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Pharm 2 > drugs for seizure/spasticity (exam 3) > Flashcards

drugs for seizure/spasticity (exam 3) Flashcards

1
Q

what is spasticity?

A

neurological
disorder/disability

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2
Q

sudden, abnormal, hypersynchronous firing of neurons

A

seizure

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3
Q

in a seizure, abnormal brain waves are found on an _____

A

EEG

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4
Q

what are the causes of seizures?

A

idiopathic or secondary

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5
Q

what are causes of secondary seizures in children?

A

developmental problem, birth injury, fever

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6
Q

what are causes of secondary seizures in adults??

A

acquired neuro disorder from injury or stroke/trauma

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7
Q

what alterations in permeability cause strokes?

A

temp, pH, viruses/bacteria

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8
Q

which ions cause seizures when distributed improperly?

A

NA, K, mg, and hypoglycemia

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9
Q

_____ inhibition of thalamic or cortical neuronal activity -> _____ signaling = seizure

A

decrease, increase

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10
Q

GABA _____ and acetylcholine _____ causes seizures

A

imbalance, excess

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11
Q

what is the acronym for remembering causes of seizures?

A

VITAMIN O

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12
Q

what does VITAMIN O stand for? (causes of seizures)

A

Vascular (stroke)
Infection (meningitis)
Trauma
Arteriovenous malformation (vein cluster)
Metabolic (hypoglycemia, hyponatremia, hypoxia)
Idiopathic
Neoplasm
Other (sleep dep, drug OD, fever, preeclampsia, MS)

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13
Q

what seizures are in a specific area and indicate localized brain lesion?

A

partial

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14
Q

what are symptoms of a partial seizure?

A

simple motor and sensory manifestations to bizarre behavior

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15
Q

what is the bizarre behavior seen in partial seizures?

A

automatisms (repeated behavior, verbal and gestural)

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16
Q

what kind of seizures are bilateral and symmetric?

A

generalized

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17
Q

what is the most common generalized seizure?

A

tonic-clonic

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18
Q

what is a tonic-clonic seizure?

A

posturing and jerking

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19
Q

what is an absence seizure?

A

brief lapse in attention

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20
Q

what is a myoclonic seizure?

A

only muscle contraction

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21
Q

what is an akinetic seizure?

A

no movement

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22
Q

what is status epilepticus?

A

generalized convulsion lasting longer than 5 mins OR more than 1 seizure with no recovery

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23
Q

an alcoholic attempted to stop drinking on his own and goes to ED because of palpitations and severe headache. he has a seizure in ED. what will physician order first?
-O2 administration
-lorazepam
-EEG
-EKG

A

lorazepam (stop seizure)

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24
Q

example benzodiazepines?

A

DIAZEPAM!
lorazepam, clonazepam, midazolam, chlordiazepoxide, clobazam, clorazepate

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25
Q

what meds are sedative-hypnotic agents?

A

benzodiazepines

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26
Q

what meds potentiate GABA? (increase attraction to receptor?

A

benzodiazepines

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27
Q

what route of benzos are used for severe recurrent convulsive seizures and status epilepticus?

A

IV

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28
Q

what route of benzos are used for moderate symptoms of alcohol withdraw and adjunctive for seizures?

A

PO

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29
Q

oral benzos take ______ to start working, IV take ______

A

30-60 min, minutes

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30
Q

benzo IM takes _____ to work, peaks at _____, and lasts ______

A

15-30 min, 45 min, 3 hr

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31
Q

rectal benzos take ______ to work, peaks at ______, and lasts _____

A

rapidly, 1 1/2 hr, 3 hr

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32
Q

what are adverse effects of benzos?

A

depression, disorientation, confusion, postural hypotension, bradycardia -> tachycardia

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33
Q

contraindications of benzos?

A

acute narrow angle glaucoma, shock/coma, alcohol intoxication, pregnancy (causes cleft lip)

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34
Q

what happens when you use benzos with alcohol or other CNS depressants

A

increase CNS depression

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35
Q

what do benzos do to cimetidine and hormonal contraceptives?

A

increase the effects

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36
Q

what do benzos do to theophylline and ranitidine?

A

decrease effects

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37
Q

black box warning of benzos?

A

do not mix with opioids

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38
Q

what is the injection rate of benzos

A

5mg/min at least

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39
Q

what are barbiturates used for?

A

generalized, tonic-clinic and partial seizures

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40
Q

are barbiturates long or short acting?

A

long

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41
Q

barbiturates are used in _______ doses for anti-convulsants

A

higher

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42
Q

what meds depress the sensory cortex, decrease motor activity, alter cerebellar fxn, cause drowsiness, sedation, and hypnosis

A

barbiturates

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43
Q

examples of barbiturates

A

PHENOBARBITAL
amobarbital, pentobarbitol

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44
Q

barbiturates inhibit impulses in the ______

A

RAS

45
Q

do barbiturates need to be titrated?

A

yes

46
Q

why is phenobarbitol the most used barbiturate?

A

the others cause porphyria

47
Q

what is porphyria?

A

group of disorders from buildup of natural chemicals that produce porphyria in the body

48
Q

if you suddenly withdraw from barbiturates, you could go into…

A

status epilepticus

49
Q

what are adverse effects of barbiturates (phenobarbitol)?

A

SEDATION!!!
confusion, vertigo, resp. depression (IV admin)

50
Q

contraindications of barbiturates (phenobarbitol)?

A

liver failure, nephritis, resp depression, porphyria

51
Q

what do barbiturates (phenobarbitol) interact with?

A

induce CYP3A4/CTP450
alcohol, chloramphenicol, diazepam, MAOIs

52
Q

what is a black box warning for barbiturates (phenobarbitol)?

A

suicidal ideation

53
Q

what are serum therapeutic levels of barbiturates (phenobarbitol) for sedative/hypnotic and seizure treatment

A

5-15 for sedative/hypnotic
15-40 for seizure treatment

54
Q

while using barbiturates (phenobarbitol), assess ________ changes that are indicative of _______________ syndrome

A

skin changes, stevens-johnson syndrome

55
Q

while using barbiturates (phenobarbitol), assess _______ for porphyria

A

CDC / differential

56
Q

while using barbiturates (phenobarbitol), assess _________ for kidney fxn

A

BUN / creatinine

57
Q

what is the maximum rate for barbiturates (phenobarbitol)

A

60mg/min

58
Q

patient on amiodarone for a-fib is prescribed phenobarbitol for seizures. nurse reminds that interactions between the 2 meds can cause?????
-increased palpitations
-dec. HR
-dec. BP
-constipation

A

inc. palpitations

59
Q

what meds are used for partial seizures (rarely), post-herpetic neuralgia, and also for alcohol withdraw?

A

GABA structural analog

60
Q

what are examples of GABA structural analogs

A

gabapentin, pregabalin

61
Q

are GABA structural analogs metabolized?

A

no

62
Q

what are adverse effects of GABA structural analogs?

A

CNS depression, somnolence, ataxia, insomnia

63
Q

contraindications for GABA structural analogs

A

none

64
Q

interactions for GABA structural analogs

A

none

65
Q

black box warnings for GABA structural analogs?

A

fatal resp depression, increased risk w/ opioids, inc. elderly risk, start in small doses

66
Q

what are examples of hydantoins?

A

phenytoin, fosphenytoin

67
Q

what meds delay influx of sodium ions (cause depolarization) (de. rate of firing = dec. seizures)

A

hydantoins (phenytoin / fosphenytoin)

68
Q

what kind of seizures are hydantoins (phenytoin/fosphenytoin) used to treat

A

tonic-clonic, psychomotor, nonepileptic

69
Q

in hydantoins (phenytoin/fosphenytoin), what are special considerations?

A

dose=weight based
renal impairment (+ albumin) = displacement
inc. osteoporosis

70
Q

BBW of hydantoins (phenytoin/fosphenytoin)

A

can not push too fast (no more than 50mg/min (adult), and 1-3 mg/kg/min (peds))

71
Q

IV phenytoin admin should not exceed ________ in adults and _________ in peds

A

50 mg/min
1-3 mg/kg/min

72
Q

adverse effects of hydantoins (phenytoin/fosphenytoin)

A

CNS depression, dizzy, drowsy, acute hepatic failure

73
Q

contraindication of hydantoins (phenytoin/fosphenytoin)

A

heart block/brady, congenital malformation / bleeding in infants (preg)

74
Q

interactions of hydantoins (phenytoin/fosphenytoin)

A

alcohol (CNS)

75
Q

what are examples of iminostilbenes?

A

carbamazepine, oxcarbazepine

76
Q

what med inhibits influx of sodium into cortical neurons and is also used for several seizures

A

iminostilbenes (carbamazepine, oxcarbazepine)

77
Q

what kind of seizures do iminostilbenes (carbamazepine, oxcarbazepine) treat?

A

-partial seizures w/ complex systems (psychomotor and temporal epilepsy)
-generalized tonic-clonic
-mixed seizures
-generalized seizures

78
Q

considerations for iminostilbenes (carbamazepine, oxcarbazepine)

A

inc. sedation/confusion, watch kidney/liver

79
Q

adverse effects of iminostilbenes (carbamazepine, oxcarbazepine)

A

hepatitis, heart block, resp. depression

80
Q

contraindications of iminostilbenes (carbamazepine, oxcarbazepine)

A

TCA (tricyclic anti-depress) hypersensitivity
(dont give with MAOI)

81
Q

interactions with iminostilbenes (carbamazepine, oxcarbazepine)

A

isoniazid (inc. liver toxicity)

82
Q

BBW of iminostilbenes (carbamazepine, oxcarbazepine)

A

aplastic anemia, agranulocytes (no blood cells)

83
Q

specific patient teaching for iminostilbenes (carbamazepine, oxcarbazepine)

A

watch for bleeding

84
Q

what anti-seizure drug controls absent and tonic clonic seizures by decreasing neuronal excitability

A

acetazolamide

85
Q

which carbonic anhydrase inhibitor helps seizures

A

acetazolamide

86
Q

which miscellaneous med increases GABA to help seizures

A

valproate

87
Q

which histone deacetylase inhibitor helps seizures

A

valporate

88
Q

what miscellaneous med inhibits voltage sensitive sodium channels and is used at the onset of partial seizures

A

lacosamide

89
Q

what miscellaneous med is a functionalized amino acid that needs the dose adjusted for renal function

A

lacosamide

90
Q

what miscellaneous med inhibits abnormal firing (no excitability effect) and is second line for status epilepticus

A

levetiracetam

91
Q

what miscellaneous med is a perodine derivative

A

levetiracetam

92
Q

what miscellaneous med increases GABA to sustain depolarization of neurons

A

topiramate

93
Q

which miscellaneous med is a diuretic and needs the dose adjusted based on GFR

A

acetazolamide

94
Q

what is the BBW for valporate

A

DC at any sign of pancreatitis; teratogenic; alterclotting

95
Q

which miscellaneous drug is not fir people younger than 10

A

valporate

96
Q

which miscellaneous prolongs PR

A

lacosamide

97
Q

which miscellaneous requires a reduced dose if impaired renal fxn

A

levetiracetam

98
Q

which miscellaneous is a weight loss med

A

topiramate

99
Q

T or F
-must make sure a pt having a seizure is stable before administering IV anti-epileptic

A

fasle
-seizure has to be stopped

100
Q

what is first line for status epilepticus

A

benzodiazepines

101
Q

what are the 3 other meds used for status epilepticus

A

fosphenytoin, valporate, levetiracetam

102
Q

upper motor neuron spinal cord injury -> ?

A

spastic paralysis

103
Q

lower motor neuron spinal cord injury -> ?

A

flaccid paralysis (no firing)

104
Q

treat resulting spasticity with ?

A

skeletal muscle relaxants

105
Q

which skeletal muscle relaxant is a schedule IV CONTRAINDICATED IN P/L

A

CARISOPRODOL (SOMA)

106
Q

which skeletal muscle relaxant is the only intrathecal relaxant approved by the FDA and causes hallucination

A

baclofen

107
Q

which skeletal muscle relaxant is used short term (anticholinergic)

A

cyclobenzaprine hydrochloride (flexeril)

108
Q

which skeletal muscle relaxant is reserved for when assistance with ADLs is needed (has oral contraceptive issues)

A

tizanidine (zanaflex)

109
Q

which skeletal muscle relaxant has a BBW of liver damage, interfere with CALCIUM, interfere contraction, used for MALIGNANT HYPERTHERMIA, and has less CNS effect

A

dantrolene sodium

Pharm 2 (10 decks)

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