Wk 11 Flashcards
(107 cards)
1
Q
Causes of seizures
A
Congenital defects (CP) Hypoxia (decreased cerebral oxygen) Cancer Alcohol/drugs (withdrawal) Elevated body temp Electrolyte/glucose disturbances
2
Q
Drugs that cause seizures
A
Meperidine
3
Q
Initial drug of choice for seizures is ___
A
type dependent
4
Q
Wrong choice in drugs for seizures may increase ___
A
seizures
5
Q
Primary drug for partial seizures
A
Valproate
Carbamazepine
Phenytoin
6
Q
Primary drugs for tonic-clonic seizures
A
Valproate
Carbamazepine
Phenytoin
7
Q
Primary drug for absence seizures
A
valproate
8
Q
primary drug for myoclonic
A
valproate
9
Q
primary drug for atonic seizures
A
valproate
10
Q
Most seizure patients respond to ___ AEDs
A
1-2
11
Q
Rarely, patients require >2 ___
A
AEDs
12
Q
50-75% of patients are controlled with ___
A
monotherapy
13
Q
30% of patients require ___
A
combination therapy
14
Q
5% poorly controlled despite ___
A
AED therapy
15
Q
Pseudoresistance can be caused by:
A
wrong dx
wrong drug
wrong dose
lifestyle issues
16
Q
___ must be ruled out to consider treatment failure
A
pseudo resistance
17
Q
Goal of AED therapy
A
prevent seizures, maintain normal functioning inprove quality of life with fewest side effects.
18
Q
select an AED recommended for the ____
A
identified seizure type
19
Q
when augmenting therapy, chose a drug with an ____
A
alternative mechanism
20
Q
discontinuation depends on ___
A
seizure type
seizure free duration
EEG
other factors
21
Q
NEVER ____ an AED
A
abruptly discontinue
22
Q
optimal treatment requires
A
individualizatoin
23
Q
AED therapy is highly ___
A
individualized
24
Q
immediately therapy rarely needed after ____
A
single seizure
25
start AED therapy for patients at risk for ____
recurrent seizures
26
generally start AED therapy after _____ seizures
2+ unprovoked seizures
27
AED therapy is not necessarily ___
life long
28
AED withdrawal should be ___
gradual (tapered)
29
sudden withdrawal may precipitate ____
status epilepticus
30
relapse is more likely if done over ____ months
1-3 months
31
relapse is less likely if done over ___ months
6
32
common significant interactions with AEDs
OCPs and warfarin
33
very significant CYP450 inducers
Phenytoin (Phenobarbitol)
Carbamazepine
Primidone
34
Less significant CYP450 inducers
Oxcarbazepine
| Topiramateq
35
much less significant CYP450 inhibitor
newer (second generation) agents
36
common s/e of AED thearpy
suicidal ideation
CNS
Osteomalacia & osteoporosis
Vision changes
37
suicidal ideation of patients on AED tx is ___ risk vs general population
2 fold
38
CNS s/e of AED therapy
sedation
slowed thinking
dizziness
ataxia
39
Correlate drug levels to ___ before abandoning medication
symptoms
40
Whenever possible, _____ is perferred
monotherapy
41
mono therapy is preferred because;
increased adherence
provides wider therapeutic index
most cost-effective
42
combinations promote _____
drug-drug interactions
43
no controlled studies on ______
comparing drug combos
44
if adding on, _____
add on with a different MOA and/or different S/E profile
45
Big Three of AED therapy
Pheytoin
Carbamazepine
Valproic acid
46
Administration of phenytoin
IV, PO
47
S/E of phenytoin
```
gingival hyperplasia
rash
acne
nystagmus
hirtuism
osteomalacia
folate deficiency
```
48
administration of carbamazepine
PO
49
S/E of carbamazepine
hyponatremia
50
advantages of carbamazepine
less cognitive impairment
51
Administration of valproic acids
IV, PO
52
S/E of valproic acid
fetal hepatotoxicity
53
brand name of divalproex
depakote
| depakote ER
54
divalproex is a ______ in an ___ coated tablet
1:1 dimer; enteric coated
55
divalproex claims to have ___
fewer GI effects
56
___ is rarely used now
phenobarbital
57
when is phenobarbital used
pregnancy
58
why is phenobarbital rarely used
other drugs as effective with fewer s/e
59
abrupt stoppage of phenobarbital may cause ___
seizuresa
60
taper phenobarbital ___
slowly
61
what drug is metabolized to phenobarbital
primidone (mysoline)
62
long term use of Benzos are not practical due to ____
development of tolerance
63
benzodiazepines used with seizures
clonazepam
diazepam
lorazepam
64
Drug of choice for absence seizures
Ethosuximide (zarotin)
65
caution with felbamate
fatal aplastic anemia
| hepatotoxicity
66
s/e of topiramate
temporary or permanent vision loss
| decreased sweating
67
chronic side effects of zonisamide are similar to ___
topiramate
68
levetiracetam has few ___
drug interactions
69
levetiracetam is available ___
IV & PO
70
Gabapentin and Pregabalin are ____ analogs
GABA
71
Gabapentin and Pregabalin have no __ and are not ___
drug interactions; first line
72
Phenobarbital is anticonvsulant of choice in ___
pregnancy
73
AAN opposes generic substitution of _____ for the treatment of ___ w/o physician approval
anticonvulsant drugs; epilepsy
74
other uses of AEDs
neuropathic pain (gabapentin, pregabalin)
bipolar disorder
migraine
75
life threatening emergency
status epilepticus
76
mortality of status epilepticus
20%
77
causes of status epilepticus
anti epileptic drug noncompliance/discontinuation
withdrawal syndromes
brain injury
metabolic abnormalities
drug use/overdose that lowers seizure threshhold
78
brain injury that could cause status epilepticus
tumor
stroke
anoxia
hypoxia
79
metabolic abnormalities that cause status epilepticus
decreased glucose
decreased Na
decreased Ca
decreased Mg
80
drugs that lower seizure threshold
imipenem (primaxin)
high dose penicillin G (IV PCN)
lidocaine
81
imipenem lowers the seizure threshold LESS w/ ))))
meropenem merrem
82
Treatment for status epilepticus
```
diazepam
lorazepam
phenytoin
fosphenytoin
phenobarbital
```
83
in status epilepticus inject ___ directly
diazepam
84
diluting diazepam in status epilepticus causes ___
precipitation
85
diazepam typically provides _____
30-40 min seizure-free interval
86
sometimes diazepam provides <20 minute seizure free interval due to
redistribution into adipose
87
recent study found lorazepam more effective then ____
phenytoin
88
lorazepam is easier to use than:
diazepam + phenytoin
| phenobarbitol
89
lorazepam is most effective in treating seizures w/I _____ and maintaining a seizure free state in the first ______
20 mins; 60 mins after treatment
90
lorazepam is ___ than diazepam
longer lasting
91
lorazepam may be diluted wiht ____
equal volumes of 0.9 NaCl (NS)
92
Phenytoin _____ IV load
15-20mg
93
phenytoin has better results in status epilepticus with ___ dosage
higher end 18-20mg
94
infuse phenytoin no faster than ___
50mg/min
95
may need to slow down phenytoin infusion due to ___
hypotension
96
pro-drug of phenytoin
fosphenytoin
97
fosphenytoin is highly _____
water soluble
98
fosphenytoin is unlikely to ___
precipitate
99
fosphenytoin allows for ___ administration
IM
100
fosphenytoin has less hypotension than with ___
phenytoin
101
you can infuse fosphenytoin ___
faster (150mg/min)
102
___mg fosphenytoin = ~ ___mg of phenytoin
1.5 mg; 1mg
103
fosphenytoin is dosed in terms of ____
phenytoin equivalents (PE)
104
fosphenytoin can be mixed in ___
any solution
105
if refractory give phenobarbital at ___ dose
IV, 15-20mg/kg @ 50 mg/min
106
Phenobarbital is not used firs line due to
slow administration
prolonged sedation
greater risk of hypotension/hypoventilation
little-used controlled substance (not quickly available)
107
half life of phenobarbitol
80-100 hours.
