Pharm Test 2

Front 1

what are the excitatory neurotransmitters?

Back 1

acetylcholine, norephiephrine, histamine, corticotropin releasing factor, glutamate (NMDA receptor)

Front 2

what are the inhibitory neurotransmitters

Back 2

GABA, dopamine

Front 3

what is the patho of seizures

Back 3

change in membrane fcn, decreased inhibition (excess neuronal firing), increased excitement (mediated by glutamate at the NDMA receptor), alterations in extracellualr ion concentration

Front 4

what are some mechanical causes of seizures?

Back 4

trauma, birth injury, neoplasm

Front 5

what are some metabolic causes of seizures?

Back 5

electrolyte imbalance(sodium), dehydration, hypoglycemia

Front 6

what are some drug withdrawal causes of seizures?

Back 6

etoh, benzos, barbiturates, antiepileptics

Front 7

what are some drug administration causes of seizures?

Back 7

clozapine, clomipromine, theophylline

Front 8

what toxins can cause seizures?

Back 8

fever, infections

Front 9

what are partial seizures

Back 9

local or focal affecting 1 hemisphere of the brain

Front 10

what are simple partial seizures?

Back 10

no impairment of consciousness; motor, visual, auditory, olfactory, sweating, flushing pallor, gagging

Front 11

what are complex partial seizures?

Back 11

impairment of consciousness; aura; olfactory, visual, auditory); behavior includes picking at clothes, lip smacking, repetitive phrases, running

Front 12

what are the characteristics of tonic-clonic seizures?

Back 12

grand mal, preceded by and aura, muscle rigidity (tonic), rhythmic jerking (clonic), 30 sec-3 min, loss of bowel/bladder, cry out, bite tongue, post ictus=confusion and lethargy

Front 13

what are the characteristics of absence seizures?

Back 13

petit mal, sudden interruption of ongoing activities, blank stare, EEG shows 2-4 cycles/spike

Front 14

what are the characteristics of atonic seizures?

Back 14

akinetic, loss of muscle tone, falling to floor, drop attacks

Front 15

What are the characteristics of myoclonic seizures?

Back 15

brief, shock-like muscle contractions of face/trunk/extremities

Front 16

what are the characteristics of status epilepticus?

Back 16

emergency, >30 min, 2 or more without full consciousness in between

Front 17

how is status epilepticus treated?

Back 17

diazepam iv and repeat after 5-10 min if not stop, lorazepam iv, repeat after 5-10 min if not stop, fosphenytoin or phenobarbital given for prolonged control of seizure

Front 18

what med is given for intractable staus epilepticus?

Back 18

barbiturates

Front 19

what are some non-pharm treatments of seizures?

Back 19

ketogenic diet(high fat, low carb/protein)

Front 20

what are some s/e's of a ketogenic diet

Back 20

diarrhea, increased lipids, protein deficiency, hypoglycemia

Front 21

when to start of AED's

Back 21

2 or more seizures, impacts life

Front 22

when to stop AED's

Back 22

seizure free for 2-5 yrs, EEG normalized, normal neuro exam/IQ

Front 23

adverse effects of carbamazepine Tegretol

Back 23

diplopia, nausea, drowsiness, sedation

Front 24

adverse effects of ethosuximide (zarontin)

Back 24

nausea, leukopenia

Front 25

adverse effects of felbamate (felbatol)

Back 25

aplastic anemia, hepatic failure

Front 26

adverse effects of gabapentin (neurontin)

Back 26

drowsiness, sedation, weight gain

Front 27

adverse effects of lamotrigine (lamictal)

Back 27

insomnia, ataxia, rash, ha

Front 28

adverse effects of levetiracetam (keppra)

Back 28

somnolene, dizziness, rash, ha

Front 29

adverse effects of oxcarbazepine (trileptal)

Back 29

somnolence, dizziness, diplopia

Front 30

adverse effects of phenobarbital

Back 30

sedation, drowsiness, ataxia

Front 31

adverse rxns of phenytoin (dilantin)

Back 31

sedation, gingival hyperplasia

Front 32

adverse rxns of tiagabine (gabitril)

Back 32

dizziness, somnolence, irritabiltiy

Front 33

adverse rxns of topiramate (topamax)

Back 33

slowed thinking, weight loss

Front 34

adverse rxns with valproate (depakote)

Back 34

tremor, drowsiness, hepatotoxicity

Front 35

adverse rxns with zonisamide (zonegran)

Back 35

somnolence, rash, psychosis

Front 36

drug of choice for partial seizures (simple and complex)

Back 36

phenytoin, carbamazepine, valproate

Front 37

drug of choice for gerneralized tonic-clonic seizures

Back 37

phenytoin, valproate

Front 38

drug of choice for absence seizures

Back 38

valproate, ethosuximide

Front 39

drug of choice for myoclonic seizures

Back 39

valproate

Front 40

drug of choice for atonic seizures

Back 40

valproate

Front 41

what is the safest way to reduce teratogenicity in pregnant women taking seizure medication?

Back 41

monotherapy (tiagabine is safest) but most are category C

Front 42

safety concern with carbamazepine

Back 42

hyponatremia

Front 43

safety concern with lamotrigine

Back 43

steven johnson's syndrome

Front 44

safety concern with felbamate

Back 44

liver tox, bone marrow suppression

Front 45

safety concern with phenytoin

Back 45

gingival hyperplasia

Front 46

safety concern with topiramate

Back 46

language dysfunction, behavioral changes secondary to cognitive effects

Front 47

when is phenytoin indicated vs fosphenytoin

Back 47

for complex partial seizures, generalized tonic clonic seizures and neuropathic pain

Front 48

characteristics of phenytoin

Back 48

highly variable, 90-95% protein bound, saturable oxidative process, half life 7-42 hrs, cbc with diff then q 6-12 months after, albumin, lfts, and calcium levels