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PHARM > Antiepileptic > Flashcards

Antiepileptic Flashcards

1
Q

whats a seizure vs convulsion?

A

Seizure
Brief episode of abnormal electrical activity in nerve cells of the brain, which may or may not lead to a convulsion
Convulsion
Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal, facial, and ocular muscles

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2
Q

epilepsy is?

A

chronic, recurrent pattern of seizures.

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3
Q

Primary (idiopathic) epilespy

A

Cause cannot be determined.
Roughly 50% of epilepsy cases

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4
Q

Secondary (symptomatic) epilepsy

A

Distinct cause is identified.
Trauma, infection, cerebrovascular disorder

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5
Q

whats the drug for immediate treatment of status epilepticus?

A

Diazepam (Valium)

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6
Q

what are epileptic drugs known as?

A

Anticonvulsants

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7
Q

how long are people on antiepileptic drugs?

A

Usually lifelong treatment and combination of drugs may be used.

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8
Q

what should be measured?

A

Serum drug concentrations and therapeutic drug monitoring.

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9
Q

Serum concentrations of what drugs correlate better with seizure control and toxicity than do those of valproic acid, ethosuximide, and clonazepam.

A

phenytoin, phenobarbital, carbamazepine, and primidone

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10
Q

Antiepileptic drugs traditionally used to manage seizure disorders include:

A
  • Barbiturates
  • Hydantoins
  • Iminostilbenes plus valproic - acid
  • Second- and third-generation antiepileptics
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11
Q

Pharmacological effects include?

A

Reduce nerve’s ability to be stimulated
Suppress transmission of impulses from one nerve to the next
Decrease speed of nerve impulse conduction within a neuron

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12
Q

Antiepileptic Drugs:Indications

A

Prevention or control of seizure activity
Long-term maintenance therapy for chronic, recurring seizures
Acute treatment of convulsions and status epilepticus
Other uses

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12
Q

Long-term therapy with ______ may cause gingival hyperplasia, acne, hirsutism, and Dilantin facies.

A

phenytoin (Dilantin®)

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13
Q

what should you do if adverse effects occurs with antiepileptic drugs?

A

Adverse effects often necessitate a change in medication.

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14
Q

Antiepileptic Drugs: Contraindications

A

Drug allergy
Pregnancy

Sometime, prescribers weigh the fetal versus mother risk of maternal epilepsy and look to newer generation of drugs

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15
Q

_________ has shown congenital spinal malformations such as spina bifida

A

Dilantin

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16
Q

Antiepileptic Drugs: Interactions - Phenytoin

A

Certain antibiotics, antifungals and SSRI’s reduce clearance and increase toxicity; increased free warfarin levels (bleeding )

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17
Q

Antiepileptic Drugs: Interactions - Carbamazepine

A

Increased metabolism of acetaminophen and its reduced efficacy

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18
Q

Antiepileptic Drugs: Interactions - Valporic acid

A

Aspirin displaces valproric acid from protein binding to increase levels and toxic risk

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19
Q

Many drugs have narrow therapeutic index so require lab drug monitoring such as:

A

phenytoin, valproic acid, phenobarbital, carbamazepine

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20
Q

what are the barbituates?

A

Phenobarbital and primidone

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21
Q

Most common adverse effects of barbiturates?

A

sedation

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22
Q

whats the the therapeutic effects of barbituates?

A

serum drug levels of 15 to 40 mcg/mL

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23
Q

contraindications of barbituates?

A

known drug allergy, porphyria, liver or kidney impairment, respiratory illness

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24
Q

adverse effects of barbituates?

A

cardiovascular, central nervous system (CNS), gastrointestinal (GI), and dermatological reactions

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25
Q

What drug is a hydantoins?

A

Phenytoin sodium

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26
Q

What has been used as a first-line drug (prototypical drug)?

A

Phenytoin (Dilantin)

27
Q

Adever effects of phenytoin sodium?

A

lethargy, ataxia, mental confusion, gingival hyperplasia, acne, hirsutism, Dilantin facies, and osteoporosis (long term)

28
Q

whats the therapeutic drug level of phenytoin sodium?

A

Therapeutic drug levels are usually 10 to 20 mcg/mL.

29
Q

how to administer phenytoin sodium?

A

Intravenous (IV) admin.
Very irritating to veins.
Slow IV directly into a large vein through a large-gauge (20-gauge or larger) venous catheter.
Diluted in normal saline for IV infusion.
Filter must be used.
Saline flush .

30
Q

whats the second most commonly prescribed antiepileptic drug in Canada after phenytoin

A

carbamazepine (Tegretol®)

31
Q

carbamazepine (Tegretol®) does?

A

Autoinduction of hepatic enzymes

32
Q

oxcarbazepine (Trileptal®) what is it?

A

Chemical analogue of carbamazepine
Precise mechanism of action has not been identified.

33
Q

ethosuximide (Zarontin®) what is it?

A

Used in the treatment of uncomplicated absence seizures
Not effective for secondary generalized tonic-clonic seizures

34
Q

ethosuximide contraindications?

A

known allergy

35
Q

adverse fx of ethosuximide?

A

GI and CNS effects

36
Q

Drug interactions of ethosuximide?

A

hepatic enzyme–inducing drugs

37
Q

gabapentin (Neurontin®) what is it?

A

Chemical analogue of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity
Believed to work by increasing the synthesis and synaptic accumulation of GABA between neurons

38
Q

Contraindicatioon of gabapentin?

A

known drug allergy

39
Q

adverse fx of gabapentin?

A

CNS and GI symptoms
Oral use only

40
Q

lamotrigine (Lamictal®) what is it?

A

Also used for the treatment of bipolar disorder, Oral use only

41
Q

lamotrigine contraindications?

A

drug allergy

42
Q

adverse fx of lamotrigine

A

relatively minor CNS and GI symptoms and possible Stevens-Johnson syndrome

43
Q

Valproic acid what is it?

A

Also used for absence and myoclonic seizures

44
Q

contraindications of valporic acid

A

drug allergy, liver impairment

45
Q

adverse fx of valporic acid?

A

weight gain, hair loss.

46
Q

interactions of valporic acid?

A

aspirin to create toxic levels of valproic acid

47
Q

levetiracetam (Keppra®) what is it?

A

Adjunct therapy for focal seizures with and without secondary generalization, comes in oral and injectable forms.

48
Q

levetiracetam contraindications?

A

known drug allergy
Mechanism of action: unknown

49
Q

levetiracetam (Keppra®) adverse fx?

A

generally well tolerated, CNS effects

50
Q

pregabalin (Lyrica®) what is it?

A

structurally related to GABA, used for adjunct therapy for neuropathic pain, postherpetic neuralgia

51
Q

pregabalin (Lyrica®) indication?

A

Focal seizures

52
Q

pregabalin contraindications?

A

known drug allergy

53
Q

pregabalin adverse fx?

A

primarily CNS related

54
Q

Nursing Implications (assessments to do)?

A

Health history, including current medications
Drug allergies
Liver function studies, complete blood count
Baseline vital signs, weight
Dental hygience (remember problem with Dilantin)

55
Q

Take regularly, ______ to maintain blood levels; may need blood levels reassessed over time

A

SAME TIME EACH DAY

56
Q

how much fluids should you take while taking antiepleptics?

A

180-240ml

57
Q

what should you not take with carbamazepine?

A

grape fruit juice

58
Q

Use only normal saline with _________. D5W causes precipitate formation

A

IV phenytoin (Dilantin)

59
Q

Encourage daily oral care and frequent dental visits to monitor and possibly manage what?

A

gingival hyperplasia

60
Q

can you discontinue an AED abruptly?

A

AEDs should not be discontinued abruptly.

61
Q

what should you tell the patient about the therapy?

A

Teach patients that therapy is long term and possibly lifelong (not a cure).

62
Q

what therapeutic effcets should you expect?

A

Decreased or absent seizure activity

63
Q

Monitor for general adverse effects such as?

A

Mental status changes, mood changes, changes in level of consciousness or sensorium
Eye problems, visual disorders
Sore throat, fever (blood dyscrasias may occur with hydantoins)
Many others

64
Q
A

PHARM (20 decks)

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