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NUR516 Final Exam > Anticonvulsants > Flashcards

Anticonvulsants Flashcards

1
Q

Anticonvulsants/ AEDs are used for what?

A

1) long term management of chronic epilepsy
2) management of seizures not caused by epilepsy

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2
Q

What is off-label use of anticonvulsants? Hint: 4

A

1) anxiety
2) bipolar disorder
3) chronic pain
4) migraines

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3
Q

What will happen if a pt abruptly stops taking their anticonvulsant?

A

It can trigger recurrence of seizures

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4
Q

Mechanisms of actions:

Sodium channel blockers

A

Prevent the rapid firing of neurons
prevent return of channel to active state – stabilizes them – inactive state

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5
Q

Mechanisms of action:

Calcium channel blockers

A

Slow down the flow of calcium into cells, limiting the development of action potentials

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6
Q

Mechanisms of action:

GABA enhancers

A

Enhances inhibitory effects, making neurons less likely to fire

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7
Q

Mechanisms of action:

Glutamate blockers

A

Prevent excitatory signaling by blocking glutamate

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8
Q

How do we select which medication is used for Tx of seizures?

A

By the classification of the seizure and epilepsy

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9
Q

What type of seizures are broad spectrum meds used for?

A

Effective for Tx of focal & generalized seizures

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10
Q

What type of seizures are narrow spectrum meds used for?

A

Used primarily for focal-onset seizures (including focal which evolve to B/L convulsive seizures)

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11
Q

List 9 things to base selection of meds for seizure Tx off of

A

1) efficacy
2) tolerability
3) presence of comorbidities
4) pharmacokinetic profile
5) potential drug-drug interactions
6) ease of use
7) cost
8) age
9) gender

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12
Q

How do AEDs that act as Ca channel blockers work?

A

Ca going in during cells resting state facilitates development of an action potential; however these meds slow the flow of Ca++ into the cell

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13
Q

What do AEDs that act as Ca channel blockers inhibit?

A

Slow depolarization which is needed for spike-wave bursts
help “lock the channel”

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14
Q

How do AEDs that act as GABA enhancers work?

A

May enhance Cl- influx which makes cell more negative & harder for cell to generate AP
some ↓ metabolism of GABA so more is available

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15
Q

How do AEDs that act as glutamate blockers work?

A

Bind glutamate (excitatory neurotransmitter)
Glutamate has 5 binding sites

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16
Q

What do many AEDs require?

A

Drug monitoring

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17
Q

List 3 patient education tips when using AEDs

A

1) take as prescribed
2) NEVER stop taking on own
3) side effect management

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18
Q

How does Phenytoin (Dilantin) work?

A

Na+ channel blocker
Works to stabilize neurons from becoming too excited
Stops spread of seizure activity in motor cortex

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19
Q

Which AED is highly (90%) protein-bound drug?

A

Phenytoin (Dilantin)

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20
Q

List 3 indications for giving Phenytoin

A

1) tonic-clonic seizures
2) status epilepticus
3) prophylaxis for surgery

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21
Q

What is the therapeutic range of Phenytoin?

A

10-20 mcg/ mL
very narrow; monitor drug levels

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22
Q

Routes of admin for Phenytoin

A

PO, IM, or IV

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23
Q

If Phenytoin is administered IV how should it be given?

A

Normal saline
Over 30-60 min b/c it can be very irritating to veins

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24
Q

Important precautions with tube feeds when using Phenytoin

A

Need to STOP feeds for 2 hrs before & after administration

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25
List 7 neuro side effects of Phenytoin
1) drowsiness 2) ataxia 3) irritability 4) visual problems 5) peripheral neuropathy 6) N/V 7) headache
26
List 2 CV side effects of Phenytoin
1) hypotension 2) arrhythmias
27
List 3 other side effects of Phenytoin
1) suicidal thoughts 2) skin rash (Steven Johnsons) 3) Gingival hyperplasia
28
Phenobarbital (solfoton, luminal) is classified as a ____
Barbiturate
29
How does Phenobarbital work?
Inactivates fast Na channels leading to enhanced GABA effects & decreased glutamate release
30
Describe the half-life on Phenobarbital
Long half-life
31
List 6 side effects of phenobarbital
1) sedation 2) diplopia 3) cognitive skill impairment 4) respiratory depression 5) hypotension 6) hyperactivity & inattention in children
32
Phenobarbital can lead to ____ ____
physical dependence (habit forming)
33
Carbamazepine (tegretol) works similar to what other AED?
Phenytoin
34
Carbamazepine is the drug of choice for what types of seizures?
Partial & generalized tonic-clonic seizures
35
Carbamazepine (tegretol) inhibits
Spread of seizure activity
36
Where should carbamazepine be kept?
**DRY** location (not a bathroom)
37
List 2 off-label uses for carbamazepines
1) trigeminal neuralgia 2) bipolar disorder
38
Carbamazepine can interact with what & cause reduction in effectiveness
Oral contraceptives
39
What types of seizures should carbamazepines NOT be used for?
Absence & myoclonic seizures (can make them worse)
40
What is therapeutic range of carbamazepine?
4-12 mcg/ mL
41
List 5 neuro side effects of carbamazepines
1) headache 2) diplopia 3) ataxia 4) drowsiness 5) sedation
42
List 5 other side effects of carbamazepines
1) N/V 2) hyponatremia 3) ↓ blood counts (neutropenia/ thrombocytopenia) 4) rashes (including steven-johnsons) 5) increase suicidal thoughts
43
What should carbamazepines be taken with?
Food
44
What labs should be monitored for someone taking Carbamazepines? **Hint: 4**
1) sodium 2) CBC 3) LFTs 4) BUN/ Cr (esp. in those w/ renal impairment)
45
What AED has the same efficacy as Carbamazepine but is better tolerated?
Oxycarbazepine (trileptal)
46
When is Oxycarbazepine used?
As adjunctive therapy or monotherapy for partial seizures in children & adults
47
Oxycarbazepine can make what two types of seizures worse?
1) absence 2) myoclonic
48
Oxycarbazepines can reduce effectiveness of ____ ____ & increase risk of _____ thoughts
Oral contraceptives; suicidal thoughts
49
How does Valproic acid/ Valproate (Depakote) work?
Inactivation of fast Na+ channels; GABA enhancer
50
List 5 indications for giving Valproic acid/ Valproate
1) absence seizures 2) myoclonic seizures 3) tonic-clonic seizures 4) partial seizures 5) neonatal seizures
51
Off-label use of Valproic acid/ Valproate
Used to control Sx of acute mania in bipolar disorder
52
What other AED can Valproic acid be given with?
Phenytoin
53
Is Valproic acid/ Valproate considered broad or narrow spectrum?
Broad spectrum
54
List 6 side effects of Valproic acid/ Valproate
1) N/V 2) sedation/ dizziness 3) pancreatitis 4) increased ammonia levels 5) thrombocytopenia 6) suicidal thoughts
55
Valproic acid/ Valproate can cause ____ toxicity
liver toxicity (hepatotoxicity)
56
Narrow therapeutic range of Valproic acid/ Valproate
50-100 mcg/ mL
57
List 3 labs you need to monitor in a patient taking Valproic acid/ Valproate
1) LFTs 2) CBC 3) ammonia levels
58
Routes of administration for Valproic acid/ Valproate
Oral or IV
59
What is important to keep in mind when giving Valproic acid/ Valproate IV?
**Must be diluted w/ at least 50 mL NSS or D5W** Give over an hr (no more than 20 mg/ min)
60
What should Valproic acid/ Valproate be given with?
Food
61
How does Gabapentin (Neurontin) work?
Thought to act on the Ca channels to ↓ glutamate & ↑ GABA in the brain
62
Indications for giving Gabapentin
1) Partial seizures 2) New onset of epilepsy
63
What type of seizure can become worse if Gabapentin is used for Tx?
Myoclonic seizures
64
List 6 off-label uses for Gabapentin
1) Chronic neuropathic pain 2) Anxiety 3) Hot flashes/ night sweats 4) Headaches 5) Hiccups 6) Alcohol withdrawal
65
What type of dose range does Gabapentin have?
Wide dose range (no monitoring needed)
66
List 9 side effects of Gabapentin
1) Fatigue 2) mental cloudiness 3) leukopenia 4) edema 5) weight gain 6) emotional lability (mood changes) 7) tremors 8) GI side effects 9) suicidal thoughts
67
Cautions for using Gabapentin **Hint: 2**
1) Use reduced dose in renal pts 2) Cautious use in those with an addiction Hx
68
What do doses of Gabapentin look like when used for pain control?
Doses will be very high

NUR516 Final Exam (21 decks)

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