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RxPrep > Seizures/Epilepsy > Flashcards

Seizures/Epilepsy Flashcards

(176 cards)

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1
Q

How is epilepsy diagnosed?

A

electroencephalogram (EEG)

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2
Q

What drugs can cause seizures?
* high-doses and/or renal impairment increase risk

A
  1. Opioids (tramadol, meperidine)*
  2. Quinolones/mefloquine
  3. Carbapenems*
  4. Cephalosporins*
  5. PCNs*
  6. Bupropion/ TCAs*
  7. antipsychotics (clozapine)
  8. Lithium*
  9. baclofen*
  10. diphenhydramine*
  11. metoclopramide
  12. metronidazole
  13. varenicline
  14. stimulants (methylphenidate)*
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3
Q

What is a focal seizure?

A

starts on 1 side of the brain, may spread to the other

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4
Q

What is a generalized seizure?

A

starts on both sides of the brain

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5
Q

What is a focal aware seizure?

A

no loss of consciousness; simple partial seizure

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6
Q

What is a focal seizure with impaired awareness?

A

loss of consciousness; complex partial seizure

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7
Q

How are rigid or tense movements described?

A

tonic

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8
Q

How is muscle twitching described?

A

myoclonus

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9
Q

What is status epilepticus?

A

seizure lasts 5 min or more (medical emergency)

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10
Q

How is status epilepticus treated?

A

0-5 min: stabilize airway/circulation/breathing; time seizure and start ECG; check anti seizure drug levels/electrolytes/treat glucose with dextrose
5-20 min (treatment 1): IV lorazepam/diazepam, IM midazolam; rectal diazepam, intranasal/buccal midazolam if seizure continues (alt)
20-40 min (treatment 2): IV fosphenytoin/valproic acid/levetiracetam/phenobarbital
>40 min (treatment 3): repeat treatment 2 or midazolam/pentobarbital/propofol

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11
Q

When and what non-injectable options for non-emergency seizure control?

A
  1. diazepam rectal gel (Diastat AcuDial)
  2. buccal/intranasal midazolam
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12
Q

What patients are Diastat AcuDial prescribed for?

A

at risk for long-lasting seizures

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13
Q

What must the pharmacist do before dispensing Diastat AcuDial?

A

dial each syringe to the correct dose (2.5, 10, 20mg) and lock before dispensing

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14
Q

What are the instructions for dialing the Diastat AcuDial to the correct dose?

A
  1. hold the barrel of the syringe with the cap facing down and dose window visible, don’t remove the cap
  2. grab the cap and turn to adjust the dose
  3. confirm dose in window, hold the cap and push up on both sides of the lock ring; green band should say READY; cannot be unlocked
  4. repeat with second syringe and check dose
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15
Q

Can anti-seizure medications (ASM) be stopped?

A

stopping abruptly increases seizures

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16
Q

What are adjuvant treatments for chronic seizures?

A
  1. CBD (Epidiolex)
  2. ketogenic diet (4:1 fats:protein/carbs)
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17
Q

What ASMs are used for focal and generalized seizures?

A

Broad spectrum ASMs (lamotrigine, levetiracetam, topiramate, valproic acid)

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18
Q

What are generalized seizures with non-motor symptoms called?

A

absence seizure (staring spell)

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19
Q

Which agent is used specifically for absence seizures?

A

ethosuxamide

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20
Q

What are narrow spectrum ASMS used for?

A

focal-onset seizures

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21
Q

What are safety concerns with all ASMs?

A
  1. Increased risk of CNS depression (sedation, cognitive impairment, ataxia/difficult coordination, falls)
  2. Suicide risk warning
  3. Bone loss/increased fracture risk
  4. SJS/TENS rash
  5. DRESS multiorgan HSR
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22
Q

What supplements should be taken with ASMs?

A
  1. Ca and Vitamin D (all)
  2. Folate (pregnancy)
  3. Carnitine (Valproic acid)
  4. Biotin, Selenium and Zinc (alopecia with valproic acid and lamotrigine)
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23
Q

Which ASMs have the MOA of enhancing GABA effect?

A
  1. Benzos
  2. Phenobarbital
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24
Q

Which ASMs have the MOA of increasing GABA by blocking Na channels?

A

Valproate

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25
Which ASMs have the MOA of inhibiting vesicle fusion by binding SV2A proteins?
Levetiracetam
26
Which ASMs have the MOA of blocking Na channels?
1. carbamazepine 2. phenytoin/fosphenytoin 3. topiramate
27
Which ASMs have the MOA of decreasing glutamate by blocking Na channels?
lamotrigine
28
Which ASMs have the MOA of blocking t-type Ca channels?
ethosuxamide
29
How does blocking Ca channels decrease seizure?
slows/stops transmission of electrical signal
30
How does blocking Na channels decrease seizure?
decreases neuronal firing rate
31
Lamotrigine
Lamictal Lamictal ODT Lamictal XR Lamictal Starter Kit Subvenite
32
How is lamotrigine dosed for seizure?
Week 1 and 2: 25mg QD Week 3 and 4: 50mg QD Week 5 and on: increase by 50mg every 1-2 weeks Maintenance dose: IR 225-375 BID, XRn300-400mg QD; dose varies based on DIs
33
What are BBW for lamotrigine?
Serious skin reactions (SJS/TEN) peds>adults; increased risk with starting doses higher than recommended or use with valproate
34
What are warnings with lamotrigine?
1. Multiorgan HSR (DRESS) 2. aseptic meningitis 3. blood dyscrasias (disorder of cells in the blood) 4. cardiac rhythm abnormalities 5. hemophagocytic lymphohistiocytosis (HLH) rare immune reaction that can be fatal
35
What are SEs with lamotrigine?
1. Alopecia (supplement with Biotin, Selenium, and Zinc) 2. N/V 3. somnolence 4. rash 5. tremor 6. ataxia 7. impaired coordination 8. dizziness 9. diplopia (double vision) 10. blurred vision
36
What should be monitored with lamotrigine therapy?
1. Rash (discontinue if any HSR or rash) 2. fever 3. Adherence (if not taken for >/= 5 half-lives (>6 days) restart initial dosing titration
37
What are DIs with lamotrigine?
1. drugs that induce/inhibit uridine diphosphate glucuronosyltransferase (UGT) 2. valproic acid increases lamotrigine conc 3. oral estrogen containing contraceptives decrease lamotrigine conc 4. carbamazepine, phenytoin, phenobarbital, primidone, lopinavir/ritonavir, atazanavir/ritonavir, rifampin decrease lamotrigine conc
38
How does Lamictal Starter Kit work?
Color coded kit: Blue- lower starting dose (used if also taking valproic acid) Orange- Standard starting dose Green- Higher starting dose (used if also taking carbamazepine, phenytoin, phenobarbital, primidone, lopinavir/ritonavir, atazanavir/ritonavir, rifampin)
39
Levetiracetam
Keppra Keppra XR Elepsia XR Spritam
40
How is levetiracetam dosed?
Initial: 500 mg BID IR or 1000mg QD XR Maintenance: max dose 3000mg/day CrCl
41
What are warnings with levetiracetam?
1. Psychiatric reactions (Psychotic symptoms, Somnolence, Fatigue, aggression, anxiety, suicidal behavior) 2. anaphylaxis/angioedema 3. coordination difficulties 4. severe skin reactions (SJS/TENS) 5. multiorgan HSR (DRESS) 6. hematologic abnormalities (mainly anemias) 7. loss of seizure control during pregnancy
42
What are SEs with levetiracetam?
1. somnolence 2. dizziness 3. weakness 4. asthenia (weakness)
43
What are DIs with levetiracetam?
None
44
What drugs are considered broad spectrum ASM?
1. Lamotrigine 2. Levetiracetam 3. Topiramate 4. Valproate
45
Topiramate
Topamax Topamax Sprinkle Eprontia
46
Topiramate extended-release
Qudexy XR Trokendi XR
47
How is topiramate dosed?
Week 1: 25mg BID IR or 50mg QD XR Week 2-4: increase by 25mg BID IR or 50mg QD XR each week Week 5 and on: increase by 100mg weekly until max dose/theraputic effect Max dose: 400mg/day CrCl<70: decrease dose by 50%
48
What are CIs with topiramate?
Trokendi XR: alcohol use 6 h before/after dose Qudexy XR: patients with metabolic acidosis taking metformin
49
What are warnings with topiramate?
1. Hyperchloremic non-anion gap Metabolic Acidosis 2. Ogliohidrosis (reduced perspiration)/hyperthermia (mostly children) 3. Nephrolithiasis (kidney stones) 4. acute myopia 5. secondary Angle-closure Glaucoma 6. Hyperammonemia 7. Visual problems (reversible) 8. Fetal Harm
50
What are SEs with topiramate?
1. Somnolence 2. Difficulty with Memory, Concentration, Attention 3. Weight loss/ Anorexia 4. paresthesia (skin sensation) 5. dizziness 6. psychomotor slowing
51
What should be monitored with topiramate?
1. electrolytes (Bicarb) 2. renal function 3. hydration status 4. eye exam (Intra Ocular Pressure)
52
What are specific administration instructions for Topamax Sprinkle?
swallow whole or open and sprinkle on a small amount of soft food (swallow whole; do not chew)
53
What are DIs with topiramate?
1. weak inhibitor CYP2C19 and inducer of CYP3A4 2. phenytoin, carbamazepine, valproate, and lamotrigine can decrease topiramate levels 3. topiramate can decrease effective ness of oral contraceptives (especially >200mg/day) Non-hormonal BC recommended 4. can decrease INR if on warfarin
54
What other indication does topiramate have?
migraine prophylaxis
55
What are BBWs with valproate?
1. Hepatic failure: usually during first 6 months of therapy, children < 2 years and those with mitochondrial disorders increased risk 2. Fetal harm: Neural tube defects and Decreased IQ scores 3. Pancreatitis
56
What are CIs with valproate?
1. Hepatic disease 2. urea cycle disorders 3. prophylaxis of migraine in pregnancy 4. certain mitochondrial disorders if <2 years of age
57
What are warnings with valproate?
1. Hyperammonemia (tx with Carnitine in symptomatic adults only) 2. hypothermia 3. dose-related thrombocytopenia (increase bleeding risk) 4. multiorgan HSR (DRESS)
58
What are SEs with valproate?
1. Alopecia (supplement biotin, selenium, zinc) 2. N/V 3. Weight changes (gain >loss) 4. Somnolence/dizziness 5. Tremor 6. headache 7. anorexia 8. abdominal pain 9. edema 10. diplopia/blurred vision
59
What should be monitored with valproate?
1. LFTs (baseline and frequently for first 6 months) 2. CBC with differential (esp. Platelets) 3. serum valproate levels (50-100 mcg/mL) 4. serum ammonia
60
What is the difference between valproate vs. valproic acid?
"valproate" is used to refer to any formulation of valproic acid, valproate sodium, or divalproex
61
Valproate
Valproic Acid (capsule/syrup) Valproate sodium (IV) Divalproex (Depakote)
62
Divalproex
Depakote (DR tablet) Depakote ER (ER tablet) Depakote Sprinkle (capsules can be opened and sprinkled on food)
63
How is valproate dosed?
Initial: 10-15 mg/kg/day Max: 60 mg/kg/day Therapeutic range: 50-100mcg/mL Albumin <3.5: may need to decrease dose DR to ER: increase TDD 8-20%
64
What are other indications for valproate?
1. Bipolar disorder 2. Migraine prophylaxis
65
What are DIs with valproate?
1. Increases levels of Lamotrigine, Warfarin, phenobarbital, and zidovudine 2. Risk of serious rash when used with Lamotrigine (use lower lamictal dose) 3. Salicylates displace valproate from protein (more valproate) 4. Carbapenems and estrogen containing contraceptives decrease valproate 5. use with topiramate can lead to hyperammonemia with or without encephalopathy
66
Which agents are narrow-spectrum ASMs?
1. Lacosamide 2. Carbamazepine 3. Oxcarbazepine 4. Phenytoin/Fosphenytoin 5. Phenobarbital
67
Lacosamide
Vimpat (CV)
68
How is lacosamide dosed?
Initial: 50-100mg BID Max: 400mg/d CrCl<30: max 300mg/d IV:PO=1:1
69
What are warnings with lacisamide?
1. Prolongs PR interval increasing risk of Arrhythmias (obtaine ECG prior to use and after titrated to steady state in those with or at risk of cardiac conduction problems) 2. Multiorgan HSR (DRESS) 3. syncope/dizziness 4. ataxia
70
What are SEs with lacosamide?
1. dizziness 2. headache 3. ataxia 4. tremor 5. diplopia/blurred vision 6. ataxia
71
What is monitored with lacosamide?
ECG (baseline and steady state) in at risk pts
72
What are DIs with lacosamide?
1. medications that prolong PR interval (beta blockers, CCBs, digoxin risk of AV block and brady) 2. inhibitors of CYP 2C19,2C9, and 3A4 can increase lacosamide conc
73
Carbamazepine
Tegretol Tegretol XR Carbatrol Epitol Equetro (for bipolar disorder)
74
What are BBWs for carbamazepine?
1. Serious Skin Reactions (SJS/TENS) 2. HLA-B*1502 allele testing required for patients of Asain descent prior to starting 3. Aplastic anemia 4. Agranulocytosis 5. D/C if significant myelosuppression occurs
75
What are warnings with carbmazepine?
1. increased risk of HSR with HLA-A*3101 allele 2. multiorgan HSR (DRESS) 3. hyponatremia (SIADH) 4. Fetal harm 5. hypothyroidism 6. increased IOP 7. liver damage 8. cardiac conduction abnormalities
76
What are CIs with carbamazepine?
1. Myelosuppression 2. HSR to TCAs 3. MAOi within 14 days 4. use with nefazodone or NNRTIs that are substrates of CYP3A4
77
What are SEs with carbamazepine?
1. dizziness/drowsiness 2. ataxia 3. N/V 4. pruritis 5. photosensitivity 6. blurred vision 7. rash 8. alopecia 9. increased LFTs 10. renal impairment
78
What should be monitored with carbamazepine?
1. CBC with differential including platelets prior to and during therapy 2. drug levels 3-5 days after initiation and after 4 weeks due to autoinduction 3.LFTs 4. rash 5. eye exam 6. thyroid function 7. serum NA 8. renal function
79
What are DIs with carbamazepine?
1. Autoinducer will decrease its own levels 2. Strong CYP3A4 and Pgp inducer (can decrease levels of warfarin, levothyroxine, and hormonal contraceptives) 3. major CYP3A4 substrate inhibitors or inducers can effect levels 4. carbamazepine suspension should not be taken with other liquid meds can precipitate
80
How is carbamazepine dosed?
Initial: 200mg BID (100mg QID suspension) Max: ~1600/d Therapeutic range: 4-12mcg/mL
81
What is a therapeutic carbamazepine drug level?
4-12 mcg/mL
82
Oxcarbazepine
Trileptal Oxtellar XR
83
How is oxcarbazepine dosed?
Initial: 300mg BID (Trileptal) or 600mg QD Oxtellar XR Max: 2400mg/d CrCl<30: start 300mg QD Carbamazepine to Oxcarbazepine = 1.5 x carbamazepine dose XR tablet: take on empty stomach 1 hour before or 2 hours after a meal Suspension: use within 7 weeks of opening original container
84
What are CIs with oxcarbazepine?
HSR to eslicarbazepine
85
What are warnings with oxcarbazepine?
1. increased risk of serious skin reactions (SJS/TENS) 2. consider screening for HLA-B*1502 prior to initialing therapy if Asian 3. multiorgan HSR (DRESS) 4. Hyponatremia 5. hypothyroidism 6. worsening of generalized seizures
86
What are SEs with oxcarbazepine?
1. somnolence/dizziness 2. N/V 3. abdominal pain 4. diplopia/visual disturbances 5. ataxia 6. tremor
87
What should be monitored with oxcarbazepine?
1. Serum Na (esp. during first 3 months) 2. thyroid function 3. CBC
88
What are DIs with oxcarbazepine?
1. decrease hormonal contraception; non-hormonal contraception preferred 2. weak CYP3A4 inducer and CYP2C19 inhibitor; not an auto inducer
89
Phenytoin
Dilantin Dilantin Infatabs Phenytek
90
How is phenytoin dosed?
Loading dose: 15-20 mg/kg (can be divided doses) Maintenance: 300-600 mg/day Therapeutic range: 10-20 mcg/mL (total), 1-2 mcg/mL (free) IV:PO=1:1
91
What are BBWs with phenytoin?
1. Phenytoin IV rate should not exceed 50mg/min 2. Fosphenytoin IV rate should not exceed 150mg phenytoin equivalents (PE)/min or 2mg PE/kg/min (use slower rate) 3. Faster administration results in hypotension and cardiac arrhythmias
92
What are warnings with phenytoin/fosphenytoin?
1. Extravasation (purple glove syndrome) 2. Avoid if HLA-B*1502 positive or hx of severe rash with carbamazepine 3. Fetal harm 4. Multiorgan HSR (DRESS) 5. bradycardia 6. risk of SJS/TENS 7. blood dycrasis 8. cardiac arrest 9. hepatic/renal impairment 10. hypothyroidism
93
What is purple glove syndrome?
edema, pain, and bluish discoloration of skin which can lead to tissue necrosis
94
What are chronic SEs with phenytoin/fosphenytoin?
1. Gingival hyperplasia 2. Hepatotoxicity 3. hair growth 4. morbilliform rash (measles-like)/rash 5. peripheral neuropathy 6. high BP 7. metallic taste 8. connective tissue hyperplasia
95
What are dose-related toxicities with phenytoin/fosphenytoin?
1. Nystagmus (rapid eye movement) 2. Ataxia 3. Diplopia/blurred vision 4. slurred speech 5. dizziness 6. somnolence 7. lethargy 8. confusion/delirium
96
What should be monitored with phenytoin/fosphenytoin?
1. Serum phenytoin concentration (metabolism can become saturated, small dose increase leads to large serum increase) 2. LFTs 3. CBC 4. Continuous ECG and respiratory function (IV)
97
What is the difference between phenytoin/ fosphenytoin?
fosphenytoin is the prodrug of phenytoin
98
How is phenytoin converted to fosphenytoin?
1 PE= 1mg phenytoin=1.5 mg fosphenytoin
99
What are DIs with phenytoin/fosphenytoin?
1. strong inducers of CYP 2C19, 3A4, Pgp, UGT1A1 can decrese conc of other ASMs 2. hormonal contraceptives 3. high protein binding
100
How is phenytoin administered IV?
1. Dilute in NS, stable for 4 hours, do not refrigerate 2. monitor BP, respiratory rate, and ECG 3. requires a filter 4. do not exceed 50mg/min
101
How is fosphenytoin administered IV?
1. Dilute in NS, stable for 4 hours, do not refrigerate 2. monitor BP, respiratory rate, and ECG 3. no filter 4. do not exceed 150 PEmg/min 5. lower risk of purple glove syndrome vs. phenyotin
102
How is phenytoin administered via NG-tube?
1. hold feedings 1-2 hours before and after administration 2. enteral feeding decrease conc
103
How should phenytoin/fosphenytoin dose be adjusted when albumin <3.5 and CrCL>/=10?
Total phenytoin mcg/mL / (0.2 x albumin g/dL) +0.1
104
What is a CI to using phenytoin/fosphenytoin?
hx hepatotoxicity from phenytoin
105
Fosphenytoin
Cerebryx
106
Phenobarbital
Sezaby (injectable formulation for neonatal seizures that is preservative free)
107
What are CIs with phenobarbital?
1. Severe hepatic impairment, dyspnea, or airway obstruction 2. hx addiction to sedative hyponotics 3. intraarterial administration
108
What are warnings with phenobarbital?
1. Potential for drug dependency 2. Fetal harm 3. Respiratory depression 4. hyperactive or aggressive behavior (acute pain/peds) 5. hypotension given IV 6. serious skin reactions SJS/TENS
109
What is the therapeutic range for phenobarbital?
Adults: 20-40 mcg/mL Peds: 15-40 mcg/mL
110
What are SEs with phenobarbital?
1. Physiologic dependence/tolerance 2. Residual sedation (hangover) 3. somnolence/dizziness 4. cognitive impairment 5. ataxia 6. depression 7. folate deficiency
111
What should be monitored with phenobarbital?
1. LFTs 2. CBC with differential
112
What are DIs with phenobarbital?
1. Strong inducer of 3A4 and Pgp 2. hormonal contraceptives
113
What is the prodrug of phenobarbital?
primidone
114
What is in common with phenobarbital and primidone?
1. sedation 2. dependence/tolerance/OD risk 3. enzyme induction 4. primidone is the prodrug of phenobartital
115
What is in common with carbamazepine, oxcarbazepine, and eslicarbazepine?
1. Hyponatremia 2. Rash 3. enzyme induction
116
What is in common with gabapentin and pregabalin?
1. weight gain 2. peripheral edema 3. mild euphoria 4. used for neuropathic pain primarily
117
What is in common with topiramate and zonisamide?
1. weight loss 2. metabolic acidosis 3. nephrothialasis and ogliohidrosis/hyperthermia in children
118
Clobazam
Onfi Sympazan
119
Diazepam
Diastat AcuDial Valtoco
120
Midazolam
Nayzilam
121
What are BBWs with benzos?
Use with opioids results in profound sedation, Respiratory depression, and Death
122
What are warnings with benzos?
1. severe skin reactions (SJS/TEN) 2. paradoxical reactions including hyperactive/aggressive behavior 3. anterograde amnesia 4. C-IV
123
What are SEs with nasally administered benzos?
1. drooling 2. pyrexia (increased body temp) 3. nasal/throat irritation
124
When is clobazam used?
Lennox-Gastaut syndrome or refractory epilepsy
125
Brivaracetam
Briviact
126
What are warnings with bivaracetam?
1. behavioral reactions including psychotic symptoms, irritability, depression, aggressive behavior, or anxiety 2. bronchospasm 3. angioedema 4. no therapeutic benefit when used with levetiracetam 5. CV
127
What should be monitored with bivaracetam?
1. somnolence 2. fatigue 3. caution driving/operating machinery
128
Cannabidiol
Epidiolex (oral solution)
129
What are warnings with cannabidiol?
1. somnolence/sedation (more risk when used with clobazam) 2. hepatotoxicity (monitor LFTs)- more risk when used with valproic acid/clobazam 3. can decrease appetite 4. used in Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex 5. C-V
130
Cenobamate
Xcopri
131
What are warnings with cenobamate?
1. multiorgan HSR (DRESS) 2. shortening of QT interval 3. somnolence 4. gait disturbance 5. visual changes 6. C-V
132
What should be monitored with cenobamate?
1. eye exam 2. serum K (can become elevated)
133
Eslicarbazepine
Aptiom
134
What are warnings SEs with eslicarbazepine?
1. Active metabolite of oxcarbazepine so same 2. drug-induced liver injury (monitor LFTs) 3. inducer of CYP3A4 4. monitor Na
135
Ethosuxamide
Zarontin
136
What are warnings with ethosuxamide?
1. serious skin reaction (SJS/TENS) 2. multiorgan HSR (DRESS) 3. blood dyscrasis 4. used for absence seizures
137
What are SEs with ethosuxamide?
1. N/V 2. abdominal pain 3. weight loss 4. hiccups 5. dizziness/somnolence
138
What should be monitored with ethosuxamide?
1. LFTs 2. CBC with differential 3. urinalysis 4. platelets 5. trough serum 6. rash
139
Felbamate
Felbatol
140
What are BBWs for felbamate?
1. Aplastic Anemia 2. hepatic failure 3. informed consent needs to be signed by patient and prescriber prior to dispensing
141
What should be monitored with felbamate?
1. LFTs 2. CBC 3. serum levels of other ASM
142
Fenfluramine
Fintepla
143
What are BBWs with fenfluramine?
1. Valvular heart disease 2. Pulmonary HTN (REMS program)
144
What are warnings with fenfluramine?
1. Decreased appetite/weight loss 2. serotonin syndrome (CI with MAOis) 3. high BP 4. angle-closure glaucoma
145
What should be monitored with fenfluramine?
1. ECG before, during, after treatment 2. weight 3. BP
146
Gabapentin
Neurontin Gralise (postherpetic neuralgia) Horizant- gabapentin enacarbil (postherpetic neuralgia and restless leg syndrome)
147
What are warnings with gabapentin?
angioedema
148
What are SEs with gabapentin?
1. Somnolence/dizziness 2. Peripheral edema (monitor) 3. Weight gain (monitor) 4. ataxia 5. diplopia/blurred vision 6. dry mouth 7. mild euphoria
149
Perampanel
Fycompa
150
What are warnings with perampanel?
BBW: Neuropsychiatric events (dose related)including irritability, aggression, anger, paranoia (mainly first 6 weeks) 1. CYP3A4 substrate 2. C-III
151
Pregabalin
Lyrica
152
What are warnings and SEs with pregablin?
same as gabapentin
153
Primidone
Mysoline
154
What is important to not about SEs and warnings with primidone?
prodrug of phenobarbital; same
155
Rufinamide
Banzel
156
What are CIs with rufinamide?
Patients with familial short QT syndrome due to QT shortening (dose-related)
157
How should rufinamide be administered?
with food
158
Stripentol
Diacomit
159
What are warnings with stripentol?
1. loss of appetite/weight loss 2. delirium/hallucinations (rare) 3. to be taken with clobazam to treat Darvet syndrome
160
What should be monitored with stripentol?
1. CBC 2. hepatic function 3. weight 4. mood
161
Tiagabine
Gabitril
162
What are warnings with tiagabine?
1. worsening of seizures/new onset seizures when used off-label for other indications 2. serious skin reactions (SJS/TENS)
163
How should tiagabine be administered?
with food
164
Vigabatrin
Sabril Vigadrone
165
What are BBWs with vigabatrin?
Permanent vision loss (>/=30% of patients)
166
What should be monitored with vigabatrin?
1. eye exam baseline, every 3 months, and every 3-6 months after D/c 2. REMS
167
Zonisamide
Zonegran Zonisade
168
What is a CI to using zonisamide?
HSR to sulfonamides
169
What are warnings with zonisamide
1. Hyperchloremic non-anion gap Metabolic Acidosis 2. Ogliohidrosis (reduced perspiration)/hyperthermia (mostly children) 3. Nephrolithiasis (kidney stones) 4. acute myopia 5. secondary Angle-closure Glaucoma 6. SJS/TENS/DRESS 7. Visual problems (reversible) 8. Fetal Harm
170
What are SEs with zonisamide?
1. Ogliohidrosis (reduced perspiration)/hyperthermia (mostly children) 2. Nephrolithiasis (kidney stones)
171
Which ASM requiring drug level range monitoring?
1. phenytoin 2. valproic acid 3. carbamazepine 4. phenobarbital
172
Which ASMs are enzyme inducers?
1. carbamazepine 2. oxcarbazepine 3. phenytoin 4. fosphenytoin 5. phenobarbital 6. primidone
173
Which ASMs are enzyme inhibitors?
valproic acid (increases levels of lamotrigine)
174
What should be supplemented in women of childbearing age on ASMs?
1. folate to decrease risk of neural tube defects 2. calcium and vitamin D to prevent bone loss
175
Which ASMs have the lowest risk of neural tube defects and other teratogenic effects?
levetiracetam and lamotrigine
176
Which ASMs are best to avoid in children?
1. Topiramate and zonisamide reduce sweating in children (must reduce sun exposure) 2. lamotrigine (highest risk of rash with fatality)

RxPrep (67 decks)

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