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Pharmacology Sem 3 > anticonvulsant pharm utf8 > Flashcards

anticonvulsant pharm utf8 Flashcards

1
Q

CNS drugs are for (x) do

A

seizure, alzheimer, parkinson, Multiple sclerosis, neuromuscular do

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2
Q

define seizure

A

sudden uncontrolled electric ouburst; involuntary contraction of muscle that last a short period, varying in duration and frequency.

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3
Q

anticonvulsants are good because

A

it prevents the spread of the seizure w/in the brain and offer protection against brain damage

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4
Q

rule of thumb when pt is having a seizure

A

protect from injury; tx cause; PERSON WITH SEIZURE SHOULD NOT DO DANGEROUS ACTIVITIES; start at the lowest dose

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5
Q

barbituates “barb”

A

“circuit breaker”; enhance GABA so it won’t inactivate neurotransmitters; for febrile seizure, status epilepticus, menigitis, toxic reaction, eclampsia; teratogenic

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6
Q

barbs causes

A

cns depression; dependence . . .coma death with ETOH or other CNS depressants; hyperkenisia in children; caution with bipolar pt

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7
Q

phenobarbital tx range

A

10-40 mcg/mL

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8
Q

how to stop taking phenobarbital

A

gradually

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9
Q

how to give phenobarbital

A

IV QID

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10
Q

when to use phenobarbital

A

1st line for part/gen seizure; 1st line for neonate; 2nd line for acute status epilepticus

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11
Q

phenobarbital not for (x) pts

A

liver, renal, lung, heart pts; or lower the dose for them to prevent toxicity

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12
Q

benzodiazepine “pams” are

A

very potent; has LIFE SAVING PROPERTIES in mgmt of status epilepticus

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13
Q

benzodiazepine “pams” act on

A

limbic, thalmic, and hypothalmic

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14
Q

can you mix diazepam valium?

A

NO. DO NOT MIX OR DILUTE with sol or other drugs; also it interacts with plastic container and admin sets

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15
Q

how to give diazepam valium

A

10 mg IVP 0.5-1 min and repeat q 15 min with MAX 30 mg (pt should respond on 2nd dose); Infuse slow at 5 mg/min adults or 2 mg/min elder and repeat q2-4hr at MAX OF 100mg/day

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16
Q

can you mix lorezepam ativan?

A

YES. Give diluted 1:1 with NS or D5W

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17
Q

lorezepam ativan is the

A

1st line for status epilepticus; it remains active for 12 hrs

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18
Q

how to give lorezepam ativan

A

4mg IVP and repeat q15 min with MAX DOSE 480 mg/day

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19
Q

what to watch out for with lorezepam ativan or other benzodiazepine?

A

METABOLIC ACIDOSIS with lorazepine ativan; plus, hypoglycemia, low BP, low RR, low O2 sat, circulation, labs,

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20
Q

tx range for lorezepam ativan

A

50-240 ng/mL

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21
Q

what to teach pt taking lorezepam ativan and benzodiazepines?

A

NO ETOH or other CNS depressants; NO dangerous activities; don’t stop med abruptly

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22
Q

clonazepam klonapin tx range

A

20-80 ng/mL

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23
Q

when to use clonazepam klonapin

A

when depakote did not work

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24
Q

what do you establish for pt with status epilepticus?

A

IV access

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25
Q

what is the antidote for benzodiazepine?

A

flumazenil Romazicon; it competes for GABA receptors

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26
Q

Succinimides “ximides” do what?

A

block Ca influx

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27
Q

Succinimides “ximides” are for?

A

petite mal, grand mal, mixed

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28
Q

succinimides “ximides” caution for children?

A

caution with children dosing

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29
Q

succinimides “ximides” risk for what organ failure?

A

liver

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30
Q

ETHROSUXIMIDE ZARONTIN is the drug of choice for

A

Petite mal absence seizure

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31
Q

tx range for ethrosuximide zarontin

A

40-100 mcg/mL

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32
Q

a/e of ethrosuximide zarontin

A

blood dyscrasia, liver, renal, lupus erythematous

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33
Q

valproic acid depakote tx range

A

50-150 mcg/mL

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34
Q

valproic acid depakote is hepatoxic at what level?

A

240 mcg/mL

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35
Q

if you od on valproic acid depakote, give?

A

Narcan to reverse CNS depression; do hemodialysis to lower toxic levels

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36
Q

antidote for succinimides “ximides”

A

activated charcoal and lavage

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37
Q

nsg consideration for valproic acid depakote

A

donﾒt chew, give with carbon drink, ASA; elevate GABA in brain; prolong bleed with anticoag med; avoid other CNS depressant; cause low folic acid, Vit E, Vit D; observe liver function; Yes Must monitor mental respiratory function; tx range is 50-150 mcg/mL; educate and evaluate

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38
Q

anticonvulsant may cause what kind ideation?

A

suicidal ideation

39
Q

can valproic acid depakote be used for alzheimer dementia?

A

nope. It decreases motor function, LOC, delayed speech, MI/hepatotox, increase risk of infx, increase memory deficit. Put pt in risk of sedation.

40
Q

valproic acid depakote are given for?

A

antipsych, anticonvulsant

41
Q

teach pt (x) regarding valproic acid depakote?

A

seizures are caused by inflam of the brain; seizure can be caused by low BG; seizure can be d/t head injury.

42
Q

when do you draw labs to test for tx range

A

before 1st dose of day; in AM consistently

43
Q

give what when pt has status epilepticus that won’t stop

A

benzodiazepine midazolam versed or propofol diprivan + high dose barbituate phenolbarbital; admin slow so no RR depression.

44
Q

name 2 hydantoins

A

phenytoin dilantin and fosphenytoin cerebryx

45
Q

hydantoins does what

A

inhibit spread of seizure activity by modulating amount of Na ions across MOTOR CORTEX during nerve impulse; “reduce the voltage”

46
Q

type of seizure hydantoin cannot tx

A

petite absence seizure; hydantoin can manage all other seizure, as well as prevent and tx seizure during and after surgery

47
Q

how do you give phenytoin dilantin

A

IV; loading dose 10-15 mg/kg given slowly over 50 mg/min adults; 20 mg/min elder; can give PO 100mg TID or QID as maintenance dose

48
Q

what dose is toxic for phenytoin dilantin?

A

30-50 mg/kg; so do hemodialysis, RR, HR, BP support

49
Q

what is phenytoind dilantin contraindicated for

A

heart block, psychosis, pregnant

50
Q

food contraindications for phenytoin dilantin?

A

it will decrease folic acid, Ca, Vit D, anticoag, birthcontrol, antihistamine, corticosteroid, dopamin, rifampin, antacid; it has increased effect with cimetidine tagamet H2 antagonist

51
Q

phenytoin dilantin a/e

A

gingival hyperplasia; leukopenia, depression, nystagamus rapid eye movement, hirsutism, osteoporosis, hepatitis

52
Q

phenytoin dilantin die

A

steven johnson (if with abx), aplastic anemia, LOW BP, V. fib, encephalopathy, UNRESPONSIVE PUPILS, COMA

53
Q

tx range for phenytoin dilantin

A

10-20 mcg/mL

54
Q

phenytoin dilantin is 1st line defense for

A

children with seizure

55
Q

teach pt on phenytoin dilantin to

A

brush teeth all the time with soft toothbrush

56
Q

maintenance dose for phenytoin dilantin is

A

100 mg IV or PO TID or QID

57
Q

can you dilute phenytoin dilantin in a large vein?

A

YES. It’s compatible with NS or 1/2 NS or LR

58
Q

what solution is not compatible with phenytoin dilantin?

A

D5W

59
Q

what do you assess if you give phenytoin dilantin IV?

A

assess the site for infiltration. It’s critical

60
Q

monitor s/s of what for phenytoin dilantin?

A

anemia; thrombocytopenia; risk for bleed

61
Q

Give what supplement to give at the start before phenytoin dilantin?

A

folic acid; if you give late, it can exascerbate seizure

62
Q

s/e of phenytoin dilantin

A

HA, diplopia, confuse, sluggish, slurred speech, ATAXIA, low BP, n/v, anorexia, PINKRED OR BROWN urine

63
Q

what to (not) do when giving phenytoin dilantin

A

not with other meds; never KCL and dilantin through same line (dilantin clogs so label dedicated line for it); never through a PICC; stop tube feeding 1-2hrs before and after dilantin; assess VS low BP during IV admin; DO NOT EXCEED 50 MG IN ADULTS

64
Q

urine output should be greater than (x) with phenytoin dilantin?

A

600 mL/day

65
Q

Herbs and phenytoin dilantin

A

primrose and borage decrase seizure threshold (get seizure more easily), so change the dose; Ginko decrease phenytoin effect

66
Q

if phenytoin dilantin is in suspension do what?

A

shake the suspension; suspension for NGT

67
Q

how much folic acid to take with phenytoin dilantin?

A

0.4-4.0 mg/day

68
Q

OMG: we care so much about what with phenytoin dilantin?

A

frequent mouth care, gum massage, and dental care

69
Q

name 2 Iminostilbene?

A

carbamazepine tegretol and oxycarbazepine trileptal

70
Q

tx range for carbamazepine tegretol is

A

4-12 mcg/mL

71
Q

what fruit you cannot eat with carbamazepine tegretol

A

grapefruit; med becomes toxic

72
Q

we use iminostilbene for

A

refractory seizure do; like severe HA d/t craniotomy (oxycarbamazepine trileptal)

73
Q

action of iminostilbene

A

block influx of Na ions into motor cortex; “reduce synaptic reaction”

74
Q

remember this for iminostilbene

A

tonic clonic seizure; evaluate SE, anorexia, nausea, dizzy, sedate, HA, sore throat, blood dyscrasia, visual disturb, ataxia, vertigo; give with food or milk; Range is 4-12 mcg/mL; evaluate anorexia it means toxic level; tablet CHEW it, unless it’s XR; Open and mix with food for XR; look for many drug interaction

75
Q

teach pt they can get what with imiostilbene carbamazepine tegretol

A

dry mouth; decrease alert; decrease urine; pink purple urine

76
Q

oxycarbamazepine trileptal is used for

A

partial seizure and HA severe post craniotomy

77
Q

tx for oxycarbamazepine trileptal is?

A

12-30 mcg/mL

78
Q

monitor what for oxycarbamazepine trileptal?

A

Renal and low Na (cerebral edema, ICP, confusion, seizure, HA, muscle spasm, weakness, n/v

79
Q

list 7 adjunct anticonvulsants?

A

GABAPENTIN NEURONTIN 2-10 mcg/mL give with food gradual dc; LEVETIRACETAM KEPPRA for partial seizure; TOPIRAMAE TOPOMAX for partial/grand mal seizure block Ca channel elder can take adult dose; LAMOTRIGINE LAMICTAL partial/grand mal block Na influx Steven Johnson Lennox Gastaut syndrome; ZONISAMIDE ZONEGRAN block Na and Ca influx don’t affect phenytoin dilantin and valproic acid depakote levels contra sulfonamide; VIGABATRIN SABRIL LAST RESORT partial seizure increase GABA vision loss nystagamus rapid eye movement assess pt q 1-3-6 mons; PREGABALIN LYRICA partial seizure chronic NEURALGIA or fibromyalgia bind to alpha2delta affecting Ca channel NOT for ADDICTS

80
Q

phenytoin dilantin tx range

A

10-20 mcg/mL

81
Q

carbamazepine tegretol tx range

A

4-12 mcg/mL

82
Q

oxycarbamazepine trileptal tx range

A

12-30 mcg/mL

83
Q

ethosuximide zarontin tx range

A

40-100 mcg/mL

84
Q

valproic acid depakote tx range

A

50-150 mcg/mL

85
Q

clonazepam klonapin tx range

A

20-80 NG/mL

86
Q

lorezepam ativan tx range

A

50-240 NG/mL

87
Q

gabapentin neurontin tx range

A

2-10 mcg/mL

88
Q

phenobartbital tx range

A

20-40 mcg/mL

89
Q

anticonvulsant general s/e

A

blood dyscrasia, thrombocytopenia, aplastic anemia, gingival hyperplasia, slurred speech, muscle weakness, discolored urine, UO < 600 mL/day, confusion, depression, ataxia

90
Q

a pt had a seizure and fell

A

don’t put anything in mouth, look for medi alert tag, time the seizure, don’t hold the pt down; have pt on side; cushion head and remove glassess, loosen clothing, as seizure ends offer help

91
Q

what percentage of pt are non compliant with anticonvulsant meds d/t s/e?

A

30%

92
Q

2 main complaints about anticonvulsants?

A

sedation and decreased cognition

93
Q

seizure precaution teaching include

A

side rails up; don’t operate heavy machinery, no ETOH, no pregant, do dental check ups, seizures cannot be cured, abrupt dc will cause seizure, no dangerous activity, wear medi alert tag, go to followup appts, keep a seizure record, lab testing, MONITOR GLUCOSE

Pharmacology Sem 3 (26 decks)

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