Drugs Affecting Neurologic Functioning: Part 3 Flashcards by Jenna Wahler

Epilepsy

Seizure generation

-Synchronous, high-frequency discharge from a group of neurons (FOCUS)

How well did you know this?

Not at all

Perfectly

Clinical symptoms of epilepsy depend on…

Location of seizure FOCUS

How well did you know this?

Not at all

Perfectly

Simple partial seizure

No LOC

Ex: twitchy thumb, sensory numbness

How well did you know this?

Not at all

Perfectly

Partial complex seizure

Loss of consciousness
Automatisms
Will not be “with you”

How well did you know this?

Not at all

Perfectly

Generalized: Tonic-clonic seizure

Major convulsions

Has post-ictal stage

How well did you know this?

Not at all

Perfectly

Generalized: Absence seizure

Brief loss of consciousness
Mild motor activity
Can have hundreds a day

How well did you know this?

Not at all

Perfectly

Mechanisms of action of anti epileptic drugs

Suppression of sodium influx
Suppression of calcium influx
Antagonism of glutamate
Potentiation of GABA

How well did you know this?

Not at all

Perfectly

What is glutamate?

Excitatory neurotransmitter

How well did you know this?

Not at all

Perfectly

What is GABA?

Inhibitory neurotransmitter

How well did you know this?

Not at all

Perfectly

What does suppressing the influx of sodium do?

Causes prolonged inactivation

How well did you know this?

Not at all

Perfectly

Monitoring Plasma drug levels: Tonic clonic seizures

Plasma drug levels
are used to adjust dosing of medications to an effective level
-Monitor patient adherence
-Identify causes of toxicity

How well did you know this?

Not at all

Perfectly

Traditional Anti-epileptic drugs

Phenytoin (Dilantin)
Carbamazepine (Tegretol)
Clonazepam (Klonopin)
Phenobarbital

How well did you know this?

Not at all

Perfectly

Newer anti-epileptic drugs

Oxcarzepine (Trileptal) 
Lamotrigine (Lamictal) 
Gabapentin (Neurontin) 
Ethosuximide (Zarontin) 
Levetiracetam (Keppra)

How well did you know this?

Not at all

Perfectly

What is the most widely used AED?

Phenytoin (Dilantin)

How well did you know this?

Not at all

Perfectly

Phenytoin (Dilantin) action

Selective inhibition of sodium channels

How well did you know this?

Not at all

Perfectly

Uses of phenytoin (Dilantin)

Epilepsy
-Partial
-Tonic clonic seizures
Cardiac dysrhythmias (Digoxin-induced)

How well did you know this?

Not at all

Perfectly

The capacity of the liver to metabolize phenytoin is

Limited

How well did you know this?

Not at all

Perfectly

The relationship between dosing and plasma levels of Phenytoin is..

Unusual.. Difficult to maintain safe and effective dosing (Plasma levels necessary)

How well did you know this?

Not at all

Perfectly

Adverse effects of Phenytoin

Nystagmus (eye shaking) 
Sedation 
Gingival hyperplasia 
Skin rash 
Effects in pregnancy (Teratogen) 
Dysrhythmias

How well did you know this?

Not at all

Perfectly

Phenytoin causes decreased levels of…

Oral contraceptives
Coumadin
Glucocorticoids

How well did you know this?

Not at all

Perfectly

Drugs that increase Phenytoin

Diazepam
Cimetidine
Alcohol

Drugs that decrease Phenytoin

Carbamazepine
Phenobarbital
Alcohol (chronic use)

Carbamazepine (Tegretol) action

Slows recovery of sodium channels

Adverse effects of Carbamazepine (Tegretol)

CNS 
-Dizziness
-Visual disturbances 
-Headache 
-Sedation 
Hematologic (Rare) 
-Bone marrow suppression 
     Leukopenia
     Anemia 
     Thrombocytopenia

Carbamazepine (Tegretol) works almost identically to...

Dilantin

You would pull patient off of Carbamazepine (Tegretol) if they had...

Hematologic effects

Benzodiazepines (Anxiolytics) meds

Clonazepam (Klonipin) Diazepam (Valium) Lorazepam (Ativan)

Benzodiazepines are also used for....

Anxiety

Benzodiazepines are used for...

Status epilepticus (seizure that will not end)

How are Benzodiazepines given?

Slow IV to prevent respiratory depression and hypotension

Adverse effects of Benzodiazepines

Sedation | Long term = dependence

What is happening during status epilepticus?

Not breathing properly, tachycardic, tachypnic, BP rises

Phenobarbital action

Pontentiates the effects of GABA

Adverse effects of Phenobarbital

Sedation for most patients Depression Children > Paradoxical response (bouncing off the walls)

Dependence issues with Phenobarbital

Physical dependence can occur, discontinuation of the drug should not be done abruptly to prevent withdrawal

Switching drugs - Phenobarbital

Slowly increase one and slowly decrease another

Compared to the traditional AEDs, the newer AEDs are....

``` Not as widely used Equally effective Less side effects Safer in pregnancy Less drug interactions Cost more ```

Oxcarbazepine (Trileptal) is a derivative of...

Carbamazepine

Oxcarbazepine (Trileptal) action

Blockade of sodium channels

Oxcarbazepine (Trileptal)

``` Hyponatremia Dizziness Double vision Headache (Less sedation than traditional drug) ```

Lamotrigine (Lamictal) is used for..

Partial and absence seizures | Children with Lennox- Gastaut syndrome

Adverse effects of Lamotrigine (Lamictal)

Rash - discontinue due to risk of Stevens-Johnsons (usually starts in periphery) Drowsiness Insomnia

Lennox-Gastaut syndrome

Fairly rare syndrome of seizure activity

Levetriracetam (Keppra) is used for..

Complex partial seizures

Levetriracetam (Keppra) in comparison to other anticonvulsants

Less drug interactions

Adverse effects of Levetriracetam (Keppra)

Drowsiness / dizziness Depression Rash

Gabapentin (Neurontin)uses

Adjunctive therapy for partial seizures | Neuropathic pain

Gabapentin (Neurontin) action

Unknown... Enhance GABA release

Gabapentin (Neurontin) reactions

Well tolerated Dizziness Fatigue Sedation

Gabapentin (Neurontin) has a _____ therapeutic window

HUGE

What group often suffers from neuropathic pain?

Diabetics

Management of epilepsy during pregnancy

Use of lowest effective dose of AEDs | Use of mono therapy during pregnancy