Term
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Definition
Paroxysmal, abnormal neuronal discharge in cerebrum of CNS
-May or May not involve LOC |
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Term
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Definition
| Specific seizure type with INVOLUNTARY muscle contractions |
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Term
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Definition
| Medical disorder with recurrent, unprovoked seizure activity |
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Term
| Occurence of First Seizure |
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Definition
-Peaks in newborns, young kids
-Peaks in patients >65 |
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Term
| Predisposing Factors of Seizures |
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Definition
Genetics
Head Trauma
Stroke
Malignancy
Infection
Substance abuse
Degenerative Disease |
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Term
| Partial/Focal seizure and Variants |
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Definition
Localized (manifestations represent that area of the brain)
-Simple: Brief, NO LOC
-Complex: widespread, alteration of consciousness
-Secondary Generalized: partial precedes tonic-clonic |
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Term
| Generalized Seizure and Variants |
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Definition
involves both hemispheres + LOC
-convulsive or non-convulsive
Absence: sudden onset, blank stare
Tonic-Clonic: convulsive
Myoclonic: brief, sudden muscle contraction
Atonic: loss of muscle tone |
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Term
| Two Neuronal Circuit Involved With Seizures |
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Definition
1. Axonal Conductance (APs along axons)
2. Synaptic transmission
**Both use ion channels |
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Term
__ & __ depolarize cell membrane
__ repolarizes (inhibitory) |
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Definition
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Term
| In ligand-gated channels, NT involved with excitation is ___ and inhibitory is ___. |
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Definition
Excitation = Glutamate
Inhibitory = GABA |
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Term
| NonPharm Therapy for Seizures |
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Definition
1) Surgery - refractory focal epilepsy only; high success rate
2) Vagus Nerve Stim - pts >12
3) Ketogenic Diet - hard compliance; high fat low carb and protein... best in kids |
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Term
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Definition
-First seizure w/ high risk patients
-->EEG abnormal, trauma, FH, young
-Second seizure |
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Term
| Monotherapy best for what type of seizures? |
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Definition
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Term
| When is medication considered ineffective for seizures? |
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Definition
| Unacceptable adverse effects with continued seizures |
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Term
| Major FDA Seizure Med Alert |
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Definition
| Suicidal Behavior/Ideation |
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Term
| Carbamazepine: First line for what? Other uses? |
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Definition
1st: Partial and General tonic clonic
Other: Bipolar, Neuralgia, Peripheral Neuropathy |
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Term
| Carbamazepine: BB warning, ADEs |
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Definition
BB: Skin reaction (Stevens-Johnson) or Toxic Epidermal Necrolysis
BB:Aplastic anemia, agranulocytosis (monitor WBCs, platelets)
ADEs:Diplopia, dizzy, drowsy, nausea, hyponatremic with chronic use, rash/blood dyscrasias
Monitor: LFT, CBC, BMP, serum |
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Term
| Carbamazepine: Dosing notes, DIs |
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Definition
Dosing: Increase 200mg/day weekly
4-6wks for full autoinduction
Therapeutic Serum = 4-12mcg/ml
DI:3A4 INDUCER
CBZ up - Valp Acid, Erythro, Cimetidine, Fluox, INH
CBZ down - phenobarb, phenytoin
CBZ decreases > oral contraceptives, doxy, warfarin, valp acid |
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Term
| Oxcarbazepine: Place in Therapy, Dosing Notes |
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Definition
Place: adjunctive or first line general tonic clonic
Dosing: Adjust in low CrCl; inactivated by glucuronide conjugation |
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Term
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Definition
3A4 Inducer
Inc OBZ-perampanel
Dec OBZ-CBZ (goes up), phenytoin, phenobarb, valp acid
Dec levels>Contraceptives, valp, lamotrigin, perampanel
ADEs: *Hyponatremia (monitor Na), sedation, N/D, ataxia |
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Term
| Phenytoin (PHT): Place in therapy, Dosing Notes |
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Definition
-1st for general tonic-clonic, partial, and epilepticus
Dosing: Need loading dose (15-20mg/kg/day in 3 doses, then maintain 300mg/d)
-Albumin levels affect serum
**cpadj = cpmeasured/((.2xalbumin)+.1) |
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Term
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Definition
CBZ/Phenobarb - can inc or dec PHT
ValpA - PHT dec then inc (valp goes down)
Inc PHT: amiodarone, disulfiram, etoh, fluconazole, fluoxetine, warfarin
Dec PHT: vigabatrin
PHT decreases>contraceptives, folic acid, thyroid products |
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Term
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Definition
Ataxia, HA, nystagmus, cognitive impaired, blurry vision, blood dyscrasia, rash
Chronic: skin thick, folate deficient, gingival hyperplasia, acne, hirsutism, osteomalacia
MONITOR: LFT, CBC, CrCl, serum |
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Term
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Definition
| Parenteral phenytoin prodrug; quick loading |
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Term
| Phenobarbital (PB): MOA, place in therapy |
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Definition
MOA: GABA receptor to block Ca and facilitate Cl channel
*DOC for neonatal seizures or pts who failed other meds |
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Term
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Definition
Inc PB: felbamate, PHT, OCZ, ValpA
Decrease> contraceptives, CBZ, lamotrigine, OCZ, valp acid
ADEs: ataxia, HA, hyperactive, rash
Chronic-behavior changes, conn.tissue disorders, intellectual blunting, metabolic bone dz
MONTIOR: LFT, CBC, serum |
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Term
| Primidone metabolized to what? |
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Definition
| Phenobarb (measure these levels when checking serum) and PEMA (phenylethyl) |
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Term
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Definition
Inc Prim-valp acid
Dec Prim-CBZ,PHT
Decreases>TCAs, contracept, valpacid, lamotrigine
ADEs: like phenobarb
MONTIOR: CBC, prim, PB serum |
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Term
| Valproic Acid (VPA): MOA, place in therapy, other uses |
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Definition
MOA: Increase GABA response
Place: 1st generalized seizures (myoclonic, atonic, absence) and can be useful in mixed disorder
Other uses: Bipolar, MIGRAINE PROPHYLAXIS |
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Term
Peak Concentrations Order for Valp. Acid
-Where is conc. the highest? |
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Definition
Syrup -> Capsule -> Ent.Coated Tab
Highest: Fetal Cord Blood (5x) |
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Term
| Valproic Acid: DDIs, ADRs |
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Definition
Inc VPA: cimetidine, salicylates
Dec VPA: CBZ, PB, PHT, primidone
VPA incre>felbamate, lamtrigine, PB, Primidone
VPA decre>topiramate
ADRS: GI, sedation, tremor, acute hepatic failure and pancreatitis, alopecia
Chronic: wt gain, hperammonemia, irregular menstrual
Monitor: LFT, platelets, serum |
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Term
| Ethosuximide: MOA, place in therapy |
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Definition
-Inhibit T-type Ca channels
-1st line: absence seizures |
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Term
| Felbamate: MOA, BB warning, ADRs |
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Definition
-Blocks NMDA synaptic response, potentiates GABA
-BB for aplastic anemia and liver failure
ADRs: Anorexia,n/v/HA,insomnia
Monitor: LFTs, bilirub, CBC |
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Term
| Gabapentin: MOA, other uses, DDIs, ADRs |
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Definition
MOA: inhibit voltage-gated Ca channels, increases GABA in brain
Other: Neuropathic pain, restless leg syndrome
NO DDIs
ADR: dizzy, fatigue, ataxia, pedal edema
Chronic: Wt gain
Monitor: Renal function |
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Term
| Pregabalin: MOA, other uses, DDIs, ADRs |
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Definition
MOA: decrease release of excitatory NTs
Other uses: Fibromyalgia, neuropathic pain
NO DDIs
ADRs: dizzy, blurry vision, somnolence, pedal edema, ELEVATED CK
Chronic: Wt gain |
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Term
| Lacosamide: MOA, DDIs, ADRs |
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Definition
MOA: slow inactivation Na voltage-gated channels
DDIs: decreased by CBZ, PB, PHT
ADRs: dizzy, HA/N/V, PR INTERVAL INCREASE, liver enzyme elevation |
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Term
| Lamotrigine: MOA, Place in therapy, other uses |
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Definition
MOA: inhibit volt-gated Na and Ca channels
Therapy: mono or adjunct
Other uses: Bipolar |
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Term
Lamotrigine Dosing:
1. No CBZ, PHT, Prim, VPA
2. Containing VPA
3. Containing CBZ, PHT, PB, Prim, and NOT VPA |
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Definition
1. ID = Wk1-2 25mg QD, Wk3-4 50mg QD, Wk 5+ Inc 50mg/d every 1-2wks; Maint: 225-375/d in 2 doses
2. Wk1-2 25mg QOD, Wk3-4 25mg QD, Wk 5+ Inc 25-50/d every 1-2wks; Maint: 100-200 VPA alone or 100-400 if w/other glucuronidation drugs
3. Wk1-2 50 QD, Wk3-4 100/d 2 doses Wk5+ inc by 100 every 1-2wks; Maint: 300-500/d Max 700 |
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Term
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Definition
| diplopia, dizzy, HA, unsteady, rash (SJS) |
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Term
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Definition
MOA: modifies glutamate, GABA
ADR: sedation, behavioral disturbance |
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Term
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Definition
MOA: inhibit GABA uptake
ADR: dizzy, fatigue, low conc, nervous, blurry vision, tremor, depression, weakness |
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Term
| Topiramate: MOA, other uses |
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Definition
MOA: inhibit volt-gated Na channels, potentiate GABA, inhibit glutamate
Other: Migraine Prophylaxis |
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Term
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Definition
Dec Top - most anticonvulsants
Inc Top-HCTZ
Top decreases oral contraceptives
ADR: difficult conc, psychomotor slowing, speech issues, metabolic acidosis, acute angle glaucoma, oligohydrosis
Chronic: kid stones, WT LOSS |
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Term
| Vigabatrin: MOA, BB warning & ADR |
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Definition
Irreversibly inhibits GABA-trans; increase GABA levels
BB: Vision loss - SHARE program
ADRs: fatigue, wt loss, somnolence, blurry vision, tremor, peripheral neuropathy, anemia |
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Term
| Zonisamide: MOA, Can mix capsules w/?, ADRs |
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Definition
MOA: inhibit Na Ca Glutamate
Capsules can mix w/ juice,H20
ADRs: sedation, cog impaired, dizzy, oligohydrosis, metabolic acidosis, rash
Chron: Kid stones, wt loss |
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Term
| Perampanel: MOA, ADR, Dosing, ADRs |
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Definition
AMPA-receptor antagonist
ADR: Hepatic impairment (not recommended in these or renal impaired patients)
**Small dosing (2mg, 4 w/inhibitors)
ADR: dizzy, HA, ataxic, anger aggressive, but usually well tolerated |
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Term
Evaluation of Seizure Control:
1) No change in seizure frequency
2) Reduction in seizure frequency but still occur
3) Seizures eliminated |
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Definition
1) FIRST max dose SECOND switch agents - always via taper
2) FIRST max dose SECOND add second agent - if seizures controlled may consider tapering first agent
3) Continue therapy |
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Term
| Status Epilepticus Definition, Tx |
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Definition
-Any seizure >30 min +/- LOC
-Convulsive or Nonconvulsive
-Recurrent seizures w/ no intervening period of consciousness between
Tx: Supportive (oxygen, preserve cardiorespiratory), Eliminate epileptiform activity (Benzos, PHT/fospho IV push then PO maintenance) |
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Term
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Definition
Up to 2-fold risk of malformations
-VPA -> spina bifida |
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Term
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Definition
May cause increased seizure freq.
Consider after 2+ seizure free years
Taper one drug at a time, slowly |
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Term
| Issues in Women with AEDs |
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Definition
-Medroxyprogesterone depot injection, IUD
-Morning after pill - double dose |
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Definition
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Definition
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