Neuro 2 Flashcards
What do anticonvulsants do to tx sz?
suppress the rapid firing of neurons that start a seizure
MCC of status epilepticus
D/c of anticonvulsants
Status epilepticus management
Assessment and supportive treatment
Initial pharmacologic therapy with a benzodiazepine
Urgent therapy that achieves long-term control using a nonbenzodiazepine antiseizure drug such as fosphenytoin
What is the initial med used to tx status epilepticus?
Benzos (preferably IV)
What is the weaning protocol of anticonvulsants?
weaned from the use of anticonvulsants after being seizure free for 2 years and having three normal EEGs separated by at least 1 year
Which labs should be checked prior to starting a pt on hydantoins?
Baseline liver function, urinalysis, and blood counts need to be taken as well as periodic plasma levels for hydantoins
Hydantoin examples
Fosphenytoin and phenytoin
Hydantoin MOA
Stabilizes neuronal membranes and decreases seizure activity by increasing efflux or decreasing influx of sodium ions
Hydantoin use
generalized tonic- clonic (grand mal) and simple complex and simple partial seizures
Hydantoin SE
Hypotension and arrythmias (with rapid phenytoin infusion), Skin rashes, stevens-johnson syndrome, gingival hyperplasia (very common), agranulocytosis and aplastic anemia, Phenytoin-induced hepatitis, ataxia, confusion, nystagmus, Hyperglycemia
What should be monitored in a pt taking hydantoin?
Therapeutic plasma levels
What can lower hydantoin levels and decrease their efficacy?
Drugs that induce the CYP P450 enzyme system - Rifampin, St. Johns wort
The flu vaccine interacts with which drugs?
phenytoin, theophylline, and warfarin
Which drugs raise hydantoin levels?
Drugs that inhibit the CYP P450 enzyme system will raise serum levels of hydantoins - Macrolides, azole antifungals, grapefruit juice
Hydantoins can impair the efficacy of this drug?
oral contraceptives
Patients with this heart condition should not be on hydrantoins?
bradycardia and heart block
Black box warning for hydantoins
IV injection quickly can cause severe hypotension
In which pts should hydantoins be used carefully?
Pts with hx of MI or hypotension
When dosed slowly over a long time, hydantoins can cause what?
Hyperglycemia and DKA
What can hydantoins do to urine?
Turn it red/ brown
Iminostilbenes examples
Carbamazepine
Oxcarbazepine
Iminostilbenes MOA
they inhibit voltage-gated sodium channels in neurons in the thamalus
Iminostilbenes use
monotherapy or adjunctive therapy for partial complex seizures
Neuropathic pain (trigeminal neuralgia)
Bipolar affective disorder
Iminostilbenes SE
stevens-Johnson syndrome, toxic epidermal necrolysis, Nausea, vomiting, Agranulocytosis, aplastic anemia, impaired antidiuretic hormone release (ADH) leading to water retention, Ataxia, tremor
Iminostilbenes (carbamazepine)black box warning
Genetic testing can be used to see if a person is at risk of developing serious SE (Asian descent)
What drink can increase Iminostilbenes serum levels?
Grapefruit juice will interact with these drugs, causing serum drug levels of these drugs to increase.
Which herbs reduce the sz threshold?
Evening primrose tea, St. John’s wort, valerian, and kava kava have all reduced the seizure threshold
Hypersensitivity to TCAs means that this drug is also contraindicated in pts
Iminostilbenes
In which pts should Iminostilbenes be avoided?
Any history of blood disorders, especially bone marrow suppression
Pregnancy
Which 2 things should be monitored regularly in pts on Iminostilbenes?
Therapeutic drug levels and IOP
Succinimides examples
ethosuximide
Succinimides MOA
blocking T-type voltage-gated calcium channels in thalamic neurons
Succinimides use
Control of absence (petit mal) seizures in children and adults that are refractory to other drugs
Succinimides SE
Rash, pruritus, Stevens-Johnson syndrome, gingival hyperplasia, Agranulocytosis, Increased libido, hirsutism
In which pts should Succinimides be used in w/ caution?
Use cautiously in patients who have liver or kidney issues or any kind of blood dyscrasia.
Succinimides GI distress can be resolved by taking what?
Glass of milk
What is valproate used for?
Sz, manic phases of bipolar disorder and prophylaxis of migraine headaches
What is gabapentin used for?
Sz, Used for restless leg syndrome, postherpetic neuralgia (PHN), and seizures
What is lamotrigine used for?
Sz
What is clonazepam used for?
Sz
What is pregabalin used for?
Sz
What is locosamide used for?
Sz
What is topiramate used for?
Sz
What is levetiracetam used for?
Sz
clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan) MOA
make abnormal electrical activity less likely by slowing CNS activity
GABA enhancers are gabapentin (Neurontin), tiagabine (Gabitril), valproate (Depakote), and vigabatrin (Sabril) use
treatment of refractory complex partial seizures in adults
Vigabatrin SE
Loss of vision
When is the used of Vigabatrin (Sabril) recommended?
after other options have proven ineffective in treating the seizures
Valproic acid/ valproate sodium SE
Significant weight gain
Valproic acid/ valproate sodium high plasma levels
severe tremors as well as liver damage, which has been fatal in children
Valproic acid/ valproate sodium MOA
blocking voltage-gated sodium channels and T-type calcium channels,
Which drug classes are used to tx peripheral neuropathy?
Pain relievers (NSAIDS, anticonvulsants (gabapentin), warming agents, topical anesthetics, TCAs, and TENS
MS drugs
Interferon, glatiramer, natalizumab, fingolimod
Interferon SE
Flu like sxs
Fingolimod is unique in treating MS because?
Its available PO
Which frugs have the most evidence for treating Alzheimers?
mild-to-moderate AD, cholinesterase inhibitors have the strongest evidence of treating cognitive symptoms
Which drug is approved to use for moderate to severe Alzheimers?
Memantine
MC Alzheimer drug SE
GI se
What increases the risk of adverse SE in alzheimer’s drugs?
Higher dose
What safety measures should be taken in pts on antidementia meds?
Safety measures to prevent falls should be taken because the patient may experience dizziness.
Acetylcholinesterase Inhibitors examples
donepezil, tacrine, galantamine, rivastigmine
Acetylcholinesterase Inhibitors MOA
Impede the breakdown of what little acetylcholine remains in the brain of an AD patient
Which Acetylcholinesterase Inhibitors has the longest acting profile?
Donepezil has the longest-acting profile
Acetylcholinesterase Inhibitors use
Symptomatic treatment of mild to moderate dementia of the Alzheimer type
Acetylcholinesterase Inhibitors SE
hypertension, Increased secretions, abdominal cramps, nausea, vomiting, diarrhea, loss of appetite, weight loss, Muscle aches/cramps, Abnormal dreams, dizziness, depression, insomnia
Acetylcholinesterase Inhibitors interactions
These drugs are metabolized by the CYP-450 system, thus drug levels and effects may be altered by other drugs that affect this metabolic pathway
Overdosing of Acetylcholinesterase Inhibitors can lead to what?
cholinergic crisis
Sxs of cholinergic crisis
slowed HR, muscle weakness, paralysis along with respiratory depression, salivation, sweating, diarrhea, blurred vision and vomiting
