Pharm2 6 Neuro pt3 Flashcards
Are most seizures dangerous?
Most seizures, of and to themselves, are not dangerous
Anti-seizure medication are drugs to __ seizures (4)
abort, control, minimize or prevent seizures
Anti-seizure Medications all act with __ receptors
- Stimulate an influx of __ ions (i.e., Valium, Ativan, Neurontin, Phenobarbital, Topamax)
- Delay an influx of __ ions (i.e., Dilantin, Cerebyx, Tegretol, Depakote)
- Delay an influx of __ ions (i.e., Zarontin, Depakote)
GABA
chloride
sodium
calcium
Prototypical Anti-seizure Benzo:
Diazepam (Valium®)
Diazepam (Valium®)
Indications
Mechanism of action
Indications: Status epilepticus
Mechanism of action: Bind to gama-amino butyric acid (GABA) receptor-chloride channels molecules increasing the effect of GABA, suppressing abnormal neuronal discharges
Diazepam (Valium®)
Adverse Effects
Contraindications
Adverse Effects: CNS depression, drowsiness, dizziness, memory impairment, ataxia, hypotension, withdrawal seizures,
Contraindications: Allergy
Prototypical Anti-seizure Barbiturate:
Phenobarbital (Nembutal®)
Phenobarbital (Nembutal®)
Indications
Mechanism of action
Indications: management of seizures unresponsive to other medications
Mechanism of action: intensify the effects of gama-amino butyric acid (GABA) receptor-chloride channels molecules increasing the effect of GABA, suppressing abnormal neuronal discharges
Phenobarbital (Nembutal®)
Adverse Effects
Contraindications
Adverse Effects: Physical and psychological dependence, drowsiness, respratory depression, respiratory arrest, CNS depression, coma , esp. with ETOH
Contraindications: Allergy
Prototypical Anti-seizure Misc:
Gabapentin (Neurontin®)
Gabapentin (Neurontin®)
Indications
Mechanism of action
Indications: Partial seizures or seizures that could become generalized [post-herpetic neuralgia, migraine prophylaxis]
Mechanism of action: Mimics GABA, speeding up release from brain neurons and suppressing abnormal neuronal discharges
Gabapentin (Neurontin®)
Adverse Effects
Contraindications
Adverse Effects: Potentiates CNS depression with other CNS depressants and/or ETOH, somnolence, dizziness, ataxia, fatigue, emotional lability
Contraindications: Allergy, avoid abrupt cessation, pregnancy
Prototypical Anti-seizure Hydantoin:
Phenytoin (Dilantin®)
Phenytoin (Dilantin®)
Indications
Mechanism of action
Indications: Tonic-clonic psychomotor seizures and seizure prophylaxis, esp. s/p head trauma; anti-arrhythmic
Mechanism of action: Chemically similar to barbiturates (but not addictive), reduces the spread of electrical discharges within the brain
Phenytoin (Dilantin®)
Adverse Effects
Contraindications
Adverse Effects: Gingival hyperplasia, dysrhythmias, hypotension, drowsiness, interacts with ETOH, anticoagulants, OCs
Contraindications: Allergy, IV bolus injection, avoid abrupt cessation, pregnancy
Behavioral, emotional, mood, psych disorders are Now, frequently diagnosed by __ , treated by __
diagnosed by specialist, treated by generalist
What psych disorders are both dx and tx by generalist?
Mild to moderate depression, PTSD
Prototypical CNS Stimulant for ADD/ADHD:
Methylphenidate (Ritalin®)
Methylphenidate (Ritalin®)
Indications
Mechanism of action
Indications: Treatment of ADD/ADHD in children and narcolepsy in adults
Mechanism of action: Stimulates the cerebral cortex with amphetamine-like action through the release of norepinephrine, dopamine, and seratonin
Methylphenidate (Ritalin®)
Adverse Effects
Contraindications
Adverse Effects: Seizures, paradoxical excitement, hypertension, psychosis, interacts with anticonvulsants, anticoagulants
Contraindications: Marked anxiety, tension, agitation, uncontrolled glaucoma, history of Tourette’s Syndrome/tics, within 14 days of MAOIs
How Sonata differs from Ambien (CNS sleep hypnotics)
It has a stronger/quicker onset, and a much shorter offset than Ambien. (i guess it’s if they are having trouble FALLING asleep. ambien would be better if they have trouble STAYING asleep)
If seizure patient doesn’t respond to Diazepam ppx, what’s the next drug?
Phenobarbital
What’s the problem with Phenobarbital? (2nd line seizure ppx drug)
10 point IQ drop in mentally handicapped
Gabapentin is probably never actually used for antiseizure purposes. What is it really used for? (3)
painful diabetic neuropathy, post herpetic neuralgia, and migraine prophylaxis.
Gabapentin vs. Pregabalin
Gabapentin has nonlinear kinetics (varies)
Pregabalin (Lyrica) has linear kinetics. has all the same indications & issues that Gabapentin does. The difference: way more expensive.
Phenytoin (Dilantin) main use is as…
anti-arrhytmic
Veterans with traumatic brain injuries (and get seizures) get what tx?
Phenytoin (Dilantin)
After Valium or Ativan stops a seizure, you can then give this other drug that has a much longer half life:
Phenytoin (Dilantin)
but i think this is more like a 3rd line drug
What anti seizure med causes gums to grow over teeth?
Gingival hyperplasia
Phenytoin (Dilantin)
You’re concerned about the speed of loading a seizure patient with Phenytoin b/c…
deadly cardiac dysthythmia
Routes of admin for Phenytoin, and how they come into play
Initial loading is IV (not too fast)
Then capsules, and check the level
Phenytoin is absolutely CI in:
pregnancy
According to DSM-5, you can only make the dx of ADHD after what age?
5
