NU553 Unit 3 Seizure Disorders Advanced Pharmacology and Pharmacotherapeutics Exam 2

How is epilepsy clinically defined?

Recurrent, unprovoked seizures, or one unprovoked seizure with high recurrence risk.

True or False: A single seizure is sufficient for an epilepsy diagnosis if a brain abnormality is identified.

True.

Seizures occurring during alcohol withdrawal or hypoglycemia are classified as ____________rather than epilepsy.

Secondary or acute seizures.

What is the primary inhibitory neurotransmitter in the central nervous system?

Gamma-aminobutyric acid.

Name two primary excitatory neurotransmitters involved in seizure activity.

Glutamate and aspartate.

The International League Against Epilepsy categorizes seizures into which three major groups based on onset?

Focal onset, generalized onset, and unknown onset.

What is the modern International League Against Epilepsy term for what many clinicians call a petit mal seizure?

Absence seizure.

What is the modern International League Against Epilepsy term for what was previously called a complex partial seizure?

Focal onset impaired awareness seizure.

How does a focal onset aware seizure differ from a focal onset impaired awareness seizure regarding consciousness?

Focal onset aware seizures involve no alteration of consciousness.

What is a focal-to-bilateral seizure?

A seizure that begins in a localized area and spreads to involve both hemispheres.

Describe the clinical manifestation of a typical absence seizure.

A blank stare and unresponsiveness without postictal confusion.

What specific electroencephalogram finding is characteristic of an absence seizure?

A 3 cycles per second spike-wave discharge.

Which seizure type is characterized by a sudden, sharp muscle contraction followed by rhythmic jerking and prolonged postictal depression?

Tonic-clonic seizure.

Atonic seizures are also commonly referred to as .

Drop attacks.

Define myoclonic seizures.

Sudden, brief, shock-like muscular contractions.

Standard clinical practice defines Status Epilepticus as continuous seizure activity persisting for more than how many minutes.

5 minutes.

What is the most useful standard test for assisting in the diagnosis of epilepsy by recording voltage fluctuations over time?

Electroencephalogram.

Which imaging modality is preferred for the neurodiagnostic evaluation of children with a first unprovoked seizure?

Magnetic resonance imaging.

What is the first principle of epilepsy management advocated by many specialists?

Monotherapy.

What is the most frequent cause of failure to control seizure activity in patients?

Lack of adherence to drug therapy.

What is the primary mechanism of action for Phenytoin?

Stabilizing neuronal membranes by decreasing sodium ion influx in the motor cortex.

To avoid cardiac arrest, what is the maximum intravenous infusion rate for Phenytoin in healthy adults?

50 milligrams per minute.

Why must oral Phenytoin be held before and after enteral nutrition feeds?

Absorption is impaired by continuous enteral nutrition.

Phenytoin exhibits what type of enzyme kinetics, meaning small dose increases can lead to disproportionate serum level rises.

Michaelis-Menten nonlinear kinetics.

Which Black Box Warning is associated with the rapid intravenous administration of Phenytoin?

Severe cardiovascular events, including hypotension and arrhythmias.

List three common non-concentration-related adverse effects of Phenytoin.

Gingival hyperplasia, hirsutism, and coarsening of facial features.

Phenytoin is a strong inducer of which major cytochrome P450 enzyme?

Cytochrome P450 3A4.

What is the first-line drug choice for monotherapy in focal onset seizures?

Lamotrigine or levetiracetam first-line; carbamazepine is an alternative.

Define autoinduction as it relates to Carbamazepine.

The drug induces its own metabolism, typically complete within 3 to 4 weeks.

Patients of Asian ancestry should be screened for which allele before starting Carbamazepine due to Stevens-Johnson syndrome and toxic epidermal necrolysis risk.

HLA-B 1502.

Carbamazepine carries a Black Box Warning for which two hematologic conditions?

Aplastic anemia and agranulocytosis.

What electrolyte abnormality is a common adverse effect of Oxcarbazepine, particularly in older adults?

Hyponatremia.

Valproic acid works primarily by increasing the availability or action of which neurotransmitter?

Gamma-aminobutyric acid.

Valproic acid carries a Black Box Warning for life-threatening what, which can occur at any time during therapy.

Pancreatitis.

In what specific patient population is the risk of Valproate-induced fatal hepatotoxicity highest?

Children age 2 and younger taking multiple anticonvulsants.

Concurrent administration of Valproic acid with what class, for example Meropenem, causes a rapid decline in Valproate levels.

Carbapenems.

Which drug is considered a primary choice for managing absence seizures?

Ethosuximide.

Pregabalin requires dosage adjustments for patients with what impairment.

Renal impairment.

What major adverse effect is associated with the combination of gabapentinoids, like Pregabalin, and opioids?

Fatal respiratory depression.

Lamotrigine carries a Black Box Warning for which condition if a rash develops?

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.

How does Valproic acid affect the half-life of Lamotrigine?

It inhibits metabolism, doubling the half-life to 48 hours.

What is a common behavioral adverse effect of Levetiracetam that may require dose reduction?

Agitation, aggression, or psychosis.

Which antiepileptic drug is uniquely associated with a potential increase in the PR interval and atrioventricular block?

Lacosamide.

Perampanel carries a Black Box Warning for which type of serious events?

Life-threatening neuropsychiatric events, including aggression, anger, and homicidal thoughts.

Name two prominent adverse effects of Topiramate.

Cognitive slowing and paresthesias.

Patients taking Topiramate must maintain proper hydration to reduce the risk of what.

Kidney stones.

Due to high risks of aplastic anemia and acute hepatic failure, which antiepileptic drug requires a signed informed consent form?

Felbamate.

Vigabatrin is only available through a restricted distribution program because it causes what.

Permanent vision loss.

What is the preferred first-line benzodiazepine dose for aborting Status Epilepticus intravenously?

Lorazepam 0.1 milligram per kilogram intravenously, maximum 4 milligrams per dose.

In the management of Status Epilepticus, what is the preferred medication for the emergent treatment phase if intravenous access is unavailable?

Midazolam 0.2 milligram per kilogram intramuscularly, maximum 10 milligrams per dose.

Define Refractory Status Epilepticus.

Clinical or electrographic seizures persisting after administration of a benzodiazepine and an appropriate antiepileptic drug.

How do simple febrile seizures in children typically affect long-term anticonvulsant therapy needs?

Long-term therapy is not indicated.

According to International League Against Epilepsy and Food and Drug Administration guidelines, what must be avoided during the first trimester of pregnancy to minimize malformations.

Valproic acid and polytherapy.

During a tonic-clonic seizure, why should nothing be placed in the patient's mouth?

It can injure the patient's mouth or airway and can injure the rescuer.

What position is recommended in the postictal period to reduce aspiration risk?

Side-lying or semiprone position.

Which antiseizure medication is first-line for absence seizures, and what drug is a common mistake because it can worsen them?

Ethosuximide is first-line; carbamazepine can worsen absence seizures.

What is the key counseling point for lamotrigine titration?

Titrate slowly to reduce the risk of serious rash, including Stevens-Johnson syndrome.

Why is levetiracetam often chosen despite not being the flashiest antiepileptic drug?

It has few major drug interactions, but mood and behavior changes must be monitored.

What is the first priority in convulsive status epilepticus before long-term seizure control questions matter?

Airway, breathing, circulation, glucose check, and rapid benzodiazepine treatment.

What is the general principle of epilepsy drug therapy before jumping to polytherapy?

Start with monotherapy and optimize it first.

Why is polytherapy less desirable when possible?

More adverse effects, more interactions, and more complexity.