Pharm- Seizures And ICP

Question 1

Hydantoins

Answer 1

Phenytoin (Dilantin)
Anticonvulsant

Question 2

Phenytoin (Dilantin) MOA

Answer 2

Inhibits/delays Na channel activation

Question 3

Phenytoin (Dilantin) - key differentiating features

Answer 3

1. Most common for seizures
2. Albumin blood work
3. Phenytoin blood work
4. Push slow
5. Purple glove - hard on veins
6. DM check BS
7. No alcohol or cns depressant - will decrease LOC
8. Gingival hyperplasia
9. Thrombocytopenia

Question 4

Phenytoin (Dilantin) contraindicated

Answer 4

1. Hypersensitivity
2. Sinus bradycardia
3. Heart block (2nd & 3rd)
4. Pregnant - Teratogenic

Question 5

Potentiate GABA

Answer 5

Barbs: phenobarbital
Benzo: lorazepam
Gabapentin
Valproic acid
Topiramate

Question 6

Anticonvulsant patient info

Answer 6

1. Adherence is key
2. Do not suddenly stop- rebound seizures
3. Risk for depression
4. Affects BC
5. Teratogenic - birth defects
6. No alcohol

Question 7

MOA of anticonvulsants

Answer 7

1. Stop Na influx
2. Stop Ca influx
3. Promote K efflux
4. Antagonize glutamate (excitatory)
5. Potentiate GABA (inhibitory)

Question 8

Most common seizure med

Answer 8

Hydantoins: phenytoin (Dilantin)

Question 9

Less adverse effects

Answer 9

Carbamazepine (Tegretol)
Gaba

Question 10

Emergency seizure med (rescue)

Answer 10

Benzo: lorazepam

Question 11

Flumazenil

Answer 11

Antidote for Lorazapam

Question 12

Can give to infants

Answer 12

Barbs: phenobarbital

Question 13

Bad for kidneys

Answer 13

Levetiracetam (Keppa)

Question 14

Good for status epilepticus

Answer 14

Benzo: Lorazapam

Question 15

Good for all seizures

Answer 15

Valproic acid

Question 16

Causes GI upset - give with food

Answer 16

Valproic acid

Question 17

Adjunct meds

Answer 17

Gabapentin
Topiramate
Keppra

Question 18

Especially no alcohol

Answer 18

Topiramate

Question 19

Mannitol drug class

Answer 19

Osmotic diuretic

Question 20

Mannitol used for

Answer 20

Cerebral edema
Reduce ICP

Question 21

Careful with mannitol for 2 main adverse effects

Answer 21

1. Fluid overload = pulmonary edema
2. Electrolyte imbalance =dehydration

Question 22

Mannitol monitor for

Answer 22

1. Vitals
2. Urine output
3. Dehydration
4. Fluid overload
5. Electrolyte imbalance
6. Neurologic status
7. Labs - lytes and urea/crreatinine

Question 23

What is MOA for Topiramate (Topamax)

Answer 23

1. block Na and Ca channels
2. Block glutamate receptors
3. Potentiate GABA

Question 24

Topiramate (Topamax) key points

Answer 24

1. Highest risk for depression and suicide
2. adjunct - give with other antiseizure meds
3. NO alcohol (6 hrs each end)
4. hyperthermia (hot/sweating)
5. bicarb is excreted = metabolic acidosis

Question 25

Vaproic acid key points

Answer 25

1. GI upset - give with food 2. Pancreatitis 3. Liver issues 4. Treats ALL major seizure types 5. well tolerated

Question 26

MOA of valproic acid (Depankene)

Answer 26

1. blocks Na channels 2. suppress calcium influx 3. potentiate GABA

Question 27

what is a caution with valproic acid?

Answer 27

bleeding disorder and bone marrow suppression

Question 28

Do not mix Dextrose IV solution with this antiseizure med

Answer 28

Phenytoin (Dilantin)

Question 29

Carbamazepine (Tegretol) key points

Answer 29

1. causes bone marrow suppression- don't give to hemophilia patients 2. If BMS happens - stop med 3. Avoid grapfruit juice 4. minimal cognitive effects 5. Preferred due to less adverse effects

Question 30

Levetiracetam (Keppa) key points

Answer 30

1. bad for kidneys - check GU output/creatinine/urea 2. mild side effects 3. no LOC affect

Question 31

Lorazapam: Benzo Key points

Answer 31

1. emergency seizure med- *IV* 2. Flumazenil - antedote 3. Good for Status epilepticus 4. follow the RX dose closely 5. CNS depression - LOC, RR 6. very addictive 7. Short term use

Question 32

What is Lorazapam contraindicated in

Answer 32

1. Sleep apnea 2. Severe hypotension

Question 33

Phenobarbitol: Barb key points

Answer 33

1. Can give to infants for seizures 2. 2-3 weeks for therapeutic effects 3. addictive 4. CNS depression - LOC, RR 5. careful with other drug dependence like cocaine 6. watch for hypotension if given IV 7. watch for thrombocytopenia 8. watch for bronchospasm

Question 34

Gabapentin (Neurontin) key points

Answer 34

1. Good for partial seizures (adjunct) 2. very safe 3. Elderly - risk for falls 4. little side effects (except for older adult)

Question 35

What med is good for partial seizures

Answer 35

Gabapentin