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Pharmacology NURS 362 > Exam 1: Epilepsy + Seizure > Flashcards

Exam 1: Epilepsy + Seizure Flashcards

1
Q

Class: Anti-Epileptic
Drugs:

A
  • phenytoin (Dilantin)
  • carbamazepine (Tegretol), Carbatrol)
  • phenobarbital
  • valproic acid (Depakene, Stavzor)
  • valproate (Depakene)
  • fosphenytoin (Cerebyx)
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2
Q

Class: Anti-epileptic

MOA (general):

A
  • Alter Ion channels (Na, K, Ca, Cl)
  • Alter Neurotransmitter Activity (↑ = Glutamate, ↓ = GABA)
  • Some are unknown
  • Metabolized in liver
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3
Q

Class: Anti-epileptic

Indications (general):

A

↑ risk recurrent sz (Prophylaxis, (2+) unprovoked sz)
- Generalized/Focal Sz

Selection:

  • Effectiveness
  • AE
  • Drug/Drug
  • Comorbidities
  • Age/Gender
  • Lifestyle
  • Cost
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4
Q 
Class: Anti-epileptic 
Side effects (general):
A

Neuro:
↑ sedation, drowsy, fatigue
↑ dizzy, blurry vision, incoordination
- neuropathy

Blood:
- blood dyscrasia
↓ bone marrow

Other:
↓ bone density
↑ gingival hyperplasia
↑ weight

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5
Q

Class: Anti-epileptic

Toxicity/AE (general):

A
  • Rash –> SJS
  • Hepatic
  • Renal
  • Teratogenesis (↓ hormonal BC)
  • Metabolic acidosis
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6
Q

Class: Anti-epileptic

Interactions (general):

A 
PREGNACY:
- ALL Folic acid (.4-.8
mg/day) 
- Preconception (counseling)
- Pregnant (drug levels, baby screening)
- Postpartum (return
to original dose, education)
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7
Q

Class: Anti-epileptic

Route/dosing (general):

A
  • SE may be relieved if titrated slowly
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8
Q

Class: Anti-Epileptic
Drug: Phenytoin (dilantin)
MOA:

A
  • BLOCKS Na channels

* *Absorption varies on preparation

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9
Q

Class: Anti-Epileptic
Drug: Phenytoin (dilantin)
Indications:

A
  • Epilepsy
  • Status Epilecticus
  • peds AND adults
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10
Q

Class: Anti-Epileptic
Drug: Phenytoin (dilantin)
Contraindications:

A
  • Avoid IM –> tissue necrosis
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11
Q

Class: Anti-Epileptic
Drug: Phenytoin (dilantin)
Side effects:

A
  • IV (↓ BP, ↓ HR)
  • ↓ Vit D
  • Gingival Hyperplasia
  • Severe Rash
  • ↑ body hair
  • ↓ folic acid
  • ↓ bone density
  • **Monitor effectiveness + tolerance
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12
Q

Class: Anti-Epileptic
Drug: Phenytoin (dilantin)
Toxicity/AE:

A

PURPLE GLOVE SYNDROME:

  • w/i 2-12 hrs
  • DO NOT FLUSH -> aspirate

Neurotoxic:

  • Nystagmus
  • Sedation
  • Ataxia
  • Diplopia
  • Cognitive Impairment

Teratogenic (risk vs. benefit)

** ↑ serum monitoring for hepatic / renal dx

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13
Q

Class: Anti-Epileptic
Drug: Phenytoin (dilantin)
Interactions:

A

↓ levels of other drugs

  • Oral BC
  • Warfarin
  • Glucocorticoids

↑ levels of Phenytoin

  • Diazepam
  • Isoniazid
  • Cimetadine
  • Alcohol (acute)
  • Valproic acid

↓ levels of Phenytoin

  • Carbamazepine
  • Phenbarbital
  • Alcohol (chronic)
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14
Q

Class: Anti-Epileptic
Drug: Phenytoin (dilantin)
Route/dosing:

A
  • frequent serum drug levels
  • Loading / Maintenance
IV:
- ADULTS: 50 mg/min max
- PEDS: 1-3mg/kg/min max
- CONTINUOUS HEART
MONITORIING **infiltration
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15
Q

Class: Anti-Epileptic
Drug: Carbamazepine (Tegretol, carbatrol)
MOA:

A
  • Binds to Na+ channels while inactive –> extend inactive phase
  • 70% protein bound
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16
Q

Class: Anti-Epileptic
Drug: Carbamazepine (Tegretol, carbatrol)
Indications:

A
  • Affective illnesses (Bipolar)

- Chronic pain syndromes (Trigeminal Neuralgia)

17
Q

Class: Anti-Epileptic
Drug: Carbamazepine (Tegretol, carbatrol)
Side effects:

A
  • N/V/D
  • ↓ Na+ (hyponatremia)
  • Rash
  • ↑fluid rtn
  • ↓ testosterone men
  • Drowsy, diplopia, HA
  • ↓ WBC (leukopenia)
18
Q

Class: Anti-Epileptic
Drug: Carbamazepine (Tegretol, carbatrol)
Toxicity/AE:

A

SJS

- Screen for Asian ancestry –> HLA- B*1502

19
Q

Class: Anti-Epileptic
Drug: Carbamazepine (Tegretol, carbatrol)
Interactions:

A

Many drug-drug

20
Q

Class: Anti-Epileptic
Drug: Carbamazepine (Tegretol, carbatrol)
Route/dosing:

A

ORAL:

  • tablet/suspension
  • *monitor plasma lvls
21
Q

Class: Anti-Epileptic Drug
Drug: Phenobarbital
MOA:

A
  • binds to GABA receptors (Blocks Cl- channels)

- 25% excreted unchanged

22
Q

Class: Anti-Epileptic Drug
Drug: Phenobarbital
Indications:

A
  • Sedation
  • Status Epilepticus
  • OFF LABEL –> withdrawal
23
Q

Class: Anti-Epileptic Drug
Drug: Phenobarbital
Side effects:

A 
↓↑CNS
↓ R, HR, BP
↑ Syncope
Dermatitis
N/V/C
Thrombocytopenia, Anemia
24
Q

Class: Anti-Epileptic Drug
Drug: Phenobarbital
Toxicity/AE:

A
  • SJS
  • ELDERLY CAN OD
    W/LOW DOSES
25
Q

Class: Anti-Epileptic Drug
Drug: Phenobarbital
Interactions:

A

↓ effect (via ↑ metabolism)

  • OCP
  • warfarin
26
Q

Class: Anti-Epileptic Drug
Drug: Phenobarbital
Route/dosing:

A
  • IV - avoid rapid admin
  • 60mg/min (adult)
  • 30mg/min (peds)
  • IM-↓5ml
  • ORAL - tablet, elixer, solution
27
Q

Class: Anti-Epileptic
Drug: Valproate OR valproic acid or VPA (Depakote, Stavzor, Depakene)
MOA:

A
  • Multiple
  • X Na+, Ca2+ channels
    ↑GABA
28
Q

Class: Anti-Epileptic
Drug: Valproate OR valproic acid or VPA (Depakote, Stavzor, Depakene)
Indications:

A
  • Broad spectrum AED
29
Q

Class: Anti-Epileptic
Drug: Valproate OR valproic acid or VPA (Depakote, Stavzor, Depakene)
Side effects:

A
  • N/V
  • Hair loss
  • Easy bruising
  • Tremor
  • ↑weight
  • ↑ insulin resistance
  • ↓ WBC
  • Issues w/coagulation
30
Q

Class: Anti-Epileptic
Drug: Valproate OR valproic acid or VPA (Depakote, Stavzor, Depakene)
Toxicity/AE:

A
  • Polycystic ovarian syndrome
  • Teratogenic –> malformations
  • Hepatotoxicity
  • Pancreatitis (rare)
31
Q

Class: Anti-Epileptic
Drug: Valproate OR valproic acid or VPA (Depakote, Stavzor, Depakene
Interactions:

A

Many drug-drug

32
Q

Class: Anti-Epileptic
Drug: Valproate OR valproic acid or VPA (Depakote, Stavzor, Depakene)
Route/dosing:

A

IV
PO
** monitor liver fx, before + during 1st 6mo

Pharmacology NURS 362 (6 decks)

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