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Pharm III - Exam 2 > Seizures > Flashcards

Seizures Flashcards

(121 cards)

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1
Q

Define seizure

A
  • Paroxysmal event caused by excessive electrical discharge of neurons
  • May disturb consciousness, sensory or motor systems
  • Discharges seen as spikes on EEG
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2
Q

Define epilepsy

A

Group of chronic neuro disorders characterized by unprovoked recurrent seizures (usually idiopathic)

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3
Q

Define status epilepticus

A

Prolonged seizures without recovery in between

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4
Q

Describe simple partial seizures

A

NO LOC

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5
Q

Describe complex partial seizures

A

With LOC, may prgoress to GTC

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6
Q

Describe secondarily generalized partial seizure

A

Begins as partial and has LOC

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7
Q

Describe absence seizures

A
  • Sudden onset, blank stare
  • Typically young children
  • LOC but returns instantly
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8
Q

Describe generalized tonic-clonic seizures

A
  • Muscle rigidity followed by sharp contractions

- LOC and confusion upon return to consciousness

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9
Q

Describe myoclonic seizures

A
  • Generalized
  • Brief sudden muscle contractions
  • Face, trunk, extremities
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10
Q

Describe atonic seizures

A
  • Generalized

- Complete loss of muscle tone

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11
Q

Describe tonic seizures

A

Uncontrolled extension of muscle groups

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12
Q

Describe clonic seizures

A

Repeated rhythmic jerking of arms and legs

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13
Q

Indications of phenytoin

A

Primary generalized

Partial

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14
Q

Advantages of phenytoin

A
  • Well studied

- Many dosage forms

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15
Q

Disadvantages of phenytoin

A
  • Challenging to dose (PK)
  • DIs (CYP inducer, highly protein bound)
  • Close monitoring required
  • Extensive SE profile
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16
Q

Which formulation of phenytoin results in more active drug in the body?

A

Phenytoin ACID

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17
Q

Monitoring of phenytoin

A
  • Risk of suicidal ideation
  • CBC, LFTs, albumin
  • Serum concentration due to narrow TI
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18
Q

Pregnancy category of phenytoin

A

D

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19
Q

Notable ADRs of phenytoin

A
  • Gingival hyperplasia
  • Hirsutism
  • Osteomalacia
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20
Q

Why does phenytoin interact with other drugs?

A

Highly protein bound - other highly protein bound drugs can displace phenytoin

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21
Q

Drugs that increase phenytoin levels

A
  • Acute ETOH intake
  • Salicylates
  • Estrogens
  • H2 blockers
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22
Q

Drugs that decrease phenytoin levels

A
  • Carbamazepine
  • Chronic ETOH abuse
  • Antacids w/Ca
  • Phenobarbital
  • Rifampin
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23
Q

How does phenytoin initially interact with warfarin?

A

Immediately, phenytoin can displace warfarin which may INCREASE INR

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24
Q

How does phenytoin interact with warfarin after prolonged administration?

A

CYP2C9 induction - phenytoin induces the metabolism of warfarin which may DECREASE INR

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25
Phenytoin and warfarin are both ___ for CYP2C9
Substrates
26
How are Vit K dependent clotting factors affected by phenytoin and warfarin interacting? How is INR affected?
- Warfarin inhibits synthesis of clotting factors - Phenytoin may also deplete them - INR INCREASES
27
Main factors of phenytoin and warfarin interactions
1. Protein binding 2. CYP2C9 induction 3. Competitive inhibition 4. Depletion of Vit K clotting factors
28
Indications for carbamazepine
- Primary generalized (non-emergent) | - Partial seizures (newly diagnosed)
29
Advantages of carbamazepine
Well studied
30
Disadvantages of carbamazepine
- Active metabolite - Auto-inducer (DIs) - CNS side effects
31
What should be monitored when using carbamazepine?
WBC and ANC - Idiopathic blood dyscrasias - Mild persistent leukopenia
32
Contraindications to carbamazepine
- Hypersensitivity to TCAs | - BM suppression
33
Black box warning of carbamazepine
Blood dyscrasias | -Asians should be screened for HLA-B*1502 beforehand
34
Pregnancy category of Carbamazepine
D
35
Oxcarbazepine indications
- Partial (mono or adjunct) | - GTC
36
Advantages of oxcarbazepine
Comparable efficacy to phenytoin, valproic acid and CBZ but may be better tolerated
37
Disadvantages of oxcarbazepine
- Hyponatremia | - DIs
38
Dosing of oxcarbazepine compared to CBZ
Oxcarbazepine doses may need to be 50% higher in order to obtain equivalent seizure control
39
Pregnancy category of oxcarbazepine
C
40
Eslicarbazepine acetate indications
Partial (mono or adjunct)
41
Metabolism of eslicarbazepine acetate
Metabolized to eslicarbazepine (active metabolite of oxcarbazepine)
42
What is the significance of eslicarbazepine acetate metabolism?
Converted to active metabolite of oxcarbazepine (better tolerated bc more exposure to active vs. inactive metabolites)
43
When should eslicarbazepine acetate be avoided?
Severe hepatic dysfunction
44
Topiramate indications
- Partial | - GTC
45
Advantages of topiramate
- Few DIs | - Wt loss?
46
Disadvantages of topiramate
- Cognitive functioning impairment - Kidney stones - Wt loss?
47
How should dosing of topiramate be adjusted?
50% dose reduction in CrCl less than 50
48
Common ADRs of topiramate
- Poor concentration, confusion, word finding difficulties - Somnolence - Wt loss
49
DIs of topiramate
- OCPs - Digoxin - Valproic acid - Phenytoin, CBZ, barbiturates - CNS depressants
50
How are OCPs affected by topiramate?
May be less effective (higher estrogen doses may be required)
51
How is digoxin affected by topiramate?
Decreased concentration
52
How does topiramate interact with valproic acid?
Increased risk of hyperammonemia
53
Lamotrigine indications
- Partial (mono or adjunct) - GTC - Absence
54
Advantages of Lamotrigine
- Not highly protein bound | - Does not cause wt gain
55
Disadvantages of Lamotrigine
- Rash | - DIs
56
Dosing of Lamotrigine
Varies based on other meds
57
Major ADR of Lamotrigine
Hypersensitivity reaction presenting as rash can lead to SJS
58
Which AED can cause a hypersensitivity rash leading to SJS?
Lamotrigine
59
DIs of Lamotrigine
- Anticonvulsants | - OCPs
60
Drugs that cause visual abnormalities
- CBZ - Eslicarbazepine - Oxcarbazepine - Lamotrigine - Phenytoin - Pregabalin
61
Anticonvulsants that cause weight loss?
- Ethosuximide - Felbamate - Topiramate - Zonisamide
62
Anticonvulsants that cause weight gain?
- Gabapentin - Pregabalin - Valproic acid - Vigabatrin
63
Indications for valproic acid
- Primary generalized (myoclonic, atonic, absence) - Partial - Mixed disorders
64
Advantages of valproic acid
- Well studied | - Multiple dosage forms
65
Disadvantages of valproic acid
- Side effect profile | - DIs (enzyme inhibitor)
66
What is the active form of valproic acid?
Valproate ion
67
Half life of valproic acid?
9-18 hours
68
PK of valproic acid
- 90% protein bound | - Undergoes glucuronidation (inhibits glucuronidation of other agents)
69
Pregnancy category of valproic acid
D
70
Notable ADRs of valproic acid
- Sedation, fine hand tremor - Hair loss, hepatotoxicity - Thrombocytopenia
71
Indications for gabapentin
Partial (with or w/o secondary generalization)
72
Advantages of gabapentin
No known DIs
73
Which AEDs have no known drug interactions?
Gabapentin Levetiracetam (Keppra) Pregabalin
74
Disadvantages of gabapentin
- Very high doses required for seizure control | - Increased frequency of dosing
75
PK of gabapentin
- Not metabolized (renally excreted unchanged) | - Does NOT induce hepatic enzymes
76
Half life of gabapentin
5-8 hours
77
Pregnancy category of gabapentin
C
78
ADRs of gabapentin
- Somnolence - Ataxia - Tremor - Dizzy - HA
79
Indications for Levetiracetam (Keppra)?
- Partial (with or w/o secondary generalization) | - Adjunctive for myoclonic or primarily generalized
80
Advantages of Levetiracetam (Keppra)?
- No known DIs - Various dosage forms - Pediatric use
81
Disadvantages of Levetiracetam (Keppra)?
Limited indications
82
Pregnancy category of Levetiracetam (Keppra)
C
83
ADRs of Levetiracetam (Keppra)
- Somnolence - Asthenia - Dizzy - Vertigo - HA * Not dependent on dose or titration
84
Indications for pregabalin
Partial (with or w/o secondary generalization)
85
Advantages of pregabalin
No known DIs
86
Disadvantages of pregabalin
- Brand name only (expensive) | - Schedule V
87
Which AED is expensive because it is available brand only?
Pregabalin
88
Pregnancy category of pregabalin
C
89
Common ADRs of pregabalin
- Dizzy - Ataxia - Somnolence - Peripheral edema - HA
90
Indications for tiagabine
Partial (adjunct)
91
PK (half life and metabolism) of tiagabine
6.7 hours | CYP3A4 metabolism
92
Drug interactions of Tiagabine
Highly protein bound but NO significant displacement of other protein bound agents
93
Pregnancy category of Tiagabine
C
94
Notable ADRs of tiagabine
- Generalized muscle weakness - Depression - Aphasia - Encephalopathy
95
Indications for Zonisamide
Partial (adjunct)
96
Drug interactions of Zonisamide
CYP3A4
97
Pregnancy category of Zonisamide
C
98
Indications for phenobarbital
All seizure disorders
99
Advantages of phenobarbital
- Oldest anti-epileptic drug | - Broad spectrum
100
Disadvantages of phenobarbital
- Pan-inducer | - Toxicity
101
What does acute intoxication of phenobarbital cause?
- Unsteady gait - Slurred speech - Sustained nystagmus
102
Signs of chronic intoxication of phenobarbital?
- Confusion - Poor judgment - Irritability - Insomnia - Somatic complaints
103
Phenobarbital and ETOH interaction?
Lethal dose is LESS if taken with ETOH (circulatory collapse and respiratory depression)
104
ADRs of phenobarbital
- Dependence | - CNS depression
105
Use phenobarbital with caution in which patients?
Renal OR hepatic dysfunction
106
What are the withdrawal symptoms of phenobarbital?
Convulsions and delirium
107
DIs of phenobarbital
- Pan inducer of CYP450 - Increases Vit D metabolism (osteomalacia) - CNS depressants (additive effect)
108
Pregnancy category of phenobarbital
D
109
Describe primidone
Converted to phenobarbital via hepatic oxidation
110
Pregnancy category of primidone
D
111
Indications for ethosuximide
Absence seizures
112
DIs of ethosuximide
Clearance is decreased by valproic acid
113
Indications for felbamate
Partial seizures (reserved for refractory cases)
114
ADRs of felbamate
Aplastic anemia | Severe hepatitis
115
When can AED therapy be discontinued?
Once a patient has been seizure free for 2-4 years
116
Treatments of status epilepticus
- 0-10 mins: IV lorazepam - 10-30 mins: IV phenytoin or fosphenytoin - 30-60 mins: additional dose of hydantoin, IV phenobarbital
117
Which GCSE treatment contains propylene glycol?
- IV Phenytoin (40%, can cause hypotension and cardiac arrhythmias) - Fosphenytoin does NOT have propylene glycol
118
How should fosphenytoin be prepared?
Diluted in 5% dextrose or NS
119
Side effects of fosphenytoin
Paresthesia and pruritus of face and groin
120
Nonpharm therapy of GCSE
- IV thiamine - IV glucose - Vital signs - Airway, ventilation
121
Describe midazolam
- Diffuses rapidly into brain | - Extremely short half life (give via continuous infusion)

Pharm III - Exam 2 (3 decks)

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