Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Can phenytoin be used in pregnancy and pediatrics?

A

Avoid in pregnancy and lactation

Approved in pediatrics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Carbamazepine (Tegretol): indications

A

Focal and generalized onset seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Can carbamazepine be used in pregnancy and pediatrics?

A

Avoid in pregnancy and lactation

Approved in pediatrics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Lamotrigine: indications

A

Adjunctive treatment (w/ valproic acid, phenytoin)

  • Partial seizures
  • Primary generalized tonic clonic seizures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Lamotrigine: MOA

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Can lamotrigine be used in pregnancy and pediatrics?

A

Avoid in pregnancy and lactation

Approved in children >2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Zonisamide: indications

A

Partial seizures in adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Zonisamide: MOA

A

Exact MOA unknown

Blocks voltage dependent sodium and chloride channels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Zonisamide: ADR

A

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

Rare: aplastic anemia, agranulocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Can zonisamide be used in pregnancy and pediatrics?

A

Avoid in pregnancy and lactation

Approved for pediatrics >16 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Succinimides - Ethosuximide, Methsuximide: indication

A

Absence seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Succinimides - Ethosuximide, Methsuximide: MOA

A

Decrease nerve impulses and transmission in the motor cortex

Suppresses seizures by delaying calcium influx into neurons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
Q

Can succinimides be used in pregnancy and pediatrics?

A

May continue therapy during pregnancy w/ close monitoring

Avoid in lactation

Approved in pediatrics >3 years

26
Q

Valproic acid: indications

A
  • Focal (partial) onset seizures
  • Generalized onset seizures
  • Focal onset impaired awareness
  • Absence seizures
27
Q

Valproic acid: MOA

A

Increases GABA availability and enhances the action of GABA

Mimics its action at the postsynaptic sites

28
Q

Valproic acid: ADR

A

HA, drowsiness, dizziness, N/V, tremor, visual disturbance, weight gain, behavioral changes

Rare: hypersensitivity reactions, SI, brain atrophy

29
Q

Valproic acid: caution and contraindications

A

Rebound seizures can occur w/ sudden withdrawal

Black box warning

  • Hepatotoxicity
  • Severe pancreatitis
30
Q

Can valproic acid be used in pregnancy and pediatrics?

A

Avoid in pregnancy and lactation

Avoid in children <2 years

31
Q

Gabapentin: indications

A

Focal seizures

32
Q

Gabapentin: MOA

A

Thought to be a GABA analogue that binds to unknown receptors in the brain

33
Q

Gabapentin: ADR

A
  • Dizziness
  • Drowsiness
  • Fatigue
  • Ataxia
  • Peripheral edema
  • Abnormal thinking
34
Q

Gabapentin: caution and contraindications

A
  • Caution on renal impairment
  • Caution in patients w/ substance abuse history
  • Rebound seizures can occur w/ sudden withdrawal
35
Q

Can gabapentin be used in pregnancy and pediatrics?

A

Only if benefits outweigh risks in pregnancy and lactation

Avoid in children <3 years

36
Q

Topiramate: indications

A
  • Focal seizures
  • Primary generalized tonic clonic seizures
37
Q

Topiramate: MOA

A

MOA unclear but may block sodium channels or potentiate GABA

38
Q

Topiramate: ADR

A
  • Ataxia
  • Paresthesia
  • Dizziness
  • Somnolence
  • Difficulty concentrating
  • Mood changes
  • Weight loss
39
Q

Topiramate: caution and contraindications

A
  • Caution in renal and hepatic impairment
  • Rebound seizures can occur with sudden withdrawal
40
Q

Can topiramate be used in pregnancy and pediatrics?

A

Avoid in pregnancy

Use only if benefits outweigh risks in lactation

Avoid in children <3 months

41
Q

Levetiracetam: indications

A
  • Focal onset seizures
  • Generalized onset seizures
42
Q

Levetiracetam: MOA

A

MOA unclear but may inhibit burst firing w/o affecting normal neuronal excitability

43
Q

Levetiracetam: ADR

A
  • Somnolence
  • Dizziness
  • Nervousness
  • Mood disturbances

Rare: SI

44
Q

Levetiracetam: caution and contraindications

A
  • Caution in renal impairment
  • Rebound seizures can occur w/ sudden withdrawal
45
Q

Can levetiracetam be used in pregnancy and pediatrics?

A

Caution in pregnancy and avoid in lactation

Avoid in children <1 month

46
Q

Factors that precipitate seizures

A

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
Q

General MOA of anticonvulsants

A
  • Stimulate influx of chloride ions (associated w/ GABA)
  • Delaying the influx of sodium
  • Delaying the influx of calcium
48
Q

Phenytoin (Dilantin): drug interactions

A
  • 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
Q

True/False: Providers should give patients phenytoin (Dilantin) IV or IM in primary care setting when needed

A

False

50
Q

Phenytoin (Dilantin): monitoring

A

TSH

Need to asses OTC drugs such as ibuprofen, antacids

51
Q

Phenytoin (Dilantin): patient education

A
  • 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
Q

Total serum concentration of phenytoin and associated adverse events

A
  • >20mcg/mL: far lateral nystagmus
  • >30mcg/mL: 45 degrees lateral gase nystagmus and staxia
  • >40mcg/mL: decreased mentation and lethargy
  • >100mcg/mL: lethal
53
Q

Carbamazepine: drug interactions

A
  • 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
Q

Lamotrigine: drug interactions

A

Levels decrease by - barbiturates, estrogens, phenytoin, mefloquine

Levels increase by - alcohol, carbamazepine, CNS depressants, valproic acid

55
Q

Lamotrigine: patient education

A
  • 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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions