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NURS 424 > Week 12 - Anticonvulsants > Flashcards

Week 12 - Anticonvulsants Flashcards

1
Q

Hydantoin - Phenytoin (Dilantin): indications

A

Tonic clonic and partial complex seizures

Grand mal and psychomotor seizures

First line treatment

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2
Q

Hydantoin - Phenytoin (Dilantin): MOA

A

Inhibit and stabilize electrical discharges in the motor cortex of the brain by increasing the influx of sodium ions during generation of nerve impulses

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3
Q

Hydantoin - Phenytoin (Dilantin): caution and contraindications

A
  • Avoid in sinus bradycardia, 2nd and 3rd degree AV block, Stocks-Adams syndrome (syncope w/ heart block)
  • Hypotension and myocardial insufficiency
  • Renal and hepatic impairment
  • Rebound status epilepticus can occur w/ sudden withdrawal
  • Narrow TI
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4
Q

Can phenytoin be used in pregnancy and pediatrics?

A

Avoid in pregnancy and lactation

Approved in pediatrics

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5
Q

Hydantoin - Phenytoin (Dilantin): ADR

A

Agitation, ataxia, confusion, dizziness, drowsiness, HA, nystagmus, hypotension, tachycardia, N/V, anorexia, altered taste, gingival hyperplasia, discolored urine

Rare: hypersensitivity reactions, SI, blood dyscrasias

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6
Q

Carbamazepine (Tegretol): indications

A

Focal and generalized onset seizures

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7
Q

Carbamazepine (Tegretol): MOA

A

Exact MOA unclear but thought to affect the sodium channels, slowing influx of sodium in the cortical neurons and slowing the spread of abnormal activity

  • Depresses neuron transmission in the nucleus ventralis anterior of the thalamus
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8
Q

Carbamazepine (Tegretol): caution and contraindications

A
  • Caution in renal and hepatic impairment

Black box warning

  • Development of SJS and toxic epidermal necrolysis in Chinese patients
  • Blood dyscrasias
  • Dermatologic toxicity
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9
Q

Can carbamazepine be used in pregnancy and pediatrics?

A

Avoid in pregnancy and lactation

Approved in pediatrics

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10
Q

Carbamazepine (Tegretol): ADR

A

Drowsiness, dizziness, ataxia, N/V, skin rash, pruritus, constipation, tremor

Bone marrow depression, impaired thyroid function, liver damage

Rare: behavior changes, SI, multi-organ hypersensitivity reactions, hepatotoxicity

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11
Q

Lamotrigine: indications

A

Adjunctive treatment (w/ valproic acid, phenytoin)

  • Partial seizures
  • Primary generalized tonic clonic seizures
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12
Q

Lamotrigine: MOA

A

Thought to affect voltage-sensitive sodium channels and inhibit presynaptic release of glutamate and aspartate in the neuron

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13
Q

Lamotrigine: caution and contraindications

A
  • Rebound status epilepticus can occur w/ sudden withdrawal
  • Caution in renal and hepatic impairment

Black box warning

  • Serious skin reactions
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14
Q

Can lamotrigine be used in pregnancy and pediatrics?

A

Avoid in pregnancy and lactation

Approved in children >2 years

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15
Q

Lamotrigine: ADR

A

GI - N/V, constipation

CV - chest pain, peripheral edema

CNS - somnolence, fatigue, dizziness, anxiety, insomnia, HA, amblyopia, nystagmus

Derm - rashes

Rare: SI, blood dyscrasias, multi-organ hypersensitivity reactions

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16
Q

Zonisamide: indications

A

Partial seizures in adults

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17
Q

Zonisamide: MOA

A

Exact MOA unknown

Blocks voltage dependent sodium and chloride channels

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18
Q

Zonisamide: ADR

A

Somnolence, anorexia, dizziness, HA, agitation, memory difficulties

Rare: aplastic anemia, agranulocytosis

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19
Q

Zonisamide: caution and contraindications

A
  • Avoid if hypersensitivity to sulfonamides
  • Avoid w/ sulfa allergy
  • Rebound seizures can occur w/ sudden withdrawal
  • Caution in renal and hepatic impairment
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20
Q

Can zonisamide be used in pregnancy and pediatrics?

A

Avoid in pregnancy and lactation

Approved for pediatrics >16 years

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21
Q

Succinimides - Ethosuximide, Methsuximide: indication

A

Absence seizures

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22
Q

Succinimides - Ethosuximide, Methsuximide: MOA

A

Decrease nerve impulses and transmission in the motor cortex

Suppresses seizures by delaying calcium influx into neurons

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23
Q

Succinimides - Ethosuximide, Methsuximide: ADR

A
  • GI distress
  • CNS - sedation, ataxia, lethargy
  • HA
  • Rash
  • Pruritus
  • Mood changes
  • Agranulocytosis, aplastic anemian granulocytopenia
24
Q

Succinimides - Ethosuximide, Methsuximide: caution and contraindications

A
  • Rebound seizures can occur with sudden withdrawal
  • Caution in renal and hepatic impairment
25
Can succinimides be used in pregnancy and pediatrics?
May continue therapy during pregnancy w/ close monitoring Avoid in lactation Approved in pediatrics \>3 years
26
Valproic acid: indications
* Focal (partial) onset seizures * Generalized onset seizures * Focal onset impaired awareness * Absence seizures
27
Valproic acid: MOA
Increases GABA availability and enhances the action of GABA Mimics its action at the postsynaptic sites
28
Valproic acid: ADR
HA, drowsiness, dizziness, N/V, tremor, visual disturbance, weight gain, behavioral changes _Rare_: hypersensitivity reactions, SI, brain atrophy
29
Valproic acid: caution and contraindications
Rebound seizures can occur w/ sudden withdrawal Black box warning * Hepatotoxicity * Severe pancreatitis
30
Can valproic acid be used in pregnancy and pediatrics?
Avoid in pregnancy and lactation Avoid in children \<2 years
31
Gabapentin: indications
Focal seizures
32
Gabapentin: MOA
Thought to be a GABA analogue that binds to unknown receptors in the brain
33
Gabapentin: ADR
* Dizziness * Drowsiness * Fatigue * Ataxia * Peripheral edema * Abnormal thinking
34
Gabapentin: caution and contraindications
* Caution on renal impairment * Caution in patients w/ substance abuse history * Rebound seizures can occur w/ sudden withdrawal
35
Can gabapentin be used in pregnancy and pediatrics?
Only if benefits outweigh risks in pregnancy and lactation Avoid in children \<3 years
36
Topiramate: indications
* Focal seizures * Primary generalized tonic clonic seizures
37
Topiramate: MOA
MOA unclear but may block sodium channels or potentiate GABA
38
Topiramate: ADR
* Ataxia * Paresthesia * Dizziness * Somnolence * Difficulty concentrating * Mood changes * Weight loss
39
Topiramate: caution and contraindications
* Caution in renal and hepatic impairment * Rebound seizures can occur with sudden withdrawal
40
Can topiramate be used in pregnancy and pediatrics?
Avoid in pregnancy Use only if benefits outweigh risks in lactation Avoid in children \<3 months
41
Levetiracetam: indications
* Focal onset seizures * Generalized onset seizures
42
Levetiracetam: MOA
MOA unclear but may inhibit burst firing w/o affecting normal neuronal excitability
43
Levetiracetam: ADR
* Somnolence * Dizziness * Nervousness * Mood disturbances _Rare_: SI
44
Levetiracetam: caution and contraindications
* Caution in renal impairment * Rebound seizures can occur w/ sudden withdrawal
45
Can levetiracetam be used in pregnancy and pediatrics?
Caution in pregnancy and avoid in lactation Avoid in children \<1 month
46
Factors that precipitate seizures
Sleep deprivation, high caffeine intake, hyperventilation, stress, hormonal changes, sensory stimuli, drug/alcohol use, infections, fever, metabolic disorders * Anticonvulsants can be used to treat mood disorders
47
General MOA of anticonvulsants
* Stimulate influx of chloride ions (associated w/ GABA) * Delaying the influx of sodium * Delaying the influx of calcium
48
Phenytoin (Dilantin): drug interactions
* Levels of phenytoin will *increase* w/ * Cimetidine, diazepam, acute alcohol intake, valproic acid, allopurinol * Levels of phenytoin will *decrease* w/ * Barbituates, antacids, calcium, chronic alcohol use * Phenytoin will cause decreased effects in... * Carbamazepine, estrogens, acetaminophen, corticosteroids, levadopa, sulfonylureas, cardiac glycosides
49
True/False: Providers should give patients phenytoin (Dilantin) IV or IM in primary care setting when needed
False
50
Phenytoin (Dilantin): monitoring
TSH Need to asses OTC drugs such as ibuprofen, antacids
51
Phenytoin (Dilantin): patient education
* Avoid driving if not seizure free for more than 1 year * Monitor oral hygiene * Phenytoin hypersensitivity syndrome (fever, skin rash, lymphadenopathy) * Occurs at 3-8 weeks of treatment
52
Total serum concentration of phenytoin and associated adverse events
* \>20mcg/mL: far lateral nystagmus * \>30mcg/mL: 45 degrees lateral gase nystagmus and staxia * \>40mcg/mL: decreased mentation and lethargy * \>100mcg/mL: lethal
53
Carbamazepine: drug interactions
* **Grapefruit juice** * Drug levels *increase* w/ * Propoxyphene (Darvocet), cimetidine, erythromycin, clarithromycin, verapamil, hydantoins (e.g. phenytoin) * Drug levels *decrease* w/ * Beta blockers, warfarin, doxycycline, succinimides, haloperidol
54
Lamotrigine: drug interactions
Levels *decrease* by - barbiturates, **estrogens**, phenytoin, mefloquine Levels *increase* by - alcohol, carbamazepine, CNS depressants, valproic acid
55
Lamotrigine: patient education
* Avoid alcohol, OTC drugs * Maintain adequate hydration * Avoid driving * Controversy about d/c medications after a few years being seizure-free * Neurologist should make final decision

NURS 424 (35 decks)

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