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exam 3 pharm

ch 22

anticonvulsants stabilize nerve cell membranes and suppress abnormal electrical activity in cerebral cortex
action of anticonvulsants 1. suppress sodium influx, prolonging channel inactivation, prevents neuron firing 2. prevents electrical current generated by Ca ions to the t-type calcium channel 3. increases the action of GABA, which inhibits neurotransmitter throughout the brain
drugs that suppress sodium influx phenytoin, fosphenytoin, carbamazepine, valproic acid, toprimate, zonisamide, lamotrigine
drugs that suppress calcium influx valproic acid and ethosuximide
drugs that enhance the action of GABA barbits, benzos, tiagabine
drug that promotes GABA release gabapentin
hydantoins ☺act by inhibiting sodium influx, stabilize cell membraines, reduce repetitive neuronal firing ☻also used for dysrhythmias by increasing the electrical stimulation threshold in cardiac tissue ♥do not use in pregnancy due to teratogenic effect on fetus ♦drug dose is age related - slower metabolism in older adult means lower dose, high metabolism in children means higher dose ♣dosage is adjusted according to therapeutic plasma or serum levels
phenytoin therapeutic level and stuff (I am tired of this stuff) ☺10-12 mcg/mL ☻highly PB ♥IV admin by direct injection into a large vein ♣may be diluted in saline, do NOT use dextrose cause it will precipitate ♠IV infusion rate greater than 50 mg/min may cause HoTN or dysrhythmia, local irritation and sloughing ♦do not give IM
s/e and a/e of hydantoins slurred speech, confusion, depression, thrombocytopenia, leukopenia, gingival hyperplasia, hyperglycemia (drug inhibits insulin), n/v, constipation, drowsiness, HA, alopecia, hirsutism, nystagmus
drug-drug interactions hydantoins ☺compete with highly protein bound drugs, anticoags, asa ☻barbits, rifampin, ethanol increase hydantoin metabolism ♥sulfonamides and cimetidine increase action by inhibiting liver metabolism ♦antacids, antineoplastic drugs decrease absorption ♣antipsychotics and herbs lower seizure threshold and increase seizure activity
barbits phenobarbital - long acting ☺used for: status epilepticus seizures, meningitis, toxic reactions, eclampsia ☻therapeutic level: 20-40 mcg/mL ♥taper to d/c ♦s/e: resp depression, confusion, depression, irritability a/e: SI, physical dependence
succinimides ethosuximide ☺treats absence or petit mal seizures ☻therapeutic range - 40-100 mcg/mL ♥a/e: blood dyscrasias, renal/liver impairment, SLE
benzos clonazepam, clorazepate dipotassium, and diazepam ☺clonazepam - petit mal but tolerance may occur w/i 6 months ☻diazepam - acute status epilepticus, must be admin IV, short-term effect, must give phenytoin or phenobarbital during or immediately after
iminostilbenes carbamazepine ☺treats refractory seizure disorders that have not responded to other drugs ☻also used for psychiatric disorders, bipolar disorder, trigeminal neuralgia, and etoh w/d ♥therapeutic level: 5-12 mcg/mL ♦no grapefruit juice
valproate valproic acid, divalproex sodium (Depakote) ☺not established as safe for small children ☻hepatoxicity therapeutic level: 50-100 mcg/mL ♥also used for bipolar and migraine ♦avoid during pregnancy
anticonvulsants and pregnancy ☺pregnancy causes seizures to ↑ by 25% ☻hypoxia can harm the fetus ♥phenytoin and carbamazepine are linked to fetal abnormalities of the heart and cleft palate, valproic acid is known to cause major congenital malformation ☺anticonvulsants act as inhibitors for vit K contributing to hemorrhage in infants - give oral vit K supp for the last 10 days of pregnancy ☻anticonvulsants increase the loss of folate - take daily folate supp
anticonvulsants and febrile seizures ☺usually occur in children 3 mo - 5 yrs old ☻do not use valproic acid in children <2 yo ♥epilepsy develops in 2.5% of children that have febrile seizures ♦phenobarbital or diazepam are used prophylactically
NC phenytoin ☺assess pts knowledge regarding medications ☻urinary output must be >1500 mL/day ♥lab values for renal and liver, if both BUN and creatinine are elevated then renal disease is suspected ♦therapeutic range: 10-20 mcg/mL; toxic level 30-50 ♣seizure precautions ♠may cause anorexia, make sure pt is receiving adequate nutrition
teach phenytoin ☺shake suspension ☻don't get pregnant on phenytoin or valproic acid ♥monitor phenytoin levels closely while pregnant (did you not just hear me tell you not to get pregnant?) ♦no etoh or CNS depressants ♣taper off medication ♠regular dental appts •get regular lab tests ◘monitor glucose levels closely - hyperglycemia
s/e of phenytoin ☺urine will be a harmless pinkish or redish color ☻use a soft toothbrush ♥report sore throat, nosebleeds, bruising - may indicate a blood dyscrasia ♦report gingivitis, nystagmus, slurred speech, s-j syndrome starts with a rash
status epilepticus tx ☺diazepam (valium) IV or lorazepam (Ativan)followed by phenytoin IV ☻if seizure continues midazolam (versed) or propofol (diprivan) and then high dose barbiturates ♥admin slowly to avoid resp depression
clonazepam ☺used for petit mal, myclonus and status epilepticus
diazepam (valium) ☺status epilepticus - drug of choice ☻admin slowly to prevent resp depression ♥repeat q10-15 min up to 30 mg PRN then q2-4 hr PRN ♦also used to treat anxiety and substance abuse w/d
lorazepam (ativan) ☺use to treat status epilepticus ☻infusion rate should not exceed 2 mg/min♥ ♥also used to treat anxiety and substance abuse w/d
carbamazepine (tegretol) ☺for tonic clonic, partial, simple, complex seizures ☻also used to treat bipolar disorder ♥t/r: 5-12
gabapentin (neurontin) ☺used as an adjuctive therapy for partial seizures ☻give with food to prevent GI upset ♥taper to d/c ♦max dose 3600 mg/d - high doses are used short term
lamotrigine (lamictal) ☺maintenance dose: 250 mg BID ☻used for partial and tonic clonic, tx of Lennox-Gastaut syndrome ♥blocks sodium influx ♣d/c if rash appears as it may be the start of s-j syndrome
pregabalin (lyrica) ☺used for partial seizures and fibromyalgia ☻affects calcium channels in CNS ♥0% PB
PB for anticonvulsants all are highly PB except for phenobarbital
herbal alert ☺evening primrose and borage may lower seizure threshold ☻gingko may decrease phenytoin effectiveness
Created by: nursingTSJC2013



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