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DPT 530 > Antiepileptic and Antispastic Medication > Flashcards

Antiepileptic and Antispastic Medication Flashcards

1
Q

what is epilepsy?

A

sudden attacks of excessive cortical neuronal discharge interfering w/brain function

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2
Q

what are seizures?

A

excessive cortical neuronal discharge causing involuntary mvt, disruption of autonomic regulation, illusions, and hallucinations

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3
Q

t/f: epilepsy and seizures are the same thing

A

false, epilepsy is the disorder, seizures are the event

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4
Q

t/f: pts often can tell when a seizure is coming on

A

true

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5
Q

what are the causes of epilepsy?

A

brain damage secondary to tumor, infection, stroke, TBI, CP, neurodegenerative disease, fever

channelopathies

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6
Q

what % of children with CP have seizures?

A

about 30-50%

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7
Q

febrile seizures are common in ___

A

children

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8
Q

how long do seizures usually last?

A

1-2 minutes

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9
Q

why do seizures stop naturally?

A

bc the brain can’t sustain that level of activity for long

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10
Q

seizures are not necessarily an emergency unless the last >5 minutes

A

true

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11
Q

what are the types of seizures?

A

generalized seizures

focal seizures

status epilepticus

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12
Q

what are generalized seizures?

A

seizures involving the entire cortex in both hemispheres

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13
Q

what type of seizures are tonic-clonic and absence seizures?

A

generalized seizures

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14
Q

what are tonic clonic seizures?

A

hypertonicity, stiffening muscles, jerky movement, may have sensation changes leading up to seizure

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15
Q

what are absence seizures?

A

brief, sudden loss of consciousness, looks like “blanking out” then coming back within a few seconds

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16
Q

are tonic clonic or absence seizures harder to detect?

A

absence seizures

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17
Q

what is a focal seizure?

A

affecting a restricted area of the cortex

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18
Q

what is status epilepticus?

A

a very serious results of seizures

a seizure lasting longer than 5 minutes or multiple seizures w/in 5 minutes w/o the person returning to normal consciousness b/w

EMERGENCY (can lead to death or brain damage and veg state or coma)

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19
Q

status epilepticus can results from ____ or ____ _____ seizures?

A

generalized, untreated focal

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20
Q

what are the treatment options for epilepsy?

A

pharmacotherapy

brain surgery

neurostimulation

behavioral adjustments

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21
Q

what is the most common brain surgery for epilepsy?

A

temporal lobe resection

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22
Q

what is neurostimuation?

A

excessive excitation is monitored and sends signals

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23
Q

t/f: early and consistent rx is key in helping epilepsy

A

true

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24
Q

how do epileptic meds work?

A

suppress excitability of neurons initiating seizures to eliminate them and their frequency

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25
Q

what are behavioral adjustments for epilepsy?

A

stress management and getting a regular sleep schedule

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26
Q

what are the 4 mechanisms of action for antiepileptic meds?

A

1) increase inhibitory effects–> increase GABA

2) decrease excitatory effects–> decrease glutamate

3) decrease NA+ entry

4) decrease Ca2+ entry

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27
Q

antiepileptic meds need to ___ inhibition or ____ excitation or both

A

increase, decrease

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28
Q

what are the older drugs for epilepsy?

A

valproate, phenytoin, carbamazepine, primidone, ethosuxmide, Clonazepam, phenobarbital

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29
Q

do older or newer drugs for epilepsy have complex pharmaco kinetic profiles, and narrow therapeutic ranges

A

older

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30
Q

do older or newer drugs for epilepsy have fewer adverse effects and are therefore safer?

A

newer

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31
Q

what are the new drugs for epilepsy?

A

gabapentin, iamotrigine, topiramate, tiagabine, levetiracetam, zonisamide, oxcarbazepine, pregabalin, esilcarbazepine, vigabatrin, lacosamide, vufinamide

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32
Q

why do we still use older drugs for epilepsy if the newer drugs are safer?

A

we know more about the side effects of the older drugs

there are generic options for the older drugs

there is more flexibility in route of administration with the older drugs

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33
Q

what is the route of administration most times for antiepileptic drugs?

A

PO (by mouth)

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34
Q

describe the pharmacokinetics of antiepileptic drugs?

A

PO

extensive distribution w/in the body-needs to get to brain to work

narrow therapeutic window (esp older drugs)

drug interactions occur with many agents and may increase the half life

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35
Q

what are the first line drugs for tonic clonic seizures?

A

valproate (Valproicacia), Lamotrigine

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36
Q

what is the first line drug for absence seizures?

A

Ethosuximide

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37
Q

what are the first line drugs for focal seizures?

A

Phenytoin, Oxcarbazepine

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38
Q

what are alternative first line drugs for seizures?

A

Gabapentin, Pregabalin

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39
Q

what is Valproate (Depalcene, Depacon)?

A

indications: generalized and focal seizures (used for bipolar and migraines too)

one of the most effective anti-seizure meds we have

mechanism of action: broad spectrum of activity; inc concentrations of GABA in the brain; increase Na+

side effects:
- common-GI distress, weight gain, increased appetite, hair loss
- tremors

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40
Q

what is one of the most effective anti-seizure meds we have?

A

Valproate (Depaclene, Depacon)

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41
Q

what are the indications for Valproate (Depaclene, Depacon)?

A

generalized and focal seizures (used for bipolar and migraines too)

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42
Q

what are side effects of Valproate (Depaclene, Depacon)?

A

GI distress, weight gain, increased appetite, hair loss

tremors at higher doses

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43
Q

what is the mechanism of action of Valproate (Depaclene, Depacon)?

A

broad spectrum of activity

inc concentrations of GABA in the brain

increase Na+

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44
Q

t/f: Valproate should be avoided in the first trimester of pregnancy bc it has a 1-2% change for causing neural tube defect

A

true

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45
Q

what is Lamotrigine (Lamictal)?

A

indications: tonic-clonic seizures, focal seizures (also used for bipolar to reduce the risk of relapse); known to improve depression in pts with epilepsy

mechanism of action: inactivate volatage-gated Na2+ channels

side effects:
- common: dizziness, headache, ataxia, vision problems (diploplia)
- rash-potentially fatal
- tremor at higher doses
- insomnia

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46
Q

what are the indications for Lamotrigine (Lamictal)?

A

tonic-clonic seizures

focal seizures

used for bipolar to reduce the risk of relapse

known to improve depression symptoms in pts with epilepsy

47
Q

what is the mechanism of action of Lamotrigine (Lamictal)?

A

inactivate volatage-gated Na2+ channels

48
Q

what are the side effects of Lamotrigine (Lamictal)?

A

common: dizziness, headache, ataxia, vision problems (diploplia)

rash-potentially fatal

tremor at higher doses

insomnia

49
Q

t/f: Lamotrigine (Lamictal) is known to improve depression symptoms in pts with epilepsy

A

true

50
Q

what is Ethosuximide (Zarontin)?

A

indications: absence seizures

mechanism of action: dec Ca2+ influx in thalamic neurons; depression of motor cortex and elevation of the threshold of the CNS to convulsive stimulation

side effects: GI distress, headache, dizziness, lethargy, fatigue, movement disorder (dyskinesia, bradykinesia)

51
Q

what are the indications for Athosuximide (Zarontin)?

A

absence seizures

52
Q

what are the mechanisms of action of Ethosuximide (Zarontin)?

A

dec Ca2+ influx in thalamic neurons

depression of motor cortex and elevation of the threshold of the CNS to convulsive stimulation

53
Q

what are the side effects of Athosuximide (Zarontin)?

A

GI distress, headache, dizziness, lethargy, fatigue, movement disorder (dyskinesia, bradykinesia)

54
Q

do antiepileptic meds have generally long or short half lives?

A

long

55
Q

the interaction bw Valproate and Lamotrigine leads to a ___ in half life up to ___ hours

A

increase, 70

56
Q

what is Phenytoin (Dilantin, Phenytex)?

A

indications: tonic-clonic and focal seizures

mechanism of action: block Na+ channels, act on the motor cortex and inhibits the spread of seizure activity

side effects: GI irritation, confusion, sedation, double vision, ataxia

57
Q

what are the indications for Phenytoin (Dilantin, Phenytex)?

A

tonic-clonic and focal seizures

58
Q

what are the mechanisms of action of Phenytoin (Dilantin, Phenytex)?

A

block Na+ channels

act on the motor cortex and inhibits the spread of seizure activity

59
Q

what are the side effects of Phenytoin (Dilantin, Phenytex)?

A

GI irritation, confusion, sedation, double vision, ataxia

60
Q

what is Gabapentin (Neurotitan), Pregabalin (Lyrica)?

A

indication: focal seizures; neuropathic pain, restless leg syndrome, anxiety disorders

structurally related to GABA-synthetic GABA that works in the brain

mechanism of action: inc GABA concentrations; dec excitatory, and block Ca2+ channels

common side effects: clumsiness/unsteadiness, uncontrolled eye movement (nystagmus), sedation

61
Q

what are the indications for Gabapentin (Neurotitan), Pregabalin (Lyrica)?

A

focal seizures

also used for neuropathic pain, restless leg syndrome, anxiety disorders

62
Q

what are the mechanisms of action of Gabapentin (Neurotitan), Pregabalin (Lyrica)?

A

inc GABA concentrations

dec excitatory, and block Ca2+ channels

63
Q

what are the common side effects of Gabapentin (Neurotitan), Pregabalin (Lyrica)?

A

clumsiness/unsteadiness, uncontrolled eye movement (nystagmus), sedation

64
Q

what are other drugs used in the management of seizures and epilepsy?

A

benzos

65
Q

what are benzos used for?

A

status epilepticus

66
Q

are benzos taken long term for epilepsy? why or why not?

A

no bc of their risk for tolerance, dependence, and addiction

67
Q

what are the benzo drugs?

A

Ativan, Valium, Klonopin, Xanax

68
Q

what are the common side effects when starting antiepileptic meds?

A

nausea, abdominal pain, dizziness, lethargy, irritability, anxiety, or mood changes

69
Q

what are side effects that can occur with higher doses of antiepileptic meds?

A

motor side effects are common

unsteadiness/ataxia, poor concentration, sleepiness, diploplia, vomiting, tremor

70
Q

what side effects are specific to certain antiepileptic meds?

A

rash, hepatic toxicity, severe behavior disturbance, worsening of seizures

71
Q

t/f: many antiepileptic meds are teratogenic

A

true

72
Q

what does it mean that a drug is teratogenic?

A

they can lead to birth defects, CV defects, cognitive delays, or facial abnormalities

73
Q

what are the PT implications for antiepileptics?

A

know if a pt has a hx/risk for seizures

monitor efficacy and toxic effects of their meds (note changes in s/s and frequency of seiures)

schedule pt appropriately (more side effects right after taking meds, so may not want to see them at this time)

environmental considerations: stress and anxiety triggers

pt education on sleep hygiene

pt advocacy

74
Q

what are common epileptic triggers?

A

stress and anxiety

loud noises, bright/flashing lights

75
Q

what is spasticity?

A

velocity dependent hypertonicity

76
Q

what are spastic disorders?

A

UMN lesions, CP, ALS, MS, stroke, SCI, TBI

77
Q

what is the primary goal of muscles relaxants?

A

to selectively decrease skeletal muscle excitability or the motor neurons leading to spasticity

78
Q

what are the 2 mechanisms of action for muscle relaxants?

A

1) increase the effects of GABA in the CNS

2) polysynaptic inhibition in the SC

79
Q

what are some drugs commonly prescribed for spasticity?

A

Baclofen

Diazepam

Gabapentin

Dantrolene Sodium

Botulinum toxin (Botox)

80
Q

what is Baclofen (Gablofen, Lioresal, Kemstro)?

A

a synthetic GABA that selectively bind to GABAb receptors in the SC to decrease excitation of alpha motor neurons

81
Q

how is baclofen administered?

A

orally or intrathecally

82
Q

does baclofen work better for conditions of the SC or brain?

A

SC (MS, SCI)

not so much for brain (CP, stroke)

83
Q

what are intrathecal injections?

A

catheter and pump deliver drug to subarachnoid space of the SC

84
Q

when would intrathecal injections of baclofen be used?

A

with severe spasticity

85
Q

intrathecal injections decrease spasticity with ___ drug, and ___ side effects

A

less, fewer

86
Q

when pts don’t respond to oral baclofen, what is done?

A

intrathecal injection

87
Q

t/f: intrathecal baclofen can be programmed or have control

A

true

88
Q

what are therapeutic classifications of Diazepam (Valium)?

A

muscles relaxants, sedative and antiepileptic

89
Q

what else can diazepam (valium) be used for?

A

anxiety and minor surgeries due to sedative effects

90
Q

what is the mechanism of action of Diazepam (Valium)?

A

inc GABA-mediated inhibition

91
Q

long term use of Diazepam (Valium) is limited by what?

A

tolerance and dependence risk

92
Q

is Dantrolene sodium (Dantrium) a CNS agent?

A

NO

93
Q

what does Dantrolene sodium (Dantrium) do?

A

it inhibits Ca2+ channel opening in skeletal muscles which reduces the effect of muscle contractions and enhances relaxation

94
Q

what is Dantrolene effective in treating?

A

severe spasticity, regardless of the pathology

95
Q

what muscle spasms is Dantrolene not effective in treating?

A

muscles spasms of a peripheral origin like musculoskeletal injury

96
Q

t/f: Dantrolene sodium is safe for children under 5

A

false

97
Q

what is a consequence of long term use of Dantrolene?

A

hepatotoxicity

98
Q

how is Dantrolene sodium administered?

A

oral or IV

99
Q

is botulinum toxin a CNS agent?

A

NO

100
Q

what does botulinum toxin do?

A

it a muscle paralytic (neurotoxin) that reduces spastic dominence

101
Q

where is botulinum toxin injected?

A

locally at a muscle or muscle group for spasticity or severe spasms

102
Q

what are the 2 serotypes of botulinum toxin that are effective in humans?

A

Type A (Botox, Dysport)

Type B (Myobloc)

103
Q

relaxation/paralysis from botulinum toxin occurs within ____ days and lasts ____ months

A

3-7, 2-3

104
Q

what does the reduced spasticity dominance from botulinum toxin result in?

A

neuromuscular training needs to occur due to possible weakness

increased residual function

improvements in ADLs

bracing may be needed

105
Q

what are the side effects of botulinum toxin?

A

local irritation of the injection site, headache, muscle aches

potential for antibody production that would make the Botox ineffective

106
Q

each set of botulinum toxin injections should limited to ____ muscles/groups of muscles at a time

A

1-2

107
Q

why are botulinum toxin injection limited to 1-2 muscles/groups at a time?

A

bc of their potential to spread through the body and to the heart

108
Q

early antispasticity meds are___

A

oral

109
Q

t/f: rx of focal or regional spasticity w/botulinum toxin injections can be started early

A

true

110
Q

later in treatment of spasticity, intervene with botulinum toxin injections where?

A

in selective key muscles to modify synergistic movement

111
Q

what are common side effects of antispastic meds?

A

sedation/drowsiness/lethargy

dizziness

headache

nausea/vomiting

dry mouth

ataxia

depression

tolerance and physical dependence with long term use

112
Q

t/f: side effects of antispastic meds can be improved by adjusting the dose of meds

A

true

113
Q

what are some PT implications for use of antispastic meds?

A

the meds complement PT interventions by decreasing spasticity so that we can work with them

there can be a drastic change in muscle tone over a relatively short period of time, so be aware of the laxity of tendinous structures that can lead to hypermobility, weakness, suppression of residual fxn, proper body mechanics, and documentation (of meds and pt responses)

reassess equipment and appropriate rehab services

DPT 530 (14 decks)

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