Anti-Epileptics/Respiratory Stimulants

Question 1

What makes up 10% of seizure causes in dogs?

Answer 1

Extracranial disorders

Question 2

What extracranial disorders can cause seizures?

Answer 2

Electrolyte imbalances
Liver disease
Renal failure
Toxins/ drugs
Hypothyroidism (rare)

Question 3

What makes up 90% of seizure causes in dogs?

Answer 3

CNS Disorders

Question 4

Name the 2 types of CNS disorders that cause seizures

Answer 4

Primary epilepsies (idiopathic)
Secondary epilepsies (organic brain disease - tumors, infections, trauma)

Question 5

T/F Epilepsy is a life-long disorder

Answer 5

TRue

Question 6

What is a seizure

Answer 6

clinical manifestation and/or hypersynchronous neuronal discharges in the brain

Question 7

How do seizures present clinically

(probably dont need to know

Answer 7

episodic impairment or loss of conciousness accompanied by :
motor abnormalities (convulsions)
sensory disturbances (flashes of light)
autonomic signs (urination/ defecation, salivation/vomiting)

Question 8

What is epilepsy

Answer 8

2 or more seizures at least 24 hr apart resulting from a nontoxice/ nonmetabolic cause

Question 9

What are clusters

Answer 9

continous seizure activity lasting longer than 30 min

Question 10

2 general mechanisms of anti-epileptic agents

Answer 10

suppress neuronal firing in the epileptiform foci

inhibit spread of seizure into normal tissue

Question 11

What are some shortcomings of AED’s?

Answer 11

Some animals become refractory to AED’s
lots of side effects
tolerance
loss of efficacy over time

Question 12

When is an AED considered effective

Answer 12

when there is > 50% reduction in number of seizures during a given time frame

Question 13

What are the goals of AED’s

Answer 13

reduce seizure frequency and severity

Question 14

What is Diazepam’s method of action

Answer 14

activates GABA-A Cl channels which inhibits depolarization and neuronal firing

Question 15

What is one great thing about diazepam

Answer 15

can be given rectally in an emergency if animal is seizuring

Question 16

What is one bad thing about diazepam

Answer 16

animals develop tolerance after 1 wk of PO TID

Question 17

What does Diazepam cause in cats

Answer 17

Idiosyncratic hepatic necrosis

Question 18

Phenobarbital

Answer 18

acidic, long acting barbituate
classified as sedative agent
moderately protein bound

Question 19

T/F Initial phenobarb dose required to treat seizures is greater than dose that causes sedation

Answer 19

True

Question 20

How is the sedative effect of Phenobarb overcome

Answer 20

tolerance to sedative effect occurs within 10-14 days

Question 21

What blood level increases with phenobarbital

Answer 21

ALP (liver enzymes)

Question 22

What are some drawbacks of phenobarbital

Answer 22

1. Animal develop dependence to drug (severe withdrawal symptoms
2. Increased liver enzymes cause tolerance so dose must be increased in chronic treatment
3. can cause drug interactions

Question 23

What drug interacts with Phenobarb

Answer 23

griseofulvin

Question 24

Side effects of Phenobarb

Answer 24

elevated liver enzymes (increase drug metabolism of many drugs)
restlessness/ irritability
PU/PD
sedation/ataxia 
decrease serum T4 with normal TSH

Question 25

What toxicity does phenobarb cause

Answer 25

Hepatotoxicity

Question 26

How often should you monitor liver enzymes and check serum chemistry

Answer 26

every 6 months

Question 27

Potassium bromide

Answer 27

Not controlled/ not FDA approved | actions diminished by increased CL- concentration

Question 28

What type of diet must animals being treated with KBr stay on

Answer 28

Low salt (chloride displaces bromide)

Question 29

What type of bromide should be used for a loading dose

Answer 29

NaBR not KBr

Question 30

Is Bromide safe for cats

Answer 30

NO!!

Question 31

What side effects do Bromide cause

Answer 31

``` Psuedohyperchloremia ( because halide) Bromism toxicity (animal looks drunk) Fatal idiosyncratic pumonary disease in CATS!! ```

Question 32

Zonisamide

Answer 32

Related to sulfonamide antibiotics metabolized by liver Really effective and safe for CATS!!!!

Question 33

how does Levetiracetam work

Answer 33

Inhibits synaptic vesicle protein (blocks Calcium channels to prevent neurotransmitter release)

Question 34

How is levetiracetam used

Answer 34

Usually as an adjunctive treatment with Phenobarb | But also used because safe for cats and RABBITS!

Question 35

Gabapentin

Answer 35

Drug of choice for RABBITS!! not effective in dogs

Question 36

What 2 respiratory stimulants do we have to know?

Answer 36

Caffeine and Doxopram

Question 37

What part of the body does Doxopram target

Answer 37

Medullary (brainstem)

Question 38

Where does caffeine target

Answer 38

Cortical

Question 39

T/F CNS stimulants like caffeine and doxopram stimulate multiple CNS pathways

Answer 39

TRUE!!!

Question 40

What is Doxopram's major actions

Answer 40

stimulates carotid chemoreceptors | stimulates brainstem respiratory centers

Question 41

What is Doxopram ONLY used for today

Answer 41

stimulate laryngeal function and respiration during laryngeal exam

Question 42

What is the Theophylline used for

Answer 42

bronchodilator