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Pharm test-4

Traditional AEDs

Phenytoin aka Dilantin
Dilantin is used for what? Seizures of all types except absence, often with generalized, tonic/clonic, and status ep. And cardiac problems. Narrow therapeutic range.
Dilantin administration PO with meals to decrease GI distress, IM not recommended (painful, erratic absorption, crystallizes causing necrosis, NEVER Sub q. Highly alkaline
Dilantin IV admin. IV not greater than 50mg/min (elderly 5-10mg/min) b/c dysrhytmias, CV collapse, dropped BP.
Dilantin Action inhibits N+ channels, suppresses action potentials, inhibits spread of seizure activity in motor cortex.
OD/ Toxic SEs of Dilantin double or blurred vision, N, V, ataxia, slurred speech, CV collapse, CNS depression, confusion, hallucinations, sleepy
SE of Dilantin rash (D/C drug), hirutism, constipation, drowsy, ginigcal hyperplasia, folic acid deficiency, hyperglycemia, dicolors urine (pink to red-brown)
What if a female is on BC? (Dilantin She needs to use another form of BC other than OC or increase the OC dosage
Effects of Dilantin Decreases effect of warfarin (blood thinner), ETOH increases durg metabolism
Teaching with Dilantin reduce drug gradually, metabolized by liver, excreated in urine (alkaline urine enhances excretion)
What is Dilantin frequently combined with? Phenobarb
Barbiturates aka Phenobarbital, prototype
What is a barbituate? a long acting, widely used, oldest, cheap, AED with few SEs
Barbiturates action potentiates effect of GABA. TR: 15-45
What are barbiturates used for? generalized, tonic/clonic, febrile in infant, alternate for status ep, sedative/ sleep induction
Why would you not give barbiturates to school age children? Intellectual decline
SE of barbiturates drowsiness, lethary, dizziness, resp depression, broncospasm, dependency with L-T use, N, V, folate deficiencies, male impotence
Adverse SE of barbiturates neurotoxicity, hematologic depression
NI with barbiturates patent airway, resuscitatibe equipment, safety--sedative/hypnotic effects, routine CBC, use another form of BC other than OCs
Barbiturates with children can cause birth defects, paradoxical response is irritability/hyperactivity
Valproic Acid aka Depakene, Depakote
What is Valproic Acid's action? Blocks sodium channels, suppresses calcium influx, and increaess GABA which has an inhibitory effect on synapses
What is Valproic Acid used for? treat absence, myoclonic, tonic/clonic. TR: 40-100 (lower = seizure, higher = toxic)
SEs of valproic acid N, V, indigestion, prolongs bleeding time, possible fatal hepatoxicity--watch for decreased appetite, malaise, abd pain, jaundice
What is valproic acid also used for? bipolar disorder and prophylaxis of migraine HA
Contraindications of valproic acid pregnant-->birth defects (NTD)
Carbamazapines aka Tegretol
Tegretol's action delays neuronal discharge around seizure foci by acting on sodium channels
What is tegretol used for? generalized, tonic/clonic, simple and complex partial in both children (over 5) and adults. Not for absence. #1 drug for partial. Bipolar disorder, trigeminal, and glossopharyngeal neuralgias
What is tegretol similar to? Dilantin, but with fewer SE (GI upset, dry mouth)
NIs with tegretol Blood counts initially and periodically, check for hematologic toxicity (bone marrow depression, aplastic anemias)
what are S&S of blood abnormalities with tegretol fever, sore throat, pallor, weakness, infection, easy bruising, petechiae
SE with tegretol CHF: crackles, water retention, dependent edema, daily weight---rashes, photosensitivity, necrosis, Stevens-Johnson syndrome
Ethosuximide aka Zarontin
What is Zarontin used for? Drug of choice for absence seizures in children and adults (Celontin, Milontin)
Contraindications for Zarontin yellow dye #5 allergy. Take with meals!
Action of Zarontin depresses nerve transmission in motor cortex, raises seizure threshold
SE with Zarontin N, V, drowsy, blood dyscrasis, discolors urine
Primidone aka Mysoline
What is Primidone used for? all major seizure disorders except absence. Nearly identical in structure to phenobarbital
Golden rule with primidone Rule with another AED (phenytoin, carbamazepine) but NEVER with phenobarbital
Adverse effects with Primidone sedation, ataxia, dizziness, confusion in the elderly, paradoxical hyperexcitability in children
Serious SE with primidone psychosis, leuropenia, thrombocytopenia, systemic lupus erytematosus
What are benzodiazepines useful for? As adjunctive and in Status Epx
Action of benzodiazepines increase availability of inhibitory neurotransmitter GABA to brain neurons
Diazepam Valium: restricted to acute tx of status ep and tonic/clonic. Parenteral, short acting, give repeatedly. 10mg: admin. 2mg/min
Clonazepam Klonopin: only one in class used for L-T tx. Long acting, used for absence, atonic, myoclonic
Lorazepam Ativan: status ep. IV-prolonged effect up to 24 hrs. Not faster than 2mg/min
what to check for with lorazepam? physical dependence, check baseline VS, decreases HR, RR, BP, shorter acting. TAPPER OFF
Created by: Keller_KI