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Pharmacology 3 > Neurology I > Flashcards

Neurology I Flashcards

1
Q

What makes a “generalized” seizure?

A

Loss of consciousness

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2
Q

What is a seizure?

A

excessive neuronal activity in the cerebral cortex

Excessive excitatory NTs (glutamate) or deficiency in inhibitory (GABA)

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3
Q

What happens in a seizure?

A

consciousness may be disrupted or completely lost + confusion and hallucinations

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4
Q

Seizure risk factors (9)

A
  • Drug toxicity or withdrawal
  • Infection
  • Genetic predisposition
  • Electrolyte disturbances
  • Surgery
  • Trauma
  • Idiopathic
  • Fever (104)
  • Stroke

(DIGEST IFS)

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5
Q

What is epilepsy?

A

chronic condition of recurring seizures, commonly a bimodal distraction in terms of epidemiology (children and elderly)

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6
Q

What is a prodrome?

A

warns patient that seizure is about to start, such as the room getting dark

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7
Q

Goal of seizure treatment?

A

reduce frequency of seizures while avoiding medication related adverse effects

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8
Q

How do you treat a seizure patient? Why?

A

MONOtherapy (one drug)
varying pharmacokinetics

stick to name brand OR generic, do NOT switch

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9
Q

What are wide spectrum seizure drugs?

A

VPA and lamotrigine

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10
Q

What happens if your seizure treatment does not work?

A

switch to another replacement treatment, do NOT stack

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11
Q

How do you decide if a treatment works?

A

6-12 months seizure free, then slowly withdrawal

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12
Q

How do you measure therapeutic levels?

A

rely on trough levels (draw right before next dose)

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13
Q

What are two major concerns when prescribing AEDs?

A

Pregnancy

Oral contraceptives

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14
Q

How do you treat eclampsia seizures?

A

magnesium sulfate

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15
Q

Phenobarbital is used for what?

A

refractory generalized seizures, it is highly sedating with a significant hangover

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16
Q

Should you give a seizing patient a paralytic?

A

NO!!!

does not provide loss of consciousness or analgesia or sedation, it only stops the cosmetic appearance of the seizure. you are still frying their brain

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17
Q

Benzos mimic what?

A

inhibitory NTs in the CNS

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18
Q

How do you treat status epilepticus?

A

benzo + antiepileptic

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19
Q

Phenytoin works how?

A

promotes sodium efflux from neurons thus stabilizing cells and reducing hyper excitability, making it difficult for the CNS to discharge

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20
Q

Phenytoin may worsen what?

A

Absence seizures

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21
Q

Why should you be cautious with phenytoin?

A

highly PPB

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22
Q

Dose related A/E of Phenytoin?

A
  • Nystagmus (shows toxicity)
  • Nausea
  • Rash
  • Confusion
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23
Q

What are the non-dose related a/e of phenytoin?

A
  • gingival hyperplasia
  • acne
  • coarsening of facial features
24
Q

Watch phenytoin interactions with what?

A
  • ethanol
  • oral contraceptives
  • vitamin D
  • folate wasting
25
Q

IV phenytoin- why bad? (3)

A
  • poor stability (short T1/2)
  • significant volume load
  • risk of hypotension
26
Q

Why risk of hypotension with IV phenytoin? How do you prevent it?

A

highly immisible- does not go into solution. Administer with diluent like propylene glycol, which causes hypotension.

27
Q

Fosphenytoin is what?

A

chemically altered, safer phenytoin. Less hypotension, volume load, and it is a rapid administration

28
Q

Phenytoin therapeutic levels?

A

10-20 mcg/ml

29
Q

Why check free phenytoin levels?

A

if you suspect patient may be hypoalbuminemic (malnourished or hepatic failure)

30
Q

Phenytoin pregnancy level?

A

D, neural tube defects due to folate wasting

31
Q

Valporic acid acts how? (3)

A
  • increase bioavailability of GABA within CNS
  • enhances activity of GABA
  • mimics action of GABA at postsynaptic receptor sites
32
Q

What else can valporic acid be used for? (3)

A
  • migrane prophalaxis
  • bipolar disorder
  • agitation
33
Q

A/E of valporic acid? (6)

A
  • weight gain
  • hepatotoxicity
  • alopecia
  • thrombocytopenia
  • drowsiness
  • pancreatitis
34
Q

Valporic acid therapeutic levels?

A

50-100 mcg/ml

35
Q

Valporic acid pregnancy level?

A

D

36
Q

What kind of seizures for valporic acid?

A

Absence seizures (wide spectrum)

37
Q

Carbamazepine is similar to what? how does it work?

A

‘TCA-like’

reduces postsynaptic transmission and response

38
Q

Carbamazepine for what types of seizures?

A
  • tonic-clonic
  • partial
  • mixed types
39
Q

how do you treat carbamazepine overdose?

A

HCO3-

40
Q

What other indications for carbamazepine? (3)

A

Trigeminal neuroglia DOC
bipolar disorder
migraine prophylaxis

41
Q

Carbamazepine therapeutic levels?

A

4-12 mcg/ml

42
Q

A/E of carbamazepine?

A
  • Steven Johnson Syndrome
  • somnolence
  • hepatotoxicity
  • SIADH
43
Q

What is special about Carbamazepine?

A

Autoinducer of its own metabolism so caution with early levels, they may be higher than they will be in 2 weeks

44
Q

Caution with carbamazepine interactions and what?

A
  • OCs

- folate wasting

45
Q

What is the carbamazepine analogue?

A

Oxycarbazepine

fewer hepatic adverse effects

46
Q

Gabapentin is for what? Eliminated how?

A

peripheral neuropathy, renal elimination, highly hydrophilic

47
Q

Gabapentin is metabolized to what?

A

Pregabalin, slightly more addictive so C5 controlled substance

48
Q

Gabapentin pregnancy category?

A

C

49
Q

Tompiramate works how? (3)

A
  • blocks Na channels
  • enhances GABA activity
  • weak carbonic anhydrase inhibitor
50
Q

Tompiramate indications? (2)

A
  • seizures

- weight loss

51
Q

A/E of tompiramate? (3)

A
  • anorexia
  • psychomotor slowing
  • nephrolitiasis
52
Q

Tompiramate pregnancy category?

A

C

53
Q

What is in a lethal injection

A
  • barbituate (knock out)
  • paralytic
  • high dose K
54
Q

Issues with 2nd generation anti-epilectics?

A

suicide risk

55
Q

What are 2 other 2nd generation anti-epileptic drugs?

A
  • Lamotrigine (rash)

- Levetiracetam (behavioral changes)

Pharmacology 3 (10 decks)

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