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Seizure > Anticonvulsants > Flashcards

Anticonvulsants Flashcards

0
Q

What do you have to correct for with Dilantin?

A

The albumin

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1
Q

Dilantin level

A

Ten to 20

10 to 29 dildos

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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

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3
Q

Property of phenytoin that is nice with afib

A

Class 1 b antiarrythmic makes it good for afib.

Vtach

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4
Q

How long does it take for anticonvulsant Dilantin effects.

A

5 to 10 says

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5
Q

Dilantin treats all seizures except

A

Pure absence

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6
Q

Dilantin is metabolized by. And excreted by.

A

Liver, bile

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7
Q

Why do you need to correct phenytoin

A

90 percent protein bound. Albumin

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8
Q

After tegretol what is drug of choice in trugeminal neuralgia.

A

Dilantin

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9
Q

Why should you not give phenytoin im?

A

Shin necrosis

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10
Q

How do you does obese w Dilantin?

A

Use ideal body weight

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11
Q

What. Can be a problem with elder and phenytoin

A

Early signs of toxicity.

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12
Q

Prego category for phenytoin

A

Death. Cleft lip
Fetal hydrant pin syndrome
Can use in orego if abs necessary.

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13
Q

What do you do for liver failure with seizure with Dilantin?

A

No loading dose?

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14
Q

standard loading dose phosphytoin

A

10 to 20 mg/ kg ideal body wt

Phosphentoin is Iv

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15
Q

What if you can’t give Iv phosphytoin

A

Give extra dose of home medication

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16
Q

Max dose of phos phenytoin is —mg? Why

A

50 mg. hypotension Iv

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17
Q

Rate of phosphenytoin.

A

No more than 50mg / hr

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18
Q

OrAl phenytoin should be used when

A

Fear of hypotension

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19
Q

Consequences of phenytoin

A 
Vertical nystagmus 
Lateral gaze
Diplopoda
Sedation
Dysarthria
Tremor
Cerebellum degradation atrophy
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20
Q

What does Dilantin do to blood levels

A

Decrease folate acid. Inhibits enzyme
Megalobladtic anemia
Gingival involvement

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21
Q

Describe fetal hydration syndrome

A 
Like fetal etoh syndrome
Broad nasal bridge
Cleft palate 
Microcephalic 
MR 70
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22
Q

Si risk w Dilantin

A

Twice the so risk with Dilantin

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23
Q

Syndrome assoc with Dilantin.

A

Lupus

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24
Q

Immune and Dilantin

A

IgA deficiency

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25
Q

Interactions with Dilantin

A

Warfarin

Antacid

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26
Q

Mechanism of Dilantin

A

Volt. Dependent sodium channels in motor cx
Increases steady state inactivation
Protects u from hyper stimulation

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27
Q

How often do you check phenytoin?

A

2 days in hospital if loading. Never the day after.

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28
Q

When was Dilantin discovered. By who. Why better than phenobarbital.

A

1908, biltz

Less sedating then phenobarbital

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29
Q

Serious side effect of Dilantin

A

Purple glove syndrome.

(Swollen extremity) requires amputation

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30
Q

Purple glove syndrome

A

Elderly given too much Dilantin
Swollen arm.
Amputate

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31
Q

Why don’t we use Iv Dilantin.

A

Because of purple glove syndrome

Explains use of Iv phenytoin cerebrex.

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32
Q

Loading dose of Dilantin oral

A

300 mg. wait 300 wait 300. There is a formula.

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33
Q

Problem with Dilantin?

A

Tough to control level.

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34
Q

Keppra aka

A

Le ve ti rac e tam

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35
Q

Trouble with keppra 2

A

Can use with kidney problems

Irritability

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36
Q

Functional weakness test

A

Leg cross

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37
Q

Side effect of Dilantin

A

Hursutism

Gingival hypertrophy

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38
Q

Depokote problems

A

Doesn’t titrate well.

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39
Q

How long does it take for keppra to reach steady state.

A

2 days.

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40
Q

How do you load keppra

A

1500 mg Iv

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41
Q

Vimpat aka

A

La co samide

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42
Q

Vvimpat was approve in —- as a —-

A

2008, adjunct for partial onset seizures. And diabetic neuropathic pain

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43
Q

What schedule is vimpat

A

5

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44
Q

Mechanism of vimpat

A

Voltage gated sodium channel
Enhances slow inactivation, no affect on fast activation
Lacosamide only inhibits neurons that have been repetitively firing neurons

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45
Q

What is really cool about vimpac or lacosamine

A

It blocks Collapsin response mediator protein (crmp) cr military police

Crmp inhibition blocks not connections

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46
Q

How is vimpat absorbed.

A

Gut

47
Q

Why is vimpat have few interactions

A

Has low plasma binding

48
Q

When does vimpac reach blood plasma concentration

A

1 to 4 hrs

49
Q

Half life is for vimpac

A

12 to 16 hr. Bid.

50
Q

What do you have to check before prescribing vimpac

A

Kidney fx. Because it is 95 p renal

51
Q

Why is vimpac a good adjunct

A

Has no interactions 3a4

Safe

52
Q

How do you dose vimpac

A

Oral 50 mg bid, up to 400 mg bid. 600 didn’t do anything

53
Q

How is vimpac administered what forms

A

Oral solution 10 mg / ml or 5 ml bid

Injected 200 mg/20 ml

54
Q

Vimpac show promise in

A

Tardive dyskinesia, schizo, anxiety, essential tremor

55
Q

What else does vimpac cover

A 
Pain
Schizo
Essential tremor
Anxiety
Diabetic neuropathy pain 400mg/day
56
Q

Side effects of vimpac

A 
Dizzy
Ataxia
Vomiting
Diplopia
Nausea
Vertigo
Blurred vision
Forgetful
Depression
57
Q

Warn pt about vimpat

A

Si for 1 week, doubles .2% to .4%
Bad for babies pregnancy
Dose dependent malformations in Zebra fish

58
Q

Off label uses if vimpac

A

Bipolar
Pain
Dementia
Finromialgia

59
Q

What uti drug causes seizure

A

Cipro

60
Q

Half life of Dilantin

A

22 to 27

61
Q

If having recurrent seizures on Dilantin 1 time per day what can you do

A

Spread out dose to ensure she isn’t coming down

62
Q

Alzheimer’s and hydrocephalus

A

Hydrocephalus evacumin

No shunt

63
Q

What do you call intractable seizure that are fake

A

Pseudo intractable seizures

64
Q

What is a good medications for generalized seizures

A

Keppra.

65
Q

Define prolonged seizure activity

A

30 min

66
Q

Most seizures last

A

20 to. 90 sec

67
Q

If you have a seizure during pregnancy you have a blank chance of fetal loss

A

25 percent

68
Q

What percent of epileptics have normal pregnancy

A

90 healthy

69
Q

How to monitor pregnant woman with aed

A

Avoid trigger
Monitor levels often
Reduce drug reigning by 1 drug
Talk follicles and vitamins

70
Q

What is the mechanism of keppra

A

Inhibits presumptive calcium channels
Binds to glycoproteins sv2a
Synaptic vesicles glycoproteins

71
Q

Side effects of keppra are

A 
Sleepiness
Weakness
Headache
Dizziness
Infection
72
Q

What are the interaction of keppra

A

None

73
Q

What is the max dose of keppra

A

3000 per day
1500 bid
3000 bid was given without side effects

74
Q

Off label uses of keppra 6

A 
Neuropathic pain
Tourette
Bipolar
Anxiety
Alzheimer's 
Essential tremors
75
Q

Half life of keppra

A

7 hrs

76
Q

How Long does it take for keppra to reach steady state

A

2 to 4 days

77
Q

How long does keppra take to clear the blood

A

2 days

78
Q

Does keppra interact with cyp450

A

No

79
Q

If u are on lamictal and deplore what do you need to do

A

Take less lamictal

Deplore increases lamictal levels

80
Q

What med is self inhibiting

A

Neurontin

81
Q

What pregnancy category is keppra

A

C

1:3000 cases

82
Q

How long dose it take for keppra to reach a therapeutic level after a loading dose

A

10 min

83
Q

Loading dose of keppra

A

750 to 1000 mg

1500 for men fat

84
Q

What percentage of keppra stop status 1000

A

70 percent 2009

85
Q

What do you call myoclonus after anoxic encephalopathy

A

Post anoxic myoclonus

86
Q

Treatment for post anoxic myoclonus

A

Keppra
Valoroic
And klonopin

87
Q

When do you need a second drug

A

If there was absolutely no response to first drug

If there is a response than you don’t need to add another drug

88
Q

What concentration is the solution of is keppra

A

100mgml

89
Q

How long is the keppra infusion

A

5 to 15

90
Q

Time to reach maximum plasma concentrations

A

1 hr ir

4 hr dr

91
Q

What are the odds of having a deformed baby with depakote

A

6%

92
Q

Dose for vimpat

A

100 mg bid
Increase by 50 weekly
Max 200 bid
Renal dose max 150 mg bid

93
Q

Vimpat and interaction

A

Ibuprofen
Abx
fungal

94
Q

Side effects of vimpat

A

Dizzy 30
Diplopia 11 %
Ha/ nausea
Tremor 7%

95
Q

Vimpat and heart issues

A

Dose dependent prolongation of PR interval

96
Q

What catagory is vimpat

A

Cat c

97
Q

Mechanism of vimpat

A

Crmp 2 phosphoprotein

98
Q

Half life of vpat

A

13 hr

Medscape

99
Q

How is vimpat administered

A

Im

Iv

100
Q

How much benzo do you give for a seizure

A

Enough

101
Q

How often do you give Ativan in a seizure

A

2 q 2

102
Q

How much keppra do you use to load

A

1500 to 2000

Kidney problems can even get 1500

103
Q

Best drug for myoclonus

A

Depakote

104
Q

Half life of keppra

A

7 hr

105
Q

Half life of vimpat

A

13hr

3 days steady

106
Q

Half like if depacon

A

16 hr

107
Q

Half life of Dilantin

A

22hr

108
Q

Half life of phosphenytoin

A

15 min to convert to phosphenytoin

22 hr phenytoin

109
Q

Loading dose of keppra

A

1500 to 2000

110
Q

Loading dose of depacon

A

15 mg/ kg

2000 mg

111
Q

Loading dose of Phosphenytoin

A

15 mg/kg

To 20 mg toxic

112
Q

Loading dose protocol for vimpat

A

200 mg in 15 min
Then 100 mg bid
Therapeutic in 1 day

113
Q

Does dilantin dialysize off

A

No. Not cleared. Keppra is.

114
Q

Loading does of depakene

A

1500

115
Q

What does val proic do to eyes

A

Dialates. Mydriasis

Seizure (4 decks)

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