Neuro Pharm

Question 1

Traditional Agents

Answer 1

• 6 meds
• Older
• More experience
• Significant AE
• Lots of drug interactions
• Expensive

Question 2

Newer Agents

Answer 2

• 13 meds
• Less side effects and drug interactions (we think)
• Better tolerability
• Generally safer in pregnancy
• MUCH MORE EXPENSIVE

Question 3

Phenytoin

Answer 3

• Used for many different types of seizures except absence seizures
• MOA: selective inhibition of sodium channels
• Exhibits saturable PK: half life is dependent on dose so lower dose = smaller half life
• Metabolized by liver: capacity to metabolize are limited
• Loading dose (IV or PO) and then maintenance dose based on plasma concentration
• Narrow therapeutic index
• Toxicity: nystagmus, sedation, ataxia, diplopia, seizures
• Lots of drug interactions

Question 4

AE of Phenytoin

Answer 4

• Gingivial hyperplasia: swelling, tenderness, bleeding
• Derm effects: 2-5% mortibilliform rash, SJS, TEN
• Pregnancy: teratogenic = cleft palate, hydrocephalus, renal defects, micromedlia, fetal hydantoin syndrome, decrease Vit K clotting factors

Question 5

IV Phenytoin AE

Answer 5

• CV effects: dysrhythmia, hypotension
• Derm effects: purple glove syndrome (watch for extravasation)
• Must give very slowly, caustic

Question 6

Fosphenytoin

Answer 6

• Converted to phenytoin in the body (prodrug)
• Easier to administer and less AE: no purple glove, decreased incidence of hypotension
• May be infused faster than phenytoin but will NOT work faster