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AMDA's 32nd Annual Symposium


C20 - Clinical Pearls: Epilepsy, Chronic Kidney Disease and Urinary Incontinence in Long Term Care


Mar 7, 2009 4:00pm ‐ Mar 7, 2009 6:00pm

Standard: $24.00

Description

AMDCP Credit Designation:

This session has been approved for a total of 2 Clinical credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

The American Medical Directors Association designates this educational activity fora maximum of 2 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Presenter(s): Barbara J. Messinger-Rapport, MD, PhD, CMD (Moderator); Ilo Leppik, MD; Daniel Bluestein,MD, MS, CMD; Margaret Baumgarten, MD; Thomas Lynch, PharmD; William N. Hovland,MD, CMD; Frank Palermo, MD, MPH

Disclosure(s):
Frank Palermo, MD, MPH is the medical director at Accelerated Care Plus.
Barbara J. Messinger-Rapport, MD, PhD, CMD received speaker honoraria from Forest Pharmaceuticals, Inc. and Novartis. Products made by these companies related to this topic: Reclase and Namenda.
Ilo Leppik, MDreceived a consulting fee from Sierra Neurosciences and Caremark, a speaker honorarium from Eisai Pharmaceuticals, and a research grant from UCB Pharma.

All other presenters reported they had no relevant financial relationships to disclose.

Session Description:
This session offers pearls on a variety of clinical topics. From learning how to differentiate between epileptic and non-epileptic seizures, and identifying the best anti-epileptic drug for an individual patient; to the epidemiology,assessment and complications of chronic kidney disease (CKD); to lastly, bladder physiology, including an explanation of the regulatory requirements for bladder retraining. Q&A time is allotted at the end of each clinical pearl.

Learning Objectives:
  • Recognize epileptic seizures from non-epileptic seizures and order the appropriate tests for diagnosis
  • Define the properties of various anti-epileptic drugs and explain the use of anti-epileptic drug levels
  • Review the scope and consequences of CKD in long term care
  • Examine strategies for CKD assessment and management including prevention of complications
  • Comprehend the variants of urinary incontinence through bladder physiology and testing

References:
Birnbaum A, Hardie NA, Leppik IE, et al. Variability of totalphenytoin serum concentrations within elderly nursing home residents. Neurology2003;60:555-559.
Birnbaum AK, Hardie NA, Conway JM,Bowers SE, Lackner TE, Graves NM, Leppik IE. Valproic acid doses,concentrations, and clearances in elderly nursing home residents. EpilepsyResearch 2004:62:157-162.
Bourdet SV, Gidal BE, Alldredge BK. Pharmacologic managementof epilepsy in the elderly. J Am Pharm Assoc (Wash). 2001 May-Jun;41(3):421-36.
Cloyd, J. C., Lackner, T. E., and Leppik, I.E. (1994). Antiepileptics in the elderly. Pharmacoepidemiology andpharmacokinetics. Arch Fam Med 3, 589-598.
Cramer JA, Leppik IE, DeRue K, Edrich P, Kramer G.Tolerability of levetiracetam in elderly patients with CNS disorders. EpilepsyResearch 2003:56:135-145.
Cusack BJ. Drug metabolism in the elderly. J Clin Pharmacol.1988;28:571-576.
Dong X, Leppik IE, White J, Rarick J. Hyponatremia fromoxcarbazepine and carbamazepine . Neurology 2005;65(12):1976-1978.
Fisher RS, van Emde Boas W, Blume W, Elger C, Genton P, LeeP, Engel J Jr. Epileptic Seizures And Epilepsy: Definitions proposed by TheInternational League Against Epilepsy (ILAE) and the International Bureau ForEpilepsy (IBE). Epilepsia 2005;46:470-472.
Garrard, J., Cloyd, J., Gross, C, Hardie, N, Thomas, L,Lackner, T, Graves,N, and Leppik, I. (2000).Factors associated with antiepileptic drug use among elderly nursing homeresidents. J Gerontol A Biol Sci Med Sci 55, M384-M392.
Garrard J, Harms S, Hardie N, et al. Antiepileptic drug usein nursing home admissions. Ann Neurol 2003;54:75-85.
Hauser WA. Seizure disorders: Thechanges with age. Epilepsia 1992;33 (Suppl 4):S6-S14.

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