Quiz 8 Flashcards

1
Q

Treatment for first phase (5-20 min) of status epilepticus? Second phase (20-40 min)?

A
  • Benzo

- No true first choice for 2nd phase - fosphenytoin, valproic acid, keppra

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2
Q

3rd phase (40-60 min) of status epilepticus treatment

A
  • repeat second line

- anesthetic doses of thiopental, midazolam, pentobarbital, propofol

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3
Q

look at slide 6-7

A

.

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4
Q

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)

A

chloride

synthesis

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5
Q

Glutamate blockers block what? (3)

A

NMDA
AMPA
kainate receptors- reduces the Na in/K out

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6
Q

Carbonic Anhydrase Inhibitors- blocks the normal function of increasing __ ions/reducing __ leading to K+ shifts to buffer acid base status and _________ seizure threshold.

A

H+

pH

increasing

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7
Q

Na channel blockers

A
  • ‘zepines
  • Dilantin
  • lotragine
  • ‘samides
  • Carbamazepine (Tegretol, Carbatrol)
  • Oxcarbazepine (Trileptal)
  • Eslicarbazepine (Aptiom)
  • Phenytoin/Fosphenytoin (Dilantin)
  • Lamotrigine (Lamictal)
  • Zonisamide (Zonegran)
  • Lacosamide (Vimpat)
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8
Q

Carbamezapime speed up or slow down other med metabolism?

A

speeds up, CYP inducer

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9
Q

Carbamazepine ADRs (3)

A
  • Stevens- Johnson syndrome
  • Increased LFTs
  • Hyponatremia
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10
Q

important for Eslicarbazepine

A

Adjust dose in renal impairment

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11
Q

Important for Phenytoin/Fosphenytoin

A
  • 70-95% protein bound

- Fosphenytoin = prodrug for parenteral administration

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12
Q

Phenytoin/Fosphenytoin ADRs

A
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
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13
Q

Lamotrigine ADR’s (5)

A
  • interaction with Valproic Acid
  • Blood dyscrasias
  • Ataxia, Tremor
  • Diplopia
  • Psychosis, insomnia
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14
Q

Zonisamide ADRs

A
  • Oligohidrosis in children

- confusion, speech abnormalities, mental slowing

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15
Q

important for lacosamide

A

Pregnancy Category C

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16
Q

GABA Agonists

GABA Reuptake Inhibitors

GABA Transaminase Inhibitors

GABA Other

A

GABA Agonists

  • Benzodiazepines
  • Phenobarbital
  • Primidone (Mysoline)

GABA Reuptake Inhibitors
-Tiagabine (Gabitril)

GABA Transaminase Inhibitors
-Vigabatrin (Sabril)

GABA Other

  • Gabapentin (Neurontin)
  • Pregabalin (Lyrica)
  • Valproate (Depakote
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17
Q

withdrawal risk greatest in which benzo

A

Clobazam (Onfi)

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18
Q

Highest safety risk of gabapentin in the operative setting

A

Post-op sedation

given 30 mins preoperatively

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19
Q

GABA analogue, binds alpha2 and delta receptor sites- reduced release of excitatory NTs via Calcium currents.

A

Pregabalin

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20
Q

Pregabalin ADRs

A

Rare - Angioedema

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21
Q

valproic acid (Depakote) concerns?

A
  • 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

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22
Q

Glutamate Blockers names?

A

The -amates and parampanel

23
Q

High risk aplastic anemia and fatal hepatic failure?

A

Felbamate

24
Q

Topiramate MOAs (4)

A
  • Inhibitory sodium effects
  • GABA enhancement via unknown mech
  • AMPA inhibition
  • Weak carbonic anhydrase inhibitor
25
Q

Perampanel common side effect concern?

A

Dizziness, irritability

26
Q

Look at slide 43

A

.

27
Q

look ast slide 47

A

.

28
Q

Tizanidine action (2) and S/E (1)

A
  • Centrally acting alpha 2 agonist
  • May potentiate glycine
  • Withdrawal also possible with abrupt discontinuation
29
Q

Blocks ryanodine channel > reduced Ca ++ release from SR

A

Dantrolene

30
Q

Dantrolene ADR and BB warning

A

-Dose dependent diarrhea and hepatotoxicity

BB warning > 800 mg/day with long term use

31
Q

Can withdraw from sedative hypnotics like Ambien, True or false?

A

True

32
Q

tricyclic antidepressants potential for?

A

Cardiotoxicity - QT prolongation, Arrhythmias

33
Q

tricyclic antidepressants MOA (3)

A
  • Serotonin and Norepinephrine reuptake inhibitition
  • Anticholinergic
  • 1A antiarrhythmic
34
Q

Serotonin inhibitory receptors

A

1, 5

35
Q

Serotonin receptor that is a Na/K ion channel?

A

3

36
Q

look at slide 57

A

.

37
Q

SSRI’s ADRs (2)

A

platelets and sodium

38
Q

SNRIs ADRs (2)

A
  • Serotonin syndrome

- HTN

39
Q

DNRIs inhibitory or excitatory?

A

excitatory

40
Q

look at slide 63

A

.

41
Q

Lithium MOA (1)

A

Alters neuronal sodium transport

42
Q

Lithium ADRs (2 categories)

A
  • Diabetes insipidus, polyuria, polydipsia

- Coma, Seizures, Tremors

43
Q

More dopamine, more agitated you are and vice versa

A

.

44
Q

Clozaril BB warning (2)

A
  • dementia related death

- agranulocytosis

45
Q

dopamine precurser

A

levadopa

46
Q

false dopamine

A

carbadopa

47
Q

COMT inhibitor

A

entacopone

48
Q

MAOB Inhibitors MOA (1), examples?

A

Increase DA availability via enzyme inhibition

Rasaligine (Azilect)
Selegiline (Eldepryl)

49
Q

for parkinsons with dementia? Concern?

A
  • Amantadine (Symmetrel)
  • Nuplazid (Pimavanserin)

QT prolongation

50
Q

look at slide 76-77

A

.

51
Q

Benzos have ________ withdrawal

A

FATAL

52
Q

Post op delirium

A

Non-pharmacologic for prevention/treatment

  • Educate healthcare professionals
  • delirium vs dementia
  • Cognitive re-orientation, sleep hygiene, early mobility, nutrition/fluids, pain mgmt
53
Q

Post op delirium, avoid which meds?

A

BDZs, anticholinergics, benadryl, H2 receptor antagonists, sedative/hypnotics, demerol, polypharmacy