front 1 A seizure occurs when | back 1 excitatory neurons produce a sudden urge of electrical activity in the brain |
front 2 Seizures can be caused by | back 2 temporary conditions such as fever (common in children), infection, alcohol withdrawal, hypoglycemia or electrolyte abnormalities |
front 3 What does it mean when it says a medication "can lower the seizure threshold" | back 3 meaning it can make a person more susceptible to a seizure (these meds should be avoided in people with a history of seizures) |
front 4 What is epilepsy | back 4 a chronic seizure disorder |
front 5 Most common test used to diagnose epilepsy, records electrical activity in the brain | back 5 electroencephalogram (EEG) (can show abnormal patterns even when the patient is not having a seizure) |
front 6 Drugs that can lower the seizure threshold | back 6 bupropion, clozapine, theophylline, varenicline, carbapenems, lithium, meperidine, penicillins, quinolones, tramadol, acyclovir, valacyclovir, cephalosporins |
front 7 Define focal seizures | back 7 start on one side of the brain but can spread to the other side (further classified) |
front 8 Define generalized seizures | back 8 start on both sides of the brain |
front 9 Define focal aware seizure | back 9 no loss of consciousness |
front 10 Define focal seizure with impaired awareness | back 10 the patient experiences loss of consciousness |
front 11 Define clonic symptoms | back 11 sustained rhythmical jerking movements |
front 12 Define atonic symptoms | back 12 limp or weak muscles |
front 13 Define myoclonus symptoms | back 13 muscle twitching |
front 14 Define tonic symptoms | back 14 rigid or tense muscles |
front 15 Generalized seizures with non-motor symptoms are called | back 15 absence seizures (typically start as staring spells) |
front 16 Define status epilepticus (SE) | back 16 a seizure that lasts 5 mins or more |
front 17 SE treatment phases | back 17 stabilization phase --> initial treatment phase --> second treatment phase |
front 18 What medications are given in the initial treatment phase of SE (5-20 mins) | back 18 IV lorazepam or IM midazolam alternatives: rectal diazepam (Diastat), intranasal or buccal midazolam |
front 19 What medications are given in the second treatment phase of SE (20- 40 mins) | back 19 IV fosphenytoin, valproic acid, levetiracetam (phenobarbital if others are unavailable) |
front 20 Non-drug and alternative options for chronic seizure treatment | back 20 medical marijuana, ketogenic diet, vagal nerve stimulation or surgical intervention |
front 21 What is the name of a FDA approved smart watch that monitors seizures in adults and children 6 years of age and older | back 21 Embrace2 |
front 22 cannabis-derived medications approved by the FDA to treat rare forms of epilepsy | back 22 Cannabidiol or CBD (Epidiolex) |
front 23 What is a ketogenic diet | back 23 high fats, normal protein and low carbohydrates (4:1 ratio of fats to combined protein and carbohydrates) |
front 24 MOA of BZDs and valproic acid | back 24 increase GABA |
front 25 MOA of phenobarbital | back 25 enhance/potentiate GABA effect |
front 26 MOA of levetiracetam | back 26 Ca channel blocker and increase GABA |
front 27 MOA of ethosuximide | back 27 T-type Ca channel blocker |
front 28 MOA of pregabalin and gabapentin | back 28 Ca channel blocker |
front 29 MOA of oxcarbazepine | back 29 Na and Ca channel blocker |
front 30 MOA of carbamazepine, lamotrigine, phenytoin/fosphenytoin, topiramate | back 30 Na channel blockers |
front 31 Brand name of lamotrigine | back 31 Lamictal |
front 32 If lamotrigine is discontinued for ≥ 5 half-lives (> 6 days for most patients), what should happen? | back 32 the initial dose titration must be restarted |
front 33 Side effects of lamotrigine | back 33 alopecia, rash (SJS/TEN), blurred vision, ataxia |
front 34 If the lamotrigine starter kit is orange, what dose is it? | back 34 standard starting dose |
front 35 If the lamotrigine starter kit is blue, what dose is it? | back 35 lower starting dose |
front 36 If the lamotrigine starter kit is green, what does is it? | back 36 higher starting dose |
front 37 Brand name for levetiracetam | back 37 Keppra |
front 38 IV:PO ratio levetiracetam | back 38 1:1 |
front 39 Brand name for topiramate | back 39 Topamax |
front 40 Brand name for topiramate ER | back 40 Trokendi XR |
front 41 Topiramate can decrease the INR in patients on | back 41 warfarin (can also decrease hormonal contraception) |
front 42 Side effects of topiramate | back 42 difficulty with memory, concentration, attention, weight loss, anorexia |
front 43 Brand name for divalproex | back 43 Depakote |
front 44 Therapeutic range for divalproex | back 44 50-100 mcg/mL |
front 45 Depakote is also used for | back 45 bipolar disorder and migraine prophylaxis |
front 46 Divalproex is a derivative of what | back 46 valproic acid |
front 47 Side effects of valproic acid/divalproex | back 47 hyperammonemia, thrombocytopenia, alopecia |
front 48 Brand name of lacosamide | back 48 Vimpat (it is a C-V) |
front 49 Brand name of carbamazepine | back 49 Tegretol |
front 50 Therapeutic range for carbamazepine | back 50 4-12 mcg/mL |
front 51 What medication is an autoinducer and will decrease its own levels | back 51 carbamazepine |
front 52 When using carbamazepine, oxcarbazepine and phenytoin in patients of Asian descent, what should they be tested for | back 52 HLA-B*1502 allele |
front 53 Brand name of oxcarbazepine | back 53 Trileptal |
front 54 Side effects of carbamazepine | back 54 SIADH, DRESS reactions, hypothyroidism |
front 55 Brand name for phenytoin | back 55 Dilantin |
front 56 Therapeutic range for phenytoin (total level) | back 56 10-20 mcg/mL |
front 57 Therapeutic range for phenytoin (free level) | back 57 1-2.5 mcg/mL |
front 58 Phenytoin IV administration rate should not exceed | back 58 50 mg/min |
front 59 Fosphenytoin IV rate should not exceed | back 59 150 mg PE/min or 2 mg PE/kg/min |
front 60 Warnings for phenytoin/fosphenytoin | back 60 extravasation (leading to purple glove syndrome), DRESS |
front 61 Side effects of phenytoin dose-related toxicity | back 61 nystagmus, ataxia, diplopia,/blurred vision, slurred speech, dizziness, somnolence, lethargy, confusion |
front 62 prodrug of phenytoin | back 62 fosphenytoin |
front 63 chronic side effects of phenytoin | back 63 gingival hyperplasia, hair growth, hepatotoxicity, morbilliform rash (measles-like), increased BG, peripheral neuropathy |
front 64 Brand name of fosphenytoin | back 64 Cerebyx |
front 65 Brand name of phenobarbital | back 65 Sezaby (C-IV) |
front 66 Therapeutic range of phenobarbital (adults) | back 66 20- 40 mcg |
front 67 Therapeutic range of phenobarbital (children) | back 67 15- 40 mcg/mL |
front 68 What is the prodrug of phenobarbital | back 68 Primidone |
front 69 Brand name of cenobamate | back 69 Xcopri (C-V) |
front 70 What is a contraindication for zonisamide | back 70 hypersensitivity to sulfonamides |
front 71 Brand name for zonisamide | back 71 Zonegran |
front 72 the metabolism of phenytoin can become saturated when | back 72 there are no enzymes left to metabolize the drug, a small increase in the dose can lead to a large increase in the drug concentration |
front 73 What kinetics does phenytoin have | back 73 michaelis-menten kinetics (also called saturable kinetics) |
front 74 When should you adjust the total level of phenytoin | back 74 when albumin is < 3.5 g/dL and CrCl ≥ 10 mL/min |
front 75 phenytoin correction calculation | back 75 total phenytoin measured/ (0.2 x albumin) + 0.1 |
front 76 AEDS can cause bone loss and | back 76 increase fracture risk (all patients on AEDS should be on calcium and vitamin D) |
front 77 Women of childbearing age on AEDs should receive | back 77 daily folate supplementation |
front 78 What doses does diastat come in | back 78 2.5, 10 and 20 mg |
front 79 Brand name of oxcarbazepine ER | back 79 Oxtellar |
front 80 How to take Oxtellar ER | back 80 on an empty stomach at least one hour before or two hours after food |