Anticonvulsants- epileptics (AEDs)

Question 1

Epilepsy is a

Answer 1

seizure disorder

Question 2

Characteristics of epilepsy

Answer 2

1. Convulsive movements

2. loss of consciousness

Question 3

Cause of epilepsy

Answer 3

1. 75% are idiopathic (primary)
2. secondary to brain damage

ex: 
trauma
anoxia 
infection
CVA
neoplasm 

3. isolated seizures due to acute changes
   fever

hypoglycemia
electrolyte imbalance (dec Na)
acid-base imbalance
ETOH / drug use

Question 4

Suppress Na+ influx = hydantoins

Answer 4

phenytoin

Question 5

side effect of phenytoin

Answer 5

1. harmless pink-red urine
   warn the patient
2. • Headache
   • dizziness
   • sedation
   • diplopia
   • nystagmus = oscillation of cornea vertically or horizontally while trying to focus

• warn against fall, driving: sedation/drowsiness

avoid: 
herbs
CNS depressants (alcohol

3. • dysrhythmia
   • bradycardia
   • hypotension
   • syncope
4. gingival hyperplasia
   - frequent oral hygiene and dental checkups
5. Hirsutism
   - returns to normal when drug is discontinued

Question 6

Routes of phenytoin

Answer 6

PO: 
shake suspension well for 2 minutes 
if not it will not work 
IV: 
Extravasation 
- purple glove syndrome - sloughing

Question 7

when to take phenytoin

Answer 7

same time daily

do not discontinue abruptly

Question 8

requirement of phenytoin

Answer 8

dose adjustment is required:
check serum levels
- toxicity
- hypotherapeutic

narrow therapeutic range

Question 9

phenytoin decreases

Answer 9

decreases effect of oral contraceptives

warfarin

Question 10

contraindication for phenytoin

Answer 10

pregnancy

Question 11

phenytoin other considerations

Answer 11

diabetics must monitor hyperglycemia

blood dyscrasia
= abnormal size shape function

stop if rash develops=
may result in stephens-johnson syndrome

Question 12

Suppress Ca++ influx

Answer 12

valproic acid

Question 13

considerations of valproic acid

Answer 13

1. dose adjustments is required
   check serum levels
   - toxicity
   - hypotherapeutic

= narrow therapeutic range

Question 14

Side effects / adverse reactions of valproic acid

Answer 14

1. CNS
dizziness
ataxia 
diplopia 
impaired cognition 
nervousness 

2. pancreatitis : self- limiting to chronic inflammation of the pancreas – caused by: alcohol use, cholelithiasis, autoimmune, drugs
   - abdominal pain
   - N/V
3. thrombocytopenia

Question 15

Promotion of GABA release

Answer 15

gabapentin

Question 16

gabapentin secondary indications

Answer 16

1. neuropathic pain = abnormal sensation without external source
2. restless leg syndrome
3. fibromyalgia
   phantom pain
   paresthesia

other uses are discussed in pain slides

Question 17

side effects of gabapentin

Answer 17

1. monitor for drowsiness/dizziness
   confusion
   depression
   suicidal thoughts
2. ataxia and FALL risk
3. GI distress
   N/V
   diarrhea
   constipation

Question 18

enhance action of GABA

long acting barbiturates

Answer 18

phenobarbital

Question 19

phenobarbital indications

Answer 19

1. antiepileptic
2. sedative
3. hypnotic

Question 20

phenobarbital contraindications

Answer 20

1. pregnancy
2. with other sedative-hypnotics
   - alcohol
   - opoids

Question 21

phenobarbital MOA

Answer 21

GABA stimulation- neurotransmitter

Question 22

side effects of phenobarbital

Answer 22

1. respiration depression
2. bradycardia
3. ataxia (FALL) –> lack of voluntary coordination of muscle movements that can include gait abnormality, speech changes, abnormal eye movement
4. dependence and tolerance–> wean off to avoid withdraw symptoms and seizure–> only for short term use
   2 weeks or less
5. REM rebound –> vivid dreams and nightmares
6. hangover effect
7. skin eruption
8. constipation
9. paradoxical effects
10. decreased effects of oral contraceptives
    use secondary method

Question 23

phenobarbital schedule

Answer 23

long acting schedule IV

Question 24

Enhance action of GABA

benzodiazepines

Answer 24

clonazepam

diazepam

lorazepam

Question 25

azepams primary prescribed for

Answer 25

treating acute status epilepticus

• must be administered IV to achieve the desired response
• due to tolerance other anticonvulsants
  need to be given or
  dose adjustments within 6 months

Question 26

clonazepam
diazepam
lorazepam
OVERDOSE REVERSAL AGENT

Answer 26

flumazenil

Question 27

MOA & schedule of

clonazepam, diazepam, lorazepam

Answer 27

GABA stimulation

Schedule IV

Question 28

indications of clonazepam, diazepam, lorazepam

Answer 28

1. sedative
   - anxiolytic
   - preventing alcohol withdrawl symptoms (DT’s)
2. epilepsy- antiepileptic
3. spasms
   - centrally acting muscle relaxant
4. insomnia
   - hypnotic
5. anesthesia induction
   - sedative/hypnotic

Question 29

Other AED’s

Answer 29

cannabidiol CBD oil drop

Question 30

cannabidiol CBD oil drop - schedule

Answer 30

V = no risk of abuse

Question 31

cannabidiol CBD oil drop - indication

Answer 31

1. two types of rare and severe epilepsy in patients two years of age and older

Question 32

cannabidiol CBD oil drop - side effects

Answer 32

1. sleepiness
2. sedation
3. lethargy
4. liver failure
5. decreased appetite
6. diarrhea
7. rash
8. weakness
9. no euphoria
10. no psychoactive

THC component

Question 33

other considerations - cannabidiol CBD oil drop

Answer 33

there are many other brands of CBD but unapproved by FDA

marijuana is schedule 1 compound