Seizures/Epilepsy

Question 1

Drugs that can cause seizures (10 drugs/classes)

Answer 1

Opioids (tramadol, meperidine)*
Quinolones
Carbapenems*
Cephalosporins*
Penicillins*
Mefloquine
Bupropion
Antipsychotics (esp. clozapine)
Lithium*
Tricyclic antidepressants

*At high doses/renal impairment

Question 2

Diastat Acudial Dispensing

Answer 2

Each package contains two rectal syringes prefilled with diazepam rectal gel
Each syringe must be dialed to the right dose and locked before dispensing

Question 3

Vitamins to take while on an ASM (4 categories)

Answer 3

ALL ASMs: calcium and vitamin D
Women of childbearing age: folate
Valproic acid: possibly carnitine
Lamotrigine and valproic acid: if alopecia develops, supplement with biotin, selenium, and zinc

Question 4

Antiseizure medications with enzyme induction (6 meds)

Answer 4

Carbamazepine
Oxcarbazepine
Phenytoin
Fosphenytoin
Phenobarbital
Primidone

Question 5

Antiseizure medications with enzyme inhibition (1 med)

Answer 5

Valproic acid (increases lamotrigine)

Question 6

Lamictal Starter Kits by Color

Answer 6

Blue: Lower starting dose, use if taking valproic acid (enzyme inhibitor)
Orange: Standard starting dose, use if no interacting medications
Green: Higher starting dose, use if taking an enzyme inducer and not taking valproic acid

Question 7

IV Phenytoin Administration pearls

Answer 7

Do not exceed 50 mg/min (slow infusion)
Monitor BP, respiratory function, and ECG
Requires a filter
Dilute in NS, stable for 4 hours, do not refrigerate

Question 8

NG-tube Phenytoin Administration pearls

Answer 8

Enteral feedings decreases phenytoin absorption
Hold feedings 1-2 hours before and after administration

Question 9

IV Fosphenytoin Administration pearls

Answer 9

Do not exceed 150 mg PE/min
Monitor BP, respiratory function, and ECG
Lower risk of purple glove syndrome than phenytoin

Question 10

Phenytoin correction calculation

Answer 10

Total phenytoin measured/(0.2 x albumin + 0.1)

Question 11

Benzodiazepine MOA

Answer 11

Enhances GABA effect

Question 12

Phenobarbital MOA

Answer 12

Enhances GABA effect

Question 13

Valproate MOA

Answer 13

Blocks sodium channels and increases GABA

Question 14

Levetiracetam MOA

Answer 14

Inhibits vesicle fusion by binding to SV2A proteins

Question 15

Carbamazepine MOA

Answer 15

Blocks sodium channels

Question 16

Phenytoin/Fosphenytoin MOA

Answer 16

Blocks sodium channels

Question 17

Topiramate MOA

Answer 17

Blocks sodium channels

Question 18

Lamotrigine MOA

Answer 18

Blocks sodium channels and decreases glutamate

Question 19

Ethosuxamide MOA

Answer 19

Blocks T-type Ca channels

Question 20

Type of diet best for patients with refractory seizures

Answer 20

Ketogenic diet
4:1 ratio of fats to protein and carbohydrates