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94 Cards in this Set
- Front
- Back
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What is epilepsy? -Results in what s/sx? |
Sudden, excessive + synchronous discharge ofcerebral neurons
Sx: LOC, Abnormal movements, Atypical behavior, & Distorted perception |
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What determines the s/s of epilepsy? |
The lesion site in the brain, (area) of abnormal firing neurons Examples: •Motor Cortex: abnormal movements •Occipital lobe: Hallucinations |
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Epilepsy: ____% have identifiable origin |
30 |
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Epilepsy: ____%identified as idiopathic |
70 |
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Epilepsy: Disruption of ____________________ mechanism of central neuronal cells |
depolarization / repolarization
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Epilepsy: Development of synchronized ________ network(re-entry) |
aberant |
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Seizures are classified by what 4 things? |
Site of origin
etiology electrophysiological correlation clinical presentation |
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Focal seizures involve only... |
a portion of the brain |
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Simple partial seizures
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a. consciousness preserved (begin locally)
b. exhibit in a limb or group of muscle |
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Complex Partial |
altered consciousness, hallucinations &motor dysfunction
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Absence |
brief loss of consciousness, staring
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Myoclonic |
short episodes of muscle contraction
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Tonic-clonic (grand mal)
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loss of consciousness, tonic (contraction)and clonic(contraction – relaxation)
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Clonic |
episodes of muscle contraction consciousness impaired |
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Tonic |
increased tone or extension of muscles |
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Atonic |
Drop attacks, loss of muscle tone |
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What is the goal of seizure therapy? |
To limit seizure with minimal or no med related side effects |
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Dose related ____________ limit the use andcompliance with antiepileptic drugs
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side effects |
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_____________ impairment is a dose related sideeffects common to most antiepileptic drugs
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Cognitive |
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What is usually not necessary and increases incidence of side effects?
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adding a second drug |
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Many anti seizure drugs are protein bound, to which protein? |
albumin |
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When other protein bound drugs are given with anti-seizure meds, what can happen? |
They compete for binding sites and can result in toxic levels |
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What are examples of highly protein bound drugs that can result in toxic levels when given with anti-seizure drugs? |
Thyroxine
Salicilates |
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What can happen with hypoalbuminemia? |
Can result in toxic levels of anti-seizure drugs |
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What conditions can cause hypoalbuminemia? |
Renal disease Liver disease Pregnancy Malnutrition |
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Inhibition of what enzyme system can cause increased levels of anti-seizure meds? |
Hepatic Cytochrome P450 |
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Name some inhibitors of the cytochrome p450 system |
cimetidine, warfarin, erythromycin, isoniazid
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What happens with cytochrome p450 enzyme inducers? |
they decrease levels of anti-seizure drugs |
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Name some cytochrome p450 inducers |
tegretol grapefruit juice St. Johns wort |
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MOA of Na+ channel inhibitors |
Inhibit the generation of repetitive action potentials |
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Name some Na+ channel inhibitors |
Carbamazepine (Tegretol)
Phenytoin (Dilantin) Lamotrigine(Lamictal) ValproicAcid Divalproex (Valproate, Depakote) Eslicarbazepine(Aptiom) Oxcarbazepine(Trileptal) |
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Carbamazapine (tegretol): used for what kind of seizures? What are some other uses? |
Convulsive & Non-convulsive
Trigeminal/glossopharyngeal neuralgia |
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Carbamazapine (tegretol) only given by which route? |
PO |
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Carbamazapine (tegretol):
is how much protein bound? half life? therapeutic range? |
70-80% 8-24H 6-12 mcg/ml |
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Carbamazapine (tegretol) = enzyme ___________ -of which meds? |
Inducer increases metabolism of TCAs,corticosteroids, ORAL CONTACEPTIVES, warfarin, cyclosporins, VALPROIC ACID and itself |
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Carbamazapine (tegretol): common SE
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diplopia (double vision)
sedation N/V/D SIADH (hyponatremia) |
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Carbamazapine (tegretol): rare SE
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aplastic anemia, thrombocytopenia, HPTN, dysrhythmias,Stevens-Johnson Syndrome, jaundice
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Phenytoin (dilantin): is a weak acid that precipitates in solutions with pH < _____ Always give with |
7.8 0.9% NS |
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Phenytoin (dilantin): routes |
PO, IV (20mins) and rarely IM |
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Phenytoin (dilantin): IV administration should not exceed > _____mg/min |
50 |
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Phenytoin (dilantin): does it have a high or low therapeutic index? |
High |
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Phenytoin (dilantin): what is the effective plasma concentration?
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10-20mcg/ml |
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Phenytoin (dilantin): is highly protein bound, how much exactly?
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90% |
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Phenytoin (dilantin): can be used for dysrhythmias induced by what?
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Digitalis |
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Phenytoin (dilantin): metabolized by what form of kinetics?
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<10mcg/ml = first order kinetics >10mcg/ml = zero order kinetics |
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Phenytoin (dilantin): enzyme inducer or inhibitor?
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inducer |
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Phenytoin (dilantin): does it cause sedation?
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not excessively |
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Phenytoin (dilantin): SEs
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Nystagmus
ataxia diplopia vertigo Peripheral neuropathy **Gingival hyperplasia Acne hirtsuism (growth of hair) Hyperglycemia glucosuria Megablasticanemia |
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Phenytoin (dilantin): problem with pregnancy
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Fetal Hydantoin Syndrome -wide set eyes, broad mandible, finger deformities, cleft lip and palate -both mother and baby have bleeding disorders post-delivery |
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Fosphentoin (Cerebyx): benefit compared to phenytoin
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Fewer SE |
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Fosphentoin (Cerebyx): only what route
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IV |
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Fosphentoin (Cerebyx): prodrug or not?
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Prodrug |
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Valpoic Acid (Depakote) (Divalproex): how much protein bound?
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80% |
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Valpoic Acid (Depakote) (Divalproex):
peak concentrations? 1/2 life? effective plasma concen? |
1-4H 7-18H 50-100 mcg/ml |
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Valpoic Acid (Depakote) (Divalproex): SE
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GI intolerance
N/V/D HEPATOTOXICITY (hyperammonemia),
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Valpoic Acid (Depakote) (Divalproex): Enzyme inhibitor or inducer?
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ENZYME INHIBITOR (slows metabolism of dilantin, can increase phenobarb levels by 50%!!!)
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What is the IV form of valpoic acid that is available? |
Depacon |
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What is the Na+ channel inhibitor that can be used for ADHD? |
Oxycarbazepine (Trileptal)
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Ca++ channel inhibitors: Ethosuximide (Zarontin) Drug of choice for what kind of seizures? |
petit mal |
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Ca++ channel inhibitors: Ethosuximide (Zarontin)
-high or low protein binding? |
Low (different from Na+ channel inhibitors |
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Ca++ channel inhibitors: Ethosuximide (Zarontin): T1/2, Therapeutic range
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20-60H 40-60 mcg/ml |
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Ca++ channel inhibitors: Ethosuximide (Zarontin): SE
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NVD |
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Phenobarbital is what class of meds? |
GABA receptor antagonist |
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Phenobarbital has slow _____ absorption but is almost _____% |
Oral 100 |
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Phenobarbital: protein binding? peak? effective plasma concentration? |
50% 12-18H 10-40mcg/ml |
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Phenobarbital: enzyme inhibitor or inducer? |
INDUCER |
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Phenobarbital: SE |
SEDATION
irritability in children depression confusion in elderly megablastic anemia osteomalacia fetal anomalies fetal coagulation defects |
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Gabapentin (Neurontin) is what class of meds? |
GABA enhancer |
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Gabapentin (Neurontin): what doesn't it bind to?
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Proteins |
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Gabapentin (Neurontin): No effects on _________ enzymes
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Hepatic |
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Gabapentin (Neurontin): T1/2 life
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5-10H |
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Gabapentin (Neurontin): Lacks _____ excretion, great for what pt population?
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Renal Renal disease/failure |
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Gabapentin (Neurontin): SE
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Somnolence, dizziness, ataxia, nystagmus, headache
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Gabapentin (Neurontin): has an __________ effect, used in ________ _________
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Analgesic Peripheral neuropathy |
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Clonazepam (Klonapen):
onset? Protein bound? t 1/2? plasma concentration?
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2-4H 50% protein bound 30-40H 0.02-0.08mcg/ml |
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Clonazepam (Klonapen): SE
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sedation
ataxia personality chgs depression in elderly excessive salivation in children hypotension respdepression after IV dose |
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Benzos MOA |
Potentiate GABA, increasing Cl- permeability and hyper polarizing the membrane |
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Bezos are used in the treatment of _________ and _________. |
Status epilepticus LA induced seizures |
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What is the dose for the treatment of seizures with Diazepam? |
0.1mg/kg every 10 minsuntil seizures stop or max dose of 30 mg is reached
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What Benzo's anti epileptic effect lasts longer than diazepam? |
Lorazepam (Ativan) |
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Lamotrigine (Lamictal) is what class of med?
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Na+, Ca++, glutamate inhibitor |
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Lennox-Gastaut Syndrome
2 drug tx? |
a severe form of epilepsy beginning beforeage 4. Tonic, clonic, myonic seizures, behavioral disturbances, limitedcognitive function.
Tx: Lamotringe, felbamate |
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Lamotrigine (Lamictal): enzyme inducers increase or decrease this drug?
enzyme inhibitors increase or decrease this drug? |
Enzyme inducers: decrease (phenobarb, phenytoin, carbamazine)
Enzyme inhibitors (valproic acid) increases this drug |
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Felbamate (Felbutol) MOA
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enhances GABA, blocks NMDA receptor and Na+channels
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Felbamate (Felbutol): Warnings
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Aplastic anemia hepatotoxicity |
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Diazepam peds dose for seizure tx |
0.2 -0.5 mg/kg q 15 mins up to 10 mg IV
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Lorazepam dose for seizure tx |
0.1mg/kg may repeat @ 0.05mg/kg IV
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Midazilam is NOT approved for seizure tx by the FDA Off label dose? |
Off label use: 2 - 5 mg IV (adult), 0.02-0.03mg/kg IV,IM,IN (peds)
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Phenytoin dose for seizure tx |
20mg/kg (50mg/min) IV
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Pregnancy increases _________ seizure activity. |
increases |
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Seizures during pregnancy can cause what bad effects? |
pre-term labor
miscarriage intracranialbleeding in mom altered placental blood flow leading to fetal hypoxia |
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Are anti-epileptics teratogenic? ____% chance of having a normal infant. |
Most of them 90% |
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Anti-epileptics: cause a decrease in what electrolyte? Cause what kind of anemia? |
K+ Supplements are given, so there is a risk of bleeding Aplastic anemia (tx with folic acid) |
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What is recommendation during pregnancy? |
Avoid Divalproex and Barbiturates
Switch todrug with better profile PRIOR to pregnancy |
