Anticonvulsants Flashcards
0
Q
What do you have to correct for with Dilantin?
A
The albumin
1
Q
Dilantin level
A
Ten to 20
10 to 29 dildos
2
Q
Formula for Dilantin correct name
A
Sheiner tozer
Measures divided by albumin x 0. with bad kidney. Creatine clearance under 20.
Multiple albumin by .1 x if goo kidney
3
Q
Property of phenytoin that is nice with afib
A
Class 1 b antiarrythmic makes it good for afib.
Vtach
4
Q
How long does it take for anticonvulsant Dilantin effects.
A
5 to 10 says
5
Q
Dilantin treats all seizures except
A
Pure absence
6
Q
Dilantin is metabolized by. And excreted by.
A
Liver, bile
7
Q
Why do you need to correct phenytoin
A
90 percent protein bound. Albumin
8
Q
After tegretol what is drug of choice in trugeminal neuralgia.
A
Dilantin
9
Q
Why should you not give phenytoin im?
A
Shin necrosis
10
Q
How do you does obese w Dilantin?
A
Use ideal body weight
11
Q
What. Can be a problem with elder and phenytoin
A
Early signs of toxicity.
12
Q
Prego category for phenytoin
A
Death. Cleft lip
Fetal hydrant pin syndrome
Can use in orego if abs necessary.
13
Q
What do you do for liver failure with seizure with Dilantin?
A
No loading dose?
14
Q
standard loading dose phosphytoin
A
10 to 20 mg/ kg ideal body wt
Phosphentoin is Iv
15
Q
What if you can’t give Iv phosphytoin
A
Give extra dose of home medication
16
Q
Max dose of phos phenytoin is —mg? Why
A
50 mg. hypotension Iv
17
Q
Rate of phosphenytoin.
A
No more than 50mg / hr
18
Q
OrAl phenytoin should be used when
A
Fear of hypotension
19
Q
Consequences of phenytoin
A
Vertical nystagmus Lateral gaze Diplopoda Sedation Dysarthria Tremor Cerebellum degradation atrophy
20
Q
What does Dilantin do to blood levels
A
Decrease folate acid. Inhibits enzyme
Megalobladtic anemia
Gingival involvement
21
Q
Describe fetal hydration syndrome
A
Like fetal etoh syndrome Broad nasal bridge Cleft palate Microcephalic MR 70
22
Q
Si risk w Dilantin
A
Twice the so risk with Dilantin
23
Q
Syndrome assoc with Dilantin.
A
Lupus
24
Immune and Dilantin
IgA deficiency
25
Interactions with Dilantin
Warfarin
| Antacid
26
Mechanism of Dilantin
Volt. Dependent sodium channels in motor cx
Increases steady state inactivation
Protects u from hyper stimulation
27
How often do you check phenytoin?
2 days in hospital if loading. Never the day after.
28
When was Dilantin discovered. By who. Why better than phenobarbital.
1908, biltz
| Less sedating then phenobarbital
29
Serious side effect of Dilantin
Purple glove syndrome.
| (Swollen extremity) requires amputation
30
Purple glove syndrome
Elderly given too much Dilantin
Swollen arm.
Amputate
31
Why don't we use Iv Dilantin.
Because of purple glove syndrome
| Explains use of Iv phenytoin cerebrex.
32
Loading dose of Dilantin oral
300 mg. wait 300 wait 300. There is a formula.
33
Problem with Dilantin?
Tough to control level.
34
Keppra aka
Le ve ti rac e tam
35
Trouble with keppra 2
Can use with kidney problems
| Irritability
36
Functional weakness test
Leg cross
37
Side effect of Dilantin
Hursutism
| Gingival hypertrophy
38
Depokote problems
Doesn't titrate well.
39
How long does it take for keppra to reach steady state.
2 days.
40
How do you load keppra
1500 mg Iv
41
Vimpat aka
La co samide
42
Vvimpat was approve in ---- as a ----
2008, adjunct for partial onset seizures. And diabetic neuropathic pain
43
What schedule is vimpat
5
44
Mechanism of vimpat
Voltage gated sodium channel
Enhances slow inactivation, no affect on fast activation
Lacosamide only inhibits neurons that have been repetitively firing neurons
45
What is really cool about vimpac or lacosamine
It blocks Collapsin response mediator protein (crmp) cr military police
Crmp inhibition blocks not connections
46
How is vimpat absorbed.
Gut
47
Why is vimpat have few interactions
Has low plasma binding
48
When does vimpac reach blood plasma concentration
1 to 4 hrs
49
Half life is for vimpac
12 to 16 hr. Bid.
50
What do you have to check before prescribing vimpac
Kidney fx. Because it is 95 p renal
51
Why is vimpac a good adjunct
Has no interactions 3a4
| Safe
52
How do you dose vimpac
Oral 50 mg bid, up to 400 mg bid. 600 didn't do anything
53
How is vimpac administered what forms
Oral solution 10 mg / ml or 5 ml bid
Injected 200 mg/20 ml
54
Vimpac show promise in
Tardive dyskinesia, schizo, anxiety, essential tremor
55
What else does vimpac cover
```
Pain
Schizo
Essential tremor
Anxiety
Diabetic neuropathy pain 400mg/day
```
56
Side effects of vimpac
```
Dizzy
Ataxia
Vomiting
Diplopia
Nausea
Vertigo
Blurred vision
Forgetful
Depression
```
57
Warn pt about vimpat
Si for 1 week, doubles .2% to .4%
Bad for babies pregnancy
Dose dependent malformations in Zebra fish
58
Off label uses if vimpac
Bipolar
Pain
Dementia
Finromialgia
59
What uti drug causes seizure
Cipro
60
Half life of Dilantin
22 to 27
61
If having recurrent seizures on Dilantin 1 time per day what can you do
Spread out dose to ensure she isn't coming down
62
Alzheimer's and hydrocephalus
Hydrocephalus evacumin
| No shunt
63
What do you call intractable seizure that are fake
Pseudo intractable seizures
64
What is a good medications for generalized seizures
Keppra.
65
Define prolonged seizure activity
30 min
66
Most seizures last
20 to. 90 sec
67
If you have a seizure during pregnancy you have a blank chance of fetal loss
25 percent
68
What percent of epileptics have normal pregnancy
90 healthy
69
How to monitor pregnant woman with aed
Avoid trigger
Monitor levels often
Reduce drug reigning by 1 drug
Talk follicles and vitamins
70
What is the mechanism of keppra
Inhibits presumptive calcium channels
Binds to glycoproteins sv2a
Synaptic vesicles glycoproteins
71
Side effects of keppra are
```
Sleepiness
Weakness
Headache
Dizziness
Infection
```
72
What are the interaction of keppra
None
73
What is the max dose of keppra
3000 per day
1500 bid
3000 bid was given without side effects
74
Off label uses of keppra 6
```
Neuropathic pain
Tourette
Bipolar
Anxiety
Alzheimer's
Essential tremors
```
75
Half life of keppra
7 hrs
76
How Long does it take for keppra to reach steady state
2 to 4 days
77
How long does keppra take to clear the blood
2 days
78
Does keppra interact with cyp450
No
79
If u are on lamictal and deplore what do you need to do
Take less lamictal
| Deplore increases lamictal levels
80
What med is self inhibiting
Neurontin
81
What pregnancy category is keppra
C
| 1:3000 cases
82
How long dose it take for keppra to reach a therapeutic level after a loading dose
10 min
83
Loading dose of keppra
750 to 1000 mg
| 1500 for men fat
84
What percentage of keppra stop status 1000
70 percent 2009
85
What do you call myoclonus after anoxic encephalopathy
Post anoxic myoclonus
86
Treatment for post anoxic myoclonus
Keppra
Valoroic
And klonopin
87
When do you need a second drug
If there was absolutely no response to first drug
| If there is a response than you don't need to add another drug
88
What concentration is the solution of is keppra
100mgml
89
How long is the keppra infusion
5 to 15
90
Time to reach maximum plasma concentrations
1 hr ir
| 4 hr dr
91
What are the odds of having a deformed baby with depakote
6%
92
Dose for vimpat
100 mg bid
Increase by 50 weekly
Max 200 bid
Renal dose max 150 mg bid
93
Vimpat and interaction
Ibuprofen
Abx
fungal
94
Side effects of vimpat
Dizzy 30
Diplopia 11 %
Ha/ nausea
Tremor 7%
95
Vimpat and heart issues
Dose dependent prolongation of PR interval
96
What catagory is vimpat
Cat c
97
Mechanism of vimpat
Crmp 2 phosphoprotein
98
Half life of vpat
13 hr
| Medscape
99
How is vimpat administered
Im
| Iv
100
How much benzo do you give for a seizure
Enough
101
How often do you give Ativan in a seizure
2 q 2
102
How much keppra do you use to load
1500 to 2000
| Kidney problems can even get 1500
103
Best drug for myoclonus
Depakote
104
Half life of keppra
7 hr
105
Half life of vimpat
13hr
| 3 days steady
106
Half like if depacon
16 hr
107
Half life of Dilantin
22hr
108
Half life of phosphenytoin
15 min to convert to phosphenytoin
| 22 hr phenytoin
109
Loading dose of keppra
1500 to 2000
110
Loading dose of depacon
15 mg/ kg
| 2000 mg
111
Loading dose of Phosphenytoin
15 mg/kg
| To 20 mg toxic
112
Loading dose protocol for vimpat
200 mg in 15 min
Then 100 mg bid
Therapeutic in 1 day
113
Does dilantin dialysize off
No. Not cleared. Keppra is.
114
Loading does of depakene
1500
115
What does val proic do to eyes
Dialates. Mydriasis
