Anticonvulsants Flashcards
Anti-Mania medication (mood stabilizer medications)
Anticonvulsant medications **
Antipsychotic medication
Treatment of Bipolar Disorder
has been used since the mid 90’s, very common as an alternative to lithium
Valproic acid
doesn’t have FDA approval for mania but it is used extensively for resistant case of BPAD. It is quite sedating which is not always appreciated by the individual
Carbamazepine
Antipsychotic medication may be required short term – treat sx of psychosis or form some individuals – long term treatment to better control ______
mood
Rapid Tranquilization - ________ 5 to 10 mgs IM prn, Ativan 1 to 2 mgs. IM prn, Olanzapine 10 mgs IM (for aggression and/or severe insomnia)
Haloperidol
is disinhibiting – can cause increase in DSB
Lorazepam
most prevalent of the neurological disorders
characterized by recurrent seizures that are not caused by secondary sources
Epilepsy
Epilepsy affects about ___ % of the Canadian Population
Abnormal electrical activity
0.6
May include:
Loss of consciousness
Sensory disturbances
Chorea
Fainting
Temporary memory loss
Symptoms are dependent on the type of seizure
Broadly categorized as: Partial or Generalized
Symptoms of Epilepsy
jerky body movement
Chorea
bilateral
Generalized Seizure
involve one hemisphere
Partial Seizure
Infectious Disease
Trauma
Metabolic Disorders
Vascular Diseases
Febrile Incidents (common in pediatrics)
Neoplastic Disease
Withdrawal
Overdose
Secondary cause of seizure
Alteration in cell membrane permeability
Altered distribution of ions across neuronal cell membranes
Decreased inhibition of thalamic or cortical neuronal activity
Imbalances in neurotransmitters
Gamma Aminobutyric Acid (GABA)
Acetylcholine
Idiopathic Seizures – Potential Causes
seizures due to an unknown cause
Idiopathic
Drugs that potentiate GABA action
Drugs that suppress sodium influx
Drugs that suppress calcium influx
Anti-Seizure Medication - categorized by action
Drugs that Potentiate Gamma – Amino Butyric Acid (GABA)
These drugs can work by increasing the inhibitory effect of _____
Drugs Include:
Barbiturates
Benzodiazepines
GABA structural analogs
Sulfamate- substituted monosaccharides
GABA
Benzo-diazepine
diazepam
Valium
_____ mg
2-40 mg
Benzo-diazepine
lorazepam
Ativan
______ mg (max 6 mg/day)
0.5 – 4 mg
These drugs work by delaying sodium ions from crossing the neuronal membranes
Neuronal activity is suppressed because Na+ channels are temporarily inactivated
This inhibits the release of neurotransmitters from the neuron
Drugs include:
Hydantoins
Iminostilbenes
Phenyltriazine Derivatives
Carboxyl Acid Derivatives
Drugs that Suppress Sodium Influx
carbamazepine
Tegretol
300-1600 mg
4-12
Sodium Influx Suppressant
Valproic Acid (VPA) /Divalproex
Epival, Depakene Syrup
750-3000 mg
50-100
(toxic – 150+)
Sodium Influx Suppressant
These drugs work by delaying the entry of Calcium into the neurons by blocking low-threshold Ca2+ channels
Reduces the likelihood of an action potential occurring.
Drugs include:
Succinimides
Drugs that Suppress Calcium Influx
Most _________ medications act as follows:
Absorption – GI Tract
Distribution – Widely & cross the placenta and enter breast milk
Metabolism - Liver
Excretion – Kidneys
anti-seizure
If in community and person does not have a known seizure disorder call 911
In acute care – persons does not have a know seizure disorder call medical 25
Time seizure!
In most cases a benzodiazepine (ex lorazepam) is given if seizure is greater than 3 min (medical emergency if 5+ min)
First Aid for Seizures
Most seizures are 1-3 min
A seizure 5+ minutes or more than one seizure within 5 minutes = status epilepticus
A seizure 10+ minutes is dangerous = ________ (can cause brain damage)
status epilepticus
Causes:
Withdrawal of Barbiturates, Benzodiazepine, Alcohol
Brain trauma/tumors
Infections
Drug overdoses (cocaine)
status epilepticus
Treatment:
Phenytoin – first line drug in treatment of
Status Epilepticus 10- 15 mg /kg
Phenobarbital – 20 mg/kg in single or divided doses
Diazepam – 5 mg/min IV Push or 5- 10 mg IM/IV as needed every 10- 15 minutes (20 mg PO for treatment in alcohol withdrawal)
Lorazepam – 2 mg/min IM or IV Push
status epilepticus
Common Adverse Effects
CNS: drowsiness, dizziness, ataxia, diplopia & hypotension
GI: nausea, vomiting & indigestion
Other: vitamin deficiencies, hair loss or excessive hair growth
Serious Adverse Effects
CNS Depression (heartrate, respiratory rate, consciousness)
Agranulocytosis
Steven – Johnson Syndrome (lamotrigine)
Angioedema
Laryngospasm
Suicidal Ideation
Bone marrow suppression and hepatotoxicity (valproic acid)
Gingival hyperplasia (ethosuximide and phenotynin)
Anticonvulsant Medications
Some common side effects that may occur in the first few _____ of taking seizure medicines include feeling tired, stomach upset or discomfort, dizziness, or blurred vision (diplopia)
weeks
Contraindications
Hypersensitivity
Central Nervous System Depression
Phenobarbital - Severe uncontrolled pain
Anti-seizure medications
Caution
Hepatic Dysfunction
History of Myocardial Infarction
Pregnancy & Breast Feeding
Anti-seizure medications
CNS Depressants – increase the risk of life threatening CNS depression
Other anticonvulsants – may increase or decrease serum levels of each other
Hormonal Contraceptives – decrease effectiveness
Herbal – Gingko and Oil of Primrose – both increase the severity and likelihood of seizures
Drug Interactions for Anti-seizure medications
_____ – Aspirin/Warfarin/ Alcohol
VPA (Valporic Acid)
Carbamazepine – ______
Lithium
risk cannot be ruled out
Category C
positive evidence of risk
Category D
Anti-seizure medication can have an impact on how children and youth learn and their _______
social development
Children are more sensitive to their ______ effects
sedative
Newborns (1 – 10 days of Age)
Respond best to _____ phenobarbital
IM
Older children (2 months – 6 years of age)
Close monitoring is required as per ___ and ___
age; weight
Age 10 – 14
Drug can be given at ______
normal adult dose
are more susceptible to the adverse effects of the drugs
Older adults
Dosages of all drugs may need to be reduced
Older adults
Older adults need to be monitored very carefully for ____ effects
toxic
Older adults should be strongly encouraged to wear a ______ bracelet to assist others in providing appropriate care
medic alert
