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Pharm Exam II > Muscle Relaxants, Anti-Convulsants, AEDs > Flashcards

Muscle Relaxants, Anti-Convulsants, AEDs Flashcards

1
Q

T/F: dantrolene is a centrally acting muscle relaxant

A

FALSE, peripheral (acts on muscle cell)

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2
Q

does dantrolene cross the BBB?

A

no, only peripheral

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3
Q

what is the MOA of dantrolene?

A

interferes w/ release of calcium from the SR

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4
Q

what is the drug of choice for malignant hyperthermia?

A

dantrolene

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5
Q

what can be a cause of malignant hyperthermia (hypermetabolic syndrome)?

A

ingestion of hops! watch out brewers

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6
Q

what is hypermetabolic syndrome?

A
  • genetically determined idiosyncratic drug rxn
  • life threatening hyperthermia, hyperkalemia, and cell death
  • shock, MODS
  • fatal
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7
Q

what species is more susceptible to hypermetabolic syndrome?

A

pigs

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8
Q

what is a hypermetabolic rxn of skeletal m. called?

A

rhabdomyloysis

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9
Q

how might you treat a tetanus (clostridium tetani) infection?

A

dantrolene, methocarbamol

-need a muscle relaxer!! have to keep calm and wait it out

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10
Q

what muscle relaxant is used to treat dogs, cats, and horses in acute inflammatory or traumatic conditions?

A

methocarbamol (think dachshunds)!

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11
Q

T/F: methocarbamol is recommended to be given IM/SQ

A

FALSE, irritating (IV or oral which has rapid absorption)

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12
Q

what drug do you use to treat intervertebral disk disease (IVDD), tetanus, and intoxication (tremorogenic)?

A

methocarbamol

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13
Q

what are examples of intoxication (tremorogenic)?

A

strychnine, metaldehyde, tremorogenic molds (“garbage gut”), pyrethrin/permethrin (cats)

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14
Q

how is methocarbamol excreted?

A

renally, caution w/ renal diseases

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15
Q

help! i gave my cat advanTIX instead of advantage!! what do i do?

A

give methocarbamol

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16
Q

guaifenesin is not only a centrally-acting muscle relaxant but also what?

A

an expectorant (helps break up cough, think mucinex)

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17
Q

besides acting as a muscle relaxant, what other effects does guaifenesin have?

A

sedative and analgesic

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18
Q

what muscle relaxant is considered a class 4 in the ARCI?

A

guaifenesin for use in horses

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19
Q

what is guaifenesin primarily used for?

A
  • combined for intubation (pharyngeal and laryngeal mms.)

- “triple drip” (GG + xylazine + ketamine) for TIVA

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20
Q

T/F: guaifenesin used in high concentrations (>10%) is more likely to cause hemolysis in horses than cattle

A

FALSE, cattle are more sensitive

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21
Q

what drug is contraindicated in horses receiving guaifenesen?

A

physostigmine

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22
Q

seizure

A

clinical manifestation of abnormal electrical activity in brain, uncontrolled firing of neurons

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23
Q

epilepsy

A

chronic syndrome of seizures, “recurrent seizures”, occur intermittently over months to years for which contributing underlying cause cannot be identified

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24
Q

idiopathic epilepsy (IE)

A

“true epilepsy”, genetic or inherited

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25
Q

acquired/symptomatic epilepsy

A

intracranial vs extra-cranial causes

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26
Q

status epilepticus (SE)

A

repeated seizures w/out full recovery between them, or a single seizure that last >5 minutes

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27
Q

cluster seizures

A

more than one seizure occurring w/in a 24 hr period w/ recovery in between

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28
Q

anticonvulsants

A

drugs that prevent or treat seizures

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29
Q

antiepileptic drugs (AED)

A

drugs that prevent or treat seizures

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30
Q

refractory seizures

A

seizures that are not responding to therapeutic doses of AEDs

31
Q

breakthrough seizures

A

seizures that occur at periodic intervals during treatment course w/ AEDs

32
Q

generalized seizures consist of what two types of seizures?

A

convulsive (tonic clonic, autonomic release) and non-convulsive (absent, brief loss of contact w/ environment)

33
Q

partial seizures consist of what two types of seizures?

A

simple partial (lateralizing motor activity, no loss of consciousness) and complex partial (altered motor activity and altered consciousness)

34
Q

what type of partial seizure is more common?

A

complex

35
Q

what maintains the resting membrane potential?

A

Na/K-ATPase

36
Q

kindling

A

process by which “seizures beget seizures”

37
Q

what is the goal of maintenance (chronic) treatment of seizures?

A

reduce the frequency and/or severity of seizures

38
Q

what is the goal for treatment of breakthrough seizures?

A

increase the time interval between seizure events, reduce the severity and duration

39
Q

what must you ALWAYS keep in mind when treating a patient for seizures?

A

look for an underlying cause!

40
Q

what is the drug of choice for treatment of a seizure in progress?

A

diazepam (IV, intranasal, per rectum)

41
Q

what drug do you use to put a patient currently seizing in a medically induced coma?

A

IV propofol or alfaxalone, helps w/ overheating from muscle tremors, probably not stopping the firing

42
Q

what must you do if you end up treating a patient currently seizing with propofol?

A
  • intubate! airway protection required

- intensive monitoring

43
Q

what might you worry about if you send a known epileptic with a history of status epilepticus or cluster seizures home with injectable diazepam?

A
  • legalities (controlled substance)
  • it binds to plastic
  • light sensitive
44
Q

how many seizures in what amount of time would drive you to treat a patient with maintenance therapy?

A

if patient has had more than 2-3 seizures in 6-12 months or cluster seizures (2 or more in an hour)

45
Q

this type of monitoring is frequently used with antiepileptic drug therapy

A

therapeutic drug monitoring (TDM)

46
Q

why might you want to avoid using bromide to treat a cat?

A

about 1/3 of cats on bromide develop asthma/pneumonitis

47
Q

T/F: seizure pathophysiology is complex and incompletely understood

A

TRUE!

48
Q

what is the most common first-line AED for chronic therapy?

A

phenobarbital

49
Q

why do you need to check phenobarbital levels in the blood?

A

because its a POTENT inducer of hepatic microsomal enzymes AND is metabolized through that system (cytochrome P450)

50
Q

what plasma protein is phenobarbital extensively bound to?

A

albumin

51
Q

what are common adverse effects you’d see when using phenobarbital?

A

-PU/PD/PP, sedation, elevated liver enzymes (ALP)

52
Q

T/F: phenobarbital can cause paradoxical hyperexcitability, nephrotoxicity, and pancytopenia

A

FALSE, all is correct except it can cause HEPATOtoxicity not nephrotoxicity

53
Q

how many binding sites do GABA receptors have?

A

5

54
Q

T/F: bromide acts by binding and prolonging the opening of chloride channels

A

FALSE, thats the MOA of phenobarbitol. bromide’s MOA is altering chloride transport across neuronal cell membranes

55
Q

T/F: bromide is the primary or add-on anticonvulsant in cats

A

FALSE!! can show asthma-like pulmonary changes, use for dogs

56
Q

T/F: chloride on serum chemistry reads falsely high for a patient taking bromide

A

TRUE! bromide is recognized as chloride

57
Q

why might you be concerned about owner compliance when it comes to bromide?

A

you must keep salt intake constant, salt can significantly interfere w/ bromide levels

58
Q

which anticonvulsant drug is NOT a GABA agonist?

A
  • levetiracetam, mechanism is unclear

- zonisamide also does not work at GABAa receptors

59
Q

what anticonvulsant is the excellent/preferred choice for treatment of seizures due to hepatic encephalopathy?

A

levetiracetam, primarily excreted unchanged in urine

60
Q

what anticonvulsant is least appropriate for the treatment of seizures due to hepatic encephalopathy?

A

phenobarbital

61
Q

what two anticonvulsants must you perform therapeutic blood level monitoring?

A

phenobarbital and bromide

62
Q

T/F: clearance is increased if a patient is on phenobarbital and levetiracetam concurrently

A

TRUE!

63
Q

which anticonvulsant is used for “pulse therapy” for use around breakthrough seizures?

A

levetiracetam

64
Q

what anticonvulsant might you see tolerance or the “honeymoon effect”?

A

levetiracetam

65
Q

which anticonvulsant is a sulfonamide derivative?

A

zonisamide

66
Q

what type of channel does zonisamide inhibit?

A

voltage-gated sodium channels

67
Q

T/F: clearance is increased if patient is on zonisamide and phenobarbital concurrently

A

TRUE!

68
Q

what two anticonvulsants would be a good choice in treatment of seizures for cats?

A

levetiracetam and zonisamide

69
Q

T/F: levetiracetam and zonisamide are used as adjunct AED agents for maintenance therapy

A

TRUE!

70
Q

in which anticonvulsant might you see idiosyncratic agranulocytosis?

A

zonisamide (in dogs)

71
Q

what anticonvulsant is only available in the UK and EU and is known for its sparing effects?

A

imepitoin

72
Q

which anticonvulsant has the longest half life?

A

bromide

73
Q

which anticonvulsant has the shortest half life?

A

levetiracetam

Pharm Exam II (6 decks)

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