NURS646 Neuro Exam Study Guide
How common are febrile seizures? - Answer •2-4 % of children age ~ 6 months - 6 years
What are alternate treatments? - Answer Ketogenic diet (high fat diet)
Vagal nerve stimulator - FDA approved for partial seizures in 12 years+
Epilepsy surgery
Valproic Acid Adverse Drug Reactions - Answer •acute liver necrosis/pancreatitis -
especially <2yo (1/600), neural tube defects,
PCOS, hormonal changes,
tremor thrombocytopenia,
weight gain,
coagulation abnl,
encephalopathy-hyperammonemia
Pregnancy Class D- teratogenic, fetal valproate syndrome
Ethosuximide [Zarontin] MOA and dosing - Answer •First choice in absense seizures
Mechanism: selectively blocking T-type Ca2+ channels
•Dosing - start 5-10mg/kg/day, increase to 20-35 mg/kg/day in divided doses BID.
Lamotrigine [Lamictal] MOA - Answer •Broad spectrum alternative to Valproic acid
•Also used for mood stabilization (bipolar).
•Mechanism: blocks the release of glutamate, the brain's main excitatory
neurotransmitter.
Lamotrigene Adverse reactions - Answer •lower cognitive effect/less sedating
compared to other AEDs , Bad skin rash- SJS or hypersensitivity syndrome (usually
within 2 months of starting), some hematologic abnormalities and elevated LFTs.
•Pregnancy Cat. C. Large changes in plasma levels - breakthrough seizures 1st
trimester, toxicity after delivery. Monitor baby LFT's.
Topirmate [Topamax] Dosing, Indications and other uses - Answer •Indications: Broad -
general, focal, spasms
•Other uses: headaches - migraine,
•Dosing: 5-9mg/kg/day in divided doses BID, start low, increase slow to try to avoid
,ADRs
Levetiracetam [Keppra] Indications , other uses, and Dosing - Answer •Indications:
Broad spectrum - generalized, focal, neonatal, status
•Other uses - consider for other uses-low side effects.
•Dosing: 20-60 mg/kg/day in divided doses BID
Levetiracetam Adverse Reactions - Answer •Dose-dependent ADRs - usual somnolence,
dizziness, anorexia, behavior changes, agitation
•Pregnancy Category C. breast milk- high transfer but very low infant levels,
contraception - no interaction.
Carbamazepine (Tegretol) Uses, MOA, Dosing - Answer •Narrow spectrum AED
•Other Uses: TCA for bipolar depression, trigeminal neuralgia
•Mechanism: blocks sodium channels and inhibits high-frequency repetitive firing in
neurons.
•Dosing: 15-25 mg/kg/day
ADHD: When is it diagnosed? - Answer •Frequently diagnosed when child goes to school
•4 x's more common in boys than girls
How should an ADHD treatment plan be developed? - Answer Comprehensive
"multimodal" interventions. Developed based on the individual needs of the child and
family and may include the following components:
§Educational interventions
§Behavioral therapy
§Individualized child interventions
§Parent guidance/Family therapy
Pharmacological Management*
AAP Recommendations: If the ADHD child does not repsond to treatment asses the
following factors - Answer ◦Unrealistic target goals
◦Lack of adequate information about the child's behavior
◦Incorrect diagnosis
◦Present of co-morbid conditions that are affecting the treatment of ADHD
, ◦Lack of adherence to the treatment plan
◦Treatment Failure
}Warrants specialist referral.
Why should the PCP monitor ADHD meds closely? - Answer •The clinician should
periodically provide a systematic follow-up for the child with ADHD. Monitoring should
be directed to target outcomes and adverse effects by obtaining specific information
from parents, teachers, and the child.
TCAs: Side effects and toxicity - Answer Side effects of TCAs: dry mouth, weight gain,
urinary retention, constipation, sedation, cardio toxicity, orthostatic hypotension
Toxicity: dangerous in overdose (monitor blood levels), possible drug interactions
Non-Stimulant Medications: se of Tricyclic Antidepressant (TCAs) - Answer }Not first line
of treatment for ADHD but have proven efficacy.
}May be helpful for treatment of hyperactivity and impulsivity in patients that have been
treatment resistant to more than 2 trials of stimulants medications.
}Less effective for treatment of distractibility than stimulant medication.
Guanfacine compared to clonidine: - Answer Less hypertension, sleep disruption,
sedation, and rebound hypertension, longer duration of clinical action (requiring fewer
doses)
Non-Stimulant Medications: Guanfacine - Answer ◦In an open label trial appeared to
improve hyperactivity, impulsivity, distractibility, aggression frustration tolerance and
affect modulation
Non-Stimulant Medications: Clonidine - Study results and Use - Answer ◦A meta
analysis of clonidine suggested it has moderate efficacy for treating ADHD but less than
that of stimulants
◦Appears to treat hyperactivity and impulsivity but not distractibility
◦Also used in children to manage sleep problems, aggression and self injurious
behavior
How much time is required for the drug level to stabilize after the AED dose is changed?
- Answer 5 half-lives i
Wjhat does the half life of AEDs indicate? - Answer •how frequently the drug should be
administered
•Half-lives is shorter in infants and children requiring more frequent dose schedule
What percentage of patients are seizure free on monotherapy? - Answer 70%
How common are febrile seizures? - Answer •2-4 % of children age ~ 6 months - 6 years
What are alternate treatments? - Answer Ketogenic diet (high fat diet)
Vagal nerve stimulator - FDA approved for partial seizures in 12 years+
Epilepsy surgery
Valproic Acid Adverse Drug Reactions - Answer •acute liver necrosis/pancreatitis -
especially <2yo (1/600), neural tube defects,
PCOS, hormonal changes,
tremor thrombocytopenia,
weight gain,
coagulation abnl,
encephalopathy-hyperammonemia
Pregnancy Class D- teratogenic, fetal valproate syndrome
Ethosuximide [Zarontin] MOA and dosing - Answer •First choice in absense seizures
Mechanism: selectively blocking T-type Ca2+ channels
•Dosing - start 5-10mg/kg/day, increase to 20-35 mg/kg/day in divided doses BID.
Lamotrigine [Lamictal] MOA - Answer •Broad spectrum alternative to Valproic acid
•Also used for mood stabilization (bipolar).
•Mechanism: blocks the release of glutamate, the brain's main excitatory
neurotransmitter.
Lamotrigene Adverse reactions - Answer •lower cognitive effect/less sedating
compared to other AEDs , Bad skin rash- SJS or hypersensitivity syndrome (usually
within 2 months of starting), some hematologic abnormalities and elevated LFTs.
•Pregnancy Cat. C. Large changes in plasma levels - breakthrough seizures 1st
trimester, toxicity after delivery. Monitor baby LFT's.
Topirmate [Topamax] Dosing, Indications and other uses - Answer •Indications: Broad -
general, focal, spasms
•Other uses: headaches - migraine,
•Dosing: 5-9mg/kg/day in divided doses BID, start low, increase slow to try to avoid
,ADRs
Levetiracetam [Keppra] Indications , other uses, and Dosing - Answer •Indications:
Broad spectrum - generalized, focal, neonatal, status
•Other uses - consider for other uses-low side effects.
•Dosing: 20-60 mg/kg/day in divided doses BID
Levetiracetam Adverse Reactions - Answer •Dose-dependent ADRs - usual somnolence,
dizziness, anorexia, behavior changes, agitation
•Pregnancy Category C. breast milk- high transfer but very low infant levels,
contraception - no interaction.
Carbamazepine (Tegretol) Uses, MOA, Dosing - Answer •Narrow spectrum AED
•Other Uses: TCA for bipolar depression, trigeminal neuralgia
•Mechanism: blocks sodium channels and inhibits high-frequency repetitive firing in
neurons.
•Dosing: 15-25 mg/kg/day
ADHD: When is it diagnosed? - Answer •Frequently diagnosed when child goes to school
•4 x's more common in boys than girls
How should an ADHD treatment plan be developed? - Answer Comprehensive
"multimodal" interventions. Developed based on the individual needs of the child and
family and may include the following components:
§Educational interventions
§Behavioral therapy
§Individualized child interventions
§Parent guidance/Family therapy
Pharmacological Management*
AAP Recommendations: If the ADHD child does not repsond to treatment asses the
following factors - Answer ◦Unrealistic target goals
◦Lack of adequate information about the child's behavior
◦Incorrect diagnosis
◦Present of co-morbid conditions that are affecting the treatment of ADHD
, ◦Lack of adherence to the treatment plan
◦Treatment Failure
}Warrants specialist referral.
Why should the PCP monitor ADHD meds closely? - Answer •The clinician should
periodically provide a systematic follow-up for the child with ADHD. Monitoring should
be directed to target outcomes and adverse effects by obtaining specific information
from parents, teachers, and the child.
TCAs: Side effects and toxicity - Answer Side effects of TCAs: dry mouth, weight gain,
urinary retention, constipation, sedation, cardio toxicity, orthostatic hypotension
Toxicity: dangerous in overdose (monitor blood levels), possible drug interactions
Non-Stimulant Medications: se of Tricyclic Antidepressant (TCAs) - Answer }Not first line
of treatment for ADHD but have proven efficacy.
}May be helpful for treatment of hyperactivity and impulsivity in patients that have been
treatment resistant to more than 2 trials of stimulants medications.
}Less effective for treatment of distractibility than stimulant medication.
Guanfacine compared to clonidine: - Answer Less hypertension, sleep disruption,
sedation, and rebound hypertension, longer duration of clinical action (requiring fewer
doses)
Non-Stimulant Medications: Guanfacine - Answer ◦In an open label trial appeared to
improve hyperactivity, impulsivity, distractibility, aggression frustration tolerance and
affect modulation
Non-Stimulant Medications: Clonidine - Study results and Use - Answer ◦A meta
analysis of clonidine suggested it has moderate efficacy for treating ADHD but less than
that of stimulants
◦Appears to treat hyperactivity and impulsivity but not distractibility
◦Also used in children to manage sleep problems, aggression and self injurious
behavior
How much time is required for the drug level to stabilize after the AED dose is changed?
- Answer 5 half-lives i
Wjhat does the half life of AEDs indicate? - Answer •how frequently the drug should be
administered
•Half-lives is shorter in infants and children requiring more frequent dose schedule
What percentage of patients are seizure free on monotherapy? - Answer 70%
