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Tx Sz D/O
Pharm II
| Question | Answer |
|---|---|
| Two classes of sz’s | Partial: simple, complex, secondarily generalized, Generalized: absence, myoclonic, clonic, tonic, tonic-clonic, atonic, infantile spasms |
| Goals of therapy for sz d/o’s | control frequency of sz’s, ensure adherence, optimize QOL, balance b/w SE’s and sz’s |
| Approach for tx | Risk for another? Find cause, select AED by sz type, AE’s and pt prefrences |
| How many drugs do we start with | monotherapy (not all are sz free) start low dose and titrate up |
| Why is adherence key | many drugs have very narrow therapeutic ranges (even missing one dose) |
| What are three nonpharmacologic therapies | Surgery, Vagal nerve stimulation, Ketogenic Diet |
| What are the three types of surgery to fix sz | Temporal lobectomy, CC section, Hemispherectomy |
| What is the vagal n. stimulator implantation | L chest to L vagus n. regular pulses. VERY expensive $15,000, only a “medication sparing effect” |
| What is the ketogenic diet | HIGH fat LOW LOW carb and protein intake→induce ketosis, bad adhearance |
| 3 MOA’s of sz medication | Na and Ca channels: stabilization of neuronal membranes, ↑inhibitory neurotransmission (GABA), ↓ excitatory neurotransmission (glutamate and aspartate) |
| Two fxns of Sz meds | ↑ sz threshold, inhibit spread of abnl dz discharges |
| What is therapeutic range | concentration that controls sz’s w/o AE’s, personal ranges |
| Two types of AE’s | Concentration related (↑dose ↑AE’s):not permanent, seen at drug peak, and Idiosyncratic: not dose related, may be permanent, seen throughout day, tx AE’s PRN |
| Meds | stuff |
| What should we be careful of when prescribing AEDs | suicide risk x2 (higher in sz tx vs. migraine, BPD tx |
| What should we be careful with epileptic pt’s | 3x risk of suicide |
| What may ↓AED absorption, prevention? | aluminum or magnesium containing antacids, separate dose by 2 hrs |
| What drugs are highly competitive for protein binding sites | phenytoin and valproic acid |
| What happens when protein binding sites are highly wanted to the transient drug | one that doesn’t get the “binding site” will have a raise in free drug → lower serum concentration because more available to be eliminated |
| AEs | stuff |
| What is monitoring for AEDs | closely first 6m, rest is controversial. |
| How should we evaluate therapy | individual therapeutic range should be established, ongoing monitoring, record severity |
| What things should we be worried about in women in childbearing age | ↓ [estrogen], tetrogenic effects during pregnancy, |
| Goals in pregnant women w/ epilepsy | monotherpy w/ lowerst possible dose, avoid VPA if possible, frequently check levels |
| Why would we genetic test someone w/ epilepsy | prior to starting CBZ or PHT check for risk of steven Johnson syndrome look for gene HLA-B 1502 |
| How do we switch medications from one AED to another | taper one, titrate up the other, If don’t NEED to taper the first immediately, can titrate other prior to tapering |
| What 5 criteria needed prior to d/cing AEDs completely | Sz free 2-5yrs, nl neuro exam, nl intelligentce, single type of sz, nl EEG w/ tx |
| How do we completely taper someone w/ a sz d/o w/o sz’s anymore | taper from poly to monotherapy, ↓[] 1-3m, decrease dose by no more than 1/3 each time |
Created by:
becker15
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