Anti-seizure - Parker

Question 1

You should be seizure free for ______ years before drug withdrawal.

Answer 1

2 years

Question 2

What’s the maximum IV dose of phenytoin?

Answer 2

50 mg/min

Question 3

There are 3 inducers and 1 inhibitor that we should know for the anti-seizure meds. What are they?

Answer 3

Inducers: carbamazepine, phenytoin, and phenobarbital
Inhibitor: valproic acid

Question 4

________ is an auto inducer, meaning it can speed up its own metabolism.

Answer 4

Carbamazepine

Question 5

With these 2 related anti-seizure meds, you get hyponatremia secondary to the induction of ADH.

Answer 5

Carbamazepine and Oxcarbamazepine

Question 6

Which has fewer toxicities: Carbamazepine or Oxcarbamazepine?

Answer 6

Oxcarbamazepine because it doesn’t have the 10,11 epoxide that carbamazepine has.

Question 7

This anti-seizure med has many uses as well as many toxicities, including weight gain, hair loss, thrombocytopenia, liver toxicity, polycystic ovarian like disease, & contraindicated in Pregnancy!! Poor choice for young woman.

Answer 7

Valproic acid

Question 8

______ is considered big and slow because it has a long ½ half so it takes a long to get in and up to steady state and a long time to come off. Its side effects include making you sleepy, cognitive slowing, and its associated with anemias, hepatic toxicities, and rash.

Answer 8

Phenobarbital

Question 9

With this anti-seizure drug, you have to start low and go slow because you can get difficulties in cognitive function as well as risk of kidney stones.

Answer 9

Topiramate

Question 10

________ is an anti-seizure drug that can reduce the efficacy of oral contraceptives at doses > 200 mg/day.

Answer 10

Topiramate

Question 11

True or false: there is a worry of rash and hepatotoxicity with lamotrigine.

Answer 11

True

Question 12

With this anti-seizure drug, it is well tolerated but you do see an increase in aggression and psychosis in the patient as side effects.

Answer 12

Levetiracetam

Question 13

_______ is an anti-seizure drug with a similar profile to Levetiracetam, but it can cause PR interval prolongation, so must watch, especially in patients with bradycardia or bradyarrhythmia.

Answer 13

Locasamide

Question 14

This anti-seizure drug is the drug of choice for absence seizures, but the problem with it is a high incidence of GI side effects.

Answer 14

Ethosuximide

Question 15

______ and _____ are anti epileptic drugs that have kidney stone issues because of the carbonic anhydrase inhibition in the kidneys.

Answer 15

Topiramate and zonisamide

Question 16

Steven Johnsons skin disease is associated with this AED.

Answer 16

Lamotrigine

Question 17

Aromatic AEDs are associated with AED hypersensitivity reactions and you don’t want to use another one if you’re allergic to one. Which AEDs are aromatic?

Answer 17

Phenobarbital, phenytoin, carbamazepine, oxcarbamazepine, and lamotrigine

Question 18

All pregnant women on an AED should get ____ mg/day of folic acid supplementation.

Answer 18

5 mg/day

Question 19

Oral contraceptives may decreased the plasma concentration of this AED by ~50%.

Answer 19

Lamotrigine

Question 20

Which AEDs reduce the efficacy of oral contraceptives?

Answer 20

Carbamazepine
Oxcarbamazepine
Felbamate
Phenobarbital 
Phenytoin
Primidone
Topiramate (at doses > 200 mg/day)

Question 21

Status epilepticus is considered a medical emergency. The first line treatments are benzodiazepines. The 2 often used are______ and ______.

Answer 21

IV lorazepam
IM midazolam

(Rectal diazepam can also be used

Question 22

If a person goes into refractory status epilepticus because they did not respond to initial therapy, you can use high dose ______ to induce coma.

Answer 22

Propofol