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26 Cards in this Set
- Front
- Back
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seizure |
Brief episode of abnormal electricalactivity in nerve cells of the brain, which may or may not lead to a convulsion |
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convulsion |
Involuntary spasmodic contractions of anyor all voluntary muscles throughout the body, including skeletal, facial, andocular muscles |
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epilepsy |
chronic, recurrent pattern of seizures |
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primary(idiopathic) |
-cause cannot be determined -roughly 50% of epilepsy cases |
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secondary (symptomatic) |
-distinct cause is identified -trauma, infection, cerebrovascular disorder |
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generalized onset seizures |
-tonic-clonic seizures -atonic seizures |
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partial onset seizures |
-localized or focal region -simple -complex -secondary generalized tonic-clonic |
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status epilepticus |
-multiple seizures occur that last 5 mins or longer of continuous of electrographic seizures activity or recurrent seizure activity without recovery between seizures -result: hypotension, hypoxia, brain damage, and possibly death -true medical emergency |
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antiepileptic drugs also known as |
-anticonvulsants |
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goals of antiepileptic therapy |
-to control or prevent seizures while maintaining a reasonable quality of life -to minimize adverse effects and drug-induced toxicity -antiepileptic drug therapy is usually lifelong |
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how many drugs are used |
single-drug therapy started before multiple-drug therapy is tried |
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serum drug concentrations must be measured |
-therapeutic drug monitoring -Serumconcentrations of phenytoin, phenobarbital, carbamazepine, and primidonecorrelate better with seizure control and toxicity than do those of valproicacid, ethosuximide, and clonazepam |
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antiepileptic drugs traditionally used to manage seizure disorders include: |
-Barbiturates -Hydantoins -Iminostilbenes plus valproic acid -Second- and third-generationantiepileptics |
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mechanism of action |
-exact mechanism of action not known |
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pharmacological effects: |
-reduce nerve's ability to be stimulated -suppress transmission of impulses from one nerve to the next -decrease speed of nerve impulse conduction within a neuron |
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indications |
-prevention or control of seizure activity -long-term maintenance therapy for chronic, recurring seizures -acute treatment of convulsions and status epilepticus |
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adverse effects |
-numerous adverse effects; vary per drug -adverse effects often necessitate a change in medication -long-term therapy with phenytoin(dilantin) may cause gingival hyperplasia, acne, hirsutism, and dilantin facies |
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barbituates: phenobarbital and primidone |
-primidone is metabolized in liver to phenobarbital -most common adverse effect: sedation -therapeutic effectS: serum drug levels of 15 to 40mcg/mL -contraindicatoins: known drug allergy, porphyria, liver or kidney impairment, respiratory illness -adverse effects: cardiovascular, CNS, GI, and dermatological reactions |
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hydantoins: phenytoin sodium |
-phenytoin(dilantin) has been used as a first-line drug for many years and is the prototypical drug -long-term therapy adverse effects: gingival hyperplasia, acne, hirsutism, dilantin facies, and osteoporosis -therapeutic drug levels are usually 10-20mcg/mL |
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IV adminsitratoin of phenytoin |
-very irritating to veins -slow IV directly into a large vein through a large-gauge(20-gauge or larger) venous catheer -diluted in normal saline for IV infusion -filter must be used -saline flush |
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carbamazepine |
-second most commonly prescribed antiepileptic drug in canada after phenytoin j -autoinduction of hepatic enzymes |
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gabapentin |
-chemical analogue of gamma-aminobutyric acid, a neurotransmitter that inhibits brain activity -believed to work by increasing the synthesis and synpatic accumulation of gaba between neurons -contraindication: known drug allergy -adverse effects: cns and gi symptoms -oral use only |
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iamotrigine |
-also used for the treatment of bipolar disorder -contraindications: drug allergy -common adverse effects: relatively minor CNS and GI symptoms and possible stevens-johnson syndrome -oral use only |
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pregabalin |
-structurally related to GABA -indication: partial seizures -most common uses: adjunct therapy for neuropathatic pain, postherpetic neuralgia -contraindication: known drug alleregy -adverse reactions: primarily cns related -oral use only |
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monitor for therapeutic effects |
-decreased or absent seizure activity |
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monitor for adverse effects |
-mental status changes, mood changes, changes in LOC, or sensorium -eye problems, visual disorders -sore throat, fever(blood dyscrasias may occur with hydantoins) |
