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Flashcards in Seizures Deck (45):
1

Treatment for:

- Partial
- Absence

- Myoclonic
- Atonic
- Atypical Absence

- Grand Mal (Tonic Clonic)

- Lennox-Gastuat Syndrome

- Status epilepticus

Partial sz 1st line:
- Carbamazepine
- Phenytoin
- Oxcabazepine
- Valproic acid

Absence: most common in children = starring/blank
- Ethosuximide
- Valproic acid

Myoclonic = cause jump/Atonic = drop attacks
- Lamotrigine
- Topiramate
- Valproic acid

Grand Mal (Tonic clonic)
- Carbamazepine, phenytoin
- Valproic acid, topiramate
- Adjunct: lomotrigine

Lennox-Gastuat syndrome = Cognitive dysfunction, mental retardation, and frequent status epilepticus
- Valproic acid
- Benzodiazepine

Status epilepticus
- Thiamine 100mg or vit B complex
- Lorazepam IV or IM
- Phenytoin 18mg/kg IV or fosphenytoin

2

Luminal

- MOA
- Indication
- SEs
- Forms
- DDI
- Monitor

Phenobarbitual

- Form: Injection
- MOA: Enhances GABA
- Indication: sedation, anticonvulsant

SEs: BARBiturates:
- Bone marrow suppression
- Ataxia, Rash
- Respiratory depression
- Behavior changes (CNS excitation/depression), Bradycardia (hypoTN)

- Form: IV (avoid >50mg/min), IM, SQ, PO
- DDI: strong inducer

Monitor:
- [ ] = 15-40 mcg/mL
- BCB
- LFTs

3

Mysoline

- MOA
- Indication
- SEs
- Max dose
- Therapeutic level

Primidone (PRM)

- MOA: metabolized to phenobarbital n PEMA
- Indication: Epilepsy
- SEs: same as above
- Max dose: 2g/d
- Therapeutic level: 5-12 mcg/mL

4

Dilantin Injection
Dilantin ER

- Dilution

Phenytoin

- Dilution: in NS adm

5

Cerebyx

- Phenytoin conversion
- Storage
- Dilution
- SEs for both drugs
- Fosphenytoin C/I

Fosphenytoin

- Rapidly converted to phenytoin. Given short term IV when phenytoin is unavailable or no IV access
- Phenytoin conversion: 1.5 fos = 1 phenytoin
- Storage: refrigerate
- Dilution: NS or DW

SEs
- Ataxia
- Rash
- Gingival hyperplasia
- Hirsutism
- Osteomalacia

Fosphenytoin CI
- Sinus bradycardia, 2nd or 3rd degree AV block

6

Stavzor

- Indication
- Form: DR
- MOA
- SE
- Therapeutic levels
- Preg Cat
- BBW
- Monitor

Valproic acid

- Indication: Absence sz, adjunct tx of complex partial sz, mania, migraine
- Form: DR
- MOA: increase brain GABA

SEs
- GI upset, hepatotoxicity, pancreatitis
- Thrombocytopenia, encephalopathy, deafness
- Tinnits, SIADH

- Therapeutic level: 50-100 ug/mL
- Preg Cat: D

BBW
- Hepatic failure: monitor LFT Q6M
- Pancreatitis
- Teratogenic

Monitor
- LFT, CBC, PT/PTT, serum ammonia

7

Depakote

Divalproex ER
Divalproex

8

Tegretol
Tegretol XR

- DDI
- Max dose
- MOA
- Level
- SE
- C/I
- Monitor
- Genetic test
- Preg Cat

CArbAmAzepine

- Form: Chewable Tab, suspension
- DDI: Auto-induction = 3A4 inducer
- Max dose: 1200 - 1600 mg/d
- MOA: block use dependent Na channel inhibit Na influx
- Level: 4-12 ug/mL

SEs
- Aplastic anemia
- Anticholinergic
- Antiarrhythmic
- SJS rash
- SAIDH

C/I
- Fatal blood cell abnormalities
- Prior bone marrow suppression

- Monitor: LFTs, CBC, level,
- Genetic test before start: Asian HLA-B 1502 = SJS or TEN
- Preg Cat: D

9

Trileptal

- Therapeutic range:
- MOA
- SEs
- DDI

OXcarbazepine

- Therapeutic range: 12-30 ug/mL
- MOA: Block Na channel
- SEs: SJS, hypoNa
- DDI: Inducer

10

Zarontin

- Indication
- SEs
- Pt counseling
- Level

EtHosuximide

- Indication: Absence sz
- SEs: hiccups, anemia, drowsness
- Pt counseling: contact MD if fever, sore throat, mouth sores, bleeding gums, bruising, sign of aplastic anemia
- Level: 40-400 mcg/mL

11

Celontin

- Indication

METhsuximide

- Indication: refractory absence sz

12

FeLbAtrol

- Max dose:
- MOA
- Indication
- SEs

FeLbAmate

- Max dose: 3600mg/d
- MOA: inhibits Na channels
- Indication: Not rec 1st line. Rec only if do not respond to any other med whose epilepsy is so severe that risk of aplastic anemia or liver failure is acceptable in light of benefits
- SEs: hepatotoxicity, aplastic anemia, HA, N/V

13

Neurontin

- MOA
- SEs
- Max dose

Gabapentin

- MOA: incr GABA synthesis
- SEs: dizziness, peripheral edema, visual effect, wt gain
- Max dose: 3600mg/d

14

Horizant

- Indication
- Administration

Gabapentin ER tab

- Indication: restless leg syndrome
- Swallow whole with FOOD @ ~ 5PM
- Not interchange with other gabapentin

15

Lyrica

- Indication
-Max dose
- SE

Pregabalin

- Indication: diabetic peripheral neuropathy, post herpetic neuralgia, fibromyalgia, partial sz
- Max dose: 600mg/d
- Lyrica seems to be similar to gabapentin in both efficacy and SE. But can be titrate more quickly and might have a faster onset

16

Lamictal

- Dose:
- Form
- Indication
- MOA
- SEs
- Blue kit
- Green kit
- Orange kit

Lamotrigine

- Dose: 25-50mg QHS
- Form: IR, XR, chewable, ODT
- Indication: SZ, bipolar I
- MOA: Inhibits Na chanel
- SEs: rash (occurs 5days - 8wks), photosensitivity, sedation, hematologic

Blue Kit
- Pt taking VA will start: 25mg QOD x 2 wks then inc to MD = 100 to 200mg/day

Green Kit
- Pt on CBZ, phenytoin, primidone, phenobarbital, rifampin: start 50mg QD x 2wks, then 50mg BID x 2 wks, up to 150-250mg BID

Orange Kit
- Pt not taking any of the above: start 25mg QD x 2wks, then 50mg QD x 2 wks, incr by 50mg/d every 1-2 wks to 225-375mg/d

17

Keppra

- Max dose:
- SEs

Levetiracetam

- Max dose: 3g/d
- SEs: somnolence, psychiatric sx

18

Gabitril Filmatabs

- Dose
- MOA
- Indication
- SEs

TiaGABIne

- Dose: start 4mg/d for 1 wk then incr by 4-8mg QW up to max 56mg/d. Take with FOODs
- MOA: inhibits presynaptic neuronal GABA reuptake
- Indication: Partial Sz
- SEs: speech/language problem, confusion

19

Zonegran

- MOA
- Indication
- SEs
- Pt counseling

ZoniSAMide

- MOA: Block Na channels
- Indication: adjunct tx for partial sz
- SEs: Kidney Stone, SJS, Aplastic anemia, Weight loss

Pt counseling
- Sulfa allergy => contact MD
- Drink plenty of fluid: decre risk of stone

20

Topamax

- MOA
- Indication
- Max dose
- SEs
- Pt counseling

Topiramate

- MOA: Block Na channels
- Indication: sz, migraine ppx
- Max dose: 200mg/d
- SEs: Difficulty [ ], psychomotor slowing, speech problem, wt loss, nephrolithiasis, hyperthermia, metabolic acidosis
- Pt counseling: don't break tabs = bitter taste, drink plenty of water

21

Vimpat

- Dose
- Indication
- SEs
- CS

LACOSamide

- Dose: 50mg BID. Max 200mg BID
- Indication: adjunct tx of partial onset sz
- SEs: heart block, PR prolongation, dizziness, ataxia
- CS: V => euphoria

22

Sabril

- Dose/indication
- Dose adj
- Special program
- SEs

VIGabatrin

Dose/Indication
- Last line for complex partial sz: 500mg BID. Max 3g/d
- Infant spasms: 150mg/kg/d

- Renal dose adj:
- Special: Only prescribed by MD who participated in SHARE program (monitor visual field defects). This drug is ship directly to pt
- SEs: Vision lost => test vision at baseline then at least Q3M and 3-6M after d/c drug
Suicidal behavior

23

POTiga

- Indicaiton
- MOAs
- SEs

EZOgabine

- Indication: partial onset sz
- MOA: K channel opener
- SEs: urinary retention (REMS)

24

Fycompa

- Indicaiton
- MOAs
- SEs

PERAMpanel

- Indication: partial onset sz
- MOA: selective noncompetitive antagonist of AMPA receptors.
- SEs: dizziness, sedation

25

Klonopin

- MOA

Clonazpam

- MOA: potentiation of GABA

26

Valium

- MOA
- Indication
- SEs

Diazepam (diastat = per rectal)

- MOA: Potentiation of GABA
- Indication: status epilepticus
- SEs: CNS depression, respiratory depression

27

Onfi

Clobazam

28

Ativan

Lorazepam

- Indication: Status epilepticus

29

Medications Cause SZ

Medications
- Theophyllines
- TCAs
- Cocaine, Lidocaine
- Meperidine (demerol)
- W/d from EtOH, benzos, barbiturate
- Tramadol (ultram)
- Bupropion (Wellbutrin, Zyban)

30

Cause of SZ

Cause of SZ
- Mostly idiopathic
- Electrolyte imbalance: hypoNa/Ca/Mg
- Hypoglycemia
- Hyperthyroid
- Liver failure
- Inborn metabolic error
- Vit B6 deficiency

31

Solfoton

- Form

Phenobarbitual

- Form: Capsules

32

Diastat

- Form

Diazepam

- Form: per rectal

33

Versed

Midazolam

34

Onfi

Clobazam

35

Phenytek

- Form

Phenytoin

- Form: ER Cap

36

Infatab

- Form

Phenytoin

- Form: Chew tab

37

Peganone

Ethotoin

38

Depakene

Valproic acid

- Form: IR

39

Depacon

- Form

Valproic acid

- Form: IV

40

Carbatrol

Carbamazepine

- Form: ER

41

Epitol

Carbamazepine

42

Equetro

- Form
- Indication

Carbamazepine

- Form: ER
- I: Mania of bipolar

43

Oxtellar

Oxcarbamazepine

44

Trokendi

- Form

Topiramate

- Form: ER

45

Qudexy

Topiramate

- Form: ER