Neuro Test 2 Set 2

Front 1

Oxcarbazepine (Trileptal)
a)approved for...
b)ADR's (3)
c)advantages over Tegretol (2)

Back 1

a)ages 4-16 and adults

b1)hyponatremia
b2)SJS/TEN
b3)sedation/fatigue

c1)No epoxide metabolite
c2)less auto induction

Front 2

Pregabalin (Lyrica)
a)other FDA indications (2)
b)MOA is @...
c)dosing
d)PK
e)drug interactions (3)

Back 2

a1)diabetic peripheral neuropathy
a2)postherpetic neuralgia

b)Ca channels (volt gated)

c)dose reduction is CrCL less than 60

d)Renally excreted (90% unchanged)

e1)CNS depressants
e2)TZD's--wt gain/edema
e3)Herbs-- avoid St Johns, valerian, kava kava, gotu kola

Front 3

Vigabatrin
a)adult indication
b)child indication
c)MOA
c)ADR's

Back 3

a)PS w/ or w/o secondarily generalized seizures
b)infantile spasms
c)inhibits GABA transaminases
d)VISUAL FIELD DEFECTS (30-50%)-- get vision exam b4 tx and then every 6months

Front 4

Drug interactions
a)guidelines (3)
b)VPA and PHY interaxn =

Back 4

1)CBZ, PHY, Pb, primidone, oxcarbazepine, felbamate, topiramate INDUCE HEPATIC ENZYMES

2)VPA INHIBITS HEPATIC ENZYMES

3)PHY, VPA, Tiagabine ARE HIGHLY PROTEIN BOUND



b)VPA displaces PHY= incr in PHY (also incr in PHY due to VPA inhibition of enzymes) WILL NEED TO MONITOR FREE PHY LEVELS

Front 5

Drugs whose absorption is delayed by food? (3) and result of this

Back 5

1)topamax
2)tiagabine
3)zonisamade

minimizes ADRs associated w/ peak

Front 6

Drugs that affect OCs

Back 6

1)enzyme inducing AEDs
2)lamotrigine

Front 7

Adverse outcomes in infants of epileptic mothers linked to...(3)

Back 7

1)increasing # of AEDs
2)particular AEDs
3)certain combinations of AEDs

Front 8

Guidelines of AEDs in pregnancy (4)

Back 8

1)alter therapy before pregnancy
2)add folic acid
3)monitor levels (due to changes in Vd and protein binding)
4)give VitK to prevent neonatal hemorrhage

Front 9

2 other affects of AEDs in women

Back 9

1)polycystic ovaries
a)20-25% of women w/ temporal lope epilepsy
b)polycystic ovaries in epileptic women take VPA b4 age 20 = 80% vs. 18% in normal controls

2)accelerates osteoporosis if pt has dyslipiemia too

Front 10

Management of Status Epilepticus at...
a)0-5min
b)6-9min
c)10-20min
d)over 20min
e)over 60min
f)over 60min and e) doesn't work

Back 10

a)confirm dx of SE and give O2
b)give thiamine then glucose if pt is hypoglycemic
c)start AED (lorazepam, diazepam)
d)give phenytoin
e)give Pb if status persists
f)general anesthesia (midazolam, propofol, Pb) admit to ICU and place on mechanical ventilator

Front 11

Look @ ADR chart if you want... (p.21)

Back 11

n/a

Front 12

Which AED's are excreted mostly unchanged (over 50%) (5) and (2) between 20-48%

Back 12

1)felbamate
2)gabapentin
3)topiramate
4)levetiracetam
5)pregabalin

1)Pb
2)zonisamide

Front 13

Meds used to tx ABSENCE SEIZURES (4)

Back 13

1)clonazepam
2)ethosuccimide
3)trimethadione
4)VPA

Front 14

Meds used to tx GTCS (6)

Back 14

1)carbamazepine
2)oxcarbazepine
3)PHY
4)Pb
5)topiramate
6)zonisamde

Front 15

Meds used to tx Lennox Gastaut (and which is adjunct) (2)

Back 15

1)Topiramate
2)Lamotrigine (adjunct)

Front 16

Meds used to tx Status Epilepticus (3)

Back 16

1)diazepam
2)lorazepam
3)PHY

Front 17

Med for seizure refractory to tx

Back 17

Felbamate

Front 18

Partial Seizure meds (9) and which are adjunct (4)

Back 18

1)carbamazepine
2)oxcarbazepine
3)PHY
4)clonazepam
5)lamotrigine
6)topiramate
7)VPA
8)vigabatrin
9)zonisamide

1)gabapentin
2)levetiracetam
3)pregabalin
4)tiagabine

Front 19

Preictal?

Back 19

aura or somatosensory (flush, sweat, visual/audio) as a warning that the pt is about to have a seizure

Front 20

Highest incidence of seizures in what age groups (2)

Back 20

1)under 14
2)over 65

Front 21

a)Basic underlying risk for epilepsy
b)special populations and their risk of seizure (6)

Back 21

a)1%

b1)retardation 10%
b2)cerebral palsy 10%
b3)mental retardation & cerebral palsy 50%
b4)mother with epilepsy 8.7%
b5)father with epilepsy 2.4%
b6)hx of single UNPROVOKED (unidentifable cause) seizure 33%

Front 22

Absorption (2) & Metabolism (2) differences in neonates

Back 22

a1)decr gastric acid
a2)delayed gastric emptying

b1)immature metabolism so slow enzymatic breakdown of drugs
b2)rapid metabolism in VERY young children

Front 23

Distribution differences in kids (5)

Back 23

a1)preemie is 1-2%
a2)term neonate is 10-15%
a3)toddler is 20-25% body fat
a4)less protein binding capacity to albumin due to competing ligands (bilirubin)
a5)so highly lipophilic drugs have increased half-life in neonates

Front 24

Neonatal seizures
a)def
b)epidemiology (4)
c)other (3)

Back 24

a)seizures in first month of life

b1)term infants 0.5%
b2)preterm infants 20%
b3)50% during first day of life
b4)75% begin by day 3 of life

c1)usually symptom of underlying disease
c2)most commonly encountered in critically ill babies
c3)does NOT necessarily represent epileptic activity

Front 25

Etiology of neonatal seizures (8)

Back 25

1)MOST COMMON IS HYPOXIC-ISCHEMIC ENCEPHALOPATHY
2)trauma/anoxia is 2nd most common cause
3)congenital abnormalities
4)metabolic problems
5)infexns
6)drug withdrawal
7)toxins
8)familial seizures

Front 26

Seizure types of neonatal seizures (5)

Back 26

1)generalized fragmentary clonic movements
2)focal or multifocal clonic seizures
3)focal tonic seizures
4)tonic extensions
5)myoclonic jerks (like dog dreaming)

Front 27

Clinical presentation of neonatal seizures
a)autonomic signs (2)
b)motor signs (4)

Back 27

a1)apnea
a2)abnormal cry

b1)eye deviation
b2)mouthing & tongue thrusting
b3)posturing of a limb
b4)rowing, swimming, bicycling movements

Front 28

Prognosis of neonatal seizures (3)

Back 28

1)high incidence of neurological sequelae
2)20-30% will develop epilepsy
3)death or neurological damage up to 75% in cases w/ EEG documented seizures and lesion on CT/MRI

Front 29

Tx of neonatal seizures
a)when to tx
b)what to use and how (3)

Back 29

a)if interfere with oxygenation, ventilation, perfusion

b1)PHENOBARBITAL IS DRUG OF CHOICE
b2)adjust dose until seizures controlled OR optimal drug []s
b3)dc drug after 1-2months if normal neurological exam

Front 30

Other tx options on neonatal seizures (6)

Back 30

1)PHY (2nd line)

2)diazepam
3)felbamate
4)topiramate
5)lamotrigine
6)AEDs MAY NOT BE BENEFICIAL

Front 31

Triad of features in INFANTILE SPASMS

Back 31

1)spasms involving extensor and/or flexor muscles
2)psychomotor retardation
3)characteristic EEG pattern called hypsarrhythmia

Front 32

Epidemiology of INFANTILE SPASMS (5)

Back 32

1)males=females
2)peak age of onset 2-8months
3)none dx after 3yo
4)50% seizure free after 3yo
5)rarely persists after 5yo

Front 33

Etiology of Infantile Spasms (6)

Back 33

1)metabolic abnormalities
2)dysplastic or dysgenic conditions
3)prenatal infexns
4)perinatally or postnatally acquired
5)intracranial tumors
6)idiopathic

Front 34

Clinical features of Infantile Spasms (4)

Back 34

1)abrupt onset
2)occurs during sleep/waking stages
3)lasts a few seconds and occur in clusters
4)plus triad

Front 35

Hypsarrhythmia?

Back 35

gone while sleeping and only seen while pt is NOT seizing

Front 36

Prognosis of Infantile Spasms (4)

Back 36

1)poor for intellectual
2)85% may have retardation or further seizures
3)35-60% develop akinetic, atonic, and myoclonic or GTCS
4)25-60% develop Lennox-Gastaut syndrome

Front 37

Infantile Spasms tx (2) and prognosis w/ tx (2)

Back 37

1)ACTH (FIRST LINE)
2)prednisone

1)60-70% of kids respond
2)30-50% relapse

Front 38

ACTH Gel (5)

Back 38

1)intramuscular admin
2)taper dose and cont at lower dose for several weeks/months if responding
3)give 2nd course if replase
4)taper/dc if toxicity occurs before 4th week of therapy (to avoid suppression of adrenal cortex)
5)try prednisone if this doesn't work

Front 39

ADRs of kids w/ prednisone (2 big ones)

Back 39

1)BEHAVIORAL CHANGES (CRY ALL THE TIME/GRUMPY)
2)wt gain/incr appetite

Front 40

Other infantile spasms drugs (3)

Back 40

1)bzd's
2)VPA
3)lamotrigine

Front 41

Q: This condition occurs primarily in kids under 3. Findings include spasms, psychomotor retardation and hypsarrhythmia.

Back 41

infantile spasms

Front 42

____ is drug of choice for neonatal seizures

Back 42

Pb

Front 43

Triad of features of Lennox-Gastaut and epidemiology (3)

Back 43

1)multiple seizure types (generalized and partial)
2)retardation and permanent social limitations
3)slow generalized spike-and-slow wave EEG pattern


1)3% of all childhood seizures
2)males greater than females
3)begins b/w 1-8yo

Front 44

Clinical presentation of Lennox-Gastaut (4)

Back 44

1)seizure onset may be gradual or abrupt
2)status epilepticus occurs frequently
3)common seizure types: tonic, atypical absence, atonic, TC
4)uncommon: myoclonic

Front 45

Lennox-Gastaut prognosis (3)

Back 45

1)poor
2)incidence of TC increases with age
3)80% of pts have seizures as adults

Front 46

Lennox-Gastaut tx (6)

Back 46

1)REFRACTORY TO TX
2)can try: VPA
3)BZD's
4)ACTH
5)TEGRETOL MAY PRECIPITATE ABSENCE STATUS*****
6)last resort is ketogenic diet

Front 47

Absence Seizures Epidemiology (4)

Back 47

1)1-11% of childhood seizures
2)onset @ 4-12yrs
3)spontaneously resolve @ 12yrs
4)females GREATER THAN males

Front 48

Clinical presentation of absence seizures (5)

Back 48

1)brief/abrupt loss of consciousness (20-30s)
2)pt may stare and be motionless and have distant expression on face
3)flickering eyelids during seizure
4)NO aura or postictal state
5)can be induced by 3-4min by hyperventilation

Front 49

Tx of Absence seizures (3)

Back 49

1)ETHOSUXIDMIDE IS DRUG OF CHOICE
a)but if pt has TC seizures it may increase them as therapy is started

2)VPA if pt has TC and absence seizure
3)last resort is ketogenic diet

Front 50

Q: This condition occurs primarily in males. Features include multiple seizure types, retardation & slow generalized spike-and-slow wave EEG patterns

Back 50

Lennox-Gastaut syndrome

Front 51

____ is the DOC for Simple Absence seizures in children

Back 51

Ethosuximide

Front 52

Ketogenic Diet
a)when used?
b)what is it (3)

Back 52

a)refractory epilepsies

b1)high fat, low carbs/protein
b2)75% of calories of RDA for kids age/wt
b3)75% of maintenance fluids

Front 53

Considerations w/ Ketogenic Diet (4)

Back 53

1)need Ca/sugar/lactose free MVI
2)can cause:
a)irritability
b)lethargy
3)need hospitalization for induction of diet

Front 54

Diazepam as an AED in kids (2)

Back 54

1)active metabolite = prolonged half-life in neonates
2)NOT DOC for status due to benzoic acid and benzyl alcohol

Front 55

AED in kids
a)tegretol
b)ethosuximide (3)

Back 55

a)IMPROVED COGNITION

b1)sleep disturbance
b2)agitation/aggression
b3)intellectual/memory disorders

Front 56

AED in kids
a)Lamotrigine (2)
b)VPA

Back 56

a1)higher incidence of rash in kids compared to adults
a2)MOOD ENHANCING

b1)MINIMAL BEHAVIORAL/COGNITIVE IMPAIRMENT

Front 57

AED in kids
a)Leveteracetam
b)Pb (5)

Back 57

a)agitation/hostile/mood swings

b1)LONG HALF-LIFE in neonates
b2)cognitive impairment
b3)lethargy or hyperactivity
b4)irritability
b5)major depression

Front 58

AEDs in kids
a)Fosphenytion (3)
b)Phenytoin (3)

Back 58

a1)rate of 150mg/min
a2)30min-1hr to convert to PHY
a3)SO onset is NOT faster than slow infusion of PHY

b1)infusion rate 50mg/min
b2)interacts w/ enteral feeds
b3)causes dyskinesia, impaired cognition, incr rxn time

Front 59

Which of the following statement are true with ketogenic diet tx?
a)High protein, low fat, and low carb diet
b)Hospitalization reqd for induction of diet
c)INcr protein intake stimulates ketosis
d)Success of treatment occurs within 4-5min

Back 59

B. Hospitalization reqd for induction of diet

Front 60

Which of the following agents may be associated with improved cognition, memory, or mood?
a)ACTH
b)Ethosuximide
c)Lamotrigine
d)PHY

Back 60

C. Lamotrigine

Front 61

Zonisamide SULFA allergy recommendations
a)interesting thing about this
b)considerations (2)
c)counsel pt to inform you of any... (4)

Back 61

a)allergy to sulfa abx NOT predictive

b1)pt w/ h/o "serious" rxns to sulfas
b2)allergy to nonarylamine meds

c1)rash
c2)unusual breathing
c3)lymph node swelling
c4)abdominal tenderness

Front 62

AED's NOT metabolized in the liver (4)

Back 62

1)gabapentin
2)pregabalin
3)topiramate (70-97% renally eliminated)
4)levetiracetam (65% renally eliminated)

Front 63

Reason why OCs fail other than enzyme induction?

Back 63

stimulation of synthesis of sex hormone binding globulin (SHBG) resulting in lower unbound active hormones

Front 64

How to prevent OC failure in enzyme inducing AEDs (3)

Back 64

1)use OC w/ higher doses of estrogen
2)use another method of contraception
3)use AED that is NOT an enzyme inducer

Front 65

AEDs decreasing effectiveness of OCs (8)

Back 65

1)carbamazepine
2)oxcarbazepine
3)felbamate
4)PHY
5)primidone
6)Pb
7)topiramate
8)lamotrigine

Front 66

Breastfeeding and AEDs
a)general things (3)
b)this indicative of a drug that will transfer to breastmilk (4)

Back 66

1)is encouraged (to breast feed)
2)monitor baby for irritability, poor wt gain and poor feedings
3)milk to maternal plasma ratio determine dose ingested by infant

1)low protein binding
2)unionization of drug
3)lipophilic
4)low MW

Front 67

Status Epilepticus criteria (2)

Back 67

More than 30min of:
a)continuous seizure activity
b)2 or more sequential seizure w/o full recovery of consciousness in b/w

Front 68

Risks of SE (7)

Back 68

1)hyperthermia
2)cardiorespiratory collapse
3)myoglobinuria
4)renal failure
5)neurologic damage
6)alterations in glc/electrolytes
7)peripheral lactate accumulation

Front 69

SE
a)mortality rate?
b)long term neurologic consequences (3)

Back 69

a)30-50%

b1)cognitive impairment
b2)memory loss
b3)worsening of seizure disorder

Front 70

Other drug available for SE

Back 70

diazepam rectal gel