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psych 1166 > Seizures > Flashcards

Seizures Flashcards

1
Q

IV phen admin instructions

A
  1. DO not exceed 50 mg/min
  2. Monitoring same as fos, BP, respiratory function, ECG
  3. Requires filter
  4. Dilute in NS, stable for 4 hours
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2
Q

Patient counseling for all AEDs?

A
  1. All can cause suicidal thoughts
  2. Dont stop taking this medication
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3
Q

Warnings for topamax? 7

A
  1. Gap: Met acidosis
  2. Oligohidrosis
  3. reduced perspiration
  4. Nephrolithiasis
  5. Angle closure glaucoma
  6. hyperammonemia
  7. Fetal harm
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4
Q

How is Diastat dispensed?

A

Must be dialed to dose and locked before dispensing

Once locked the green band should say ready

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5
Q

Boxed warning for Tegretol? 4

A

`SJS/TEN

  1. Asian decent should be tested for HLA-B1502
  2. Aplastic anemia
  3. agranulocytosis
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6
Q

Phenobarbital and Primidone (prodrug of pheno) SEs, 5

A
  1. Sedation
  2. Dependence
  3. tolerance
  4. risk of overdose
  5. enzme inducer
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7
Q

What to do during initial phase of SE? 5-20 minutes 5 things

A
  1. If seizure continues
    1. Give IV BZD, IV lorazepam
    2. Alt if IV not available
      1. IM Midazolam
      2. Rectal diazepam (Diastat)
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8
Q

What drugs come in easy to swallow formulations for children 2

A

Lamotrigine and Levetiracetam

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9
Q

What can topiramate and zonisamide cause in children?

A

Reduce or lack of sweating

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10
Q

Women of child bearing age on AEDs should get?

A

Daily folate sup

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11
Q

Warnings for gabapentin?

A

Peripheral edema

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12
Q

Valproic acid MOA?

A

Increase GABA

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13
Q

Lamotrigine drug interaction 1 specifically

A

Valproic, increases lam concentrations

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14
Q

Carbamazepine MOA?

A

Na channel blocker

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15
Q

Therapeutic range for tegretol?

A

4-12 mcg/mL

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16
Q

Initial dosing for lamotrigine?

A

Wks 1 and 2, 25 mg

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17
Q

What drug needs a filter?

A

Phenyoin

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18
Q

What schedule is Vimpat?

A

Lacosamide

CV

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19
Q

Tegretol

A

Carbamazepine

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20
Q

Kepra

A

Levetiracetam

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21
Q

BZD MOA?`

A

Increase GABA

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22
Q

WHat is purple glove syndrome?

A

Extravasation: characterized by edema, pain, and blush color

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23
Q

How is an absence seizure described?

A

Momentary loss of awareness

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24
Q

Lamotrigine can increase the risk of what?

A

Serious rash when taken with lamotrigine

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25
Warnings for Phenobarb??
1. Habit forming 2. Physiological dependence 3. Hangover effect 4. Tolerance
26
Phenobarb DI?
Can decrease the effect of hormonal contraceptives non-hormonal contra rec'd
27
Ethosuximide MOA?
T-type Ca channel blocker
28
Note about Trileptal?
Not an autoinducer
29
Zonisamide and Topirimate SEs? 5
1. Wt loss 2. Metabolic acidosis 3. Nephrolithiasis 4. Oligohidrosis 5. hyperthermia (in children) 1. Bring bottles of water stay hydrated, limit sun
30
Lamotrigine Black Box
Serious skin reactions, including SJS/TEN
31
What is ethosuximide used for?
Isolated conditions absence seizures
32
Warnings fro Trilepta
Oxcarb 1. Asian decent HLA 1502 prior of positive dont use 2. Hyponatremia
33
What other risk do AEDs have?
Suicide risk monitor mood
34
How is a tonic clonic seizure described?
Uncontrolled jerky movements
35
Vimpat
Lacosamide
36
Drugs for neuroleptic pain? 2
Pregabalin and gabapentin
37
AEDs and teratogenicity?
Contraception is required Enzyme inducing AEDs decrease hormonal contraceptives
38
IV fosphen admin instructions? 3
1. Do not exceed 150 mg PE/min 2. Monitor BP, respiratory function and ECG 3. Lower risk of purple close
39
4 SEs of Gabapentin?
1. Somnolence 2. Peripheral edema 3. et gain 4. mild euphoria
40
Boxed warning for Valproic acid? 3
1. Hepatotoxicity 2. Fetal harm: neuronal tube defects decrease IQ 3. Pancreatitis
41
Trileptal
Oxcarb
42
IV PO ratio for phenytoin?
1:1
43
Phenobarb therapeutic range?
20-40 mcg/mL in adults
44
What do increase lamotrigine levels do?
Increase risk of severe rash
45
Many AEDs and pregnancy?
Decrease efficacy of hormonal contraceptives
46
G-tube phen admin insruction?
Enteral feedings tube feeds decrease absorption Hold feedings 1-2 hours before and after
47
What are generalized seizures?
Start on both sides
48
What to do during the stabilization phase? 7 things to do
1. Time seizure 2. Start EEG 3. Check BG if low 4. Treat with D25-D50 5. Check AED level 6. and electrolytes 7. May need oxygen
49
WHen can a kid be tapered off AEDs?
seizure free for 1 -2 years
50
Drug that is also used for bipolar and migraine prophylaxis?
Valproic acid
51
What two drugs have the MOA of Na channel blocker?
Carbamazepine Phen/fos others do though lamotrigine, phenytoin, fosphenytoin
52
Monitoring for Trileptal?
Oxcarb Monitoring Na
53
Primidone?
Pro drug of phenobarbital
54
What AEDs have blood levels you can check? 4
1. Carb 2. Phen 3. Phenobarb 4. Valproic
55
What doses does diastat acudial come in? 3
2.5, 10, 20
56
Key drugs that can lower seizure threshold High doses and renal impairment increase risk 6
1. High doses and renal impair increase risk in 1. Carbapenems especially imipenem 2. Lithium 3. Meperidine 4. PCN 5. Quinolones 6. Theophylline
57
Contraindication to Carbamazepine?
1. Myelosuppression
58
Status epilepticus tx What are the phases?
Stabalization phase: 0-5 Initial Tx: 5-20 second treatment phase 20-40
59
2 main valpro SEs
Alopecia Wt gain
60
What AED has the highest teratogenic risk?
Valproic acid
61
Phenobarb DIs?
Strong inducer of most enzymes
62
What is a seizuring lasting more than 5 minutes?
Status epilepticus SE
63
Monitoring for Tegretol?
1. CBC: with differential and plats 2. Electrolytes especiialy Na
64
What are patients on AEDs at risk for?
Bone loss All pt on AEDs should get Calcium and Vit D
65
Whats the most common test to dx epilepsy?
ECG
66
Zarontin Warniings 2
SJS/TENs, Blood dyscrrasia
67
What kinetics does phenytoin follow and what is the corrected equation?
Michalis mentin: Pheny level/(0.2\*alb)+0.1
68
2 SEs of Valproic acid?
1. Hyperammonemia treat with carnitine 2. dose related thrombocytopenia
69
Valproic acid counseling?
Take with food to limit GI upst
70
What lamictal starter pack should be given to a pt taking valproic acid?
Blue the lower starting dose pack
71
Valproic acid DI: can increase the levels of what 5 drugs?
Inhibitor of 2C9, weak and substrate of 2C19 and 2E1 1. Lamotrigine 2. Phenobarb 3. phenytoin 4. warfarin 5. Zidovudine
72
3 main SEs of Topamax?
1. Somnolence 2. Wt loss 3. Anorexia
73
Warnings for Kepra 4
1. Psychiatric reactions 1. Including pscyhotic symptoms, solmonlence, fatigue
74
How are SEs initially treated?
BZDs
75
What drug is also used for migraine prophylaxis?
Topamax
76
Important note about keppra?
No signficant DIs CrCl\<=80 decrease dose
77
Other drugs that lower seizure threshold? 5
1. Clozapine 2. Bupropion 3. Tramadol 4. Varinicline
78
What happens to AEDs during pregnancy?
AED levels decrease
79
AEDs enzyme inducers? 6
1. Carbamazepine 2. Ox carb 3. Phenytoin 4. Fosphen 5. Phenobarb 6. Primidone
80
Felbamate Black box? 2
1. Hepactic failure 2. Aplastic anemia
81
Other DI for lamotrigine?
Estrogen containing contraceptives decrease lam efficacy
82
What is valproic acid?
Enzyme inhibitor not really an issue except for lamotrigine
83
Diastat Acudial dispensing Each pack contains?
2 rectal syringes
84
IV PO rations of keppra?
1:1
85
Depakene, Depacon
Valproic acid
86
Interesting note about tegretol?
Inducer and autoinducer decreases concentrations of other drugs and itsef
87
Monitoring for Valpro
1. LFTs: Baseline and frequently in the first 6 months 2. Platelet
88
What to do for secondary tx? 20-40 5 things
1. If seizure continues give regular AED option 1. IV fosphenytoin 2. Valpro 3. Levetiracetam 4. Or phenobarb if others are unavailable
89
Lamotrigine formulations? 3
Tablet, Chew, ODT
90
Zarontin?
Ethosuximide
91
AEDs decrease abnormal electrical acitivity by what two main things?
Increase gaba Decrease glutamate
92
What can a ketogenic diet be used for?
Refractory seizures 4:1 combined fats to protein and carbs
93
What do all AEDs do?
Cause CNS depression
94
Warning fro tegretol?
* Hyponatremia (SIADH) * Fetal harm
95
What is eslicarbazepine?
Produrg of oxcarb
96
SEs of Zonisamide
Oligohidrosis, hyperthermia nephrolithiasis
97
Phenytoin and Fosphenytoin MOA?
Na channel blocker
98
Supplements that need to be taken with all AEDs?
1. Vit D and Calcium 2. Women of child bearing age folate 3. Valproic acid possibly carnitine 4. Lamotrigine if alopecia consider selenium and zinc
99
Topamax
Topirmate
100
What is the therapeutic range for valproic acid?
50-100 Effected by albumin \<3.5 use phen calc
101
Warnings for Phenytoin?
1. Extravasation: characterized by edema, pain, and blush color 2. Avoid with positive HLAB1502 3. Fetal harm
102
What is epilepsy?
A chronic seiure disorder
103
Warniings for Vimpat
Prolonged PR interval and increased risk of arrythmias
104
Boxed warning for phenytoin
1. Pheny IV admin rate should not exceed 50mg/min and fosphen IV should not exceed 150 mg PE/min if faster hypotension and cardiac arrhythmias
105
Main Topamax interaction?
1. Weak 2C19 inhibitor and inducer of 3A4 2. Can decrease efficacy of non-hormonal contraeptives 3. Can decrease INR
106
Tegretol DIs
Strong inducer of many (1A2, 2C19, 2C8/9, 3A4) and p-glycoprotein Use of alternative non hormonal contraception recommneded
107
Therapeutic level for phenytoin
10-20 mcg/mL total
108
3 common SEs of Carb, Oxcarb, and Exslicarb?
1. Hyponatremia 2. Rash 3. Enzyme INducers
109
Valpro formulations
1. Capsule and syrup depakene 2. Depakote: delayed release decrease GI upset 3. ER 4. Sprinkle: on food
110
Dilantin, Dilantin Infatab
Phenytoin
111
Phen 3 DI things
1. Strong inducer of several 2. Non hormonal contra is recommened 3. High protein bound can be displaced with other high protein bound
112
What occurs more commonly with lamotrigine in children?
Life threatening rash
113
What are focal seizures?
Start on one side
114
Vimpat dose changes
CrCl\<30 max dose of 300 per day
115
Diastat?
Rectal Diazepam
116
Zonisamide contraindications?
Hypersens to sulfonamides
117
Lamictal starter kits 3 sets to know When are they used?
1. Orange: 1. Standard dosing 2. Use if no interacting meds 2. Blue 1. Lower starting 2. Use if taking valproic acid 3. Green 1. Higher starter dose 2. Use if taking enzyme inducers
118
WHat can be given IM?
Midazolam
119
Vigabatrin (Sabril) Boxed warning
Permanent vision loss
120
When should AEDs be stopped?
Not abruptly can cause seizures
121
Formulations fo Keppra? 3
Tablet Oral Solution Injection
122
What two things need to happen to correct phenytoin levels?
Alb\<3.5 g/dL CrCl \>= 10
123
3 SEs of Pregabalin and Gabapentin
Wt gain, peripheral edema, mild euphoria

psych 1166 (20 decks)

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