meds

Question	Answer
Which antiepileptic medications are used to treat conditions other than epilepsy and what do they treat?	Carbamazepine, Lamotrigine, Valproic acid used as mood stabilizers in bipolar disorder. Gabapentin and Pregabalin used to treat pain in neuropathic pain syndromes. VPA in form of Depakote and topiramate used as prophylaxis for migraine. Benzos such as Clonazepam, Clobazam, Lorazepam used to treat anxiety.
Which medication(s) are typically used to treat status epilepticus? At what point are they administered?	Lorazepam (or Diazepam as this can be given rectally)- typically given after 5 minutes of seizure activity. Dilantin load for continued seizure activity or for recurrent seizures. Phenobarb or VPA may also be given during acute status epilepticus if not responding to above meds. If STILL no seizure control, then propofol and/or midazolam, or pentobarbitol (requires transfer to ICU, intubation as these sedate to comatose state)
What are the main treatments for infantile spasms?	Vigabitrin (brand name Sabril), ACTH (adrenocorticotropic hormone) injecions, ketogenic diet, prednisone, additional AEDs (such as topiramate, lamotirigine, levetiracetam, etc)
Besides medications, what are some things that are used/done to treat seizures? Give examples of when these forms of treatment might be used.	Surgery- usually involving resection of the epileptogenic area or even the entire hemisphere. Used to treat localized uncontrolled/chonic seizures for example, in mesial temporal sclerosis or conditions that affect one hemisphere and not the other like Rasmussen's encephalitis or hemimegalencephaly, Sturge-Webber Syndrome. Ketogenic diet- (high fat, low carb). Used to treat intractible seizures that have failed many medications. Ketogenic diet is commonly successful at treating LGS, and to some degree infantile spasms. Vagus nerve stimulator ("pacemaker for the brain") again used with refractory seizures.
What is the ketogenic diet/ what does it consist of? How does it work? Generally speaking, when is it used? Generally speaking, how effective is it?	Very high fat, very low carb, adequate protein diet, like an extreme Atkins diet. Usually 4:1 ratio (fat:protein+carbs), 75-90% of caloric intake is from fat. Anti-seizure effect is thought to be through ketosis, though other mechanisms also may have beneficial effects. Generally used in kids with severe, debilitating and intractable seizures, especially with multiple seizure types (ie Lennox Gastaut). Varied effectiveness, but generally helps- 50% have a >50% seizure reduction, 30% have a >90% seizure reduction.
Give at least 3 examples of medications that fall under the category of benzodiapines. Generally what effects might benzos have on the EEG?	Clobazam, clonazepam, midazolam, lorazepam, diazepam. Generally shows ++increased beta activity, decreased epileptiform activity, at high levels can cause slowing and/or coma patterns.
What are volatile gases and when are they used? Give an example of a volatile gas. Generally what effects might this drug class have on the EEG?	Class of anesthetic that comes in gas form. Used in surgery/ dentistry. Most common example is "laughing gas"/ nitrous oxide; others include desflurane and sevoflurane. Generally shows (with increasing doses) decreased fast, increased delta slowing, decrease in amplitude, burst-suppression to ECI at high levels.
Give at least 2 examples of medications that fall into the class of barbiturates. Generally what effects might this drug class have on the EEG?	Thiopental, pentobarbitol (nembutol), phenobarbitol. Generally shows ++increased beta, decreased epileptiform activity, diffuse slowing, at high levels/ when loaded quickly burst suppression.
Morphine, hydromorphone (dilaudid), fentanyl, remifentanil, and sufentanil belong to which class of medications? What are they used for? Generally what effects might this class of medications have on the EEG?	Opiates/narcotics. Anesthetics- used for pain relief. Generally may cause no changes to EEG or mild slowing and decrease in amplitude only. Can see more marked slowing if given in very high doses or fast infusions.
Succinylcholine and rocuronium belong to what class of medications? When might these be used? What considerations have to be taken into account before giving these during an EEG? Generally what effects might this drug class have on the EEG?	Muscle relaxants/ neuromuscular blockade. Used for surgery, placement of lines, etc, when there is movement that is becoming a hazard to the patient, even during EEG. Must consider that these may only be given if the patient is already intubated/ventilated because they can cause paralysis of respiratory muscles. Brain activity is NOT altered, but less muscle and mvoement artifact will be seen :)
Common brand name for Ethosuximide	Zarontin
Ethosuximide is indicated for what seizure type(s)? Can this med worsen other seizure types? If so which types?	Indicated for absence seizures. Adjunctive therapy in JME and LGS with absence. Does not help any other seizure types, can worsen partial and gen'd seizures.
What effects does Ethosuximide have on EEG at therapeutic levels? Toxic levels?	Therapeutic: decreased 3Hz SW. Toxic: slowing (decreased alpha, increased theta and delta).
Common brand name for Phenytoin	Dilantin
Phenytoin is indicated for what seizure type(s)? Can this med worsen other seizure types? If so which types?	Indicated for focal and gen'd seizures. Also status/ongoing seizures. Can worsen absence and JME.
What effects does Phenytoin have on EEG at therapeutic levels? Toxic levels?	Therapeutic: usually none +/- mild slow. Toxic: slowing that parallels levels. Epileptiform activity/ seizures can be a manifestation of toxicity.
What is a common brand name for Carbamazepine?	Tegretol
Carbamazepine is indicated for what seizure type(s)? Can this med worsen other seizure types? If so which types?	Indicated for partial seizures, GTCs, mixed seizures. Can worsen absence/ JME.
What effects does Carbamazepine have on EEG at therapeutic levels? Toxic levels?	Therapeutic: usually none, rarely increased theta slowing. Toxic: slowing (decreased alpha, increased theta and delta)
Common brand name for Lamotrigine	Lamictal
Lamotrigine is indicated for what seizure type(s)? Can this med worsen other seizure types? If so which types?	Indicated for wide range of seizures: partial, partial with secondary generalization, GTC, absence, refractory seizures. 1st line treatment of gen'd seizures in women of childbearing age. Not known to worsen other seizure types.
What effects does Ethosuximide have on EEG at therapeutic levels? Toxic levels?	Therapeutic: decreased epileptiform and decreased photoconvulsive response. Toxic: same as therapeutic.
Common brand name for Levetiracetam	Keppra
Levetiracetam is indicated for what seizure type(s)? Can this med worsen other seizure types? If so which types?	Indicated for partial seizures. Adjunctive therapy for partial seizures, myoclonic and GTCs.
What effects does Levetiracetam have on EEG at therapeutic levels? Toxic levels?	Therapeutic: decreases epileptiform activity. Toxic: none
This response results in either constriction (miosis)[1], narrowing the pupil, or dilation (mydriasis), widening the pupil.	a

Next up

Description

Resource summary

Similar

	Created by Danielle Morley about 10 years ago