neuro exam 2

phenytoin uses 

tonic / partial seizure 

trigeminal neuralgia 

class IB antiarrhythmic 

phenytoin 

IV AE 

arrhythmia , hypotension

phenytoin

AE

ataxia

nystagmus (eyes going sideways)

what chronic therapy is phenytoin associated with?

gingival hyperplasia

osteomalacia

seizure

brief abnormal brain activity

convulsion

involuntary muscle contractions

epilepsy 

2 unprovoked seizures separated by 24 hrs 

etiology of seizure

genetics

diseases

medications

• anesthetics

• psychotropic

• antibiotics

• drug withdrawl

diagnosis of epilepsy

2+ seizures separated by 24 hrs

carbamazepine potent inducer

CYP 1A , 2C , 3A

carbamazepine 

contraindications 

history of bone barrow suppression 

carbamazepine

idiopathic

cholestatic jaundice

LFT increase

hyponatremia (135-145)

carbamazepine

CBC monitoring

CBC

LFT

electrolyte

drug level

carbamazepine

PK

zero-order metabolism

phenytoin 

contraindications 

brady

2nd/3rd AV block 

phenytoin

idiopathic

bloody

dyscrasis

hepatotox

gingival

vit D / osteoporosis

phenytoin monitoring 

CBC

LFT

bone density 

drug level 

is fosophenytoin less of an issue than phenytoin?

yes

valproate

PK

inhibits lamotrigine

valproate

contraindications

pregnancy

valproate 

SE 

CNS

weight gain 

valproate

idiopathic

hepatotoxicity

pancreatitis

phenobarbital/primidone

off-label use

tremor

what does phenobarbital/primidone induce?

1A2 , 2C , 3A

just like carbamazepine

phenobarbital/primidone

contraindications

airway obstruction

phenobarbital/primidone

side effects 

respiratory depression

hypotension

phenobarbital/primidone

montioring 

CBC

LFT 

ethosuximide

indication

absence seizures ONLY

is ethosuximide well tolerated?

yes

ethosuximide

adverse effects

blood dyscrasis

CNS depression

benzodiazepenes 

lorazepam

diazepam 

clonazepam

lorazepam and diazepam

indication

status epilepticus

what is clonazepam used for?

seizure disorder

which benzodiazepenes are used IV?

lorazepam

diazepam

benzodiazepene

SE

CNS depression

respiratory depression

which 2nd / 3rd generation ASD are renally cleared?

levetiracetam

gabapentin

escarbazepine

lamotrigine + concomitant enzyme inhibitor

ex: valproate

slow titration

lamotrigine is broken down slower → rash if going too fast

lamotrigine + concomitant enzyme inducer 

ex : carbamazepine 

faster titration 

carbamazepine speeds up liver enzymes that metabolizes lamotrigine

lamotrigine

SE

rash

SJS

lamotrigine

monitoring

dermatologic assessment

what is felbamate used for ?

lennox-gastaut syndrome in children

felbamate 

SE 

aplastic anemia 

liver failure 

gabapentin

SE 

weight gain 

respiratory depression

oxcarbazepine structure analog

carbamazepine

oxcarbazepine

SE

hyponatremia

sedation

levetiracetam

SE

aggression

irritable

what is topiramate used for? 

mono / adjunct for focal and generalized 

adjunct for lennox-gastaut 

topiramate

SE

weight loss

psycho slow

reduces oral contraceptives 

SKINNY AND STUPID

which 3rd generation ASD is a CV?

pregabalin

lancosamide

brivaracetam

cannadibiol

which 3rd generation ASD is a C-IV?

clobazam

which 3rd generation ASD is a CIII?

perampanel

what is vigabatrin used for?

mono for infantile spasm

last resort

vigabatrin

SE

vision loss

vision exam 3-6 months

zonisamide

SE

confusion

weight loss

zonisamide 

contraindications 

sulfa allergy 

ezogabine

indication

failure to other ASD

refractory seizure

ezogabine

SE

vision loss

skin discoloration

pregabalin

dosing requirement

need titration

pregabaline 

SE 

weight gain

respiratory depression withdrawl

what is brivaracetam the analog of?

levetiracetam

brivaracetam

SE

psychiatric disturbances

nystagmus

perampanel

SE

aggression

hostile

what is perampanel extensively metabolized by? 

CYP3A4 

eslicarbazepine acetate

indication

mono / adjunct therapy for focal seizures

what does eslicarbazepine pro drug activate to? 

S-licabazepine

eslicarbazepine

SE

hyponatremia

sedation

childhood seizure medications 

cannabidiol - DS / LGS 

stiripentol - DS as adj therapy to clobazpam 

childhood seizures

dravet syndrome

lennox gastaut syndrome

clobazam 

BBW

respiratory depression + opioid 

what is clobazam approved for?

adj therapy for LGS

HLA-B 15:02

asian descent have significant risk for SJS

what medications should be tested for HLA-B 15:02?

carbamazepine

lamotrigine

phenytoin

status epilepticus

both side of brain

5 mins last

2+ seizures→ incomplete recovery consciousness

medical emergency

status epilepticus 

increased risk 

hyperthermia

renal failure 

cardio collapse 

refractory seizure

seizure doesn’t stop even with with 2+ medications

termination of seizure

IV

benzodiazpenes

• lorazepam

• diazepam

prolonged control of seizure

IV

1st line: phenytoin, fosphenytoin

2nd line: phenobarbital, valproate

3rd line: levetiracetam , lacosamide

refractory seizure

pentobarbital

midazolam

propofol

pathophysiology of MDD

biogenic amine hypothesis

• deplete 5HT, NE, and DA

what lab findings should you collect when you assess MDD?

thyroid function

renal function → for the medication that might be given

CBC

liver function

urine drug screen

pharmacogenomics

what rating scale should to assess MDD? 

patient health questionnaire - 9 

what type of drugs induces depression?

antihypertensives

• BB

• a1 blocker

hormonal therapy

• gender affirming

• oral contraceptives

isotretinoin

interferon

• cancer/hepatitis treatment

what drugs are the 1st line treatment for MDD? 

SNRI 

• citalopram 

• escitalopram

• fluoxetine

• paroxetine

• sertraline

• fluvoxamine

which SSRI is the most sedating?

paroxetine

SSRI adverse effects

anxiety

insomnia / agitation

sedation

headache

nausea

diarrhea

delayed ejaculation / decreased libido

management for anxiety

low → taper

management for insomnia

take in AM

management for sedation / headache 

take at bedtime → takes 2 weeks 

management for nausea 

take with food 

management for diaherra

may need to switch

management for delayed ejaculation and libido

discont , lower dose, switch

treatment with PDE5 inhibitor

other approved uses for SNRI

MDD

pain

SNRIs 

duloxetine 

venlafaxine XR / IR 

desvenlafaxine

levomilnacipran

milnacipran

SNRIs

SE

insomnia

cardiac → more with venlafaxine

• hypertension

• tachy

mirtazapine

buproprion

preffered antidepressant in certain patients

mirtazapine

SE

appetite stimulation

sedation

which antidepressant has little risk of drug-induced sexual function? 

mirtazapine

vortioxetine

bupropion

what can bupropion be added with to reverse sexual dysfunction?

serotonergic antidepressant

bupropion

SE

higher chance for seizure

avoid in

• head trauma

• alcohol use

pros of using bupropion

pts with excessive sedation

early morning