Pharm Seizure Meds Flashcards
What are seizures
Recurrent, uncontrolled cerebral excitation
What initiates seizures
Specific neurons that are overactive, will spread to adjacent parts of the brain
What causes seizures in children
Unknown cause, but there is some sort of cerebral insult
What causes seizures in adults
Can be secondary to a specific event.
Trauma
CVA (stroke)
Tumor
How does the seizure “travel” in the CNS? Does it stay local or spread out
Could do either depending on the type of seizure
What are the types of partial seizures
Simple (focal) and Complex
What are simple (focal) seizures
Limited to one area of the brain
Cause motor and sensory loss
What are complex seizures
Start in one area but can progress to generalized seizure
What are the types of generalized seizures
Absence (petit mal)
Myoclonic
Tonic-Clonic (Grand mal)
What is the most common seizure
Complex partial
What is the most common generalized seizure
Grand mal
What is the goal of anti-seizure medication
Will target selective neurons that are firing too often and stop them from firing/starting the seizure
Why should the anti-seizure drugs be selective
Do not want to stop the firing of the surrounding neurons. This could impair other functions
What are the primary anti-seizure drugs
The front four Dilantin Depakote Tegretol Zartonin
Why are the front four usually chosen first
They are more selective
What are the “other” drugs used for seizures
Benzodiazepines
Barbiturates
Why are the “other” drugs used
They are very effective in inhibiting the CNS.
Not as selective as the front four
Barbiturates are the most commonly used anti-seizure meds in the US
What are the second generation anti-seizure drugs
Neurontin Lamictal Keppra Lyrica Gabitril Topamax
What is the benefit of the second generation drugs
Tend to have less side effects
Able to mix with the other new meds
Could have same effect with lower dosage after mixing
Better treatment of chronic pain syndrome
How would the 2nd gen drugs work for chronic pain
Instead of quieting the neurons creating the seizures they would quiet the neurons causing the chronic pain
Which specific drug could be used to stop neuropathic pain
Neurontin
What is the mechanism of the primary drugs
Inhibit the Na channels of over active neurons
Inhibit the Ca++ entry into thalamic neurons
Increase the inhibitory effects of GABA
Which drugs will inhibit the Na channels
Dilantin
Tegretol
Depakote
Which drug will inhibit Ca channels
Zarontin
Which drugs will increase the inhibitory effect of GABA
Benzodiazepine
Barbiturates
What is the mechanism of the newer drugs
Decrease the release of excitatory amino acids
What are the minor side effects of anti-seizure drugs
Sedation Headache Dizziness Incoordination GI problmes
Why do we call them minor side effects
They are not life threatening
Will usually deal with adjusting the dosage so side effects go away
What are the major side effects of anti-seizure meds
Liver toxicity Blood dyscrasia(bad mixture) Increase risk of birth defects
What are the types of blood dycrasisa
Aplastic anemia (bone marrow and blood cells damaged) Agranlocytosis (problems or low WBC's)
Why do the anti-seizure meds cause birth defects
Neural tube defects will double risk
Mother cannot decide to go off meds by herself
How many patients will remain seizure free after they get off meds
60-70%
What are the clinical signs showing you have a good chance of being seizure free after going off meds
Free of seizures for the past 2 years with meds
Have good control of seizures when they first start
Neurological exam prior to withdrawal
Initial onset of seizures was in childhood
What are some things we need to be aware of as physical therapists
Any patients taking anti-seizure meds
Document seizure activity to monitor efficacy of drugs
