Neuropsychiatric Meds - Quiz 8 Flashcards
What should be done in the first 5 minutes of a seizure?
Rule out everything else
ABC’s
Check Blood Sugar & Labs
What should be done in the First Phase (5-20 min) of a Seizure?
Give any Benzo
What should be given in the Second Phase (20-40 min) of a Seizure?
Fosphenytoin
Valproic Acid
Keppra
What should be done in the Third Phase (40-60 min) of a Seizure?
Repeat any Second Line Therapy
or
Anesthetic Dose of Thiopental, Propofol, Versed, or Pentobarbital
How do Calcium Channel Blockers work as Anticonvulsants?
Blocks T-Type Ca Channels in Thalamus
What is a major consideration with using Carbamazepine & Oxacarbazepine?
Drug Interaction - CYP inducers that reduces their own affects along with Versed & Propofol
What electrolyte should be checked when using the -azepines?
Sodium Level - risk for Hyponatremia
What are common side effects of -azepines?
Dizziness
PONV
Sedation
Why was Oxcarbazepine created?
Prevent Auto-Induction of Carbamazepine
How does Oxcarbazepine compare to Carbamazepine?
Same Side Effects, but LESS Drug Interactions & Better tolerated
What is different about the Pharmacokinetics of Phenytoin?
Non-Linear
Need much smaller dose adjustments
Why was Fosphenytoin created?
Prodrug for IV Administration
Can be given Safer & Faster
What are the Side Effects of Phenytoin?
Gingival Hyperplasia
Nystagmus
Vitamin K Deficiency
Arrhythmias
Hypotension
Osteoporosis
Bleeding
Ataxia
What can Phenytoin cause in Pregnancy?
Cleft Palate & Lip
Slowed Growth
Mental Deficiency
Congenital Heart Disease
What is the Advantage & Disadvantage of using Lamotrigine?
Autoinducer, but very LOW drug interactions, except when given with Valproic Acid
What happens if Lamotrigine is given with Valproic Acid?
Steven-Johnson Syndrome
What is the main concern with Zonisamide?
Increased risk for Kidney Stones
What is the advantage of using Locosamide?
Less Side Effects, Drug Interactions, and No CYP effects
What is the ONLY indications for Clobazam (Onfi)
Seizures
HIGH RISK for Withdrawal
Which Benzo has the longest duration?
Diazepam & Clonazepam d/t High Lipophilicity
Higher Lipophilicity = Faster Onset
What is the biggest risk associated with Vigabatrin?
Permanent Vision Loss
What is the advantage of using Gabapentin?
Neuropathy Pain Control
Not Protein Bound
No Drug Interactions
Excreted Unchanged
What is the biggest concern with Gabapentin?
Post-Op Sedation
Severe Respiratory Distress when given with Opiates
What is Pregablin used for?
Neuropathy
Seizure
Anxiety
How does Pregablin compare to Gabapentin?
Similar, but risk for Ataxia
What pregnancy category risk does Valproic Acid have?
Category D - X
What are the main concerns related to Valproic Acid?
Thrombocytopenia
↑Ammonia
Liver Toxicity
Which Anti-Seizure meds are Glutamate Blockers?
Felbamate
Topiramate
Perampanel
How does Topiramate work?
Inhibits Sodium, AMPA, and Carbonic Anhydrase
&
Enchances GABA
What are the main concerns with using Topiramate?
Psychomotor Slowing
Depression
Agitation
Loss of Appetite
What is the Black Box warning for Perampanel?
Life-Threatening Behavioral Effects
Agression
Hostility
Homicidal
What are the main side effects of Perampanel?
Dizziness & Threats
How does Levetiracetam work?
Inhibits Calcium via SV2A Protein to reduce Hyperexcitability