Term
| 4 remedial causes of seizures: |
|
Definition
1. mechanical
2. metabolic
3. sudden withdrawal of CNS meds
4. Fvr/infection |
|
|
Term
| 4 sz meds that cover GTCS: |
|
Definition
1. phenytoin
2. carbemazepine
3. phenobarbitol
4. clonazepam |
|
|
Term
| 4 sz meds for partial seizures: |
|
Definition
1. phenytoin
2. carbemazepine
3. Oxcarbazepine
4. Phenobarbitol |
|
|
Term
| med for myoclonic seizures: |
|
Definition
|
|
Term
|
Definition
|
|
Term
| med reserved for refractory sz: |
|
Definition
|
|
Term
| med for partial and GTCS: 3 |
|
Definition
| phenytoin, phenobarbitol & carbemazepine |
|
|
Term
| monotherapy or adjunctive therapy in adults and adjunctive therapy in kids for partial sz: |
|
Definition
|
|
Term
| med for GTCS & myoclonic: |
|
Definition
|
|
Term
| 6 broad spectrum AEDs that cover multiple sz types: |
|
Definition
1. felbamate
2. lamotrigine
3. topiramate
4. levetiracetam
5. VPA
6. Zonisamide |
|
|
Term
| taking into consideration the goal of treatment is to supress the seizure w minimal supression of the CNS, what is the recommended dose titration? |
|
Definition
| start w 1/4 to 1/3 of the expected amintenance dose and increase over 3-4wks |
|
|
Term
| 2 indications for therapeutic drug monitoring: |
|
Definition
1. continued seizures after therapeutic dose is achieved
2. recurrent seizures after control had been achieved |
|
|
Term
| define the free concentration of AED |
|
Definition
| free concentration is the active concentration not bound by serum protein |
|
|
Term
| 3 factors promoting d/c of AED" |
|
Definition
1. seizure free for 2-4yrs wo other complicating factors (high freq seizures, multi episodes of Stat Epi, abn neuro exam, structural abn on MRI)
2. complete seizure control wn 1yr onset
3. normal EEG |
|
|
Term
| when withdrawing meds it ahs been shown that a gradual decline in dosing over at least __ __ helps to prevent ____. |
|
Definition
| over 6mo helps to prevent recurrence |
|
|
Term
| what should be done before adding a second drug to the sz tx regimine? |
|
Definition
| first drug of choice should be titrated to max before adding a second drug. |
|
|
Term
| describe therapeutic monitoring and changes in doses when adding a rx to the sz tx regimine: |
|
Definition
| if a second drug is added you would titrate it to max dose while withdawing the first drug. |
|
|
Term
|
Definition
| 80-95% protein bound, saturable @ apx 100mg/ml |
|
|
Term
|
Definition
| inhibits hepatic metabolism, N/V, tremor, thrombocytopenia> all dose related |
|
|
Term
| pharmacokinetics of carbemazepine: |
|
Definition
| the active form is an epoxide of itself and exists @ 10-40% of the parent compound. the parent compound is what can be measured by serum analysis. |
|
|
Term
| describe autoinduction of carbemazepine: |
|
Definition
| Carb speeds up the metab in the liver to all drugs including itself. reducing the efficacy of all drugs metab by the liver. as a result there is a reduction in serum concentration after 4 day and levels out at about 21-28days |
|
|
Term
| what is one drug in particular that carbemazepine reduces the efficacy in? |
|
Definition
|
|
Term
| Oxcarbazepine differs from Carbemazepine in that: |
|
Definition
| there is no formation of an epoxide and no autoinduction |
|
|
Term
| AEDs that have autoinduction: |
|
Definition
| carbemazepine & lamotrigine |
|
|
Term
| phamacokinetics of Tiagabine: |
|
Definition
| 96% protein bound, 65% excreted in the feces. Give w food to avoid ADR assoc w high peak levels |
|
|
Term
| 5 AEDs implicated in Severe Cutaneous Adverse Reaction (SCAR) |
|
Definition
1. phenytoin
2. carbemazepine
3. primidone
4. phenobarbitol
5. lamotrigine |
|
|
Term
| chronic use toxicities in phenytoin use: |
|
Definition
1. hepato
2. endocrinopathies
3. osteomalacia
4. megaloblastic anemia
5. gingival hyperplasia |
|
|
Term
| acute concentration dependant SE of phenytoin: |
|
Definition
|
|
Term
| dose related SE of carbemazepine: |
|
Definition
1. drowsiness
2. dizziness
3. nystagmus
4. blurred vision/diplopia
5. leukopenia
6. HYPONATREMIA |
|
|
Term
|
Definition
1. dizziness
2. sedation
3. fatigue
4. N/V
5. visual disturbances
6. HYPONATREMIA |
|
|
Term
| which two AED cause hyponatremia: |
|
Definition
| carbemazepine & oxcarbazepine |
|
|
Term
|
Definition
1. dose related
2. chronic use
3. idiosyncratic |
|
|
Term
|
Definition
| N/V, tremor, thrombocytopenia |
|
|
Term
|
Definition
1. weight gain
2. hair loss
3. PCOS |
|
|
Term
|
Definition
| liver toxicity; occuring primarily in children on VPA + another AED |
|
|
Term
|
Definition
CNS Depression
1. sedation
2. coma
3. resp collapse |
|
|
Term
|
Definition
1. liver tox
2. rash
3. arthritic changes
4. SJS/TEN |
|
|
Term
| AED causes hyperactivity and cognitive imapairment in children. |
|
Definition
|
|
Term
| AED with a high rate of tolerance and recurrence of sz: |
|
Definition
|
|
Term
| SE: aplastic anemia, hepatic failure, photosensativity, HA, insomnia, dizziness, N/V, dyspepsia, constipation |
|
Definition
|
|
Term
| free of interactions with other anticonvulsants |
|
Definition
|
|
Term
| SE: common peripheral edema |
|
Definition
|
|
Term
| AED: rash in 10% within 4-6wks (use slow titration to prevent rash) |
|
Definition
|
|
Term
| AED SE: psychomotor slowing, renal stones, |
|
Definition
|
|
Term
| AED: usually well tolerated |
|
Definition
|
|
Term
| seevere kidney stones (4%), considered hypersensativity to sulfonamide |
|
Definition
|
|
Term
| visual field defects, requires a visual field check prior to admin and then q6mo |
|
Definition
|
|
Term
| therapeutic range phenytoin: |
|
Definition
|
|
Term
| therapeutic range carbemazepine: |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| therapeutic range of ethosuximide: |
|
Definition
|
|
Term
| AED: does not cause significant displacement of other proitein bound AED due to low serum concentration |
|
Definition
|
|
Term
| 7 AED that induce hepatic enzymes: |
|
Definition
1. Pb
2. primidone
3. PHY
4. felbamate
5. topiramate
6. oxcarbazepine
7. carbamazepine |
|
|
Term
| AED that inhibits hepatic enzymes: |
|
Definition
|
|
Term
| 3 AEDs that are highly protein bound: |
|
Definition
|
|
Term
| considerations in young women and AEDs: 6 |
|
Definition
1. decreased serum alb > increased free fraction
2. higher occurence of seizures during follicular phase of menstrual cycle and premenstrual period
3. monitor AED levels before conception through to the eighth wk post partum
4. efficacy of birth control hindered
5. alterations in therapy should occure at least 6 months before preg
6. high rates of PCOS (probably from VPA) |
|
|
Term
| first line AED for status elipelticus |
|
Definition
| lorazepam 4mg over 2-5min, repeat in 10-15min if no response (2x) |
|
|
Term
| second line AED for Stat Epi |
|
Definition
|
|
Term
| third line AED for Stat Epi |
|
Definition
|
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