Term
| What is the likelihood of a second seizure? |
|
Definition
| 50% of those who have a recurrent seizure have it within the first 6 months; 80% have it within 2 years |
|
|
Term
| what factors increase the risk of a recurrent seizure? |
|
Definition
1. structural brain lesion such as tumor, abscess, AVM, CVA
2. postictal Todd's paralysis
3. history of prior CNS infection
4. traumatic brain injury
5. status epilepticus
6. epileptiform discharges on EEG
7. history of childhood febrile seizure
8. sibling with epilepsy |
|
|
Term
| general side effects of AEDs |
|
Definition
| some degree of lethargy, cognitive slowing, dizziness, GI upset, decreased coordination |
|
|
Term
|
Definition
can cause osteoporosis, rickets and osteomalacia
polytherapy increases the risk of bone metabolism abnormalities |
|
|
Term
|
Definition
1. risk of birth defects rises to 5% in women with untreated epilepsy
2. risk rises to 8% with AEDs
3. risk increases with higher doses and polytherapy
4. most common are cardiovascular malformations, orofacial clefts, neural tube defects
5. highest risk wtih valproate and carbamazepine |
|
|
Term
| AEDs and drug interactions |
|
Definition
1. may have inductive or inhibitory effect on P-450 cytochrome system
2. drugs may be strongly protein bound - affected by albumin levels
3. higher failure rates of oral contraceptives |
|
|
Term
| non-drug treatments for seizures |
|
Definition
1. surgical intervention
2. ketogenic diet
3. vagal nerve stimulator |
|
|
Term
| indications for carbamazepine (tegretol) |
|
Definition
| partial and generalized seizures, may exacerbate absence seizures |
|
|
Term
| administration and mechanism of carbamazepine (tegretol) |
|
Definition
oral, sustained release, suppository
inhibition of voltage dependent sodium channels; may also affect NMDA, monoamine, and acetylcholine receptors |
|
|
Term
| clearance and drug interactions of carbamazepine |
|
Definition
hepatic clearance
protein bound
p-450 enzyme inducer |
|
|
Term
| side effects of carbamazepine |
|
Definition
1. nausea
2. blurred vision/diplopia
3. behavioral disturbance
4. hyponatremia
5. thrombocytopenia, leucopenia, aplastic anemia
6. hepatotoxicity
7. Stevens-Johnson and lupus-like syndromes
8. rash |
|
|
Term
| indications of ethosuximide (Zarontin) |
|
Definition
|
|
Term
| administration and mechanism of ethosuximide |
|
Definition
oral
inhibits calcium T-channel conductance |
|
|
Term
| clearance and drug interactions of ethosuximide |
|
Definition
renal and hepatic
some protein binding |
|
|
Term
| side effects of ethosuximide |
|
Definition
1. nausea, headache
2. diplopia
3. behavioral disturbance
4. acute psychotic reactions
5. rash
6. Stevens-Johnson and lupus-like syndromes
7. bone marrow depression |
|
|
Term
| indications of phenobarbital |
|
Definition
| partial or generalized seizures |
|
|
Term
| administration and mechanism of phenobarbital |
|
Definition
oral, IV
enhances activity of GABA-A receptor, depresses glutamate excitability, reduces sodium, potassium and calcium conductance |
|
|
Term
| clearance and drug interactions of phenobarbital |
|
Definition
hepatic and renal
protein bound
p-450 enzyme inducer |
|
|
Term
| side effects of phenobarbital |
|
Definition
1. hyperactivity in children
2. nystagmus
3. rash
4. stevens-johnson syndrome
5. hepatotoxicity
6. connective tissue abnormalities
7. vitamin K and D deficiencies
8. bone marrow disorders |
|
|
Term
|
Definition
| partial and primary and secondarily generalized seizures |
|
|
Term
| administration and mechanism of phenytoin (dilantin) |
|
Definition
oral, sustained release, IM, IV
inhibition of voltage dependent sodium channels, inhibitory action on calcium and chloride conductance |
|
|
Term
| clearance and drug interactions of phenytoin |
|
Definition
hepatic
highly protein bound
p-450 enzyme inducer |
|
|
Term
| side effects of phenytoin |
|
Definition
1. nausea
2. nystagmus
3. gingival hyperplasia
4. hirsuitism
5. coarsened facies
6. diplopia
7. peripheral neuropathy
8. megaloblastic anemia, aplastic anemia
9. vitamin K deficiency
10. fever, rash
11. hepatic failure
12. stevens-johnson and lupus-like syndromes
13. pseudolymphoma |
|
|
Term
|
Definition
| primary and secondarily generalized seizures, including myoclonus (only one) and absence seizures (either this or ethosuximide); partial seizures |
|
|
Term
| administration and mechanism of valproate (Depakote) |
|
Definition
oral, sustaned release, IV
effects GABA and glutaminergic activity, calcium and potassium conductance |
|
|
Term
| clearance and drug interactions of valproate |
|
Definition
hepatic
very protein bound
p-450 enzyme inhibitor |
|
|
Term
| side effects of valproate |
|
Definition
1. nausea
2. tremor
3. weight gain
4. hair thinning
5. amenorrhea
6. polycystic ovarian syndrome
7. thrombocytopenia, neutropenia
8. pancreatitis
9. hypoammonemia
10. hepatic failure, especially young children
11. encephalopathy |
|
|
Term
| focal seizure - with or without generalization |
|
Definition
| carbamazepine, phyenytoin, phenobarbital, valproate |
|
|
Term
| primary generalized tonic-clonic |
|
Definition
| carbamazepine, phenytoin, phenobarbital, valproate |
|
|
Term
|
Definition
| ethosuximide or valproate |
|
|
Term
|
Definition
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