness
-similar presentation to simple focal onset seizures, but may also not make sense while speaking, lip smacking, picking at clothes, staring off into space, extreme changes in behavior postictal state (post- seizure) common

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5
Q

Describe Absence Generalized Onset Seizures

A

-sudden interruption
-blank stare
-no aura (“warning”) or postictal state
-shorter than complex focal seizures (2-30 seconds)
-generally presents in children and adolescents

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6
Q

Describe Myoclonic Generalized Onset Seizures

A

-brief shock-like muscle contractions
-may be repetitive
-can be confined to small isolated muscle group or larger areas

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7
Q

Describe Clonic Generalized Onset Seizures

A

-bilateral, symmetrical, rhythmic jerk movements
-longer than myoclonic seizures

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8
Q

Describe Tonic Generalized Onset Seizures

A

-stiffness in the limbs
-bilateral increased tone
-seconds to a minute

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9
Q

Describe Tonic-Clonic Generalized Onset Seizures

A

-5 phase characterization: loss of consciousness, flexion, extension, tremor, clonic
-phase of tonic followed by clonic
-prodromal (“warning”) symptoms in some patients

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10
Q

Describe Atonic Generalized Onset Seizures

A

-sudden loss in muscle tone
-very brief
-often in patients with intellectual impairment
-protective hardware
-hallmark of Lennox-Gastaut

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11
Q

What is Lennox-Gastuat Syndrome?

A

-severe, refractory seizure disorder
-commonly identified in childhood
-includes a variety of seizure types
-often requires combination medication therapy

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12
Q

What are the symptoms of postictal?

A

-confusion
-frustration
-weakness
-fatigue
-memory loss/confusion
-embarrassment
-headache
-nausea

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13
Q

How is seizure type identified and diagnosed?

A

-history and clinical evaluation (pt may not be a reliable historian of details of their seizures)
-radiologic evaluation
-laboratory evaluation
-EEG (most useful DURING seizure)

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14
Q

What are the consequences of not treating seizures?

A

-uncontrolled seizures may impact quality of life, lead to development of new seizure types, altered response to anticonvulsants
-prolonged seizure activity may lead to neurological damage and could be life threatening

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15
Q

What are factors associated with successful pharmacological therapy withdrawal?

A

if the patient…
-single seizure type
-age of onset of seizure was age 2-35
-has been seizure free for 2 years+
-normal neurological exam, EEG, and IQ
-complete seizure control within 1 year of initiating treatment
-taper dose over 6 months (no more than 25% per 2 weeks)

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16
Q

What is the relapse rate of seizures once withdrawn from pharmacotherapy?

A

70%

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17
Q

What drugs are considered broad spectrum for seizures?

A

-lamotrigine
-levetiracetam
-topiramate
-valproic acid
-zonisamide

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18
Q

What is the Black Box Warning of Lamotrigine?

A

serious skin rash

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19
Q

What are the adverse effects of Lamotrigine?

A

ASEPTIC MENINGITIS

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20
Q

What are the drug interactions of Lamotrigine?

A

-oral contraceptives
-valproic acid

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21
Q

What are the advantages of Lamotrigine?

A

-multiple uses in seizure disorders (efficacy in focal onset and generalized)
-multiple dosage forms
-generally well tolerated
-use in bipolar disorder
-fewer cognitive effects in the elderly

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22
Q

What are the disadvantages of Lamotrigine?

A

-slow titration to avoid serious skin rash
-not for rapid control

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23
Q

What are the adverse effects of Levetiracetam?

A

mood changes
-irritability
-aggression/agitation

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24
Q

What are the drug interactions of Levetiracetam?

A

minimal

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25
What are the monitoring parameters of Levetiracetam?
behavioral and renal function (dosing adjustment needed)
26
What are the advantages of using Levetiracetam?
-well tolerated -no significant drug interactions -can be loaded
27
What are the disadvantages of Levetiracetam?
behavioral problems can limit therapy in some patients
28
What are the adverse effects of Topiramate?
-word filling difficulty -paresthesias -psychomotor slowing -nephrolithiasis -oligohydrolysis -metabolic acidosis -weight loss
29
What are the drug interactions of Topiramate?
phenytoin and valproic acid
30
What is Topiramate place in therapy?
may be considered for comorbid conditions such as migraines (efficacy seen) or obesity (due to SE of weight loss)
31
What are the adverse effects of Valproic Acid?
-GI upset -thrombocytopenia -hepatotoxicity -hyperammonemia -pancreatitis -alopecia -PCOS -weight gain
32
What are the drug interactions of Valproic Acid?
-lamotrigine -carbapenems -aspirin
33
What are the monitoring parameters of Valproic Acid?
CBC, LFT, levels 50-100
34
What is Valproic Acid place in therapy?
may be useful in comorbidities such as migraines and bipolar disorder
35
What are the adverse effects of Zonisamide?
-impaired concentration -paresthesias -nephrolithiasis -oligohydrosis -metabolic acidosis -agitation/irritability -skin rash (SJS)
36
What are the disadvantages of Zonisamide?
-cognitive impairment with rapid dose increase -sulfa allergy cross reaction and renal stones
37
What is the Black Box Warning of Valproic Acid?
hepatoxicity, mitochondrial disease, fetal risk, pancreatitis
38
What are the adverse effects of Carbamazepine?
-diplopia -dizziness -unsteadiness -lethargy -nystagmus -ataxia -nausea -leukopenia, anemia, and thrombocytopenia -HYPOnatremia -skin rash (SJS or TEN) -decreased vitamin D and bone density
39
What are the drug interactions of Carbamazepine?
-CYP3A4 substrate -CYP3A4 major inducer (autoinducer, induces its own metabolism)
40
What are the monitoring parameters of Carbamazepine?
-HLA-B *1502 allele -renal -CMP -BMP -levels (4-12)
41
What drug may worsen absence seizures?
carbamazepine
42
What is the advantage of Carbamazepine?
minimal cognitive impairment
43
What are the disadvantages of Carbamazepine?
-may worsen absence seizures -may precipitate tonic clonic seizures in pt with other generalized seizures -do not use in pregnancy, teratogenicity -rash risk with fast titration
44
What is the Black Box Warning of Carbamazepine?
rash, aplastic anemia, agranulocytosis
45
What are the adverse effects of Oxcarbazepine?
-HYPOnatremia (SIADH) -skin rash (SJS/TEN) -dizziness -diplopia -nystagmus -nausea -ataxia/gait -drowsiness -tremor -decreased bone density
46
Is hyponatremia (SIAHD) more common with Carbamazepine or Oxcarbazepine?
oxcarbazepine
47
What are the disadvantages of Oxcarbazepine?
-hyponatremia is more common -can be used if no response to carbamazepine but if pt had rash with CBZ there is a 30% chance that they will experience rash with oxcarbazepine
48
What is the indication of Eslicarbazepine?
typically reserved for failure of other agents
49
What are the side effects of Eslicarbazepine?
-HYPOnatremia -rash
50
What are the advantages of Eslicarbazepine?
-once daily dosing (prodrug) -lower risk of hyponatremia (SIADH)
51
What are the adverse effects of Phenytoin?
-gingival hyperplasia -hirsutism, acne -neuropathy -agranulocytosis -skin thickening, coarsening of facial features (look older) -purple glove syndrome -CNS effects -cognitive dysfunction -bone health
52
What are the drug interactions of Phenytoin?
-CYP2C9 substrate and inducer -CYP2C19 substrate and inducer
53
What is the Black Box Warning of Phenytoin?
cardiovascular risk with rapid infusion
54
What are the disadvantages of Phenytoin?
-narrow therapeutic window (levels 10-20) -zero-order: increase in dose leads to increased proportional drug levels
55
What are the adverse effects of Phenobarbital?
-respiratory depression -liver dysfunction -paradoxical hyperactivity (more agitation/irritability) -cognitive effects
56
What are the drug interactions of Phenobarbital?
CYP2C9 substrate and major inducer
57
What are the monitoring parameters of Phenobarbital?
-LFT -CBC -behavior -renal -levels (10-40)
58
Primidone is a prodrug that is activated to be ________.
phenobarbital
59
What are the adverse effects of Lacosamide?
-CNS/GI effects -ECG PR prolongation -liver enzyme elevation
60
What are the drug interactions of Lacosamide?
very minimal
61
What are the monitoring parameters of Lacosamide?
-ECG -renal -hepatic
62
What are the disadvantages of Lacosamide?
AV conduction abnormalities so contraindicated in pt with heart block
63
What are the adverse effects of Gabapentin?
-dizziness -drowsiness -GI effects -peripheral edema -weight gain
64
What are the drug interactions of Gabapentin?
very minimal
65
What are the disadvantages of Gabapentin?
-frequent dosing -risk of withdrawal
66
What are the indications of Gabapentin?
considered second line for focal onset seizures but consider if comorbid neuropathic pain
67
What are the adverse effects of Pregabalin?
-peripheral edema -weight gain -CNS effects
68
What are the advantages of Pregabalin?
-longer acting than gabapentin -multiple other uses
69
What is the Black Box Warning of Perampanel?
serious psychiatric and behavioral reactions
70
What are the adverse effects of Perampanel?
-paranoia -euphoria -aggression
71
What are the adverse effects of Tiagabine?
-impaired concentration -weakness -CNS effects -GI effects
72
What are the disadvantages of Tiagabine?
-caution in absence seizures -can worsen some seizures if refractory
73
What is the Black Box Warning of Vigabatrin?
permanent vision loss
74
What are the adverse effects of Vigabatrin?
-blindness -weight gain/edema -GI effects -CNS effects
75
What is the use of Vigabatrin?
infantile spasms
76
What is the monitoring parameters of Vigabatrin?
eyes, has a REM program (SHARE)
77
What is the Black Box Warning of Clobazam?
risk of concomitant benzo + opioid use, abuse/misuse/addiction, dependance, withdrawal
78
What are the adverse effects of Clobazam?
-behavioral changes -amnesia -CNS effects
79
What are the drug interactions of Clobazam?
*LOTS OF INTERACTIONS* -CYP2C19 substrate -CYP3A4 substrate -CYP2D6 substrate -CYP3A4 inducer
80
What is the Black Box Warning of Clonazepam?
risk of concomitant benzo + opioid use, abuse/misuse/addiction, dependance, withdrawal
81
What are the contraindications of Clonazepam?
severe hepatic impairment
82
What is the Black Box Warning of Felbamate?
aplastic anemia, hepatic failure
83
What are the adverse effects of Felbamate?
-GI upset -anorexia/weight loss -CNS effects
84
What are the drug interactions of Felbamate?
CYP3A4 substrate/inducer/inhibitor
85
What are the monitoring parameters of Felbamate?
-LFT -CBC -hepatic
86
What drug is ONLY indicated for absence seizures?
ethosuximide
87
What drugs should be avoided in absence seizures?
-carbamazepine -phenytoin -vigabatrin
88
What drugs are frequently used for Atonic seizures?
*these are not the only ones used* -clobazam -felbamate -rufinamide
89
What are the adverse effects of Rufinamide?
-shortens QTc -rash -CNS effects -GI effects
89
What are the drug interactions of Rufinamide?
*prone to interactions* -CYP2E1 inhibitor -CYP3A4 inducer
89
What are the advantages of Rufinamide?
minimal effect on cognition
89
What anticonvulsants are highly protein bound?
carbamazepine, phenytoin, valproic acid
90
What are some considerations when prescribing the elderly anticonvulsants?
-reduced organ function (reduced clearance, metabolism, and hypoalbuminemia= caution using highly protein bound medications, *phenytoin, valproate*) -sensitive to neurocognitive effects -additional medications (interactions)
91
What drugs may cause sperm abnormalities in males?
carbamazepine, oxcarbazepine, and valproic acid
92
What anticonvulsant may cause testosterone levels to increase?
levetiracetam
93
What anticonvulsant may cause testosterone levels to decrease?
valproic acid
94
How does estrogen effect seizures?
proconvulsant effects
95
How does progesterone effect seizures?
anticonvulsant effect
96
What are Catamenial Seizures?
seizures before/during menses or during ovulation
97
How can Catamenial Seizures be treated?
-intermittent dose increase of benzos -consider acetazolamide or cyclic natural progesterone
98
What anticonvulsants are NOT safe for pregnancy?
-valproic acid -topiramate -carbamazepine -phenytoin -phenobarbital

Therapeutics 2 (13 decks)

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