-

Home Study Webcast

A Bird's-Eye View of Antiepileptic Drugs for
the Pharmacy Technician 1.0 HOUR CE

Edward Spivey, PharmD Candidate, MUSC

Pharmacy Extern, PharmCon
Kevin Hope, RPh
Preceptor, PharmCon
 A Bird’s-Eye View
of Antiepileptic
Drugs for the
Pharmacy
Technician
Edward Spivey, PharmD Candidate, MUSC
Pharmacy Extern, PharmCon
Kevin Hope, RPh, Preceptor

Faculty Disclosure

• Edward Spivey declares no existence of a financial interest in any amount related to

the content of this activity.

• Advisory Board members and other individuals, not previously disclosed, who may
review, propose recommendations, and/or edit the content of PharmCon CE activities
declare no existence of a financial interest in any amount related to the content of this
activity.

2
 Learning Objectives

At the conclusion of this activity, participants should be better able to:

– Recognize what a typical seizure looks like
– Distinguish between the drugs used to prevent seizures and the
drugs used to treat seizures
– Recognize antiepileptic drugs with the highest potential for drug
interactions
– Identify the class-wide side effects of antiepileptic drugs and the
important side effects of select antiepileptic drugs

About Me

• Grew up in Greenville, South Carolina

• Attended Clemson University for undergraduate studies
• Currently a fourth-year student at the Medical University of South
Carolina

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 Important Definitions

Seizure

• A sudden alteration of behavior due to a temporary change in the functioning of the brain

Epilepsy

• A disorder of the brain characterized by repeated seizures

Status Epilepticus

• A seizure with 5 minutes or more of continuous clinical and/or electrographic seizure activity
or recurrent seizure activity without recovery between seizures

Prophylaxis

• Actions taken to prevent disease; preventative healthcare

• American Academy of Neurosurgeons. (n.d.). Epilepsy. AANS. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Epilepsy

• Wylie T, Sandhu DS, Murr N. Status Epilepticus. [Updated 2022 May 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK430686/

Introduction to Epilepsy

Background, Epidemiology, and

Burden

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 Epidemiology

• About 1.2% of the US population (3.4 million people) have active

epilepsy
– Active epilepsy is defined as doctor-diagnosed epilepsy or seizure
disorder and patients are currently taking medication to control it
and/or have had one or more seizure in the past year

Centers for Disease Control and Prevention. (2023, March 29). Epilepsy data and statistics. Centers for Disease Control and Prevention. https://www.cdc.gov/epilepsy/data/index.html

Epidemiology
• Epilepsy incidence is highest in
both very young and very old
populations
• Epilepsy is slightly more common in
men than women, and there are no
racial differences in epilepsy
incidence
• It is the fourth-most common
neurologic disease

Centers for Disease Control and Prevention. (2023, March 29). Epilepsy data and statistics. Centers for Disease Control and Prevention. https://www.cdc.gov/epilepsy/data/index.html

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 Burden on Healthcare

1 million emergency
department visits in Average hospital
2014 and 280,000 stay of 3.6 days
hospital admissions

Estimated direct
Aggregate hospital costs of epilepsy are
costs of about $2.5
approximately $28
billion
billion per year

MJH Life Sciences. (n.d.). Examining the economic impact and implications of epilepsy. AJMC. https://www.ajmc.com/view/examining-the-economic-impact-and-implications-of-epilepsy

Burden on Patients

• About 36% of people with

epilepsy have uncontrolled
seizures, meaning that, despite
treatment with antiepileptic
drugs, they continue to have
seizures
• Approximately 24% of
individuals with epilepsy are
diagnosed with a with a mental
health disorder (compared to
11% of people without epilepsy)

MJH Life Sciences. (n.d.). Examining the economic impact and implications of epilepsy. AJMC. https://www.ajmc.com/view/examining-the-economic-impact-and-implications-of-epilepsy

10
 Pathophysiology
• Seizures are caused by
hyperexcitability of neurons in the
brain
• This leads to repeated improper
electrical impulses that can travel
across the brain

11

Meet AA

• AA was a patient who suffered from a traumatic brain injury, which led
to her experiencing seizures
• The patient was titrated up to a dose of 1500 mg of levetiracetam
(Keppra®) BID over the course of her hospital stay until she was
discharged to a rehabilitation facility
• She was continued on this dose until she was discharged home,
where the attending physician placed her on 500 mg and the nurse
signed off on the order
• The patient would go on to experience several seizures at home
before passing away

PC, L. & M. (n.d.). Medication dosing lawsuit results in $1.75 million settlement in death of woman. Lubin & Meyer PC. https://www.lubinandmeyer.com/cases/medication-dosage-malpractice.html

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 Tonic-Clonic Seizures (Grand Mal)

• Tonic-clonic seizures are characterized by a loss of consciousness, muscle spasms in

the arms, legs, and back, and jerking and twitching of muscles
• While there are many other types of seizures, such as absence, partial, atypical, or
seizures with retained awareness, these can be difficult to differentiate or diagnose, so
this presentation will focus on tonic-clonic seizures

Schachter, S. (n.d.). Evaluation and management of the first seizure in adults. UpToDate. https://www.uptodate.com/contents/evaluation-and-management-of-the-first-seizure-in-
adults?search=seizure+types&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

13

Initial Treatment of a Seizing Patient

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 Initial Seizure First-Aid: Dos and Don’ts

DO DON’T
• Ease them onto the floor if possible • Hold the patient down or try to stop
• Clear the area around the patient of them from moving
anything sharp • Put anything in the patient's mouth
• Place something soft under the • Give mouth to mouth or CPR
patient’s head
• Remove things like eyeglasses or • Give food or water until the patient
ties is fully alert
• Turn the patient onto their side after
the convulsions have stopped
• Call 911 if seizure lasts longer than
5 mins
Centers for Disease Control and Prevention. (2022, January 2). Seizure first aid. Centers for Disease Control and Prevention. https://www.cdc.gov/epilepsy/about/first-aid.htm

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Initial Pharmacologic Treatment of Seizures

• Benzodiazepines are both first- AND second-line treatment

– Give first dose of benzodiazepine, and then, if seizure continues,
for 5 mins give a second dose
– Common Benzodiazepines
• Lorazepam - IV
• Diazepam - rectal, Intranasal
• Midazolam – IM, Intranasal, buccal

Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J, Bare M, Bleck T, Dodson WE, Garrity L, Jagoda A, Lowenstein D, Pellock J, Riviello J, Sloan E, Treiman DM. Evidence-Based Guideline: Treatment of
Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016 Jan-Feb;16(1):48-61. doi: 10.5698/1535-7597-16.1.48. PMID: 26900382;
PMCID: PMC4749120.

16
 Benzodiazepines

17

Lorazepam

• Typically given IV for seizure

rescue, as the oral route is not an
option
• This should be the
benzodiazepine of choice due to
its pharmacologic profile
– It has a quick onset of action
when given IV, and it stays in
the brain the longest, which
helps to prevent future
seizures from occurring

Lorazepam. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio.

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 Midazolam
• This is typically the antiepileptic
medication of choice in patients in the ICU
or with severe status epilepticus
– It has the quickest onset of action of
the benzodiazepines, when given
through the IV route
• This medication leaves the brain
quicker than lorazepam, so there
is a somewhat increased chance
of recurrent seizures when used
– Can also be given buccally,
intranasally, or intramuscularly if IV
access cannot be obtained

Midazolam. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio.

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Diazepam

• Commonly seen in pediatric patients due to rectal dosage form

• Also comes in a nasal spray dosage form
• ALL benzodiazepines can be reversed with the reversal agent
“flumazenil” if an overdose is suspected
• ALL benzodiazepines can be habit-forming
• Benzodiazepines should be avoided in patients who are taking
opioids

Diazepam. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio.

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 Full prescribing information: Contents* - bausch health. (n.d.). https://pi.bauschhealth.com/globalassets/BHC/PI/altreno-pi.pdf

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Second-Line Pharmacologic Treatment of Seizures

• Second-line treatment of seizures is much more nuanced and

complex. The drugs typically used as second-line treatment are as
follows:
– Levetiracetam (Keppra®) – One of the safest AED drugs
– Phenytoin/fosphenytoin – Very common medication error drug due
to fosphenytoin being dosed as phenytoin equivalents. Very
common drug for drug interactions. High potential for
accumulation and toxicity.
– Valproate (Depakote®) – Should not be used in pregnancy, weight
gain, alopecia, rash

Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J, Bare M, Bleck T, Dodson WE, Garrity L, Jagoda A, Lowenstein D, Pellock J, Riviello J, Sloan E, Treiman DM. Evidence-Based Guideline: Treatment of
Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016 Jan-Feb;16(1):48-61. doi: 10.5698/1535-7597-16.1.48. PMID: 26900382;
PMCID: PMC4749120.

22
 What if Seizures Just Don’t Stop?

Status epilepticus that does not respond to typical treatment

may require the use of a pharmacologic coma if the seizure
continues for longer than 30 minutes

A pharmacologic coma will involve intubating the patient as

well as starting them on a continuous drip of either
midazolam, propofol, or pentobarbital

This will generally continue until there is electronic

evidence of no seizures in the brain for at least 24 hours, at
which point a slow wean can be initiated

Other antiepileptic drugs should be maintained at

therapeutic levels throughout this time

G lauser T, S hinnar S , G loss D , A lldredge B , A rya R , B ainbridge J, B are M , B leck T, D odson W E , G arrity L, Jagoda A , Low enstein D , P ellock J, R iviello J, S loan E , Treim an D M . E vidence-B ased G uideline: Treatm ent of C onvulsive S tatus E pilepticus in C hildren and
A dults: R eport of the G uideline C om m ittee of the A m erican E pilepsy S ociety. E pilepsy C urr. 2016 Jan-Feb;16(1):48-61. doi: 10.5698/1535-7597-16.1.48. P M ID : 26900382; P M C ID : P M C 4749120.

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Case Report

A patient from out of town comes into your pharmacy to get a medication refilled. She is
told that it will take some time, so she takes a seat nearby to wait. You hear her gasp and
as you look over, she is shaking and twitching in her seat and does not appear to be
conscious. What should you do?
A. Gently lie her on the floor and place a jacket under her head as this is a seizure. If the seizure persists for
more than 5 minutes call 911.
B. Quickly administer epinephrine from the pharmacy and call 911 as this is an anaphylactic reaction.
C. Immediately call 911 and gently lie her on the floor and place a jacket under her head as this is a seizure.
D. Quickly find some lorazepam in your pharmacy, crush up a tablet, and mix it with some water so she can
swallow it as this is first-line treatment for a seizure.
E. Quickly find a clean cloth to place in her mouth to prevent her from biting her tongue, then attempt to
restrain the patient to prevent her from hurting herself.

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 Case Report

The patient is lying on the floor with a jacket under her head, but the
seizure is continuing. As the patient continues to seize, your coworker
goes into her purse and finds the following antiepileptic medications:
levetiracetam 500 mg, oxcarbazepine 300 mg, and a diazepam nasal
spray. The pharmacist is on the phone with 911 and is looking after the
patient. They ask you if the patient had any rescue medication in her
purse, how do you respond?

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Case Report

A. The patient has levetiracetam, which can be crushed and given

to the patient in water for rescue
B. The patient has oxcarbazepine which can be used for rescue,
however, since the tablets cannot be crushed, another dosage
form at the same dosage should be retrieved from the pharmacy
C. The patient has diazepam nasal spray, which should be given
immediately as first-line rescue medication
D. There are no appropriate rescue medications in the patient's
purse, however you know that the pharmacy stocks NARCAN®
nasal spray, which should be given to the patient

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 Medications for Seizure Prophylaxis

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Drug Used to Prevent Seizures

• There are many drugs used to

prevent seizures and many are
often given in combination
• For the purpose of this
presentation, we will look at
some of the most-prescribed
drugs, their side effects, and
any notable traits that we
should pay attention to

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 Things to Keep in Mind for
ALL Antiepileptic Medications

ALL antiepileptic drugs have

the potential to cause suicidal
thoughts and behavior

ALL antiepileptic drugs should

not be discontinued abruptly
and should be tapered down

ALL antiepileptic drugs should

be started at low doses and
titrated up

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Levetiracetam (Keppra®)

• Exceptionally safe when compared to

other antiepileptic drugs
• Can be used for both prevention and
treatment (though if using for
prevention, another drug should be
used for treatment)
• Notable side effect is an increase in
agitation, which is more common in
children
• One of only two antiepileptic drugs that
are metabolized by the kidneys
• Only indications are for seizures

Levetiracetam. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio

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 Oxcarbazepine (Trileptal®)

• Common to have drug interactions with this drug (but less than
carbamazepine)
– Has an interaction with itself?
• Must be protected from light and moisture
• Can cause rash with a potential for Stevens-Johnson syndrome, low
sodium, bone marrow suppression, and decrease in cognitive
learning
• Sometimes used off-label for trigeminal neuralgia

Oxcarbazepine. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio

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Valproic Acid (Depakote®)

• Side effects:
– Thrombocytopenia
– Pancreatitis
– Menstrual cycle changes
– Weight gain
– Rash
• Do not use in pregnancy
• Be wary of several different brand
names and dosage forms
• Also used for bipolar disorder and
migraine prevention

Valproic acid. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio

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 Lamotrigine (Lamictal®)

• Most likely antiepileptic medication to cause rash

• Increased risk of rash (including Stevens-Johnson syndrome) when
given with valproic acid
• Many look alike/sound alike drugs, high potential for medication error
• Also used for bipolar disorder and neuralgia

Lamotrigine. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio

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Lacosamide (Vimpat®)

• Can increase the cardiac effects

of medications like beta blockers
(metoprolol, carvedilol, labetalol,
etc.) and calcium channel
blockers (amlodipine, verapamil,
diltiazem, etc.)
– Watch out for patients with
new fatigue, lethargy, or
dizziness
• Potential for blurred or double
vision in patients
• Only used for seizures

Lacosamide. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio

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 Phenytoin and Fosphenytoin
• VERY HIGH RISK for medication
error with fosphenytoin
– Is dispensed in phenytoin
equivalents (PE)
• High potential for drug interactions
• Side effects:
– Nystagmus (early warning of
toxicity)
– Decrease in cognitive learning
– Hypotension (infusion rates)
– Gingival hyperplasia
• Only used for seizures

• phenytoin. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio
• fosphenytoin. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio

35

Phenobarbital (Luminol®)

• Many drug interactions

• Avoid in patients with substance
use disorder, as tolerance to
phenobarbital can develop
• May cause anemia and rash
• Also used as a sedative

phenobarbital. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio

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 Topiramate (Topamax®)

• Can cause metabolic acidosis,

kidney stones, and paresthesia
• Also used for weight loss and
migraines
• Protect from moisture
• Avoid alcohol (especially with
extended-release formulation)

Topiramate. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio

37

Case Report

• The seizing patient from earlier has recovered and, after a brief trip to the hospital,
returns to thank your pharmacy staff
• She is very scared by her seizure and wants to know if there is anything she can do to
help prevent something like this from happening again
• After talking to the pharmacist, the following information is revealed:
– The patient’s levetiracetam dose was recently increased; however, since the patient started taking it, she felt
bad and stopped taking it altogether
– The patient stores all of her medications in her bathroom cabinet
– The patient removes all of her medications from their original packaging in order to place them into a pill box
– The patient has recently started consuming more fruits and leafy greens to lose weight
– The patient has recently stopped smoking

38
 Case Report
• Which of the patient’s lifestyle changes could have led to her recent
seizure?
A. Her levetiracetam dose may have increased due to the increased
diet of leafy greens. Rather than increase the dose, another
antiepileptic medication should have been selected and leafy
greens should be avoided in epilepsy.
B. Her smoking cessation and stopping her levetiracetam. Both of
these should have been tapered to reduce the risk of seizures.
C. The patient stopping her levetiracetam, storing her meds in the
bathroom cabinet, and removing them from the original container.
Levetiracetam should have been tapered and oxcarbazepine needs
to be protected from light and moisture.
D. The abrupt stopping of her levetiracetam is the only recent lifestyle
change that may have led to her seizure

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Real-World Examples

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 Real-World Medication Error
• A 1-month-old baby was given a
prescription for phenobarbital 9 mg
twice per day; however, the
prescription was entered as 9 mL of a
5 mg/mL solution twice per day
• This resulted in the baby receiving 45
mg of phenobarbital twice per day – 5
times the prescribed amount
• Fortunately, the parent quickly
noticed that her baby was very
lethargic, was told by a doctor to stop
the medication, and the error was
quickly identified, so no lasting harm
was done

SafeMedicationUse newsletter. SafeMedicationUse.ca - Newsletter. (n.d.). https://safemedicationuse.ca/newsletter/newsletter_InfantMedicineDose.html

41

Real World Medication Error

• An 81-year-old woman was discharged with a prescription for valproic

acid 10 mL bid of a 40 mg/mL solution and quickly became
somnolent and fatigued to the point of requiring a wheelchair
• Upon readmission to the hospital her valproic acid levels were 234.5
mg/L (therapeutic range is 40-100 mg/L)
• It was revealed that the doctor who wrote the prescription accidently
selected the 300 mg/mL pediatric drop formulation rather than the 40
mg/mL adult formulation, and the patient was getting 10 mL of the
higher strength
• This error was not caught by the pharmacy computer system,
pharmacists, or technicians and was dispensed to the patient
Frankfort, S. (2004, November 18). Journal of the American Geriatrics Society - Wiley Online Library. Prescription error resulting in valproic acid intoxication. https://agsjournals.onlinelibrary.wiley.com/journal/15325415

42
 Key Takeaways

• ALL antiepileptic drugs can cause an increase in suicidal ideation

• ALL antiepileptic drugs should be tapered off and not stopped
abruptly
• ALL antiepileptic drugs should be started at low doses and titrated up
• Oxcarbazepine, phenytoin, fosphenytoin, phenobarbital – think drug
interactions

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Thank You!
We truly appreciate you attending this program

44
 References
1. American Academy of Neurosurgeons. (n.d.). Epilepsy. AANS. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Epilepsy
2. Wylie T, Sandhu DS, Murr N. Status Epilepticus. [Updated 2022 May 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430686/

3. Centers for Disease Control and Prevention. (2023, March 29). Epilepsy data and statistics. Centers for Disease Control and Prevention. https://www.cdc.gov/epilepsy/data/index.html

4. MJH Life Sciences. (n.d.). Examining the economic impact and implications of epilepsy. AJMC. https://www.ajmc.com/view/examining-the-economic-impact-and-implications-of-epilepsy

5. PC, L. & M. (n.d.). Medication dosing lawsuit results in $1.75 million settlement in death of woman. Lubin & Meyer PC. https://www.lubinandmeyer.com/cases/medication-dosage-malpractice.html
6. Schachter, S. (n.d.). Evaluation and management of the first seizure in adults. UpToDate. https://www.uptodate.com/contents/evaluation-and-management-of-the-first-seizure-in-
adults?search=seizure+types&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
7. Centers for Disease Control and Prevention. (2022, January 2). Seizure first aid. Centers for Disease Control and Prevention. https://www.cdc.gov/epilepsy/about/first-aid.htm

8. Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J, Bare M, Bleck T, Dodson WE, Garrity L, Jagoda A, Lowenstein D, Pellock J, Riviello J, Sloan E, Treiman DM. Evidence-Based Guideline: Treatment of
Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016 Jan-Feb;16(1):48-61. doi: 10.5698/1535-7597-16.1.48. PMID: 26900382; PMCID:
PMC4749120.
9. Lorazepam. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio.

10. Midazolam. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio.
11. Diazepam. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio.

12. Levetiracetam. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio.
13. Oxcarbazepine. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio

14. Valproic acid. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio
15. Lamotrigine. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio

16. Lacosamide. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio
17. phenytoin. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio

18. fosphenytoin. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio
19. phenobarbital. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio
20. Topiramate. Lexi-Drugs [updated 2023 May 9; cited 2023 May 10] In: Lexicomp Online [Internet]. Wolters Kluwer Clinical Drug Information, Inc. Hudson, Ohio

21. SafeMedicationUse newsletter. SafeMedicationUse.ca - Newsletter. (n.d.). https://safemedicationuse.ca/newsletter/newsletter_InfantMedicineDose.html

22. Frankfort, S. (2004, November 18). Journal of the American Geriatrics Society - Wiley Online Library. Prescription error resulting in valproic acid intoxication. https://agsjournals.onlinelibrary.wiley.com/journal/15325415

23. Full prescribing information: Contents* - bausch health. (n.d.). https://pi.bauschhealth.com/globalassets/BHC/PI/altreno-pi.pdf

45
Test Questions Pharmacy Technician
To receive CE credit, access the webcast and take the test online at freeCE.com

1. Which of the following are indicative of a 6. A patient comes in complaining of lack of

seizure? interest in daily activities and thoughts of
a. Muscle spasms and jerks suicide, could this be a side effect of her new
b. Swelling of the throat, tongue, and lips antiepileptic medication?
c. Irregular electrical activity in the brain a. No, antiepileptic medications do not cause
d. Cessation of cardiac function suicidal ideation.
e. A and C b. Yes, but only if the patient has a history of
depression.
2. Which of the following drugs are used in the c. Yes, but only if the patient is under 18.
treatment of seizures? d. Yes, almost all antiepileptic medications have a
a. Lorazepam risk for increasing suicidal ideation.
b. Diazepam
c. Midazolam 7. An actively seizing patient has received 2
d. Levetiracetam doses of lorazepam but continues to seize,
e. A, B, and C
f. All of the above
which of the following would be a viable
option to treat her seizure?
a. Levetiracetam tablets
3. Which of the following drugs are used in the b. A third dose of IV lorazepam
prevention of seizures? c. IV Levetiracetam
a. Levetiracetam d. A dose of either midazolam or diazepam
b. Lorazepam
c. Oxcarbazepine
d. A and C
8. A patient who was recently prescribed
e. All of the above lacosamide has been feeling tired and
lethargic lately, which of the following drugs is
4. In which of the following drugs are you most likely interacting with lacosamide to cause
concerned about the potential for drug this?
interactions? a. Amlodipine
a. Phenytoin b. Metformin
b. Levetiracetam c. Semaglutide
c. Lorazepam d. Hydrochlorothiazide
d. Midazolam 9. Nystagmus (repetitive, uncontrolled
movements of the eye) is an early sign of
5. How should antiepileptic medications for toxicity for which antiepileptic medication?
prophylaxis be given? a. Lorazepam
b. Phenytoin
a. Start at the highest dose and titrate down.
c. Valproic acid
b. Start at the lowest dose and titrate up.
d. Levetiracetam
c. Discontinue immediately if any side effects are
noticed.
d. Antiepileptic drugs are always given at a doctor’s 10. Alcohol should be especially avoided with
office, so patients do not need to worry. which medication?
a. Topiramate
b. Phenytoin
c. Lamotrigine
d. Oxacarbazepine
PHARMACY TECHNICIAN LEARNING OBJECTIVES
1. Recognize what a typical seizure looks like
2. Distinguish between the drugs used to prevent seizures and the drugs used to treat seizures
3. Recognize antiepileptic drugs with the highest potential for drug interactions
4. Identify the class-wide side effects of antiepileptic drugs and the important side effects of select antiepileptic drugs

OVERVIEW
Epilepsy is a life-threatening condition characterized by recurrent seizures. The knowledge of how to recognize when someone is having a seizure and how to best assist that
person could save the life of a patient. Furthermore, the medications used to prevent seizures from occurring in the first place typically have narrow therapeutic ranges meaning
that minor medication errors can put a patient at risk of having a seizure. This is complicated by the fact that these medications are often associated with significant side effects
and toxicities. After this presentation, learners will be able to spot someone who is having a seizure and know which drugs can be used to stop an active seizure. Learners will also
become more familiar with drugs that prevent seizures, as well as which of them are the most dangerous, and the most important side effects of these medications.

ACCREDITATION
PharmCon is accredited by the Accreditation Council for Pharmacy PharmCon is approved by the California Board of Registered Nursing (Provider Number
Education as a provider of continuing pharmacy education. CEP 13649) and the Florida Board of Nursing (Provider Number 50-3515). Activities
approved by the CA BRN and the FL BN are accepted by most State Boards of Nursing.
PharmCon reports CPE credits to CPE Monitor automatically after credit is
earned. Your NABP ePID and birth date must be in your online profile for successful ACPE accredited programs provided by PharmCon meet requirements for American
credit submission. Nurses Credentialing Center (ANCC) Category 1 pharmacotherapeutic/pharmacology
credit towards
PharmCon reports CPE credits to CE Broker automatically after credit is earned. Your
license number must be in your online professional profile for successful credit certification renewal. ACPE accredited programs are listed by the ANCC and AANP as
submission. an acceptable, accredited continuing education organization for applicants seeking
renewal through continuing education credit.

TARGET AUDIENCE AUTHOR DISCLOSURE

Pharmacy Technician Edward Spivey and Preceptor Kevin Hope report no financial relationship with the
manufacturer(s) or provider(s) of any commercial interest(s) or service(s) that appear in
this program.

ACPE UNIVERSAL ACTIVITY NUMBER

PHARMACY TECHNICIAN: 0798-0000-23-169-H01-T ACTIVITY TYPE: Knowledge-based
CE BROKER ID NUMBER: 20-1076300 RELEASE DATE: 06/07/2023

EDUCATIONAL SUPPORT PROVIDED BY: PharmCon EXPIRATION DATE: 11/30/2025

All opinions expressed by the author(s) are strictly their own and not necessarily approved or endorsed by PharmCon.
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