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PT2 Neuro 1-5 > therapeutics > Flashcards

therapeutics Flashcards

1
Q

epilepsy treatment goals

A
  • complete elimination of seizures
  • no medication adverse effects
  • optimal quality of life
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2
Q

main reason seizure drugs fail

A

nonadherance

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3
Q

common comorbidities of epilepsy

A

depression
anxiety
suicide risk

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4
Q

patient quality measures pharmacist is involved in

A
  • evaluation of seizure frequency
  • querying and counseling about ASD side effects
  • counseling about epilepsy safety issues
  • counseling women of childbearing age
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5
Q

what can trigger seizures

A
  • metabolic disturbances
  • cerebral trauma
  • intracranial hemorrhage
  • tumor
  • stroke
  • medication nonadherance
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6
Q

risk of seizure in diabetes

A

diabetic ketoacidosis and hypoglycemia can trigger seizure activity

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7
Q

drugs that may induce seizures

A
  • bupropion
  • theophylline
  • meperidine
  • tramadol
  • antipsychotics
  • antibiotics
  • amphetamines, cocaine
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8
Q

drugs that may cause seizures after withdrawal

A
  • alcohol
  • barbiturates
  • benzodiazepines
  • ASDs
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9
Q

when is greatest risk of 2nd seizure following an unprovoked seizure

A

in the first 2 years after the 1st unprovoked

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10
Q

drug of choice for absence seizures

A

ethosuximide

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11
Q

drug of choice for infantile spasms

A

vigabatrin

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12
Q

broad spectrum ASD

A
  • levetiracetam
  • lamotrigine
  • valproate
  • topiramate
  • clobazam
  • felbamate
  • perampanel
  • rufinamide
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13
Q

broad spectrum ASD can be used to treat

A

focal and generalized seizures

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14
Q

how to start patient on a new ASD

A

start at the low dose and titrate up, following dosing guidelines

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15
Q

ethosuximide adverse effects

A

nausea/vomiting, depression, rash

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16
Q

how to change from one drug to another

A

titrate the 2nd drug to its max dose and then taper off the 1st drug

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17
Q

common CYP450 inducers

A

phenytoin
carbamazepine
oxcarbazepine
phenobarbital

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18
Q

common CYP450 inhibitor

A

valproate

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19
Q

autoinduction

A

the process of a drug inducing a CYP enzyme that then metabolizes the drug, causing levels to become subtherapeutic

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20
Q

drugs associated with skin reactions

A 
carbamazepine
phenytoin
lamotrigine
oxcarbazepine
eslicarbazepine
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21
Q

drug associated with autoinduction

A

carbamazepine

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22
Q

drug associated with protein binding

A

phenytoin

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23
Q

highest risk of bone loss tied to which drugs

A

phenytoin

phenobarbital

24
Q

special considerations for elderly

A
  • drug interactions
  • hypoalbuminemia
  • body mass changes
  • neurocognitive AEs
  • may need lower serum conc.
25
Q

special considerations for young

A
  • increased body water
  • may require higher doses
  • rapid changes in metabolism
26
Q

special considerations for women

A
  • hormones may affect electrical excitability
  • estrogen (proconvulsant)/progesterone (anticonvulsant)
  • DDI with oral contraceptives
  • catamenial seizures
27
Q

catamenial seizure

A

seizure before/during menstrual flow and at times of ovulation

28
Q

seizures in pregnancy

A
  • not contraindicated
  • increased seizures by 25-30%
  • must have adequate folic acid
29
Q

drugs that have risk of neural tube defect

A

valproic acid

carbamazepine

30
Q

risk of teratogenic effects with which ASDs

A

phenobarbital
phenytoin
topiramate

31
Q

avoid valproic acid and ASD polypharmcy when

A

1st trimester of pregnancy

32
Q

when can you stop ASDs

A
  • seizure free for 2-5 years
  • history of single type of seizure
  • normal neuro exam and IQ
  • EEG normalized
33
Q

how to stop an ASD

A

always taper

34
Q

most seizures last how long

A

<2 minutes

35
Q

status epilepticus

A

seizure lasting over 5 minutes

36
Q

status epilepticus associated with

A

brain damage or death

37
Q

types of status epilepticus

A
  • generalized convulsive status epilepticus (tonic/clonic)

- nonconvulsive status epilepticus (altered consciousness/behavior)

38
Q

most generalized convulsive status epilepticus seizures occur in who

A

individuals with no history of epilepsy

39
Q

highest risk of status epilepticus

A

< 1 y/o and over 60 y/o

40
Q

phase I of GCSE

A
  • increased BP and HR
  • muscular contraction+hypoxia = lactic acid release and acidosis
  • airway obstruction
  • aspiration pneumonia risk
41
Q

phase II of GCSE

A
  • hypotensive
  • decreased cerebral blood flow
  • hypoglycemia
  • hyperthermia
42
Q

treatment steps of patient undergoing status epilepticus

A
  1. stabilize airway
  2. note onset time, get vitals, identify precipitating factors
  3. terminate seizure
  4. prevent recurrence
43
Q

drugs used for termination of status epilepticus

A

benzodiazepines

possibly phenytoin or barbiturates

44
Q

benzodiazepine that can be given nasally

A

midazolam

45
Q

initial hospital care for seizures

A

-assess airway and heart function
-IV access
-begin IV fluids
o Thiamine 100 mg for adults
o pyridoxine 50-100 mg for infant
-glucose if BG <60
-naloxone if suspected narcotic OD
-antibiotic if suspected infection

46
Q

benzodiazepine given in hospitals for seizure

A

IV lorazepam

47
Q

why are benzo’s used to terminate seizures

A
  • work very quickly (2-3 mins)

- shorter half life in CNS

48
Q

after benzo is given in hospital what to we give after

A

IV phenytoin or fosphenytoin

49
Q

benefits of phenytoin in termination of seizures in hospital

A
  • long half life

- less respiratory depression and sedation

50
Q

problems in using phenytoin in termination of seizures in hospital

A
  • cannot be given rapidly
  • must be diluted to 5mg/ml in NS
  • max rate of 50 mg/min
51
Q

fosphenytoin

A
  • water soluble phenytoin prodrug
  • no propylene glycol
  • converts 100%
52
Q

how do we dose fosphenytoin

A

in phenytoin equivalents

53
Q

drugs for refractory seizures (>60 minutes) in hospital

A

IV midazolam
IV pentobarbital
IV propfol

54
Q

when do refractory seizures occur

A

when adequate doses of benzo’s, hydantoin, or barbiturate have failed

55
Q

what drug can be given rectally to terminate a seizure

A

diazepam

PT2 Neuro 1-5 (4 decks)

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