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Pharm Exam 3 > Treatment for Seizures, Epilepsy, and Spasticity > Flashcards

Treatment for Seizures, Epilepsy, and Spasticity Flashcards

1
Q

what is the definition of seizures?

A

brief episodes of abnormal electrical activity in nerve cells of the brain that may or may not be accompanied by visible changes in appearance or behavior

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2
Q

what is the definition of epilepsy?

A

one or more seizures not caused by a reversible medical condition

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3
Q

what is spasticity?

A

increase in muscle tone or contraction

  • stiff or awkward movements
  • associated with brain/nerve damage related to the spinal cord
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4
Q

what are partial seizures?

A

begins focally in the cerebral cortex with limited spread to adjacent cortical areas
- simple or complex

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5
Q

what is a simple partial seizure?

A
  • no memory loss
  • no loss of consciousness
  • muscle rigidity, spasms, jerking movements
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6
Q

what is a complex partial seizure?

A
  • memory loss
  • loss of conciousness
  • lip-smacking, chewing, impaired coordination
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7
Q

what is a generalized seizure?

A

seizure activity is conducted widely throughout both hemispheres

  • often lose consciousness
  • typically 1-3 minutes
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8
Q

what is the prodromal period?

A

before the seizure - can be triggered by stress, overstimulation, mood changes, infection

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9
Q

what is the aura?

A

trigger or feeling prior to seizure

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10
Q

what are the possible triggers for seizures?

A
  • infection
  • depression
  • stress
  • lights
  • over stimulation
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11
Q

what is the ictal period?

A

during the seizure event - this is what you time

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12
Q

what is the post-ictal period?

A

the period after seizure activity

  • headache
  • tired
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13
Q

what is tonic?

A

contraction of skeletal muscle

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14
Q

what is clonic?

A

rhythmic, jerking movements

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15
Q

what are the 4 stages of a seizure?

A
  • prodromal
  • aura
  • ictal
  • postictal
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16
Q

what is the part of the seizure that you time?

A

ictal

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17
Q

what is seen with tonic-clonic seizures?

A

stiffness and shaking

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18
Q

what is seen with absence seizures?

A
  • staring spells and spacing out
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19
Q

what is seen with atonic seizures?

A
  • loss of muscle tone

- drop to the ground or head starts bobbing

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20
Q

what is seen with myoclonic seizures?

A
  • shakey and jerky
  • short in duration
  • specific limb
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21
Q

what are the possible causes of seizures?

A
  • idiopathic
  • fever
  • hypoglycemia
  • electrolyte imbalance
  • drug overdoses
  • withdrawal from alcohol of sedative-hypnotics
  • developmental defects
  • birth injury
  • eclampsia
  • alzheimer’s
  • head injury
  • stroke
  • brain tumor
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22
Q

what health history would be taken while diagnosing seizures?

A
  • TBI
  • drug use
  • history of CVA or brain tumor
  • brain swelling
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23
Q

what IMAGING studies would be used while diagnosing seizures? why?

A

looking for scaring or abnormalities

  • CT scan
  • MRIs
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24
Q

what is the most important test for diagnosing seizures?

A

electroencephalograms (EEGS)

  • outpatient or inpatient
  • detect seizures via electrical brain activity
  • shows the specific area of seizure
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25
Q

what is the goal with antiepileptic drugs (AEDs)?

A
  • reduce seizures (not a cure)

- improve quality

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26
Q

what are the different actions of AEDs?

A
  • suppress sodium influx
  • suppress calcium influx
  • antagonism of glutamate
  • potentiation of GABA (increase)
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27
Q

is glutamate excitatory?

A

yes (we want to decrease)

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28
Q

provide examples of traditional AEDs

A
  • phenytoin (Dilantin)
  • carbamazepine (Tegretol)
  • phenobarbital (Luminal)
  • diazepam (Valium)
  • clonazepam (Klonopin)
  • lorazepam (Ativan)
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29
Q

what is the action of phenytoin (Dilantin)?

A

delay influx of sodium into neurons thus preventing excitability (calms down nerves)

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30
Q

what are the adverse effects of phenytoin (Dilantin)?

A
  • toxicity
  • gingival hyperplasia (overgrowth of gums)
  • rash - steven johnson’s syndrome
  • CV: arrhythmias and hypotension
  • GI: nausea and vomiting (take with food)
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31
Q

what teaching is needed with phenytoin (Dilantin)?

A
  • monitor for levels of toxicity (should be 10-20, more than 20 is toxic, and less than than 10 is not therapeutic)
  • increase dental exams
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32
Q

is phenytoin (Dilantin) safe for pregnancy?

A

no, and it decreases the effectiveness of birth control

- would need to use two forms of birth control

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33
Q

what are the signs and symptoms of toxicity with phenytoin (Dilantin)?

A
  • unsteady walk
  • trembling hands
  • can’t speak well
  • serum level greater than 20
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34
Q

what is a common but severe side effect of AEDs?

A

steven johnson syndrome

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35
Q

what is the action of carbamazepine (Tegretol)?

A

inhibits sodium uptake

36
Q

what black box warning is seen with carbamazepine (Tegretol)?

A

agranulocytosis (decrease WBCs, increased risk for infection)

37
Q

what side effects are seen with carbamazepine (Tegretol)?

A
  • agranulocytosis
  • steven johnson syndrome
  • aplastic anemia
38
Q

what is the action of valproic acid (Depakene)?

A

increase GABA

39
Q

what side effects are seen with valproic acid (Depakene)?

A
  • teratogenic (toxic to fetuses)

- PCOS in women of childbearing age

40
Q

is valolporic acid (Depakene) safe for pregnancy?

A

no, it is teratogenic

41
Q

what kind of medication is phenobarbital (Luminal)?

A

barbiturate - AED

42
Q

what black box warning is seen with phenobarbital (Luminal)?

A

increased suicide ideation - don’t use if the patient is depressed because they can commit suicide by overdosing

43
Q

what are the signs of overdose with phenobarbital (Luminal)?

A
  • decreased respirations
  • constricted pupils
  • bradycardia
  • coma (decreased level of consciousness)
44
Q

what side effects are seen with phenobarbital (Luminal)?

A
  • steven johnson syndrome

- increased suicide ideation

45
Q

provide examples of newer AEDs?

A
  • lamotrigine (Lamictal)
  • gabapentin (Neurontin)
  • levetiracetam (Keppra)
  • topiramate (Topamax)
46
Q

what side effect is seen with newer AEDs?

A

steven johnson syndrome

47
Q

what is one benefit to newer AEDs?

A

helps regulate and calm mood because there are fewer neurons firing

48
Q

what is the action of lamotrigine (Lamictal)?

A

decreases release of glutamate

49
Q

what drug would require drug level monitoring?

A

Dilantin (10-20)

50
Q

what newer AED can not be crushed?

A

levetiracetam (Keppra)

51
Q

what is glutamate?

A

an excitable neurotransmitter (we want to decrease in patients with seizures)

52
Q

what does Gabapentin (Neurontin) treat?

A

seizure, restless leg syndrome, hot flashes, alcohol withdrawal, peripheral neuropathy, deep nerve pain.

53
Q

what happens if a patient does not take their AED regularly?

A

increased seizure activity

54
Q

how to stop AEDs?

A

don’t stop abruptly

55
Q

what drug creates a higher risk for suicide?

A

phenobarbital (Luminal) - black box warning

56
Q

what are some nondrug therapies for seizures?

A
  • neurosurgery
  • vagal nerve stimulation
  • ketogenic diet
  • marijuana treatment????
57
Q

what kind of diet is good for seizure patients? why?

A

ketogenic diet because it is high in fat, fat breaks down into ketones, and ketones decrease risk of seizures

58
Q

what is vagal nerve stimulation?

A

kind of like a pacemaker that stimulates the vagal nerve to increase the stimulation of norepinephrine

  • takes weeks or a year to be effective
  • patient still needs to be on meds especially till it starts working
59
Q

can service alert dogs help?

A

yes

60
Q

what is status epilepticus?

A

the most dangerous and extreme type of surgery

- TONIC CLONIC seizure that lasts longer than 5 minutes or frequent events closer together

61
Q

what is there a high risk of with status epilepticus?

A

permanent brain damage

- loss of oxygen/perfusion to the brain

62
Q

what are the possible causes of status epilepticus?

A
  • brain trauma
  • cerebral damage
  • systemic infection
  • drug overdose
  • alcohol withdrawal
  • abrupt discontinuation of AEDs
  • brain tumor
  • epilepsy syndrome
  • electrolyte abnormalities
  • encephalitis
63
Q

how common is status epilepticus? what is the treatment?

A

15% of epileptic pt’s will experience status epilepticus

- treatment includes: oxygen, neuro exam, IV Ativan (benzodiazepine)

64
Q

what should a nurse do when taking care of a patient who is seizing?

A
  • turn on their side, head support, nothing in mouth
  • oxygen therapy or suctioning if needed
  • time the event
  • administer Ativan for prolonged seizures
  • monitor for possible loss of consciousness
65
Q

what are anti-spasmotic drugs used for?

A

muscle spasms

66
Q

what is the action of carisoprodol (Soma)?

A

inhibits multineuronal spinal reflexes

67
Q

what is carisoprodol (Soma) used for?

A

relieve pain caused by MS conditions

68
Q

what are the side effects of carisoprodol (Soma)?

A
  • dizziness
  • vertigo
  • ataxia
  • tremor
  • agitation
  • irritability
  • idiosyncratic reactions
69
Q

what are examples of idiosyncratic reactions caused by carisoprodol (Soma)?

A

drug reactions not related to the chemical makeup of the drugs itself after multiple doses

  • rashes
  • decreased WBC
  • anemia
  • kidney damage
  • jaundice
70
Q

what are concerns with carisoprodol (Soma)?

A
  • avoid operating heavy machinery
  • don’t stop abruptly
  • high levels of abuse
  • should not be taken for more than 3 weeks
71
Q

what is baclofen used for?

A

decrease muscle spams, spasticity, and rigidity

- spasms from multiple sclerosis

72
Q

what is the action of baclofen?

A
  • inhibits impulse transmissions from the spinal cord

- increases GABA

73
Q

what form can baclofen come in?

A

a pump that continuously delivers baclofen to the spinal cord

74
Q

what are the side effects seen with baclofen?

A
  • drowsiness
  • fatigue
  • weakness
  • confusion
  • headache
  • insomnia
  • hypotension
  • urinary frequency
75
Q

what does dantrolene sodium do and what is it used for?

A

decreases spasticity
- multiple sclerosis, cerebral palsy, spinal cord injury, CVA
relaxes skeletal muscle

76
Q

what side effects are seen with dantrolene sodium?

A
  • drowsiness, dizziness, diarrhea, fatigue, and hepatitis
77
Q

what needs to be monitored with dantrolene sodium?

A

may need to monitor liver function - black box warning

78
Q

what else is dantrolene sodium used for?

A

malignant hypothermia

  • increased carbon dioxide (hypocarbia)
  • metabolic acidosis - rigidity of skeletal muscles
79
Q

what is cyclobenzaprine (Flexeril) used for?

A

short term therapy

  • relieves spasms by relaxing skeletal muscles
  • commonly given post-op for spine or joint surgery
80
Q

what are the side effects seen with cyclobenzaprine (Flexeril)?

A
  • drowsiness
  • dizziness
  • anticholinergic
81
Q

what teaching is needed with cyclobenzaprine (Flexeril)?

A

avoid alcohol use because of CNS depression

82
Q

what is tizanidine (Zanaflex) used for?

A

given for spasms due to increased muscle tone

83
Q

what is the action of tizanidine (Zanaflex)?

A

disrupts excitatory actions from the spinal interneurons

84
Q

what is the absorption like for tizanidine (Zanaflex)?

A

rapid absorption via GI tract

85
Q

what side effects are seen with tizanidine (Zanaflex)?

A
  • drowsiness
  • dizziness
  • constipation
  • dry mouth
  • hypotension
  • hallucinations
  • anticholinergic

Pharm Exam 3 (5 decks)

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