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NRSG Pharm CH 15
Seizure drugs
| Question | Answer |
|---|---|
| Epilepsy | neurologic disorder characterized by reoccurring seizures |
| Known causes of seizure: | Fever, ID, metabolic, neoplastic, trauma, vascular, meds, eclampsia, drug abuse, withdrawal from sedative-hypnotic or alcohol, idiopathic |
| Simple partial | olfactory, auditory, visual, emotions, twitching |
| complex partial (psychomotor) | aura, postictal confusion, fumbling, no response to verbal |
| Absence (petit mal) | few seconds, often in children, staring into space, no verbal response, eye fluttering/jerking, often misdiagnosed as ADHD or daydreaming |
| Atonic (drop attack) | falling/stumbling/slumping, few seconds |
| Tonic-clonic (grand mal) | Aura, intense muscle contractions (tonic) followed by alternating contraction/relax (clonic), crying/lungs empty at start, incontinence, shallow breathing with periods of apnea 1-2min, disorientation/deep sleep (postictal state) |
| febrile | tonic-clonic 1-2min, rapid return to consciousness, children esp 3mo-5yo |
| myoclonic | large jerking major muscle groups, falling from sitting/dropping what is in hand |
| Status Epilepticus | medical emergency, 2 or more seizures w/o return to consciousness or continuous 5+ min |
| Preg considerations | many antiseizure drugs decrease oral contraception, most are Preg cat D, |
| Eclampsia | Severe hypertensive disorder of pregnancy, seizures, coma, perinatal mortality |
| Rx choice / dose | Highly individual, type of seizure, pt hx, EEG, low initial dose, grad inc, may add in small increments of diff med newer drugs > older w/ serious adverse |
| Rx consideration | SI risk in children, balance clinical need vs risk SI |
| Benzodiazepine and barbiturate mech | mimic effects of GABA - predominant effect is CNS depression |
| Phenobarbital (Luminal) class, mech | Barbiturate, T: antiseizure drug, sedative, GABA A receptor agonist, enhance GABA and suppress abnormal neuronal discharges |
| Phenobarbital (Luminal) uses | Antiseizure, sedation, low safety margin, profound CNS depression |
| Phenobarbital (Luminal) side/adverse | Sedation, drowsiness, vit deficiencies, laryngospasms, resp dep, CNS dep, coma, death, high dependance potential, sch IV, preg D, many drug0drug |
| Diazepam (Valium) class, mech | Benzodiazepine, T: Antiseizure mech: Binds @ GABA receptor-chloride channels |
| Diazepam (Valium) uses | short-term seizure control, calms w/o strong sedation |
| Diazepam (Valium) side/adverse: | drowsiness, dizziness, risk for abuse/tolerance/dependance sch IV Hypotension, tachy, resp dep hepatotoxicity |
| lorazepam (Ativan) | Benzo for anxiety, management for SE |
| clonazepam (Klonopin) | Benzo for anxiety, absence and myoclonic seizures |
| Benzodiazepine OD reversal agent | flumazenil (Romazicon) blocks benzodiazepine receptor site |
| diazepam (Valium) considerations | Oral contraception ineffective, excessive bleeding, drowsiness, bone pain, alcohol OTC drugs, herbal, driving/ect, rebound seizures if D/C fast, take w/ food, routine labs/serum level, routine liver/kidney function labs |
| Phenytoin (Dilantin) | Hydantoin, suppress Na influx, |
| Valproic Acid (Depakene) | Phenytoin-related drug, Na/Ca influx, enhance GABA |
| Hydantoin and Phenytoin considerations: | serum drug levels - peak and trough draws! narrow therapeutic range. Monitor for signs toxicity, blood dyscrasias, bleeding, kidney and liver funct |
| phenytoin (Dilantin) classes, mech | P: Hydantoin T: Antiseizure drug, antidysrhythmic, mech: desensitizes Na channels in CNS to prevent spread of electrical activity |
| phenytoin (Dilantin) side/adverse: | Dysrhythmias, hypotension hyperglycemia! CNS dep gingival hyperplasia, blood dyscrasias, severe skin reactions |
| Valproic Acid (Depakene) classes, mech | Valproate, phenytoin-related drug T: antiseizure drug M: ibhibit Na/Ca influx, enhance GABA useful wide range of seizure types, migraine, bipolar, |
| Valproic Acid (Depakene) side/adverse: | N/V, sedation, blurred vision, bruising and bleeding time hepatotoxicity, pancreatitis, preg D |
| Valproic Acid (Depakene) black box | fetal hepatic failure, esp in >2YO, nonspecifc sx: facial edema, weakness, anorexia, vomiting LIVER FUNCT TESTS prior tx and first 6months life-threatening pancreatitis and teratogenic effects |
| ethosuximide (Zarontin) classes, mech | Succinimide T: antiseizure drug Suppresses Ca influx For absence seizures |
| ethosuximide (Zarontin) side/adverse: | abd distress, wt loss behavioral changes drowsiness, dizziness, rare: blood dyscrasias, systemic lupus erythematosus DO NOT DC abruptly |
| Anticonvulsant therapy goals | reduce frequency of seizure activity minimize adverse effects improve quality of life Rx selection depends on seizure type, age, gender, potential adverse, ID cause and factors of seizure disorder Anticonvulsants increase threshold |
| Anticonvulsants mech | inhibit excitatory or enhance inhibitory |
| DO NOT DC ABRUPTLY |
Created by:
kmulla
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