Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
55 Cards in this Set
- Front
- Back
|
List the Generalized seizures
|
Absence
Myoclonic Tonic-Clonic Tonic Clonic Atonic |
|
|
describe a myoclonic seizure
|
Brief lightning-like jerking movements of the whole body or upper extremities
|
|
|
Describe the Tonic-Clonic seizures
|
Five phases:
Flexion Extension Tremor Clonic Postictal |
|
|
What is Clonic?
|
Rhytmic jerking
|
|
|
what is tonic?
|
Flexion and extension
|
|
|
What type of NTS is GABA?
|
Inhibitory, therefore if there is a loss of GABA there will be more excitatatory NTS in brain
|
|
|
What is the ideal therapy for seizures?
|
monotherapy, although most patients require two drugs
|
|
|
What is the MOA of antiepilectic drugs?
|
Act on ion channels; enhances inhibitory NTS and neuroreceptors
|
|
|
Name 1st Gen. AEDs
|
Phenobarbital
Phenytoin Valproic Acid Carbamazepine |
|
|
What is the MOA of Phenobarbital
|
Enhances GABA
Prolongs Cl channels Blocks NA channels |
|
|
what is the half-life of phenobarbital
|
75-125 hrs
|
|
|
T/F Phenobarb can be an inducer or inhibitor
|
TRUE
|
|
|
What are the side effects of Phenobarb
|
CNS depression
Lethargy/sedation Cognitive impairment Hyperactivity in children |
|
|
What is the MOA of Phenytoin
|
Blocks NA channels
|
|
|
T/F Phenytoin can be an inducer of inhibitor
|
False: its only an inducer
|
|
|
how many half-lives will it take for phenobarb to get out of your system?
|
~5 half-lives
|
|
|
what AED is not effective with absence seizures?
|
Phenytoin
|
|
|
why is it important to monitor levels of phenytoin every few months?
|
because the drug can saturate all receptors and accumulate causing toxicity (Michaelis menten kinetics)
|
|
|
what test is best to assess protein level?
|
pre-albumin; measures last three days
Good for pts on phenytoin because drug is highly protein bound |
|
|
What is the drug of choice for status epilepticus?
|
Lorazepan
|
|
|
Dose of phenytoin in status epilepticus
|
Loading dose: 500mg (smaller person)
1000mg (bigger person) 50mg/min |
|
|
why do you never give phenytoin IV push?
|
causes extravasation and phlebitis
|
|
|
why do you NOT infuse phenytoin for longer than 30 min?
|
the drug crystalizes
|
|
|
what are the side effects of ORAL phenytoin
|
Hirtuism
Ataxia Nystagmus Drowsiness(dose related) Rash(steven johnson) Acne Gingival hyperplasia |
|
|
which drug is an inducer and autoinducer
|
Carbamazepine
|
|
|
what are the side effects of carbamazepine?
|
Rash
Hyponatremia Aplastic anemia Thrombocytopenia SIADH |
|
|
what is the MOA of Valproic acid?
|
Potentiates GABA
Blocks T-type Ca and Na channels |
|
|
T/F Valproic Acid is an Inducer
|
False: its an inhibitor
|
|
|
If pt has a new onset of seizures, what drug would you use?
|
Phenytoin
|
|
|
This AED drug causes hepatotoxicity, N/V, Wt gain, pancreatitis, and alopecia
|
Valproic Acid
Get ALT and AST levels |
|
|
your pt is a child that has Lennox-gestaut seizures, you've tried all other drugs with minimal effects, what can you try next?
|
Felbamate(used as last resort due to its liver and aplastic anemia effects)
Monitor LFTs and CBC Must sign a consent form |
|
|
What are the 2nd Gen. AEDs?
|
Felbamate
Ethosuximide Gabapentin Lamotrigine Oxcabazepine Topiramate Zonisamide Pregabalin |
|
|
This 2nd Gen. drug is renally excreted, acts on GABA and calcium channels
|
Gabapentin
|
|
|
what are the side effects of Gabapentin
|
fatigue
dizzienss sleepiness |
|
|
This drug is a 2nd Gen AED and its MOA is by blocking Na channels which inhibits release of glutamate and aspartate; RASH is a major concern, must titrate and start at low dose
|
Lamotrigine
|
|
|
what does carbonic anhydrous inhibitors do?
|
Stimulates GABA release
|
|
|
which drug maily effects Na and GABA and has weak carbonic anhydrous inhibition?
|
Topiramate (topromax)
|
|
|
what the advantage of Fosphenytoin over phenytoin?
|
It can be given IM or IV
Phlebitis is minimized Faster infusion Can mix in D5 or NS |
|
|
Name the Benzodiazepines
|
Clonazepan (klonopin)
Diazepam (Valium) Lorazepam (Ativan) |
|
|
How do you treat status epilepticus?
|
Lorazepam 1 mg over 30 sec then phenytoin
|
|
|
What is oxcarbazepine?
|
an active metabolite of carbamazepine
|
|
|
S.E of oxcarbamezepine?
|
Hyponatremia
Blood dyscrasias |
|
|
which 2nd Gen. AED is indicated for Absence seizures?
|
Ethosuximide
|
|
|
which 2nd Gen. causes kidney stones and causes depression?
|
Zonisamide
|
|
|
which 2nd Gen drug is used for seizures and pain management because it releases Glutamate and Substance P?
|
Pregabalin
|
|
|
What is unique about Pregabalin?
|
Works in the brain and spinal cord
|
|
|
what is the max dose you can give phenytoin?
|
50mg/min to avoid S.E
|
|
|
What is the dose of IM Fosphenytoin?
|
3 ml
|
|
|
What is the phenytoin equivalents?
|
1mg phenytoin = 1.5mg fosphenytoin
|
|
|
what are the advantages of fosphenytoin
|
can be given faster
IM or IV |
|
|
What do the BZDs effect?
|
GABA
Blocks ascending RAS; leads to sedation and ataxia |
|
|
What AED is used in children for status epilepticus?
|
rectal diazepan
|
|
|
What AED is used in adults for status epilepticus?
|
Lorazepan
|
|
|
A pt comes in status epilepticus, what do you do?
|
Give 1mg lorazepam over 30sec, repeat every 10-15 min, max of 4mg then
Phenytoin |
|
|
what category AED is preferable in pregnant women?
|
Category B
|
