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85 Cards in this Set

  • Front
  • Back
What is the definition of epilepsy?
an occurrence of two or more unprovoked seizures
What is the definition of seizures?
• a paroxysmal disorder of the CNS
• characterized by abnormal cerebral neuronal discharges with or without the loss of consciousness
What are general classifications for seizures?
• may be convulsive or nonconvulsive
• classified as partial or generalized
What are characteristics of partial seizures?
begin in one hemisphere of the brain
What are the different classifications of partial seizures?
• Simple
• Complex
• Secondarily generalized
What are characteristics of simple partial seizures?
• no LOC throughout the seizure
• symptoms may be classified as motor, autonomic, or sensory
What are characteristics of a complex partial seizure (CPS)?
• loss of consciousness
• can have a prodrome or begins with an aura (feeling that you'll have a seizure)
• automatic behavior and psychic conditions occur
• can last seconds to minutes
What are characteristics of a secondarily generalized seizures?
begins as a partial seizure, but spreads to involve both hemispheres
What are characteristics of generalized seizures?
seizures that begin in both hemispheres of the brain
What are different types of generalized seizures?
• Absence
• Myoclonic
• Tonic-clonic
• Tonic
• Clonic
• Atonic
What are characteristics of absence seizures?
• brief and abrupt, last less than 30 seconds, occurs in clusters
• short duration of LOC
• blank stares
• common in kids
What is the definition of myoclonic seizures?
brief, lightning-like jerking movements of the whole body or the upper extremities
What are the 5 phases of a tonic-clonic seizure?
• Flexion (open mouth, eyes upward, LOC)
• Extension
• Tremor (tonic rigidity)
• Clonic (rhythmic jerks)
• Postictal
What is the definition of status epilepticus?
generalized, longer-acting seizures (can last 20 sec - 20 min) or recurrent siezures where patient does not regain consciousness
What lab test should you consider for a patient having seizures?
• CBC (look for infections)
• therapeutic drug levels (dilantin levels)
• glucose level
Is GABA an inhibitory or excitatory neurotransmitter?
How can a loss of GABA or GABA receptors affect seizure activity?
• by decreasing GABA, there is a loss of inhibitory transmitter
• causes an increase in excitability
List 1st generation anti-epileptic drugs
• Phenobarbital
• Phenytoin (Dilantin)
• Carbamazepine
• Valproic Acid
What is the MOA of Phenobarbital?
• enhances GABA
• prolongs chloride channels & blocks Na channel
Phenobarbital comes in what formulations?
IV or PO
What are side effects of phenobarbital?
• CNS depression
• cognitive impairment
• lethargy
• sedation
• hyperactivity in children
What is the MOA of Phenytoin (Dilantin)?
blocks Na channels
True/False: Phenytoin (Dilantin) is a good drug for absence seizures
Phenytoin is not effective in absence seizure. The correct answer is: false
What is Michaelis-menten kinetics, in regards to phenytoin (dilantin)?
• drug can saturate
• continued intake of drug can cause toxicity
Is Phenytoin an inducer or inhibitor?
• an inducer
• will induce metabolism and decrease concentrations of other drugs
What is the effect of low albumin on phenytoin (dilantin)?
• low albumin levels will cause more free phenytoin in the body
• phenytoin (dilantin) is highly protein bound
What is the best lab level to get to measure protein (albumin) levels?
prealbumin (will show albumin level over the last 3 days)
What is the drug of choice for status epilepticus?
Lorazepam (a benzodiazepine)
Phenytoin (Dilantin) can be given for treatment of status epilepticus. What is the dose?
• 500 mg IV (for a small person) OR 1 gm IV (for a large person)
• give slowly (at a max rate of 50 mg/min)
Why is phenytoin (dilantin) never given IV push?
can cause phlebitis or extravasation
What happens if phenytoin (dilantin) is hung in a bag for longer than 30 minutes?
it will precipitate
What are side effects of phenytoin (dilantin) when taking PO?
• acne
• ataxia
• coarsing of facial features
• drowsiness (should take drug at night)
• gingival hyperplasia
• hirsutism
• nystagmus
• rash
What are severe side effects of 1st generation anti-epileptic drugs?
• bone marrow suppresion
• skin rash
• Steven-Johnson Syndrome
What is the MOA of carbanazepine (Tegretol)?
Na channel blocker
Is carbamazepine (Tegretol) an induce or inhibitor?
• an inducer
• can cause autoinduction (may have lower levels of the drug because it induces itself)
What are side effects of Carbamazepine (Tegretol)?
• aplastic anemia
• hyponatremia
• rash
• thrombocytopenia
What is the MOA of Valproic Acid (Depakote)?
• potentiates effects of GABA
• blocks T-type calcium channels (on smooth muscle) and Na channels
Why is Valproic Acid (Depakote) considered "broad spectrum"?
• has many uses
• can be used of bipolar disorder, seizures, and neuropathic pain
Is Valproic Acid (Depakote) an induce or inhibitor?
What are side effects of Valproic Acid (Depakote)?
• Alopecia
• Hepatotoxicity
• Nausea/Vomiting
• Pancreatitis
• Weight gain
What lab values that should be monitored on a patient on Valproic Acid (Depakote)?
• Amylase & Lipase
List 2nd generation anti-epileptic drugs?
• Ethosuximide
• Felbamate
• Gabapentin
• Lamotrigine
• Oxcarbazepine (Trileptal)
• Pregabalin (Lyrica)
• Tiagibine (Gabatril)
• Topiramate (Topamax)
• Zonisamide
What is the MOA of Felbamate?
• blocks glycine site on n-methyl d-aspartate receptor
• blocks glutamate (an excitatory neurotransmitter)
What are serious side effects of Felbamate?
• Aplastic anemia
• Hepatotoxicity

* need baseline CBC & LFTs and require monitoring
What type of seizure is Felbamate typically used for?
• Lennox-gastaut seizures (in children)
• reserved for refractory patients
What is MOA of Gabapentin?
• designed to act on GABAa and GABAb (increases levels of GABA in the brain)
• affects auxilary portein subunit of voltage-gated calcium channels
How is Gabapentin absorbed and eliminated?
• actively absorbed (taken PO)
• eliminated in the kidney (adjust dosage in renal failure)
• not metabolized by the liver (does not cause hepatotoxicity)
What is the maximum dose of Gabapentin?
3600 mg per day
What are side effects of Gabapentin?
• dizziness
• fatigue
• sleepiness
What is the MOA of Lamotrgine?
• selectively blocks the slow inactivated state of the Na channels (blocks at resting state)
• inhibits the release of gultamate & aspartate (excitatory neurotransmitters)
What is a significant side effect of Lamotrigine?

* must start Lamotrigine at the lowest dose & titrate up
What is the MOA of Topiramate (Topamax)?
• Na channel blocker
• NMDA receptor blocker
• enhances GABA activity
• weak carbonic anhydrous inhibitor (which helps stimulate GABA release)
What is unique about the elimination of Topiramate (Topamax)?
eliminated in the urine
What are side effects of Topiramate (Topamax)?
• hyperthemia
• metabolic acidosis (drug retains CO2 and bicarb)
• paresthesias
• psychomotor slowing
• renal stones
What is the MOA of Oxcarbazepine (Trileptal)?
blocks Na channels
What is the relation between Oxcarbazepine and Carbazepine?
• Oxycarbazepine is structurally similar to Carbazepine
• Oxycarbazepine is an active metabolite of Carbazepine
Is Oxcarbazepine (Tripleptal) and inducer or inhibitor?
• inducer
• no auto-induction (like Carbazepine)
What are side effects of Oxcarbazepine?
• hyponatremia (worse than Carbazepine)
• blood dyscrasias (like aplastic anemia)
What is the MOA of Ethosuximide?
T-type calcium channel blocker
What type of seizure is Ehosuximide used for?
absence seizures
What is the MOA of Tiagibine (Gabatril)?
blocks GABA reuputake in the presynaptic neurons
What is the MOA of Zonisamide?
• broad spectrum drug with multiple MOA
• Na channel blocker
• blocks T-type calcium currents
• weak carbonic anhydrous inhibitor
What are side effects of Zonisamide?
• depression
• kidney stones
• oligohidrosis (decreased sweating)
• paraesthesias
• psychomotor slowoing
What patients should avoid Zonisamide?
patients who are allergic to sulfa
What is the MOA of Pregabalin (Lyrica)?
• a GABA derivative that binds where GABA would bind (presynaptically to the alpha-2 delta subinit of voltage-gated calcium channels
• modulates release of excitatory neutrotransmitters (Gluatmate, Substance P, Noradrenlanine)

* drug can be used for seizures and neuropathic pain
What is the site of action of Pregabalin?
• brain and spinal cord
• action of spinal cord makes the drug effective for treatment of pain
What are side effects of Pregabalin (Lyrica)?
dizziness and somnolensce
What are characteristics of Fosphenytoin?
• prodrug of Phenytoin
• Status epilepticus alternative to Phenytoin
• can be given IV or IM (IM route is not available for Phenytoin)
What are advantages of Fosphenytoin over Phenytoin?
• can be given IM (good if the patients doesn't have an IV)
• can be given at a faster rate
• phlebitis is minimized
• will not precipitate like phenytoin
__ mg of Phenytoin = __ mg of Fosphenytoin
1 mg of phenytoin = 1.5 mg of fosphenytoin
What are side effects of Fosphenytoin?
• hypotension (especially if given the drug too fast)
• perianal itching
What is the MOA of Benzodiazepines?
effects on GABA
List examples of Benzodiazepines
• Clonazepam (Klonopin)
• Diazepam (Valium)
• Lorazepam (Ativan)
Which benzodiazepine would you use for a child having a seizure? for an adult?
• for a child, use Diazepam (Valium), given PR (per rectum)
• for an adult, use Lorazepam (Ativan)
What is the treatment of Status Epilepticus?
• ABC (airway, breathing, circulation)
• give rapidly acting medication (1st line - Benzodiazepine)
• follow with longer acting medication (ie Dilantin, Fosphenytoin, etc.)
What is the DOC (and its dosage) for Status Epilepticus?
• Lorazepam (Ativan) is the DOC
• 1 mg over 30 sec, may repeat every 10-15 min to a max of 4 mg
What is the dosage of Diazepam (Valium) for Status Epilepticus?
0.3 mg/kg over 2-3 minutes every 20 min
What is the dosage of Phenytoin for Status Epilepticus?
• 20 mg/kg dose, then administer 50 mg/min OR
• 500 mg (for a patient < 70 kg); 1 gm (for a patient > 70 kg)
What is the dosage of Fosphenytoin for Status Epilepticus?
150 PE/min

*PE = phenytoin equivalents
What drug and dosage can you give in severe cases of status epilepticus?
• Phenobarbital (coma)
• 15 mg/kg loading dose over 1 hr, folowing 1-2 mg/kg/hr
What is the dosage and target serum concentration for Phenobarbital?
• Dose: 1-3 mg/kg/day
• Target Serum: 10-40 mcg/ml
What is the dosage and target serum concentration of Phenytoin?
• Dosage: 3-5 mg/kg PO
• Target Serum: 10-20 mcg/ml (total); 0.5-3 mcg/ml (unbound)
What is the dosage and target serum concentration of Gabapentin?
• Dosage: 900 mg/day
• Target Serum: 4-16 mcg/ml
What is the dosage and target serum concentration of Carbazepine?
• Dosage: 400 mg/day
• Target Serum: 4-14 mcg/ml
What is the dosage and target serum concentration of Valproic Acid (Depakote)?
• Dosage: 15 mg/kg
• Target Serum: 50-150 mcg/ml