Quiz 8 Flashcards
Treatment for first phase (5-20 min) of status epilepticus? Second phase (20-40 min)?
- Benzo
- No true first choice for 2nd phase - fosphenytoin, valproic acid, keppra
3rd phase (40-60 min) of status epilepticus treatment
- repeat second line
- anesthetic doses of thiopental, midazolam, pentobarbital, propofol
look at slide 6-7
.
GABA enhancers: Increased _________ movement through the GABA-A receptor, blocking pre-synaptic GABA uptake, inhibiting GABA metabolism by GABA transaminase, increasing GABA ______ (modulate glutamic acid decarboxylase)
chloride
synthesis
Glutamate blockers block what? (3)
NMDA
AMPA
kainate receptors- reduces the Na in/K out
Carbonic Anhydrase Inhibitors- blocks the normal function of increasing __ ions/reducing __ leading to K+ shifts to buffer acid base status and _________ seizure threshold.
H+
pH
increasing
Na channel blockers
- ‘zepines
- Dilantin
- lotragine
- ‘samides
- Carbamazepine (Tegretol, Carbatrol)
- Oxcarbazepine (Trileptal)
- Eslicarbazepine (Aptiom)
- Phenytoin/Fosphenytoin (Dilantin)
- Lamotrigine (Lamictal)
- Zonisamide (Zonegran)
- Lacosamide (Vimpat)
Carbamezapime speed up or slow down other med metabolism?
speeds up, CYP inducer
Carbamazepine ADRs (3)
- Stevens- Johnson syndrome
- Increased LFTs
- Hyponatremia
important for Eslicarbazepine
Adjust dose in renal impairment
Important for Phenytoin/Fosphenytoin
- 70-95% protein bound
- Fosphenytoin = prodrug for parenteral administration
Phenytoin/Fosphenytoin ADRs
Ginginval hyperplasia Arrhythmias, cardiovascular depression, hypotension Ataxia Nystagmus Osteoporosis Blood dyscrasias N/V Rash Vitamin K and folate deficiencies Bone marrow hypoplasia If given during pregnancy: cleft palate, cleft lip, congenital heart disease, slowed growth rate, mental deficiency
Lamotrigine ADR’s (5)
- interaction with Valproic Acid
- Blood dyscrasias
- Ataxia, Tremor
- Diplopia
- Psychosis, insomnia
Zonisamide ADRs
- Oligohidrosis in children
- confusion, speech abnormalities, mental slowing
important for lacosamide
Pregnancy Category C
GABA Agonists
GABA Reuptake Inhibitors
GABA Transaminase Inhibitors
GABA Other
GABA Agonists
- Benzodiazepines
- Phenobarbital
- Primidone (Mysoline)
GABA Reuptake Inhibitors
-Tiagabine (Gabitril)
GABA Transaminase Inhibitors
-Vigabatrin (Sabril)
GABA Other
- Gabapentin (Neurontin)
- Pregabalin (Lyrica)
- Valproate (Depakote
withdrawal risk greatest in which benzo
Clobazam (Onfi)
Highest safety risk of gabapentin in the operative setting
Post-op sedation
given 30 mins preoperatively
GABA analogue, binds alpha2 and delta receptor sites- reduced release of excitatory NTs via Calcium currents.
Pregabalin
Pregabalin ADRs
Rare - Angioedema
valproic acid (Depakote) concerns?
- 85-95% protein bound - watch out for low protein/burn victims
- In utero exposure- lower IQ in children compared to other anti-epileptics
- Hepatotoxicity (highest risk in children), rare but fatal pancreatitis
- Hyperammonemia
metabolized by liver