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Seizure/Epilepsy

Terms in this set (29)

EEG (electroencephalogram)
commonly used to diagnose epilepsy, records and measures electrical activity in the brain
focal seizures
generalized seizures
unknown seizures
focal seizures start on one side
generalized start on both sides
unknown = unknown what side
focal aware seizure
focal seizure with impaired awareness
no loss of consciousness
loss of consciousness
Status Epilepticus (SE)
seizure that last > 5 mins

0-5 mins: stabilization phase
-time the seizure, start eeg, oxygen may be needed, check AED levels, electrolytes, if BG low give D25 or D50

5-20 mins: initial treatment phase
-Give IV lorazepam
-alternatives if not accessible:
--IM midazolam, rectal diazepam (Diastat Acudial)

20-40 mins: second treatment phase
-give regular AED: IV fosphenytoin, valproic acid, keppra (phenobarb if others aren't available)
-if seizure lasts longer there is no clear treatment
Diastat AcuDial
Diazepam rectal gel
comes in 2.5, 10, and 20 mg
syringes must be dialed to the right dose and locked BEFORE DISPENSING to patient
once locked the green band should say "READY"
when counseling, check both syringes with patient before they leave to ensure it is locked and ready
non-drug treatment
medical marijuana (CBD)
ketogenic diet
vagal nerve stimulation

do not d/c AED abruptly
drugs that can lower seizure threshold
bupropion
clozapine
theophylline
varenicline
carbapenems
lithium
meperidine
penicillin
quinolones
tramadol
AED work by
increasing GABA and decreasing glutamate
Carbamazepine, oxcarbazepine, eslicarbazepine
hyponatremia, rash, enzyme inducer
gabapentin and lyrica
weight gain, peripheral edema, mild euphoria
used for neuropathic pain
Phenobarbital & Primidone (Prodrug of phenobarbital)
sedation, dependence/tolerance/OD risk
enzyme inducers
topiramate and zonisamide
weight loss, metabolic acidosis
nephrolithiasis (kidney stone), oligohidrosis (reduced sweating)/hyperthermia (children)
All AEDs
supplement with calcium and vitamin D
women of childbearing age: folate
valproic acid: carnitine (possibly)
lamotrigine and valproic acid: if alopecia occurs selenium and zinc
Lamotrigine (Lamictal)
tab, chewable, odt
initial week 1 & 2: 25mg QD
BW: serious skin rxns (SJS/TEN)
alopecia
valproic acid inc lamotrigine levels use blue starter kit

orange box: normal starter kit
blue box: lower dose starting kit
green box: high dose starting kit
Keppra (levetiracetam)
tab, oral solution, injection
IV:PO 1:1
psychiatric reactions including psychotic symptoms, somnolence and fatigue
no significant drug interactions **
Topiramate (Topamax)
also used for migraine prophylaxis, can cause weight loss

Trokendi XR CI with alcohol use 6 hours before or after
metabolic acidosis, oligohidrosis, nephrolithiasis, angle closure glaucoma (visual problems), fetal harm

somnolence, memory/concentration/attention difficulty, anorexia/weight loss

can decrease OC effectiveness, non-hormonal contraception required
Valproic Acid (Depakote)
also used for migraine and bipolar prophylaxis

therapeutic range 50-100mcg/mL
BW: hepatic failure, fetal harm
hyperammonemia (treat with carnitine), thrombocytopenia (inc bleeding risk)
alopecia (selenium and zinc)
monitor LFTs, CBC with diff, platelets
use caution with lamotrigine due to serious rash
Carbamazepine (Tegretol)
therapeutic range 4-12 mcg/ml
BW: serious skin reactions, HLA B* 1502, aplastic anemia, agranulocytosis
CI in myelosuppression
hyponatremia, fetal harm
monitor CBC with diff and platelets
enzyme inducer and autoinducer**
use of non-hormonal contraceptive recommended
Lacosamide (Vimpat)
C-V
prolongs PR and inc risk of arrhythmia
Oxcarbazepine (Trileptal)
eslicarbazepine is active metabolite
inc risk for skin reactions
HLA B* 1502
hyponatremia, monitor Na levels
use of a non-hormonal contraception
phenobarbital
C-IV
therapeutic range 20-40 mcg/ml
habit forming, dependence, tolerance, respiratory depression, fetal harm, hangover effect

use of non-hormonal contraception
Phenytoin (Dilantin)
Fosphenytoin (Cerebryx)
IV: PO 1:1
10-20mcg /ml total level
1-2.4 mcl/ml free level

BW: phenytoin IV admin rate should not exceed 50mg/min and fosphenytoin should not exceed 150mg PE/min; if given faster - hypotension and cardiac arrhythmias
extravasation (purple glove syndrome)
HLA B* 1502
fetal harm

dose related (acute): nystagmus, ataxia, diplopa/blurred vision

chronic related: hair growth, gingival hyperplasia, hepatotoxicity

monitor drug levels, LFTs
IV: continuous cardiac monitoring and respiratory monitoring
use of non-hormonal contraception
high protein binding
phenytoin requires filter and be diluted with NS only, stable for 4 hours do not refrigerate
NG tube feeding: hold feedings 1-2 hours before and after phenytoin NG tube
Ethosuximide (Zarontin)
absence seizures
SJS/TEN
Felbamate (Felbatol)
hepatic failure and aplastic anemia
primidone
prodrug of phenobarbital
Vigabatrin (Sabril)
causes permanent vision loss
Zonisamide (Zonegran)
hypersensitivity to sulfonamides
oligohidrosis, nephrolithiasis
phenytoin correction
total phenytoin measured / [(0.2 x alb) + 0.1]
if albumin is <3.5 and crcl 10+ adjust with formula
AED
cause bone loss
supp with calcium and vitamin D
all AED carry suicide risk
caution with topiramate and zonisamide in children due to dec sweating and kidney stones
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