Final exam Flashcards
Seizure
brief episode of abnormal electrical activity in nerve cells of the brain
Convulsion
Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal, facial, and ocular muscles
Epilepsy
chronic, recurrent pattern of seizures
primary - idiopathic 50% of epilepsy cases
secondary - symptomatic - trauma, infection, cerebrovascular disorder
Generalized onset seizures
Formerly known as grand mal seizures
Tonic-clonic seizures
Absence seizures
Partial onset seizure
Simple (formerly known as petit mal seizures)
Complex
Secondary generalized tonic-clonic
Status epilepticus
multiple seizures occur with no recovery between them
Results: hypotension, hypoxia, brain damage, and death
MEDICAL EMERGENCY
Anti-epileptic drugs - AED (anticonvulsant)
To control or prevent seizures while maintaining a reasonable quality of life
To minimize adverse effects and drug-induced toxicity
Life long drugs
Single -drug therapy is started before multiple drug therapy is tried.
serum drug concentrations must be measured
Take regularly, same time each day
Take with meals to reduce GI upset
use only NS with phenytoin
Should not be discontinued abruptly
Anti-epileptic drug - MOA
No known MOA
Reduce nerve’s ability to be stimulated
Suppress transmission of impulses from one nerve to the next
Decrease speed of nerve impulse conduction within a neuron
Anti-epileptic drug - indications
prevention or control of seizure activity
long term seizure management
acute treatment of convulsions and status epileptics
Anti-epileptic drug - Adverse effects
Black box warning - suicidal thoughts and behavior
Phenytoin - gingival hyperplasia, acne, hirsutism, and dilantin facies.
Hydantoin - Phenytoin
Dosage - IV & PO
1st line for seizures - STATUS EPILEPTICS
therapeutic levels: 10-20 mcg/ML
expected adv: gingival hyperplasia - teach hygiene and dental care
REPORT: ataxia, nystagmus, slurred speech (toxicity >20)
no pt. with bradycardia
no more than 50mg/1min IV
use a large gauge, large vein, & filter
NS flush
long half life
Contraindication - bradycardia related diseases
Carbamazepine (Tegretol)
2 used seizure drug - partial seizures
auto induction og hepatic enzymes - DRUG IS SLOW - 2 months for results - enhances hepatic enzymes - BAD
MONITOR WBC count (agranulocytosis)
REPORT: rash - stevens johnson’s syndrome
Therapeutic - 4-12 mcg/ml
not used for emergency situations
BLACK BOX: suicide (according to power point)
no grapefruit or bezos
Levothyroxine
indications : Hypothyrodism, thyroidectomy (lack of TH)
Adverse effects - increase (hyperthyroidism) cardiac dysrhythmia, increase nervoseness/ tremors, increase BP, HR, diarrhea, weightloss, temp
theraputoic effects - good mood, improved energy
long half life
Take in AM, 30-60 mins before food
With at least 6-8 oz of water
Do not change brands
Keep appointments for thyroid function lab monitoring
Do not abruptly discontinue the drug - 8 weeks for full effect
Immediately report palpitations, chest pain, weight loss, etc (s/sx of toxicity)
Report s/sx of HYPO-thyroid
Keep a daily journal of how you feel
Protect tablets from light
MOA - minics T4 thyroxine
PTU (anti-thyroid drugs)
MOA -
1 - inhibiting the incorporation of iodine molecules into the amino acid tyrosine (impedes formation of thyroid hormone)
2 - inhibits the conversion of T4 to T3 in peripheral circulation
Slow onset of action
Adverse effects - liver and bone marrow toxicity
Drug interactions - anti-coagulants and drugs affecting the bone marrow
Take with food to minimize stomach upset
Take at same time every day
Report s/sx of infection to provider immediately
Mouth ulcers or sores, or skin eruptions, as well as any unusual bleeding or bruising needs to be reported to the prescriber immediately
Avoid the use of iodized salt or eating shellfish because of their potential for altering the drug’s effectiveness
Alendronate - Bisphosphonate
indication - prevention and treatment of osteoporosis
MOA - inhibiting osteoclast-mediated bone resorption, which in turn indirectly enhances bone mineral density
contraindication - inability to sit or stand upright for at least 30 mins after taking the medication because there is a risk for esophageal burns.
Drug interactions - NSAIDS
long half life
Take in the morning, upon rising
Take with a full glass of water
Take 30” intake of food, drink or medication
Remain sitting or standing for 30”
Report jaw pain to provider immediately
Report chest pain / esophageal pain to provider immediately
Osteoclasts
Osteoclasts are bone cells that break down bone, causing calcium to be reabsorbed into the circulation
This resorption eventually leads to osteoporosis if not controlled or countered by adequate new bone formation
Finasteride
Male pattern baldness & benign prostatic hyperplasia
wear gloves - highly teratogenic effects of the drug
Urinary patterns
Take without regard for meals
Women should not touch or handle tablets with bare hands
Keep log / journal of urinary symptoms (flow, urgency, frequency)
CAUSED IMPOTENCE
Protect drug from exposure to heat / light
May take 3+ months to see improvement in urinary obstructive symptoms
Theophylline
Derivative of caffeine - increases levels of CAMP
THEO IS GOING TO CAMP - watch for GI issues
do NOT give to people with cardiac issues
therapeutic range 10-20 mcg/ml
NOT for acute asthma attacks
increases HR - no cigarettes, no st.john’s wort, no warfarin.
Heparin
Anticoagulant
antidote: Protamine Sulfate
CHECK APTT LEVELS!
cannot be given to pt. with catheter
contraindications: bleeding, gi issues, liver and kidney disease
can cause thrombocytopenia (decreased platelet count)
normal platelets count: 150,000-450,000
warfarin
anticoagulant
CHECK INR (2-3) & PT
avoid potassium rich foods (apricots, dates, leafy greens, fish etc)
antidote: vitamin K
adverse: nausea, GI, HEPATOXCITY
used for atrial fibrillation
Metformin
Non insulin drug - type 2 diabetic
decreases glucose production in the liver and absorption in the intestines (can then cause liver and GI issues)
decreases insulin resistance
cannot cause hypoglycemia
admin 2x a day
DO NOT USE W CONTRAST DYE (24 before 48 hours after)
ventrogluteal
3ml
subQ
up to 1.5
vastus lateralis
1-3mL
