Chapter 22 Exam Flashcards by Cailee Meyers

Anticonvulsants

•reduce the number and/or severity of seizures in patients with epilepsy

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Epilepsy

recurrence of unprovoked seizures, characterized by sudden attacks of altered consciousness, motor activity, or sensory impairment

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Generalized seizures

bilaterally symmetrical and without local onset

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generalized seizures occur in what percent of patients with epilepsy?

40%

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what causes partial seizures?

•Caused by a lesion in the temporal lobe of the brain and limited to one cerebral hemisphere

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partial seizures account for what percent of new cases of epilepsy?

•account for up to 60% of new cases of epilepsy

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simple=?

no loss of consciousness

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partial seizures usually have what type of symptoms?

complex symptoms

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Status epilepticus

•seizures are prolonged or so frequent that the patient doesn’t regain consciousness between seizures

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status epilepticus is considered….

a true neurological emergency

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Unilateral seizures

•Affect only one side of the body

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First-Generation Anticonvulsants

•Prophylactic treatment of generalized and partial seizures should start with a single drug such as valproate, lamotrigine, levetiracetam, carbamazepine, oxcarbazepine, or phenytoin

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Goal of first-generation anticonvulsants

•Aim of therapy is to prevent seizures without oversedation; dosage adjusted as needed

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what is an example of first-generation anticonvulsants

•valproic acid (Depakote) is a broad-spectrum anticonvulsant

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Drug Therapy for Febrile Seizures-

•Involves searching for the cause of the fever and taking measures to control it

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Second-Generation Anticonvulsants examples

•gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), topiramate (Topamax), etc.

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what are 2nd generation anticonvulsants used for?

•For adjuvant treatment of partial (psychomotor) and generalized seizures

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2nd generation compared to 1st generation anticonvulsants

Not yet considered superior in efficacy for seizure control
Fewer adverse effects and drug interactions; does not require drug level monitoring; daily dosing

Parkinson’s disease

•Chronic neurological disorder characterized by fine, slowly spreading muscle tremors, rigidity, and generalized slowness of movement

what is one of the most common neurodegenerative diseases in adults?

parkinson’s disease

pathology of parkinsons….

Underlying pathology is not completely understood

is there a a cure for parkinsons disease?

Timeline of patients with parkinsons

•Patients with PD progress to severe disability over 10 to 20 years

how do antiparkinsonian drugs work?

•Normal dopamine activity as it relates to acetylcholine is diminished, with resulting relative overactivity of cholinergic output

goal of treatment for parkinsons disease...

relieve symptoms and maintain mobility

Levodopa function

crosses the blood-brain barrier, where it is converted to dopamine

what does carbidopa do?

enhances effects of levodopa, increasing therapeutic effect of dopamine in CNS and reducing adverse reactions

what is sinemet?

a combination of levodopa and carbidopa

when is sinemet most often used?

is most often used for long-term treatment

as PD progresses patients with most likely require what?

•As PD progresses, most patients will eventually require treatment with levodopa

what medicines are commonly used in conjunction with levodopa to delay the onset of levodopa-caused motor complications or used alone in early PD?

pramipexole (Mirapex) & ropinirole (Requip)

what effect can the dopamine agonists have?

• May reduce the required dose of levodopa for patients with advanced Parkinsons

amantadine

• antiviral agent that alters dopamine release and has anticholinergic properties

what does amantadine treat?

• Treats parkinsonism (extrapyramidal reactions)

when in parkinsons disease is amantadine used?

• Used early in the disease as monotherapy

amantadine's efficacy

• Its efficacy may wane rather quickly (weeks or months)

amantadine's benefit when added to ledopa

• Of little benefit when added to levodopa

COMT inhibitors function

• block the enzyme responsible for metabolizing peripheral levodopa

COMT inhibitors increase concentration of _____+_____

levodopa and dopamine

COMT inhibitors related to levodopa

• Allows for the patients dose of levodopa to be lowered and results in a decrease in the incidence or severity of the dose-related side effects of levodopa

what are drugs used to treat primary RLS?

• dopamine agonists pramipexole (Mirapex), ropinirole (Requip), and rotigotine (Neupro patch) are FDA-approved treatments

what second line agents are used to treat specific symptoms?

• Second-line agents gabapentin (Neurontin), benzodiazepines (such as clonazepam), and opioids (hydrocodone, oxycodone) are used for specific symptoms

RLS may be secondary to other causes including-

* Iron deficiency * Renal failure * Diabetes * Rheumatoid arthritis * Fibromyalgia, etc. * Treatment of secondary RLS focus on identifying and treating the underlying cause

Cholinesterase Inhibitors function...

- the delay of symptoms in AD • Prevent breakdown of acetylcholine in the synaptic cleft, thereby increasing acetycholine levels and improving cognitive function