drugs for seizure/spasticity (exam 3) Flashcards
what is spasticity?
neurological
disorder/disability
sudden, abnormal, hypersynchronous firing of neurons
seizure
in a seizure, abnormal brain waves are found on an _____
EEG
what are the causes of seizures?
idiopathic or secondary
what are causes of secondary seizures in children?
developmental problem, birth injury, fever
what are causes of secondary seizures in adults??
acquired neuro disorder from injury or stroke/trauma
what alterations in permeability cause strokes?
temp, pH, viruses/bacteria
which ions cause seizures when distributed improperly?
NA, K, mg, and hypoglycemia
_____ inhibition of thalamic or cortical neuronal activity -> _____ signaling = seizure
decrease, increase
GABA _____ and acetylcholine _____ causes seizures
imbalance, excess
what is the acronym for remembering causes of seizures?
VITAMIN O
what does VITAMIN O stand for? (causes of seizures)
Vascular (stroke)
Infection (meningitis)
Trauma
Arteriovenous malformation (vein cluster)
Metabolic (hypoglycemia, hyponatremia, hypoxia)
Idiopathic
Neoplasm
Other (sleep dep, drug OD, fever, preeclampsia, MS)
what seizures are in a specific area and indicate localized brain lesion?
partial
what are symptoms of a partial seizure?
simple motor and sensory manifestations to bizarre behavior
what is the bizarre behavior seen in partial seizures?
automatisms (repeated behavior, verbal and gestural)
what kind of seizures are bilateral and symmetric?
generalized
what is the most common generalized seizure?
tonic-clonic
what is a tonic-clonic seizure?
posturing and jerking
what is an absence seizure?
brief lapse in attention
what is a myoclonic seizure?
only muscle contraction
what is an akinetic seizure?
no movement
what is status epilepticus?
generalized convulsion lasting longer than 5 mins OR more than 1 seizure with no recovery
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
lorazepam (stop seizure)
example benzodiazepines?
DIAZEPAM!
lorazepam, clonazepam, midazolam, chlordiazepoxide, clobazam, clorazepate
what meds are sedative-hypnotic agents?
benzodiazepines
what meds potentiate GABA? (increase attraction to receptor?
benzodiazepines
what route of benzos are used for severe recurrent convulsive seizures and status epilepticus?
IV
what route of benzos are used for moderate symptoms of alcohol withdraw and adjunctive for seizures?
PO
oral benzos take ______ to start working, IV take ______
30-60 min, minutes
benzo IM takes _____ to work, peaks at _____, and lasts ______
15-30 min, 45 min, 3 hr
rectal benzos take ______ to work, peaks at ______, and lasts _____
rapidly, 1 1/2 hr, 3 hr
what are adverse effects of benzos?
depression, disorientation, confusion, postural hypotension, bradycardia -> tachycardia
contraindications of benzos?
acute narrow angle glaucoma, shock/coma, alcohol intoxication, pregnancy (causes cleft lip)
what happens when you use benzos with alcohol or other CNS depressants
increase CNS depression
what do benzos do to cimetidine and hormonal contraceptives?
increase the effects
what do benzos do to theophylline and ranitidine?
decrease effects
black box warning of benzos?
do not mix with opioids
what is the injection rate of benzos
5mg/min at least
what are barbiturates used for?
generalized, tonic-clinic and partial seizures
are barbiturates long or short acting?
long
barbiturates are used in _______ doses for anti-convulsants
higher
what meds depress the sensory cortex, decrease motor activity, alter cerebellar fxn, cause drowsiness, sedation, and hypnosis
barbiturates
examples of barbiturates
PHENOBARBITAL
amobarbital, pentobarbitol
barbiturates inhibit impulses in the ______
RAS
do barbiturates need to be titrated?
yes
why is phenobarbitol the most used barbiturate?
the others cause porphyria
what is porphyria?
group of disorders from buildup of natural chemicals that produce porphyria in the body
if you suddenly withdraw from barbiturates, you could go into…
status epilepticus
what are adverse effects of barbiturates (phenobarbitol)?
SEDATION!!!
confusion, vertigo, resp. depression (IV admin)
contraindications of barbiturates (phenobarbitol)?
liver failure, nephritis, resp depression, porphyria
what do barbiturates (phenobarbitol) interact with?
induce CYP3A4/CTP450
alcohol, chloramphenicol, diazepam, MAOIs
what is a black box warning for barbiturates (phenobarbitol)?
suicidal ideation
what are serum therapeutic levels of barbiturates (phenobarbitol) for sedative/hypnotic and seizure treatment
5-15 for sedative/hypnotic
15-40 for seizure treatment
while using barbiturates (phenobarbitol), assess ________ changes that are indicative of _______________ syndrome
skin changes, stevens-johnson syndrome
while using barbiturates (phenobarbitol), assess _______ for porphyria
CDC / differential
while using barbiturates (phenobarbitol), assess _________ for kidney fxn
BUN / creatinine
what is the maximum rate for barbiturates (phenobarbitol)
60mg/min
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
inc. palpitations
what meds are used for partial seizures (rarely), post-herpetic neuralgia, and also for alcohol withdraw?
GABA structural analog
what are examples of GABA structural analogs
gabapentin, pregabalin
are GABA structural analogs metabolized?
no
what are adverse effects of GABA structural analogs?
CNS depression, somnolence, ataxia, insomnia
contraindications for GABA structural analogs
none
interactions for GABA structural analogs
none
black box warnings for GABA structural analogs?
fatal resp depression, increased risk w/ opioids, inc. elderly risk, start in small doses
what are examples of hydantoins?
phenytoin, fosphenytoin
what meds delay influx of sodium ions (cause depolarization) (de. rate of firing = dec. seizures)
hydantoins (phenytoin / fosphenytoin)
what kind of seizures are hydantoins (phenytoin/fosphenytoin) used to treat
tonic-clonic, psychomotor, nonepileptic
in hydantoins (phenytoin/fosphenytoin), what are special considerations?
dose=weight based
renal impairment (+ albumin) = displacement
inc. osteoporosis
BBW of hydantoins (phenytoin/fosphenytoin)
can not push too fast (no more than 50mg/min (adult), and 1-3 mg/kg/min (peds))
IV phenytoin admin should not exceed ________ in adults and _________ in peds
50 mg/min
1-3 mg/kg/min
adverse effects of hydantoins (phenytoin/fosphenytoin)
CNS depression, dizzy, drowsy, acute hepatic failure
contraindication of hydantoins (phenytoin/fosphenytoin)
heart block/brady, congenital malformation / bleeding in infants (preg)
interactions of hydantoins (phenytoin/fosphenytoin)
alcohol (CNS)
what are examples of iminostilbenes?
carbamazepine, oxcarbazepine
what med inhibits influx of sodium into cortical neurons and is also used for several seizures
iminostilbenes (carbamazepine, oxcarbazepine)
what kind of seizures do iminostilbenes (carbamazepine, oxcarbazepine) treat?
-partial seizures w/ complex systems (psychomotor and temporal epilepsy)
-generalized tonic-clonic
-mixed seizures
-generalized seizures
considerations for iminostilbenes (carbamazepine, oxcarbazepine)
inc. sedation/confusion, watch kidney/liver
adverse effects of iminostilbenes (carbamazepine, oxcarbazepine)
hepatitis, heart block, resp. depression
contraindications of iminostilbenes (carbamazepine, oxcarbazepine)
TCA (tricyclic anti-depress) hypersensitivity
(dont give with MAOI)
interactions with iminostilbenes (carbamazepine, oxcarbazepine)
isoniazid (inc. liver toxicity)
BBW of iminostilbenes (carbamazepine, oxcarbazepine)
aplastic anemia, agranulocytes (no blood cells)
specific patient teaching for iminostilbenes (carbamazepine, oxcarbazepine)
watch for bleeding
what anti-seizure drug controls absent and tonic clonic seizures by decreasing neuronal excitability
acetazolamide
which carbonic anhydrase inhibitor helps seizures
acetazolamide
which miscellaneous med increases GABA to help seizures
valproate
which histone deacetylase inhibitor helps seizures
valporate
what miscellaneous med inhibits voltage sensitive sodium channels and is used at the onset of partial seizures
lacosamide
what miscellaneous med is a functionalized amino acid that needs the dose adjusted for renal function
lacosamide
what miscellaneous med inhibits abnormal firing (no excitability effect) and is second line for status epilepticus
levetiracetam
what miscellaneous med is a perodine derivative
levetiracetam
what miscellaneous med increases GABA to sustain depolarization of neurons
topiramate
which miscellaneous med is a diuretic and needs the dose adjusted based on GFR
acetazolamide
what is the BBW for valporate
DC at any sign of pancreatitis; teratogenic; alterclotting
which miscellaneous drug is not fir people younger than 10
valporate
which miscellaneous prolongs PR
lacosamide
which miscellaneous requires a reduced dose if impaired renal fxn
levetiracetam
which miscellaneous is a weight loss med
topiramate
T or F
-must make sure a pt having a seizure is stable before administering IV anti-epileptic
fasle
-seizure has to be stopped
what is first line for status epilepticus
benzodiazepines
what are the 3 other meds used for status epilepticus
fosphenytoin, valporate, levetiracetam
upper motor neuron spinal cord injury -> ?
spastic paralysis
lower motor neuron spinal cord injury -> ?
flaccid paralysis (no firing)
treat resulting spasticity with ?
skeletal muscle relaxants
which skeletal muscle relaxant is a schedule IV CONTRAINDICATED IN P/L
CARISOPRODOL (SOMA)
which skeletal muscle relaxant is the only intrathecal relaxant approved by the FDA and causes hallucination
baclofen
which skeletal muscle relaxant is used short term (anticholinergic)
cyclobenzaprine hydrochloride (flexeril)
which skeletal muscle relaxant is reserved for when assistance with ADLs is needed (has oral contraceptive issues)
tizanidine (zanaflex)
which skeletal muscle relaxant has a BBW of liver damage, interfere with CALCIUM, interfere contraction, used for MALIGNANT HYPERTHERMIA, and has less CNS effect
dantrolene sodium
