Seizure DRUGS Flashcards
Benzodiazepines for seizures
-Indications
Absence seizures and myoclonic seizures
- One of the MOST widely prescribed classes
- used also for: Anxiety, skeletal muscle spasms, and alcohol withdrawal symptoms
Tolerance may develop quickly
Benzodiazepines for seizures
-Risks and Contraindications
Monitor for drug abuse potential (Schedule IV)
Pregnancy Category D
Contraindicated in NARROW-ANGLE GLAUCOMA
Benzodiazepines for seizures
-Side effects and OD
- Respiratory depression may result w/ other CNS depressants
- Common side effects include dizziness, drowsiness
- for overdose give FLUMAZENIL (ROMAZICON)
Benzodiazepines for seizures
-Prototype drug
Diazepam (Valium)
- Mechanism:
- Similar to that of barbiturates but safer - Primary Use:
- Short-term seizure control - Adverse effects:
- Drowsiness and dizziness
Examples of Benzodiazepines
- Clonazepam (Klonopin)
- Clorazepate (Tranxene)
- Lorazepam (Ativan
- Diazepam (Valium)
Barbiturates for seizures
-Overview
- Low margin for safety
- High potential for dependence
- Profound CNS depression
- Effective against all major seizure types EXCEPT absence seizures
Barbiturates for seizures
-What type of seizure they DO NOT treat?
Barbiturates are not effective against absence seizures
Examples of Barbiturates
- Phenobarbital (Luminal)
- Amobarbital (Amytal)
- Secobarbital (Seconal)
- Pentobarbital (Nembutal)
Barbiturates for seizures
-Prototype Drug
Phenobarbital (Luminal)
- Mechanism:
- Changing the action of GABA - Primary Use:
- Controlling seizures - Adverse effects
- Dependence, drowsiness, vitamin deficiencies, laryngospasm
Barbiturates for seizures
-Monitor?
- Monitor Pt condition
- Liver and kidney function
- Pregnancy Category D
Barbiturates for seizures
-Patient Teaching
- Use Reliable contraception
- Immediately report pregnancy
- Report excessive signs of bleeding
- Report drowsiness and bone pain
Hydantoins for Seizures
-Overview
- Useful for all types of epilepsy except ABSENCE SEIZURES
2. Provides effective seizure Suppression w/out abuse potential or CNS depression associated w/ barbiturates
Hydantoin and Phenytoin-like Drugs
-Monitor??
- Monitor serum-drug levels and signs of toxicity
- Blood dyscrasias and bleeding disorders
- liver and kidney function
- Fatal hepatotoxicity can occur
- Watch for GINGIVAL HYPERPLASIA
Hydantoin and phenytoin-like drugs
-contraindications
- Pt’s w/ hypersensitivity to hydantoin products
2. Rash, seizures due to hypoglycemia, sinus bradycardia, and heart block
Hydantoin and phenytoin-like drugs
-Patient Teaching
- Immediately report heart block, hypoglycemia, or pregnancy
- Immediately report unusual bleeding
- Routine labs for liver and kidney function
- Report signs of toxicity
Hydantoins
-Prototype Drug
phenytoin (Dilantin)
- Mechanism
- Desensitize sodium channels - Primary Use
- Treats all types of seizures except absence seizures - Adverse Effects:
- CNS depression, Gingival hyperplasia, skin rash, cardiac dysrhythmias, Hypotension
Examples of Hydantoins
- Phenytoin (Dilantin) –MOST COMMON
2. Fosphenytoin (Cerebyx)
Hydantoin and newer drugs
-Overview of mechanism
- Delay an influx of sodium ions across membrane
- Sodium movement determines action potential
- Sodium channels are not blocked; they are just desensitized
Phenytoin-Like Drugs
-Prototype Drug
Valproic Acid (Depakene)
- Mechanism:
- Desensitize sodium channels - Primary Use:
- ABSENCE SEIZURES - Adverse effects:
- Limited CNS depression, Visual disturbances, ataxia, vertigo, headache - Additional Adverse Reactions:
- GI effects, Hepatotoxicity, pancreatitis
Examples of Phenytoin-Like Drugs
- Carbamazepine (Tegretol) - tonic-clonic and partial seizures
- Felbamate (Felbatol)
- Lamotrigine (Lamictal)
- Valproic acid (Depakene, Depakote) –absence seizures
- Zonisamide (Zonegran)
Phenytoin-like Drugs
-Carbamazepine (Tegretol)
Used for Tonic-clonic and partial seizures
Phenytoin-like Drugs
-Valproic acid (Depakote, Depakene)
Used for absence seizures
Phenytoin-like Drugs
-Patient Teaching
- Avoid alcohol, OTC drugs, and herbal meds
- Avoid Nicotine
- Avoid driving and hazardous activities
- Rebound seizures if discontinued abruptly
- Take w/ food
Succinimides for Seizures
- Overview
- Suppress seizures by delaying calcium influx into neurons
- Generally ONLY effective against ABSENCE SEIZURES
- Ethosuximide (Zarontin) -MOST COMMON prescribed drug in this class
