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Neonatal Pharmacology > Anticonvulsants > Flashcards

Anticonvulsants Flashcards

1
Q

Phenobarb is what class of med?

A

Barbituate

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2
Q

True/False: Phenobarb is usually effective in achieving complete seizure control

A

False, usually incomplete seizure control

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3
Q

Phenobarb is ___-line management for neonatal seizures

A

1st-line

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4
Q

What are the indications for use of Phenobarb?

A
  1. Neonatal seizures
  2. Generalized Tonic-clonic seizures
  3. Partial seizures
  4. Prolonged febrile convulsions
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5
Q

Newer agents such as _______ may develop a role in the mgmt of neonatal seizures as experience in their use is gained.

A

Keppra

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6
Q

What are the advantages of Phenobarbital use?

A 
Wide spectrum of seizure activity
Wide therapeutic range
Availability IV & PO forms
Low cost
Extensive use in Pediatrics
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7
Q

What are the disadvantages of Phenobarbital use?

A 
Respiratory depression
Sedation
Physical dependence
Negative cognitive effects
Hyperactivity
Potential negative effects on developing neurons
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8
Q

What are the other conditions Phenobarbital may be used?

A

NAS

Cholestasis (enhances bile secretion)

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9
Q

How does Phenobarbital work?

A

potentiates inhibitory NT’s by prolonging the open state of GABA-mediated Na+ channels

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10
Q

True/False: Phenobarb has a large Vd?

A

True. It is distributed to all tissues, 50% bound to plasma protein

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11
Q

As GA increases, the Vd of Phenobarb _______.

A

Decreases

so as total body water decreases, the body fat increases

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12
Q

Do you give a loading dose of Phenobarbital?

A

Yes, 20 mg/kg IV

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13
Q

How often can additional doses be given after the load?

A

30-60 min for persistent seizures

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14
Q

What is the therapeutic level of Phenobarbital?

A

30-40 mcg/mL

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15
Q

True/False: effective seizure control has been r/t Phenobarb dose w/70% control in doses of 40 mg/kg

A

True

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16
Q

Infant’s requiring ECMO may need lower/higher doses of Phenobarbital to achieve effective serum concentrations.
Why?

A

Higher doses

Larger Vd

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17
Q

Serum concentrations of Phenobarbital 40-50 mcg/mL may produce what effects?

Levels >50 mcg/mL are a/w?

Levels >80 mcg/mL are a/w?

A

Respiratory depression
Coma

Bradycardia (too)

Respiratory depression & death

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18
Q

What is the T2 of Phenobarbital?

A

100-200 hours in a newborn

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19
Q

Phenobarb is metabolized where?

Excreted by?

A

Liver

Kidneys/in urine

20
Q

Lorazepam (Ativan) is what type of drug?

A

Anticonvulant

21
Q

When is Ativan used for seizures?

A

When they are refractory to conventional therapy

22
Q

Lorazepam has dose-dependent _____ depression

A

CNS depression

23
Q

Onset of action of Ativan is?
Peak concentration w/in?
Duration of action?
Mean T2 is?

A

5 minutes (quick!)
45 min
3-24 hrs
40 hrs

24
Q

Can IV ativan be repeated?

A

yes, is given slow-push

25
Q

What are the adverse effects of Ativan?

A

Respiratory depression
Rhythmic myoclonic jerking (preterm)
IV site-phlebitis/infiiltration
Monitor Renal fxn (excreted by kidneys)

26
Q

Levetiracetam is also known as?

A

Keppra, LEV

27
Q

Keppra is what type of medication?

A

Anticonvulsant

28
Q

Is Keppra 1st or 2nd line tx for seizures?

A

2nd line refractory to Phenobarbital

29
Q

Has Keppra been used as an alternative to Phenobarbital in neonates?

A

Yes

30
Q

How does Keppra work?

A

Inhibits burst firing without affecting neuronal excitability

31
Q

What are the therapeutic levels of Keppra?

Are levels usually run?

A

10-40 mcg/mL

No

32
Q

What are the adverse effects of Keppra?

Are they common?

A

Minimal:

Somnolence, Fatigue, Ataxia, H/A, Behavioral changes

33
Q

Phenytoin is also known as?

A

Dilantin

34
Q

Phenytoin is an….?

A

Anticonvulsant

35
Q

What are the indications of Phenytoin?

A
  • Second-line therapy for managing neonatal seizures
  • Status epilepticus
  • Generalized tonic-clonic seizures
  • Partial seizures with or without secondary generalization
36
Q

Phenytoin continues to be used along with what other drug?

A

Phenobarbital

37
Q

How does Phenytoin work?

A
  • Blockade of voltage-sensitive Na+ channels–>inhibiting repetitive neuronal firing
  • Alteration of Na+, K+, Ca++ conduction; membrane potentials; concentrations of AA’s; Norepinephrine, Acetylcholine; & GABA
38
Q

If increase in Phenytoin is needed, how should it be done?

Why?

A

Small, incremental dose increases

As therapeutic serum concentrations are approached, the fraction of drug eliminated per unit of time decreases

39
Q

How is Phenytoin metabolized?

A

Liver

40
Q

Is Phenytoin given as a load + maintenance?

A

Yes, start w/load

41
Q

True/False: the rate of infusion of Phenytoin is very important to prevent cardiac toxicity

A

True: bradyarrythmias & hypotension

42
Q

Phenytoin is only compatible with?

A

NS

43
Q

Is therapeutic monitoring of Phenytoin recommended?

A

Yes to minimize risk of toxicity

44
Q

Are there many pharmacodynamic/pharmacokinetic interactions w/Phenytoin?

A

Yes, need to be considered very carefully

45
Q

Is the therapeutic range for Phenytoin narrow or broad?

A

Narrow

Neonatal Pharmacology (17 decks)

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