Diagnosis and Treatment of Acute and Chronic Seizures (Dr. Wente)

Select the drugs that does not decrease the efficacy of oral contraceptives

lamotrigine

3 multiple choice options

What drug interacts with lamotrigine to delay clearance and increase risk of rash?

valproic acid

3 multiple choice options

Julie is on Keppra and having suicidal ideation. Her partner has noticed significant changes. What would you NOT do?

check Keppra level and decrease dose

3 multiple choice options

Mr. Walker is a 67 year old male who has a small hemorrhagic stroke yesterday. The nurse finds him having convulsions and he is not responding to commands.

His wife said this happened briefly yesterday but she thought it was normal after a stroke. A code is called...

Mr. Walker is 70 kg and 68 in tall.

What agent should you give first? Choose the BEST answer

lorazepam 4 mg IV

3 multiple choice options

Mr. Walker is a 67 year old male who has a small hemorrhagic stroke yesterday. The nurse finds him having convulsions and he is not responding to commands.

His wife said this happened briefly yesterday but she thought it was normal after a stroke. A code is called. He is given 2 doses of benzodiazepine and still seizing.

Mr. Walker is 70 kg and 68 in tall

What should you do next?

levetiracetam 4500 mg IV x 1

or

fosphenytoin 1500 mg PE IV x 1

3 multiple choice options

When selecting a second anticonvulsant, you should ...

choose one with a different MOA and different ADEs

3 multiple choice options

Which of the following medications can cause severe, treatment limiting psychomotor slowing?

topiramate

3 multiple choice options

Which answer choice is NOT a chronic ADE of phenytoin?

hyperactivity

3 multiple choice options

Which one of the answer choices are NOT a sign/symptom of phenytoin toxicity?

hyperactivity

3 multiple choice options

Which is NOT true about levetiracetam>

Can cause renal failure

3 multiple choice options

Martin is a 41 year old man on carbamazepine for 15 years after a TBI. He's consistently therapeutic and his last seizure was 8 years ago. WWYD?

consider tapering off and stopping if EEG & IQ are normal

3 multiple choice options

Which of the following anticonvulsant is NOT a controlled substance?

topiramate

3 multiple choice options

Which of the following medications does NOT decrease the seizure threshold?

oxycodone (Oxycontin)

3 multiple choice options

Which of the following seizure medications is NOT safe in pregnancy?

valproic acid

3 multiple choice options

Which carbapenem is most associated with seizures?

imipenem

2 multiple choice options

Arthur is a 36 year old man with seizures who wants to stop smoking. He drinks 6 beers a night. Choose a strategy

nicotine patches

2 multiple choice options

Joel is a 27 year old with spina bifida. Phenytoin level is 4.6 and his albumin is 3.3. Renal function is WNL. What is calculated corrected PHT level?

6

3 multiple choice options

Ashley is a 22 year old woman who is having a seizure. She weighs 68 kg. What dose of Keppra do you recommend?

4 g IV x 1 now

3 multiple choice options

Roger is a 16 year old who has been off phenytoin for 10 days is now in status epilepticus. He weights 62 kg, choose your strategy.

give lorazepam 4 mg IV then fosphenytoin 1250 mg PE IV x 1

3 multiple choice options

Which medications decrease the seizure threshold?

tramadol

bupropion

Varenecline (Chantix) + EtOH

carbapenems

fluoroquinolones

isoniazid

clozapine

Which fluoroquinolone decreases the seizure threshold the most?

ciprofloxacin

2 multiple choice options

What is the DDI between meropenem and valproic acid?

decreases valproic acid levels