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72 Cards in this Set
- Front
- Back
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What is Phenytoin
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drug used for partial seizures and clonic tonic. Taken PO. IV. Pregnancy risk C.85-95% protein bound. High lipid solubility.
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What is the class of drug and mechanism of Action for both phenytoin and fosphenytoin?
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The class is Hydantoin and the MOA they block NA+ channels.
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Benxodiazepines increase efficacy of GABA (used only in status epilepticus) name these two drugs?
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Diazepam and Lorazepam
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Phenobarbital and primidone are barbituates that act on epilypse by doing what?
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They Increase the efficacy of GABA
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Ethosuximide works on what type of seizure by what method of action?
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Block Ca 2+ channels, but only works for absence seizures.
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The choice of AED used depends on what 2 things?
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1. the type of seizure
2. patient related variables, such as age and health status. |
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What is monotherapy?
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The use of one drug and the desired goal for Seizure treatment
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What drug in particular treats all types of seizures?
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Valproic Acid
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What happens if Phenytoin is administered too quickly via IV?
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Cardiovascular collapse may occur?
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What is a safer drug to administer through IV and a prodrug of Phenytoin?
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Fosphenytoin
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What are the major differences between phenytoin and Fosphenytoin?
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Phenytoin must be administered in a pH of 13 and precipitates readily. Fosphenytoin can be given quickly and in a standard solution.
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How is Fosphenytoin converted to phenytoin?
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By way of enzymes in the RBC, this is done really quickly.
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What is the therapeutic range for phenytoin?
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10-20 mcg/ml in patients with normal serum albumin and with no competing drugs
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What toxic are the toxic levels for Phenytoin and what are particular indications of them?
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20 mcg ----- indication is nystagmus
30-40 mcg- indication is gross motor changes/ ataxia which may be permanent. 50 mcg --- coma |
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What is Stevens-Johnsons Syndrome?
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a.k.a. toxic epidermal neocrolysis or erythema multiforma is a severe reaction to Phenytoin. Looks like burns all over the skin. teach patient to report anytype of rash
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What is gingival hyperplasia?
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Adverse Effect of Phenytoin. it is an overgrowth of the gums. Can be helped or prevented with routine hygenie.
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Phenytoin decreases the effect of Folic Acid and Calcium along with what two vitamins does it decrease absorption in?
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Vitamin K and Vitamin D
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What is Carbamazepine?
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AED used for partial and tonic clonic, trigeminal neuralgia, bipolar disorder, neuropathic pain.
Taken PO only 80% bioavailability |
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What is the distribution, pregnancy risk, and metabolism of Carbamazepine?
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Distribution- Lipid soluble
Pregnancy Class D Hepatic Metabolism- 450 Inducer- Avoid grapefruit juice. |
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What are the Adverse effects of Carbamazepine?
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Aplastic Anemia, Inappropriate Antidiuretic Hormone Secretion. bone marrow suppression. rash. (possible Stevens-Johnson) photosensitivity.
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What is a trade name for Carbamazepine?
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Tegretol and Carbatrol
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What is a trade name for Fosphenytoin?
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Cerebryx
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What are the uses for Valproic Acid?
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Used for All types of Seizures. as well as bipolar, migraine and prophylaxis.
Well absorbed. PO only. |
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For Valproic Acid, what is its pregnancy category, its distribution, and metabolism?
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It is Category D, It is lipid soluble, Hepatic metabolism
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What are the adverse effects of Valproic Acid?
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Rare severe hepatotoxicity. Nausea vomiting, rare severe pancreatitis. rash. weight gain. hair loss, tremor. blood dyscrasias.
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What are the uses of Phenobarbital and Primidone (mysoline) ?
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Partial and generalized tonic-clonic seizures. Given Po. Iv in emergency.
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What are Phenobarbital and Primidone's pregnancy risk, distribution, and metabolism?
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Pregnancy D. High lipid solubility. 1/2 life is 50-140 hrs in adult. 35-75 hrs in child. Major 450 inducer.
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What are adverse effects of Phenobarbital and Primidone?
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CNS depressant. Not used to often because it is very sedating. Agitation in the elderly and young. folate and vitamin K depletion.
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What is Ethosuximide (Zarontin) used for and how is it administered?
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Used in Absence seizures only. given PO. Well absorbed.
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Pregnancy risk, distribution, metabolism, and adverse effects of ethosuximide are what?
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Pregnancy risk is C. It is lipid soluble. Hepatic and renal metabolism. Long 1/2 life. Does not induce 450 but will be metabolized by them. Rare systemic lupus, aplastic anemia. dizziness, lethargy disappears overtime. Nausea vomiting give with food.
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What are Benzodiazepines? What are their pregnancy, Metabolism, and uses?
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Lorazepam (Ativan), Diazepam (Valium). Given for tonic-clonic. both are schedule IV controlled substances. Pregnancy risk D. Diazepam. 72 hr. effect. Lorazepam 10-15 effect. Can't mix in IV will percipitate, always given with a long acting AED. Have emergency equipment nearby.
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What three drugs increase dopamine levels in the synapse?
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Levodopa/ carbidopa Dopamine replacement.
Entacapone, COMT inhibitor Selegiline MAO inhibitor |
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What drug acts as a dopamine agonist?
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Bromocriptine. stimulates the dopamine receptors.
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What anticholinergics decrease the stimulation of muscurinic receptors and are used in the treatment of Parkinson's disease?
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Benztropine and diphenhydramine (Benadryl)
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Levodopa is a precursor to what neurotransmitter and it does/ does not cross the blood brain barrier?
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Precursor for dopamine, It does cross the Blood Brain Barrier.
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What is the problem with Levodopa's conversion to dopamine?
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99% of it occurs in the periphery
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What drug is given with Levodopa to enhance its ability to convert in the brain?
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Carbidopa
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Since Lev/Carbadopa are transported across the BBB by active transport with a neural amino acid transporter and the drugs are given PO you should not do what to ensure transport?
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You should eat a low protein diet. Do not take with food.
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What drug used for the treatment of Parkinson's disease inhibits lactation?
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Levodopa, Carbidopa
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Levodopa and Carbidopa are metabolized by what method?
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COMT degradation and MAO
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What are some various concerns with Levodopa/ Carbidopa?
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Effects may take months or weeks. May darken urine or sweat. Must reduce Vit B6, this normally inhibits its ability to turn into dopamine. Must watch out for B6 Deficiency. May have to keep increasing the dosage, eventually large dose may not have any effect.
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What are the symptoms of a vit B deficiency and what Parkinson's drug may lead to it?
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Symptoms are paresthesias, numbness, mental confusion, depression. Levodopa, carbidopa.
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What are the adverse reactions that may occur when dopamine levels get too high do to Levodopa/Carbidopa?
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Abnormal movements, dyskinetic movements. involuntary movement. May have to decrease dosage which may lead to return of PD symptoms.
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What are some adverse psychatric effects of Levodopa/ Carbidopa?
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Personality, behavioral change, mental confusion, suicidal ideation, hallucination. These effects occur because of dopamine's effect on the brain not the striatum.
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MAOI can cause hypertension crisis when given within what time frame of Levodopa and Carbidopa?
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Within 2-4 wks. Must titrate the dose carefully. May cause orthostatic hypotension and cardiac dysrhythmias
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What is the ON- OFF phenomenon?
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Acute loss of effect in previously effective regimen of levodopa, carbidopa.
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What is the wearing off effect?
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Loss of effect at the end of a dosing period. Due to low levels of drugs. Increase the dose or decrease the the dosing interval.
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What is Pramipexole and Ropinirile?
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These are parkinson drugs. Non-ergot drugs selective for dopamine receptors. SE--- N & V
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What are to ergot derivatives also active at serotonin and Alpha receptors, these are dopamine agonist?
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Parkinson's drugs Bromocriptine and pergolide SE --- N & V
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What are the SE when an dopamine agonist is used with Levodopa?
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There is an increased risk in orhtostatic hypotension, hallucination, and dyskinesias.
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What is Rotigotine (Neupro) ?
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It is a transdermal dopamine agonist. Approved 5-07. Same SE as PO dopamine agonist. More constant blood level dose.
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COMT Inhibitors increase dopamine by what method?
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Prevent the peripheral degradation of levodopa, thus increasing the amount that is in the brain.
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What are some drugs that COMT inhibitors will increase ?
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1.Methyl dopa, BP drug,
2.Dobutamine used for heart failure. 3.isoproterenol (beta agonist), |
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What is Amantidine?
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An antiviral drug. Used to treat influenza. In PD it increased the release of dopamine from the presynaptic nerve. Also muscarinic antagonist. Second line PD drug. wears off in 3-6 months.
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What are the SE of a muscarinic antagonist?
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Dry mouth, confusion, blurred vision, urinary retention.
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Anticholinergic Agents?
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Benztropine, Trihexyphenidyl, Dipenyhydramine. Used as 2nd and 3rd line drug treatment in PD.
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Anticholinergic Agents can not be used in patients with what diseases?
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In parkinson's patients with memory loss, glaucoma, or dementia.
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Name one short acting barbiturate?
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Thiopental, this is used for induction.
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Benzodiazepines is used for what type of sedation when used alone? What type when used with another drug?
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Diazepam or Midazolam used for conscious sedation when used alone, or for induction when used with other anesthetics.
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Propofol serves what purpose in anesthesia?
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It is used as a continuous infusion for sedation and as an induction agent.
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What is a Ketamine?
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a dissociative anesthetic- it has neuropsychiatric effects.
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When giving Nitrous Oxide for anesthesia you must combine it with what? Why?
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Another drug, such as Halothane. Because for Nitrous Oxide to cause complete sedation. Because given alone to cause complete sedation NO must be given at 105% allowing for no oxygen and death would ensue
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What are the 3 factors in balanced general anesthesia?
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Loss of consciousness, Analgesia, Muscle relaxation.
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What is the Method of Action for Inhalation Anesthetics?
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They get into the lungs, where they are absorbed into the bloodstream and then cross into the brain where they act to decrease neural activity.
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How are inhalation anesthetics eliminated?
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By way of the expired breath.
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What is one side effect of almost all inhalation anesthetics, with the exception of NO?
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The lower blood pressure, therefore a vasopressor is usually given.
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What is Neuromuscular Blocker? What are the 2 types?
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This is used to produce complete paralysis. The patient must be intubated and ventilated. The 2 types are depolarizing and nondepolarizing.
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Which neuromuscular blockade can be reversed, Depolarizing or Nondepolarizing?
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Nondepolarizing
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Local Anesthetics use what method of action to prevent pain from the nociceptors going to the spinal cord?
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They block the transmission by blocking the Sodium Channels.
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What type of methods might be employed to keep a local anesthetic from diffusing away from the site?
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A tourniquet may be applied to a limb to keep the local anesthetic confined to that limb or by using a vasoconstrictor such as Epinepherine
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True or False. Local Anesthetics are delivered via Intramuscular.
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False. They are considered to be topical since they are applied to the site of action.
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What is Lidocaine, what are it MOA, its onset, its duration?
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Lidocaine is a local Anesthetic it blocks sodium channels which prevents nerve impulse transmission. It has a rapid onset, 1-3hr duration.
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