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Neurology > AED and Seizure Drugs > Flashcards

AED and Seizure Drugs Flashcards

1
Q

Diazepam drug class

A
  • Benzodiazepine
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2
Q

Diazepam MOA

A
  • Works on GABA receptors –> CNS depression
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3
Q

Half life of diazepam?

A
  • Very short

- 2-4 hours

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4
Q

Contraindications of diazepam

A
  • Overall very safe

- Contraindicated in liver toxicity

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5
Q

Can diazepam be used as an AED?

A
  • No
  • Anti-seizure
  • Patients develop tolerance to it
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6
Q

Emergency doses of diazepam

A
  • 0.5 mg/kg IV bolus as needed
  • 1 mg/kg per rectum
  • Repeat every 30 sec if no seizure resolution
  • May do a CRI
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7
Q

What can happen with repeated doses of diazepam?

A
  • Tolerance can develop
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8
Q

How many mL approx of diazepam for:

Small dog
Medium dog
Large dog

A

Small: 1 mL
Medium: 2 mL
Large dog: 3-5 mL

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9
Q

What if you have a continued need for diazepam?

A
  • Consider CRI
  • # doses /hr –> CRI rate
  • If you gave 4 doses of 2 mL each in 1 hr, the CRI rate is 8mL/hr
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10
Q

What is the diazepam still isn’t working?

A
  • Propofol –> stops physical manifestations

- Gas anesthesia –> stops physical manifestations

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11
Q

Precautions with diazepam

A
  • Light sensitive
  • No IM administration
  • Doesn’t play well with others (precipitation/binding)
  • Binds to plastic (only one catheter)
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12
Q

Phenobarbital MOA

A
  • Acts on GABA receptors

- Prevents ionized calcium influx at presynaptic terminals

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13
Q

Metabolism of phenobarbital

A
  • Metabolized by the liver
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14
Q

Protein binding of phenobarbital

A
  • Large portion is protein bound

-

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15
Q

Starting dose of phenobarbital

A
  • 2.5 - 3 mg/kg PO BID
  • Loading dose usually done too
  • IV formulation
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16
Q

Route of phenobarbital

A
  • Oral but also IV
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17
Q

Half life of phenobarbital and how long to reach steady state?

A
  • Half life is 2-3 days

- Takes 10-14 days to reach steady state

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18
Q

Therapeutic levels of phenobarbital

A
  • 15-45 µg/mL

- Target range is 15-40 (<35 µg/mL)

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19
Q

Side effects of phenobarbital

A
  • Sedation**
  • PU/PD
  • Ataxia
  • Polyphagia
  • TRANSIENT
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20
Q

Toxicities possible with phenobarbital

A
  • Blood dyscrasias –> neutropenia, thrombocytopenia
  • Liver toxicity**
  • Dermatologic reactions (sloughing skin and pseudolymphoma can happen)
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21
Q

When is PB contraindicated?

A
  • Hepatic dysfunction or disease
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22
Q

What levels are concerning for PB?

A
  • Levels greater than 35
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23
Q

What blood work should be done with PB and when?

A
  • Before starting: CBC/CHem/UA; bile acids to show normal liver function
  • After starting, PB level in 14 days and CBC/Chem in 1-6 months
  • Routine monitoring is CBC/Chem/UA/Bile acids/PB level q6 months
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24
Q

Metabolism of PB again

A
  • Liver metabolism

- Induces cytochrome P450

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25
Q

What can happen with PB metabolism over time?

A
  • Decreased value over time possible because PB induces Cytochrome P450 and can metabolize it quickly
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26
Q

Effect of PB on liver, thyroid panel?

A
  • Elevated liver values (ALP»>ALT; run a bile acids if worried)
  • He also measures albumin because if it decreases a lot, he wants to check it
  • Thyroid panel will show euthyroid sick
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27
Q

Which medications should you be careful with when using phenobarbital?

A
  • Enzyme inhibitors like ketoconazole and chloramphenicol
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28
Q

Potassium bromide MOA

A
  • It’s a salt that mimics chloride

- Hyperpolarization of neurons

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29
Q

Protein binding of KBr

A
  • None
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30
Q

Excretion route of KBr?

A
  • Urine!
31
Q

Half life of KBr in the dog and cat

A
  • 28 days in dogs

- 10 days in cats

32
Q

Steady state of KBr in the dog and cat

A
  • 4-5 months in dogs

- 6 weeks in cats

33
Q

Dose of KBr and loading possibility?

A
  • DOse is 25-35 mg/kg PO SID

- Loading is possible but not ideal because it is quite salty

34
Q

Therapeutic range of KBr

  • can you go higher than the therapeutic range?
A
  • 1-3 mg/mL

- Okay to go higher if no side effects

35
Q

Contraindications of KBr

A
  • Kidney disease caution (excreted in urine)

-

36
Q

Side effects of KBr

A
  • GI irritation! (vomiting, diarrhea, anorexia)**
  • Pancreatitis
  • Hyperactivity
  • Better with food
  • Liquid probably better than the tablet
  • Ataxia, paresis, sedation
37
Q

Formulation of KBr

A
  • ORAL ONLY
38
Q

Dietary considerations with KBr

A
  • Constant diet must be had
39
Q

What can happen with KBr given to cats?

A
  • Fatal pulmonary edema in the cat**
40
Q

Levetiracetam MOA

A
  • Blocks a protein (SV2A) associated with release of NT vesicles
41
Q

Metabolism of levetiracetam

A
  • No hepatic metabolism
42
Q

Side effects of levetiracetam

A
  • Minimal to no side effects
43
Q

Therapeutic level of levetiracetam

A
  • Not important

- It’s very safe

44
Q

Routes of levetiracetam

A
  • IV/PO/rectally
45
Q

Cost of levetiracetam

A
  • Expensive but less monitoring required
46
Q

Zonisamide drug class

A
  • Sulfa based drug
47
Q

Zonisamide MOA

A
  • Blocks T-Type Ca channels and voltage gated Na channels
48
Q

Where is zonisamide metabolized?

A
  • Liver
49
Q

Dosing interval of zonisamide

A
  • twice a day
50
Q

Do you increase or decrease the dose of zonisamide given with phenobarbital?

A
  • INCREASE due to clearance
51
Q

Dosing interval of levetiracetam?

A
  • every 8 hours
52
Q

Side effects of zonisamide

A
  • Minimal effects
  • Sulfa based drugs though
  • Blood dyscrasias
  • Renal tubular acidosis
  • Acute hepatic failure
  • KCS
  • They say don’t give sulfas to brown and black dogs
53
Q

Gabapentin or pregabalin for seizures

A
  • Better for pain
54
Q

Other AED

A
  • Gabapentin/pregabalin
  • Felbamate
  • Topiramate
  • Meh?
55
Q

What to think about with starting AED?

A
  • GOALS OF THERAPY
  • Cluster seizures
  • Status epilepticus
  • Owner conern and safety
56
Q

AED process

A
  • Choose one (in theory all are equal except for in humans)
  • Maximize the dose of first AED (Assess therapeutic levels if applicable; side effects)
  • 2nd AED once the first is maxed out!
57
Q

ER seizure - what should you do?

A
  • RELAX!

- Administer valium (Big 4/patient assessment); see what happens/get history once the patient is deemed stable

58
Q

What to do if the ER seizure has another seizure?

A
  • Another valium dose +/- long term AED
  • DON’T BE A VALIUM WIMP

Benefits for having levetiracetam

59
Q

Sequela of seizures

A
  • Increased ICP (look for Cushing’s reflex; pupillary size/symmetry and response to light)
60
Q

Treatment for increased ICP secondary to seizures?

A
  • Draw edema out of the brain

- Mannitol vs hypertonic saline

61
Q

Mannitol drug class

A
  • Carbohydrate
62
Q

Mannitol MOA

A
  • Decreases blood viscosity and decreases ICP
  • Osmotic diuresis
  • Decreases CSF production
  • Free radical scavenger
63
Q

Mannitol contraindications

A
  • Dehydration or hypovolemia

- Can give awhile also administering IVF

64
Q

Hypertonic NaCl MOA

A
  • Osmotic effect to decrease brain edema
65
Q

Which drug to decrease ICP might you use in a patient that is hypovolemic?

A
  • Hypertonic saline rather than mannitol
66
Q

Nursing care for patients with seizures

A
  • Eye lube PRN
  • Recumbency care q4 hours
  • Keep head elevated 30 degrees (jugular is a main vessel)
  • Suction mouth PRN
  • CN assessment
  • Seizures watch with diazepam/midazolam orders
67
Q

Know the three general types of seizures

A
  • Generalized
  • Partial
  • Behavioral/psychomotor
68
Q

Know the three general causes of seizures

A
  • Structural
  • Reactive
  • Idiopathic/genetic
69
Q

5 differentials for structural brain disease

A
  • Tumor
  • Inflammation
  • Anomaly (hydrocephalus)
  • Trauma
  • CVA (stroke)
70
Q

Common metabolic causes for seizures

A
  • PSS or liver dysfunction

- Hypoglycemia

71
Q

Know when to start AED

A

Do it

72
Q

Know the different AED

A

Do it

73
Q

Know the treatment of status epilepticus

A

Know it

74
Q

Know how to assess and treat ICP

A
  • Know it

Neurology (14 decks)

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