1 Antiepileptic Flashcards
Epilepsy is a __________ neurologic disorder
characterized by ___________________.
Epilepsy is a chronic neurologic disorder
characterized by recurrent seizures.
Epilepsy is associated with the presence
of a group or focus of cerebral neurons
that are ______________.
hyperexcitable, or irritable.
What initiates an epileptic seizure?
The spontaneous discharge of these
irritable neurons initiates the epiletic
seizure.
What are the classifications of an epileptic seizure?
Partial
Generalized
Unclassified
Partial seizures affect ___________ the
brain.
Partial seizures affect only part of the
brain.
Generalized seizures affect __________
brain.
Generalized seizures affect the whole
brain.
What are two other names for a generalized seizure?
Grand mal
Tonic-clonic
True or false: Antiepileptic medications are used to stop seizures and are administered when one has commenced.
False
• Seizures are self-limiting.
• Drugs are used to stop the recurrence of
seizures to prevent further damage to
already damaged neurons.
True or false: Barbiturates for epilepsy are safe for adults and not children
True.
• Phenobarbital is prescribed for all
types of adult seizures.
• Very safe and effective.
• Limited because of strong tendency
to produce sedation.
Why are barbiturates unsafe to treat pediatric epilepsy?
Paradoxical increase in seizures and an increase in hyperactivity in some children.
What is the mechanism of action for barbiturates in the treatment of epilepsy?
Increase the effects of GABA
(See Steph’s post 10/9/16 or page 107)
Decrease release of glutamate
What are the side effects of barbiturates in treating epilepsy?
- Sedation, nystagmus, ataxia, folate deficiency, vitamin K deficiency, and skin problems.
- Paradoxical increase in seizures and an increase in hyperactivity in some children.
Barbiturates to treat epilepsy have one HUGE flaw in regards to when they take effect, what is it?
It takes a lot to build up in system so patient has a bunch of seizures before they even realize they’re not helping
Why are Benzodiazepines limited?
Limited in use because of sedation and tolerance.
What are some examples of benzodiazepines to treat epilepsy?
Valium and Ativan
What is the most common benzodiazepine chosen to treat epilepsy, especially in children?
Ativan
What are the side effects of benzodiazepines used to treat epilepsy?
• Sedation, ataxia, and behavioral changes.
What are some examples of hydantonins used to treat epilepsy?
Dilantin and Cerebyx
What is the mechanism of action of how hydantoins treat epilepsy?
Decrease neural excitability
What are the side effects of hydantoins?
Gastric irritation, confusion, sedation, dizziness, headache, ataxia, nystagmus, increased body and facial hair👨🏽
Iminostilbenes not starred are prescribed how often?
Rarely prescribed for epilepsy
Last choice if the others don’t work
Side effect: cardiac arrhythmias and CHF
My patient was experiencing global seizures and was prescribed this drug years ago. Now, they’re presenting with Parkinson’s like symptoms. What was the drug?
not starred, she said this as a side bar thing
Succinimides
Neurontin is prescribed for which populations of epileptics?
Partial seizures in adults and children
What is the neurological mechanism of neurontin for epilepsy?
It is a GABA agonist
What are the side effects of neurontin?
Sedation
Fatigue
Dizziness
Ataxia
True or false: Neurontin can be use to treat both partial seizures and musculoskeletal pain
False, it treats partial seizures and neurological pain
What are the first generation epilepsy drugs?
*Barbiturates
*Benzodiazepines
*Hydantonins
(Iminostilbenes and Succinimides)
What is the only second generation epileptic drug?
Neurontin
What are the pharmacokinetics of anti-epileptic drugs?
- When given long-term to control epilepsy, drugs are given orally.
- Distributation in body is extensive
- Biotransformation occurs via the liver.
True or false: it is safer for both an epileptic mother-to-be and her offspring-to-be if she stays on her anti-epileptic medication during the pregnancy
It’s a toss up.
You can have birth defects with the medication
You can miscarry if you have a grand mal seizure
Either way, it’s her call
What is the protocol for going off anti-epileptic medication?
Seizure free for 2 years while on meds.
Having a normal neurologic examination prior to withdrawal.
Being young when the seizures started.
Must be done under close medical supervision.
Tapered over 6 months
How long until one loses their diagnosis of epilepsy?
5 years
2 years of being seizure free on medication + 3 years. After you taper off
What is Status Epilepticus?
• One long extended seizure.
• Untreated, it will result in permanent
damage or death.
• Treatment begins with standard
emergency procedures: airway, IV, blood sampling, drug administration. (valium or Ativan)
• Last resort, anesthesia to stop neural activity
