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Pharm II - Week 3
Antiepileptics and Parkinson's drugs
| Question | Answer |
|---|---|
| List different types of epilepsy | Focal (myoclonic), absent (petit mal), generalized (tonic clonic), status epilepticus (lasts greater than 30 minutes) |
| Epilepsy involves a disturbance in ______ patterns of the brain and has potential for ____ | Electrical; hypoxia |
| Antiepileptic medications are used primarily to decrease ____ in pts. with epilepsy and to ____ acute sympotmatic seizures resulting from disease-induced transient brain dysfunction | Decrease; abort |
| Seizures are the result of abnormal excessive discharges of _____ ______ | Cortical neurons |
| Seizures effect 1 out of ____ people over course of lifetime | 11 |
| True or false: many people experience isolated, unprovoked seizure that never recurs | True |
| True or false: the occurrence of a seizure leads to the diagnosis of epilepsy | False; not always |
| Define epilepsy (not patho) | Epilepsy is a group of chronic disorders characterized by recurrent unprovoked seizures |
| Drug therapy allows what percentage of patients with epilepsy to achieve satisfactory seizure control? | 60-70% |
| True or false: Many patients continue to have frequent seizures despite optimal drug therapy | True. Some pts. with well-defined epilepsy syndromes may have higher response to drug therapy, but others predictably fare less well |
| Choice of antiepileptic depends largely on _______ | Seizure type |
| Abrupt withdrawal of drug causes what significant AE? | Prompting of seizures. |
| Withdrawling from antiepileptic medication should take how long? If on multiple medications, how should a pt. be withdrawn? | 6-20 weeks, withdraw one drug at a time |
| Before Px antiepileptics, what assessment must be done? | Baseline neurological assessment |
| Anticonvulsant drugs are category _____ | D due to many structural and cognitive disorders if taken during pregnancy |
| Status epilepticus are _____ convulsions that last at least _____ minutes | Tonic-clonic; 20 |
| __ % of status epilepticus events result in _____ | 20; death |
| Status epilepticus is a medical emergency. What is the order of interventions? | Maintain airway, stop seizure, correct glucose/fluid imbalances |
| What drug is given to a pt. experiencing status epilepticus? | Benzodiazepine (diazepam, lorazepam aka Valium and Ativan) via IV route |
| Antiepileptic drugs classified as teratogens include... | Phenobarbital, phenytoin (Dilantin), vaproic acid (Depakote) |
| Phenytoin, valproic acid, and phenobarbital can interact with BCP to increase chances of ____ | Pregnancy |
| For almost all anti-epileptic drugs, _____ is a risk | Sedation. To prevent injury, think safety! |
| True or false: Since anti-epileptic drugs are measurable, when administered at therapeutic range pt. will not show major signs of toxicity | False. May show toxicity even within TI range |
| DDI to be especially cautious of with anti-epileptics include _____ ______ such as ______. | CNS depressants; alcohol |
| Anti-epileptic drugs increase risk of ______ | Suicide |
| How do you monitor effectiveness of anti-epileptic drug in patient? | Maintain seizure chart |
| What is the therapeutic effect of phenobarbital? | Decrease of tonic-clonic seizures |
| Explain the mechanism of action of phenobarbital | Potentiates GABA, which is an inhibitory NT of the brain. |
| What are the adverse effects of phenobarbital? | Sedation, dullness, hyperactivity (in children). |
| True or false: tolerance to phenobarbital is rare | False. It is common |
| True or false: A rare SE of phenobarbital includes vertigo | True |
| Phenobarbital has many DDIs due to three drug characteristics: | Liver enzyme inducer, highly protein bound, additive effects with other CNS depressants |
| What is the most common anti-epileptic drug given to patients? | Phenytoin (Dilantin) |
| What are the therapeutic effects of Dilantin? | Decreases tonic-clonic seizures, used to prevent seizures in post-op neurosurgical clients |
| Describe the mechanism of action for phenytoin | Inhibits sodium from entering neurons, suppressing action potential, specifically acts on hyperactive neurons |
| True or false: Dilantin dosage requires fine-tuning as small changes can have big effects on patients | True |
| True or false: phenytoin absorption is rapid | False; highly variable. Depends on preparation. Metabolism of Dilantin generally poor |
| Dilantin has very low TI | Expected levels 10-20 mcg/mL |
| Half life of phenytoin is dose-dependent. At low doses, you have ____ half life, at high doses ____ half life | Short; high |
| What is a common AE of Dilantin? | Hypersensitivity (rash) in 5-10% pt. Others include CNS depression and gingival hyperplasia |
| Phenytoin is contraindicated in pts. with _____ problems | Respiratory |
| Phenytoin is a category ____ drug and level __ in lactation risk category | D; L4 |
| Phenytoin is highly protein bound, a liver enzyme inducer, and cause efficacy of ______ pills to decrease | Birth control |
| Dilantin has drug potential with many drugs, including | Alcohol, antihistamines, any CNS depressants |
| List the CNS effects of Dilantin: | Ataxia, slurred speech, poor coordination, coarsening of facial features, confusion |
| What are some less common AE of Dilantin? | Hirsutism, cardiac dysrhythmias, rickets/osteomalacia, bleeding in newborns |
| Pt. teaching regarding Dilantin include... | Advised importance of strict drug adherence. If need to stop drug, wean pt. off. Pt. cautioned use of other drugs. Report ADE. Good oral hygiene should be stressed |
| Valproic acid (VPA) is also known as | Depakene/Depakote |
| VPA is a ____ type of anti-epileptic drug | Potent |
| What is the therapeutic effect of VPA? | Decrease wide range of seizure types, Tx bipolar disorder with dominant mania, migraines |
| ______ is the drug of choice in idiopathic generalized epilepsy | VPA |
| VPA enhances _____ function at high concentrations and may increase synthesis. | GABA |
| Depakene produces selective modulation of ____ currents during sustained, ____, and ______ neuronal firing | Sodium; rapid and repetitive |
| Can you measure VPA levels in a patient? | Yes |
| VPA is highly _____ soluble | Water |
| True or false: VPA is not protein bound | False. 95-95% protein bound |
| The half=life of VPA is 16 hours, but can be reduced to 9 if given with _____-inducing AEDs | Enzyme |
| It takes _____ to excrete VPA fully from body | a long time |
| What are the AE of valproic acid? | N&V, hair loss, sedation, hepatotoxicity |
| VPA is a cateogry ___ drug and contraindicated in people with impaired ____ | D; livers |
| VPA can cause ____ _____ defects. A pt. should increase their _____ acid even if not planning to be pregnant | Neural tube; folic acid |
| True or false: the new AEDs can only be used as part of adjunctive therapy | False. Can be used as single therapy as well |
| List two newer anti-epileptic drugs | lamotrigine (Lamictal); gabapentin (Neurontin) |
| What are the advantages of using newer AEDs? | Better tolerated, less teratogenic, overall less severe DDIs |
| Off-label use of gabapentin is common. Used for... | Postherapeutic neuralgia, postmenopausal hot flashes, prevention of migraines |
| True or false: less is known about lamotrigine and gabapentin in terms of monotherapy | True |
| What is Parkinson's? | A slow, progressive neurodegenerative disease. Dopamine levels decreased while ACh remains unopposed. Causes damage to extrapyramidal system |
| What drugs are used to treat Parkinson's? | Anticholinergics and dopamine agonists |
| True or false: dopamine can directly enter the blood-brain barrier | False. Drugs like levodopa are carried by active transport into brain |
| How can one decrease the effects of Parkinson's? | Give something that increases dopamine in brain to stimulate dopa receptor sites. Enhance conversion of levodopa to dopamine in blood. |
| Parkinsonism is defined as... | Symptoms that can be adverse effect of antipsychotic drugs that mimic signs of disease (but are NOT the disease itself) |
| True or false: it is likely that pts. will develop tolerance to anti-parkinsonism drugs | True |
| True or false: there is no current cure for Parkinson's | True |
| List the symptoms of Parkinson's disease | Resting tremor, shuffling gait, pin-rolling with hands, no expression (masked faces), postural instability, rigidity, bradykinesia, depression, dementia, psychosis |
| Degeneration of neurons happen _____ years prior to onset of Parkinson's symptoms | 5-10 |
| Carbidopa-levopoda is known as Sinemet, and is used to... | Improve Parkinson's symptoms |
| How does levodopa and carbidopa work to provide anti-parkinson effects? | Levopoda promotes syntehsis of dopamine while carbidopa enhances levodopa in intestine and periphery to make more of levodopa available to CNS |
| Carbidopa's actions on levodopa allows for _____ doses, prolonging inevitable tolerance | Lower |
| Sinemet is prepared as... | Sustained release; immediate release |
| True or false: with carbidopa-levodopa, only a small portion of drug reaches drug since most is metabolized in periphery | True |
| Sinemet's major AE are _____ dependent | Dose |
| List the AE of carbidopa-levodopa | N/V, anorexia, extrapyramidal effects (dystonia; tardive dyskinesia, akathisia, restlessness); anxiety, nervousness, and psychosis |
| When pt. is also taking ______ drugs, more dopmaine available so ____ dose effects more likely | Anticholinergic; high |
| Describe two types of motor dysfunctions | On-off phenomenon (acute/abryupt loss of effect); end of dose deterioration/wearing off of effects |
| Benztropine (Cogentin) is a ______ that is given to treat _______ symptoms occuring as AEs of drugs | Anticholinergic; Parkinsonism |
| Benzotropine is used to retard ______ adverse effects as well | extrapyramidal effects |
| What are AE of benztropine? | CNS depression (safety and worsening mental issues) |
| True or false: benztropine is used for Parkinsons' | False |
| Benztropine requires... | Balance of realistic treatment goals and quailty of life compared to adverse effects. Requires listening and Ax by nurse and family education |
Created by:
choel
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