Anticonvulsants

Question 1

Phenobarb is what class of med?

Answer 1

Barbituate

Question 2

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

Answer 2

False, usually incomplete seizure control

Question 3

Phenobarb is ___-line management for neonatal seizures

Answer 3

1st-line

Question 4

What are the indications for use of Phenobarb?

Answer 4

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

Question 5

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

Answer 5

Keppra

Question 6

What are the advantages of Phenobarbital use?

Answer 6

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

Question 7

What are the disadvantages of Phenobarbital use?

Answer 7

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

Question 8

What are the other conditions Phenobarbital may be used?

Answer 8

NAS

Cholestasis (enhances bile secretion)

Question 9

How does Phenobarbital work?

Answer 9

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

Question 10

True/False: Phenobarb has a large Vd?

Answer 10

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

Question 11

As GA increases, the Vd of Phenobarb _______.

Answer 11

Decreases

so as total body water decreases, the body fat increases

Question 12

Do you give a loading dose of Phenobarbital?

Answer 12

Yes, 20 mg/kg IV

Question 13

How often can additional doses be given after the load?

Answer 13

30-60 min for persistent seizures

Question 14

What is the therapeutic level of Phenobarbital?

Answer 14

30-40 mcg/mL

Question 15

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

Answer 15

True

Question 16

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

Answer 16

Higher doses

Larger Vd

Question 17

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?

Answer 17

Respiratory depression
Coma

Bradycardia (too)

Respiratory depression & death

Question 18

What is the T2 of Phenobarbital?

Answer 18

100-200 hours in a newborn

Question 19

Phenobarb is metabolized where?

Excreted by?

Answer 19

Liver

Kidneys/in urine

Question 20

Lorazepam (Ativan) is what type of drug?

Answer 20

Anticonvulant

Question 21

When is Ativan used for seizures?

Answer 21

When they are refractory to conventional therapy

Question 22

Lorazepam has dose-dependent _____ depression

Answer 22

CNS depression

Question 23

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

Answer 23

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

Question 24

Can IV ativan be repeated?

Answer 24

yes, is given slow-push

Question 25

What are the adverse effects of Ativan?

Answer 25

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

Question 26

Levetiracetam is also known as?

Answer 26

Keppra, LEV

Question 27

Keppra is what type of medication?

Answer 27

Anticonvulsant

Question 28

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

Answer 28

2nd line refractory to Phenobarbital

Question 29

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

Answer 29

Yes

Question 30

How does Keppra work?

Answer 30

Inhibits burst firing without affecting neuronal excitability

Question 31

What are the therapeutic levels of Keppra? | Are levels usually run?

Answer 31

10-40 mcg/mL | No

Question 32

What are the adverse effects of Keppra? | Are they common?

Answer 32

Minimal: | Somnolence, Fatigue, Ataxia, H/A, Behavioral changes

Question 33

Phenytoin is also known as?

Answer 33

Dilantin

Question 34

Phenytoin is an....?

Answer 34

Anticonvulsant

Question 35

What are the indications of Phenytoin?

Answer 35

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

Question 36

Phenytoin continues to be used along with what other drug?

Answer 36

Phenobarbital

Question 37

How does Phenytoin work?

Answer 37

- 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

Question 38

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

Answer 38

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

Question 39

How is Phenytoin metabolized?

Answer 39

Liver

Question 40

Is Phenytoin given as a load + maintenance?

Answer 40

Yes, start w/load

Question 41

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

Answer 41

True: bradyarrythmias & hypotension

Question 42

Phenytoin is only compatible with?

Answer 42

NS

Question 43

Is therapeutic monitoring of Phenytoin recommended?

Answer 43

Yes to minimize risk of toxicity

Question 44

Are there many pharmacodynamic/pharmacokinetic interactions w/Phenytoin?

Answer 44

Yes, need to be considered very carefully

Question 45

Is the therapeutic range for Phenytoin narrow or broad?

Answer 45

Narrow