Pharm - Sleep And Seizures Flashcards
A sedative is…
… a drug that reduces irritability/excitement to create sedation
A hypnotic is…
… a drug that makes you sleepy
A sedative-hypnotic is…
… a drug that is used to relieve anxiety by depressing the CNS AND makes you sleepy.
An anticonvulsant is…
… a drug that suppresses the rapid firing of neurons that starts a seizure
Status-epilepticus is
30+ minutes of seizure or a series of seizures.
Can occur with any seizure type
What are the common effects that sedative-hypnotics have on the body? What are they used for?
Primarily for anxiety and insomnia.
Any drug that depresses CNS function will have similar effects:
sleepiness
Impaired thinking and perception (reduced pain sensitivity, too)
Slowed reflexes and breathing
What are the three types of sedative-hypnotics?
Benzodiazepines
Z-drugs (benzodiazepine receptor agonists)
Barbiturates
BZDs and Z-drugs work the same way: what is it?
How are barbiturates different?
BZDs, Z-drugs: increase the frequency of the GABA channel opening
Barbiturates: depends on the dose:
Low-dose: keep the GABA channel open longer
High-dose: mimics GABA
Six uses for BZDs?
Panic attacks Insomnia Seizures Anesthesia Muscle spasm ETOH withdrawal (PISAME)
What happens if you take too much BZD?
What’s the antidote?
Respiratory depression
Sedation and lethargy
Antidote: flumazenil
When would you use a rapid action benzo (2)?
What are examples for each?
Short procedures (Midazolam: versed)
Insomnia (Triazolam)
What are intermediate acting BZDs sometimes used for insomnia?
Alprazolam
Lorazepam
Oxazepam
Temazepam
Why would you use long-acting BZDs?
Examples?
ETOH withdrawal
Clonazepam
Diazepam
Chlordiazepoxide
Flurazepam
What are Z-drugs supposed to be used for?
Insomnia. Very short term only.
NOT anxiety
What’s a weird side effect of Z-drugs?
Sleep-walking and strange dreams
What are the three Z-drugs we learned?
Zolpidem (ambien)
Eszopiclone (Lunesta)
Zaleplon (Sonata)
What are barbiturates typically used for?
Three drug names and length of action?
Refractory seizures
Thiopental (ultra-short acting)
Secobarbital (short-intermediate acting)
Phenobarbitol (long-acting)
Why do we have to be careful with barbiturates?
OD will kill you b/c of CNS depression.
What is a focus?
The term used for a group of hyperexcitable neurons that create a high-frequency, synchronous discharge, initiating a seizure.
What are the two kinds of partial seizures?
Simple partial (10-20s): no loss of consciousness
Complex partial (45-90s): impaired consciousness
What are tonic-clonic seizures?
Last 90s or less
Major convulsions:
-muscle rigidity (tonic) and muscle jerks (clonic)
Postictal state follows (CNS depression)
What are absence seizures?
10-30s, mild, brief loss of consciousness
What are atonic seizures?
Sudden loss in muscle tone: “head drop” or “drop attack”
What are myoclonic seizures?
1s sudden muscle contraction
What are febrile seizures most likely to resemble? What ages are they most likely to happen in?
Tonic-clonic seizures
6mos-5yrs.
What is the goal of antiepileptic drugs?
Suppress the discharge of neurons at the focus
Suppress the propagation of seizure activity from the focus to elsewhere in the brain
What are 4 MOAs of antiepileptic drugs?
- Suppress sodium influx
- Suppress calcium influx
- Antagonize glutamate
- Potentiate GABA
Phenytoin: MOA? Therapeutic range? AEs? ok in pregnancy?
MOA: blocks voltage-gated sodium channels
Therapeutic range: 10-20mcg/ml
Stevens-Johnson Syndrome & Gingival hyperplasia
Hirsutism
CNS probs (confusion, slurred speech, poor coordination, Nystagmus)
Vit D deficiency
Category D!
Carbamazepine: MOA Therapeutic range SEs Ok in pregnancy?
MOA: blocks sodium channels
Therapeutic range: 4-12mg/ml
Suppresses bone marrow (leukopenia, thrombocytopenia, anemia)
Stevens-Johnson Syndrome
CNS probs (blurred vision, ataxia, vertigo, nystagmus)
-note: give a larger dose at bedtime because of this
Photosensitivity
Category D!!
Lamotrigine
MOA
SEs
MOA: blocks voltage-gated sodium channels
SJS: needs very slow titration
Levetiracetam
Therapeutic range
Guesstimated MOA
12-46mcg/ml
MOA: they think it’s voltage-gated sodium channels
Well tolerated
Lacosimide
MOA
SEs?
Schedule?
MOA: slow inactivation of voltage-gated sodium channels
CNS effects
GI effects
Schedule V
Valproic Acid
Therapeutic range
AEs
Pregnancy?
(Unclear MOA)
Therapeutic range: 50-100mcg/ml
Category D!!
Liver toxicity & Ammonia build-up
Pancreatitis (ab pain, NV, anorexia)
Ethosuximide
MOA
What kind of seizures
AEs
MOA: suppresses calcium influx
Only for Absence seizures
Systemic lupus erythematosis (butterfly rash)
Leukopenia or anemia
SJS
Topiramate
MOA
AEs
Pregnancy?
MOA: alters sodium channels, GABA receptors AND calcium channels
Category D!
Metabolic acidosis
CNS cognitive effects
Phenobarbital MOA Schedule Therapeutic range AEs
MOA: potentiates GABA and depresses glutamate
Schedule IV
Therapeutic range 10-40mcg/ml
CNS depression
Gabapentin
MOA
AEs
MOA: increases GABA via calcium channels
(Second-line or adjunct therapy only)
Edema
CNS suppression
What do you recommend to pregnant women taking phenobarbital, phenytoin, carbamazepine or primidone?
Take vitamin K daily to reduce risk of bleeding
Take folic acid at 5x recommended pregnancy dose
Seizures are more dangerous for fetus than the drug risk
Management of status epilepticus
Maintain ventilation
Correct hypoglycemia
Use IV bzds (lorazepam or diazepam) to terminate seizures
