Anticonvulsants Flashcards
Anticonvulsants
Anti-seizure, Anti-epileptic Drug used to treat seizures **Control signs not cause of problem**
Seizure (convulsion)
Clinical manifestation of abnormal activity in the brain
Epilepsy
Multiple seizures during long period of time
Status epilepticus
Seizure lasting 5+mins, or two or more discrete seizures without full recovery of consciousness between seizures
Anticonvulsant Causes of seizures
Primary Secondary Reactive
Primary type causes of seizure
Idiopathic epilepsy
Secondary type causes of seizure
Distemper Head/Injury Encephalitis CNS tumors
Reactive type causes of seizure
Fever/ Heatstroke Poisoning
Anticonvulsant Mechanism of action
Limit either the initialization or spread of seizure focus *PICTURE*
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Anticonvulsant- Status Epilepticus At-Home treatment
Diazepam - Emergency! 1-2 mg/kg per rectum (teat cannula, rubber catheter) up to 3x within a 24 hour period -Suppositories, gel formations
Anticonvulsant- Status Epilepticus In-hospital management
ABC - airway, breathing, circulation STOP SEIZURES Treat cause Prevent further brain damage
Anticonvulsant- Status Epilepticus Stop Seizure! Treatment Name the drugs
Diazepam (IV, Rectal, CRI) Lorazepam Midazolam Clonazepam Clorazepate Phenobarbital General anesthesia (last resort)
Anticonvulsant- Status Epilepticus - Treatment Diazepam - IV
5-10 mg to effect ~= 0.5 mg/kg
Anticonvulsant- Status Epilepticus - Treatment Diazepam - Rectal
1-2 mg/kg if no IV access
Anticonvulsant- Status Epilepticus - Treatment Diazepam - CRI
0.5 mg/kg/h - absorption into plastics -If seizures recur after diazepam boluses
Anticonvulsant- Status Epilepticus - Treatment Phenobarbital
10-20 mg/kg IV increments to effect
Anticonvulsant Prevention When to start treatment?
More than one seizure per month Seizure within one week of head injury Brain lesion identified
Anticonvulsant Treatment
Drugs given long term Quality of life Reduce frequency & severity while avoiding serious side effects
Anticonvulsant - Long term treatment stats
Effective in about 33% Some control in 33% Ineffective in the rest
Anticonvulsant Benzodiazepines Used for long term treatment?
No! not for long-term
Anticonvulsant -Benzodiazepines Duration of action?
Short, frequent administration
Anticonvulsant -Benzodiazepines Cross tolerance?
No further use in status epilepticus Enzyme induction
Anticonvulsant -Benzodiazepines Oral diazepam in cats
Leads to fatal liver necrosis
Anticonvulsant - Client education
Client compliance Goals of treatment Potential side effects Missed dose Supply of medication Data log
Anticonvulsant - Drug choice criteria
Efficacy Safety Price Pharmacological information Clinical experience Single drug vs. combination
Anticonvulsant - Drug dose
Recommended doses are only a guide Lower end for new patients, (adjust upward as needed) Higher end of “loading dose” for frequent & severe seizures (then adjust downward)
Anticonvulsant - PK considerations
Loading Dose PK change over time (phenobarbital)
Anticonvulsant - PK considerations - Loading Dose
For drugs eliminated slowly (brombide & phenobarbital) No time for tolerance to sedative side effects
Anticonvulsant - Drug list
Peanut Butter Love Zone Feels Very Good Phenobarbital Brombide Levetiracetam Zonisamide Felbamate Valproate Gabapentin
Anticonvulsant Phenobarbital Length of action
Long-acting barbiturate