Wk 11 Antiseizure

Question 1

1. What is the difference between the dose for an anxiolytic effect and the dose for a hypnotic effect?

Answer 1

Anxiolytic effect with low doses.

Hypnotic effect with high doses.

Question 2

2. How do benzodiazepines work?

Answer 2

They bind to the GABA receptor-chloride channel complex and inhibit cell excitability.

Question 3

3. What are the three main indications for benzodiazepines?

Answer 3

Anxiety, insomnia, seizures

Question 4

4. Can most benzodiazepines be safely administered during pregnancy?

Answer 4

No

Question 5

5. Name two major adverse effects of benzodiazepines?

Answer 5

CNS depression, anterograde amnesia. Sedation may decrease over time.

Question 6

6. What type of drug-drug interaction do benzodiazepines have on CNS depressants?

Answer 6

Potentiation

Question 7

7. What significant withdrawal symptoms may occur with rapid discontinuation of benzodiazepines?

Answer 7

Panic, paranoia, delirium, hypertension, muscle twitching, and seizures

Question 8

8. What is the antagonist for a benzodiazepine?

Answer 8

Flumazenil (Romazicon)

Question 9

9. Describe the type of stressors for which benzodiazepines are given.

Answer 9

They are to help with significant stressors only, not eliminate all stress from life.

Question 10

10. Barbiturates bind to what receptors?

Answer 10

GABA receptor-chloride channel complex and inhibit cell excitability.

Question 11

11. How do barbiturates affect the clearance of other drugs?

Answer 11

Increase drug clearance

Question 12

12. What effect does barbiturates have on oral contraceptives?

Answer 12

Increase their clearance which increase the chance of pregnancy

Question 13

13. What two physiologic functions do barbiturates depress?

Answer 13

CNS function and respirations

Question 14

14. Who should not be prescribed barbiturates due to the seriousness of overdose?

Answer 14

Suicidal patients

Question 15

15. Which class of drugs requires medically-supervised detoxification?

Answer 15

Barbiturates

Question 16

16. What signs make up the classic triad for barbiturate toxicity?

Answer 16

Respiratory depression, coma, pinpoint pupils (miosis)

Question 17

17. Abrupt withdrawal from barbiturates may result in what?

Answer 17

Death

Question 18

18. Buspirone (BuSpar) is solely used for what indication?

Answer 18

Anxiety

Question 19

19. An advantage of BuSpar is that it does not enhance the _____________.

Answer 19

CNS depression of benzodiazepines, alcohol, and barbiturates.

Question 20

20. Zolpidem (Ambien), eczoplicone (Lunesta), and trazadone (Desyrel) have an advantage over other hypnotics in that they do not interfere with what?

Answer 20

REM sleep

Question 21

21. Which significant daytime effect of Benadryl precludes its use for sleep?

Answer 21

Daytime somnolence

Question 22

22. List at least four anticholinergics effects.

Answer 22

Decreased salivation, decreased lacrimation, urinary retention, dry defecation, blurred vision, photophobia, tachycardia

Question 23

23. Why is trazadone (Desyrel) given only at night?

Answer 23

Significant sedation

Question 24

24. Name the five mechanisms of action of antiepileptic drugs (AEDs).

Answer 24

Delays recovery of sodium channels to reduce firing, blocks calcium channels to reduce firing, promotes potassium movement out of the neurons for repolarization, blocks glutamate receptors to prevent excitation, and potentiates GABA to decrease excitability.

Question 25

25. How should a competent prescriber stop an AED?

Answer 25

Slowly titrate off one drug at a time while keeping a seizure frequency chart.

Question 26

26. Name adverse effects of AEDs.

Answer 26

Depression, suicide, and CNS depression.

Question 27

27. What types of seizures are affected by phenytoin (Dilantin)?

Answer 27

All except absence.

Question 28

28. What is the mechanism of action for phenytoin (Dilantin)?

Answer 28

Slows recovery of sodium channels in hyperactive neurons.

Question 29

29. Name common adverse effects of phenytoin (Dilantin) at normal dosage.

Answer 29

Mild sedation and nausea, gum hyperplasia, rash, bleeding in neonates.

Question 30

30. When giving phenytoin (Dilantin) IV, how do you administer it?

Answer 30

No faster than 50mg/min and flush afterwards with normal saline. Also recommend flushing prior to dose administration to clear IV tubing.

Question 31

31. Name the contraindications for phenytoin (Dilantin)?

Answer 31

Bradycardias and heart blocks.

Question 32

32. What pregnancy category is phenytoin (Dilantin)?

Answer 32

Category D

Question 33

33. What would you tell a woman who is taking phenytoin (Dilantin) and oral contraceptives?

Answer 33

Phenytoin (Dilantin) reduces the blood levels of oral contraceptives. Use backup contraception.

Question 34

34. What seizures are affected by carbamazepine?

Answer 34

Tonic-clonic, partial, and complex partial seizures.

Question 35

35. What is the mechanism of action for carbamazepine (Tegretol)?

Answer 35

Delays recovery of sodium channels.

Question 36

36. How does carbamazepine (Tegretol) influence hepatic metabolism?

Answer 36

Carbamazepine (Tegretol) induces (speeds up) hepatic metabolism of other drugs.

Question 37

37. What pregnancy category is carbamazepine (Tegretol)?

Answer 37

Category D

Question 38

38, What antiepileptic drug should not be used during pregnancy? Why? What preventative measure is recommended?

Answer 38

Valproic acid. Causes neural defects and lowers IQs. Take folic acid 5 mg daily in case becomes pregnant.

Question 39

39. What organ dysfunctions may be precipitated by valproic acid?

Answer 39

Hepatotoxicity and pancreatitis. Hepatotoxicity and pancreatitis.

Question 40

40. What is the first drug recommended for acute seizure management? Why?

Answer 40

Lorazepam (Ativan). Lasts 72 hours.