Pharm - Sleep And Seizures Flashcards by mhari scott

A sedative is…

… a drug that reduces irritability/excitement to create sedation

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A hypnotic is…

… a drug that makes you sleepy

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A sedative-hypnotic is…

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

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An anticonvulsant is…

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

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Status-epilepticus is

30+ minutes of seizure or a series of seizures.

Can occur with any seizure type

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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

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What are the three types of sedative-hypnotics?

Benzodiazepines
Z-drugs (benzodiazepine receptor agonists)
Barbiturates

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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

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Six uses for BZDs?

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

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What happens if you take too much BZD?

What’s the antidote?

Respiratory depression
Sedation and lethargy

Antidote: flumazenil

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

What are examples for each?

Short procedures (Midazolam: versed)

Insomnia (Triazolam)

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What are intermediate acting BZDs sometimes used for insomnia?

Alprazolam
Lorazepam
Oxazepam
Temazepam

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Why would you use long-acting BZDs?

Examples?

ETOH withdrawal

Clonazepam
Diazepam
Chlordiazepoxide
Flurazepam

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What are Z-drugs supposed to be used for?

Insomnia. Very short term only.

NOT anxiety

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

Sleep-walking and strange dreams

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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