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2nd Semester Nursing > Pharm - Sleep And Seizures > Flashcards

Pharm - Sleep And Seizures Flashcards

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1
Q

A sedative is…

A

… a drug that reduces irritability/excitement to create sedation

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2
Q

A hypnotic is…

A

… a drug that makes you sleepy

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3
Q

A sedative-hypnotic is…

A

… a drug that is used to relieve anxiety by depressing the CNS AND makes you sleepy.

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4
Q

An anticonvulsant is…

A

… a drug that suppresses the rapid firing of neurons that starts a seizure

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5
Q

Status-epilepticus is

A

30+ minutes of seizure or a series of seizures.

Can occur with any seizure type

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6
Q

What are the common effects that sedative-hypnotics have on the body? What are they used for?

A

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

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7
Q

What are the three types of sedative-hypnotics?

A

Benzodiazepines
Z-drugs (benzodiazepine receptor agonists)
Barbiturates

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8
Q

BZDs and Z-drugs work the same way: what is it?

How are barbiturates different?

A

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

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9
Q

Six uses for BZDs?

A 
Panic attacks
Insomnia
Seizures
Anesthesia
Muscle spasm
ETOH withdrawal
(PISAME)
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10
Q

What happens if you take too much BZD?

What’s the antidote?

A

Respiratory depression
Sedation and lethargy

Antidote: flumazenil

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11
Q

When would you use a rapid action benzo (2)?

What are examples for each?

A

Short procedures (Midazolam: versed)

Insomnia (Triazolam)

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12
Q

What are intermediate acting BZDs sometimes used for insomnia?

A

Alprazolam
Lorazepam
Oxazepam
Temazepam

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13
Q

Why would you use long-acting BZDs?

Examples?

A

ETOH withdrawal

Clonazepam
Diazepam
Chlordiazepoxide
Flurazepam

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14
Q

What are Z-drugs supposed to be used for?

A

Insomnia. Very short term only.

NOT anxiety

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15
Q

What’s a weird side effect of Z-drugs?

A

Sleep-walking and strange dreams

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16
Q

What are the three Z-drugs we learned?

A

Zolpidem (ambien)
Eszopiclone (Lunesta)
Zaleplon (Sonata)

17
Q

What are barbiturates typically used for?

Three drug names and length of action?

A

Refractory seizures

Thiopental (ultra-short acting)
Secobarbital (short-intermediate acting)
Phenobarbitol (long-acting)

18
Q

Why do we have to be careful with barbiturates?

A

OD will kill you b/c of CNS depression.

19
Q

What is a focus?

A

The term used for a group of hyperexcitable neurons that create a high-frequency, synchronous discharge, initiating a seizure.

20
Q

What are the two kinds of partial seizures?

A

Simple partial (10-20s): no loss of consciousness

Complex partial (45-90s): impaired consciousness

21
Q

What are tonic-clonic seizures?

A

Last 90s or less
Major convulsions:
-muscle rigidity (tonic) and muscle jerks (clonic)

Postictal state follows (CNS depression)

22
Q

What are absence seizures?

A

10-30s, mild, brief loss of consciousness

23
Q

What are atonic seizures?

A

Sudden loss in muscle tone: “head drop” or “drop attack”

24
Q

What are myoclonic seizures?

A

1s sudden muscle contraction

25
Q

What are febrile seizures most likely to resemble? What ages are they most likely to happen in?

A

Tonic-clonic seizures

6mos-5yrs.

26
Q

What is the goal of antiepileptic drugs?

A

Suppress the discharge of neurons at the focus

Suppress the propagation of seizure activity from the focus to elsewhere in the brain

27
Q

What are 4 MOAs of antiepileptic drugs?

A
  • Suppress sodium influx
  • Suppress calcium influx
  • Antagonize glutamate
  • Potentiate GABA
28
Q 
Phenytoin: 
MOA? 
Therapeutic range?
AEs?
ok in pregnancy?
A

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!

29
Q 
Carbamazepine: 
MOA
Therapeutic range
SEs
Ok in pregnancy?
A

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!!

30
Q

Lamotrigine
MOA
SEs

A

MOA: blocks voltage-gated sodium channels

SJS: needs very slow titration

31
Q

Levetiracetam
Therapeutic range
Guesstimated MOA

A

12-46mcg/ml

MOA: they think it’s voltage-gated sodium channels

Well tolerated

32
Q

Lacosimide
MOA
SEs?
Schedule?

A

MOA: slow inactivation of voltage-gated sodium channels

CNS effects
GI effects

Schedule V

33
Q

Valproic Acid
Therapeutic range
AEs
Pregnancy?

A

(Unclear MOA)

Therapeutic range: 50-100mcg/ml
Category D!!

Liver toxicity & Ammonia build-up
Pancreatitis (ab pain, NV, anorexia)

34
Q

Ethosuximide
MOA
What kind of seizures
AEs

A

MOA: suppresses calcium influx

Only for Absence seizures

Systemic lupus erythematosis (butterfly rash)
Leukopenia or anemia
SJS

35
Q

Topiramate
MOA
AEs
Pregnancy?

A

MOA: alters sodium channels, GABA receptors AND calcium channels

Category D!

Metabolic acidosis
CNS cognitive effects

36
Q 
Phenobarbital 
MOA
Schedule
Therapeutic range
AEs
A

MOA: potentiates GABA and depresses glutamate

Schedule IV

Therapeutic range 10-40mcg/ml

CNS depression

37
Q

Gabapentin
MOA
AEs

A

MOA: increases GABA via calcium channels
(Second-line or adjunct therapy only)

Edema
CNS suppression

38
Q

What do you recommend to pregnant women taking phenobarbital, phenytoin, carbamazepine or primidone?

A

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

39
Q

Management of status epilepticus

A

Maintain ventilation
Correct hypoglycemia
Use IV bzds (lorazepam or diazepam) to terminate seizures

2nd Semester Nursing (18 decks)

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