anticonvulsant theraphy

Question 1

anticonvulsant mechanism of action

Answer 1

• prevent excessive discharge of abnormal neurons
• prevent discharge of normal neurons adjacent to abnormal area
• raise threshold of stimulation
• activate inhibitory pathways

Question 2

phenytoin

Answer 2

• Therapeutic use
  
  • generalize non-convulsive seizures (petit mal)
  • febrile seizures
  • generalized convulsive seizures (gran mal)
  • seizures following withdrawal of short acting barbiturates

Question 3

phenytoin side effects

Answer 3

• hyperplasia of gums
  
  • occurs with bad oral hygiene
• dermatitis
  
  • rash can occur within 14 days of use
• hirsuitism
  
  • abnormal growth of hair
• GI upset
• sedation
  
  • tolerance develops to this side effect

Question 4

Phenytoin 2

Answer 4

• Toxicities
  
  • nystagmus is early sign
• food/drug interaction
  
  • folic acid supplementation may be needed

Question 5

Barbiturates

Answer 5

• primidone is converted to phenobarbitol
  
  • pro drug not drug unless consumed
  • liver will metabolize it and turn it to phenobarbitol
• therapeutic use
  
  • febrile seizures
  • convulsant seizures
  • barbiturate withdrawal seizures

Question 6

barbiturate properties

Answer 6

• Side effects —–> sedation
• Drug interactions
  
  • hepatic induction
  • stimulates metabolism of other agents including other anticonvulsant agents

Question 7

ethosuximide

Answer 7

• Therapeutic use
  
  • general non- convulsant seizures (petit mal)
• Side effects
  
  • sedation
  • headache
  • dizziness

Question 8

Divalproex

Answer 8

• Therapeutic use
  
  • febrile seizures
  • non-convulsant seizures
  • convulsant seizures
• side effects
  
  • sedation

Question 9

benzodiazepines

Answer 9

• clonazepam
  
  • always used as adjunt therapy only
  • tolerance develops to therapeutic properties
• lorazepam/ diazepam
  
  • IV use for status epilepticus

Diazepam not water soluable

1cc/min

Question 10

Carbamazepine

Answer 10

• therapeutic use
  
  • partial seizures
  • neurologic pain
• Toxicity
  
  • bone marrow depression

Question 11

Fospheytoin

Answer 11

intravenous administration of phenytoin

• injectable only
• water soluable
• shortage of drug
• 100x more expensive than phenytoin

Question 12

gabapentin

Answer 12

adjunct therapy for partial seizures

• not a control substance

neurologic pain