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Advanced Pharm - Unit 3 > Week 10 - Anticonvulsants > Flashcards

Week 10 - Anticonvulsants Flashcards

1
Q

This class of medications is 1st line for tonic-clonic and partial complex seizures

A

Hydantoins
* phenytoin
* fosphenytoin

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2
Q

Abrupt discontinuation of any of the anticonvulsants increases the risk for _______

A

seizure

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3
Q

What is the MOA of the hydantoin class?

A

affect Na+ influx into neurons = decreased propagation of nerve impulses

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4
Q

True or false

The hydantoins are the most sedating of all the anticonvulsants

A

False
They are the least sedating

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5
Q

The hydantoins may worsen which type of seizures?

A

Absence

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6
Q

Due to the MOA, hydantoins are contraindicated in patients with ________ disease

A

heart disease
* may cause bradycardia/heart block (Na+ channel affects)

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7
Q

What monitoring is required for the hydantoin class?

A

Plasma drug levels

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8
Q

The carbamezapine anticonvulsants are structurally related to _______

A

Tricyclic antidepressants

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9
Q

The carbamezapine class of medications is used to treat _______

A

Partial or tonic-clonic seizures
Epilepsy
Bipolarism
Aggressive/assaultive behavior

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10
Q

What is the black box warnings associated with the carbamezapine class?

A
  • Steven-Johnson Syndrome and Toxic epidermal necrolysis (Asian population especially at risk)
  • Potential for blood dyscrasias
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11
Q

The carbamezapine class carries a risk of decreased ________ function

A

thyroid

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12
Q

What are the monitoring considerations with the carbamezapine class?

A
  • CBC
  • Liver function tests
  • TSH levels
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13
Q

Because of their structural relation to another class of medications, it is important that the Carbamezapines are not administered within 14 days of _________

A

MAOI’s

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14
Q

Carbamazapine MOA

A

Affects Na+ channels and nerve impulse propagation

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15
Q

Many of the anticonvulsants share a common ADR of ___________

A

increased suicidal thoughts

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16
Q

Lamotrigine is used as __________ therapy for patients with partial or generalized seizures

A

adjunct

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17
Q

Lamotrigine carries a black box warning of?

Which medication given in conjunction increases this risk?

A

Steven-Johnson syndrome, Toxic epidermal necrolysis

Valproate

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18
Q

This possible ADR of lamotrigine necessitates monitoring of CBC

A

Blood dyscrasias

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19
Q

Anticonvulsant drugs that affect GABA include:

A
  • Gabapentin
  • Topiramate
20
Q

True or false

Plasma drug level monitoring is required for gabapentin and topiramate

A

False

21
Q

Behavior problems such as hostility/aggression, “thought disorder”, and worsening school performance has been observed in patients aged 3-12 taking ___________

A

Gabapentin

22
Q

What possible ADR of topiramate requires labratory monitoring?

A

Decreased serum bicarbonate, altered electrolytes

23
Q

Patients taking topiramate who have eye pain or blurred vision should _________

A

contact their provider immediately
* drug reaction causing acute myopia and angle closure glaucoma

24
Q

Ethosuximide is a(n) ___________ with an indication of _____________

A

anticonvulsant, childhood and adult absence seizures

25
Q

With careful monitoring of plasma drug levels, ethosuximide may be safe for use during ___________

A

Pregnancy

26
Q

The most common ADR associated with ethosuximide is ___________ and may be relieved by ___________

A

GI upset, taking the medication with food or milk

27
Q

Ethosuximide may decrease the effectiveness of ___________

A

oral contraceptives

28
Q

Leviteracetam is used for _________

A

adjunct therapy in partial or generalized seizures

29
Q

The most common ADR’s associated with leviteracetam include:

A
  • Somnolence
  • dizziness
30
Q

What is a common severe side effect of phenytoin (not CNS related)

A

Phenytoin-induced hepatitis is a common hypersensitivity reaction

31
Q

What black-box warning does phenytoin carry?

A

Rapid IV administration may cause severe cardiovascular events such as…

Bradycardia
SA block
2nd, 3rd degree block
Stokes-Adams

32
Q

Phenytoin is a pregnancy category…

A

D

May cause malformations and infants exposed may experience lower vitamin K dependent clotting factors

33
Q

What labs should be monitored with administration of phenytoin?

A

CBC
Liver labs
Urinalysis
Thyroid labs (may alter thyroid hormone demand)

34
Q

What benign effect may happen to patients when on phenytoin?

A

May discolor urine a reddish color, not cause for alarm

35
Q

Regarding lab values with carbamazepine, what may occur after months of treatment despite good compliance?

A

Initial concentrations within the therapeutic range may fall.

36
Q

Patients taking gabapentin may experience weight __________ ?

A

Gain

37
Q

Patients taking gabapentin may experience increased risk of?

A

Suicidal ideation

38
Q

Patients taking lamotrigine may experience weight ________ ?

A

Loss

39
Q

When combined with phentermine, topiramate can be used to treat

A

Anorexia

40
Q

When used alone, topiramate causes appetite ____________ ?

A

Suppression

Use cautiously in patients with eating disorders due to the risk of developing low serum bicarb

41
Q

Topiramate may cause ___________ if coadministered with carbonic anhydrase inhibitors (ex. acetazolamide)?

A

Renal calculi

42
Q

What is the MOA of levetiracetam?

A

Inhibits burst firing without affecting normal excitability, prevents spread of seizure.

43
Q

Lab monitoring needed for patients started on levetiracetam?

A

Trick question: None

Though you may see a transient decrease in WBC

44
Q

Unique to levetiracetam is that it is approved for children ___________ month(s) or older.

A

One

45
Q

The two most common adverse reactions to the succinimide class are?

A

GI distress and CNS depression

Relieve by taking meds with food and milk

46
Q

What is the most common Hydantoin used?

A

Phenytoin

47
Q

Gabapentin and topiramate are also used for?

A

Neuropathic pain

Migraines

Advanced Pharm - Unit 3 (35 decks)

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