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Pharm test-4
Traditional AEDs
| Question | Answer |
|---|---|
| Phenytoin aka | Dilantin |
| Dilantin is used for what? | Seizures of all types except absence, often with generalized, tonic/clonic, and status ep. And cardiac problems. Narrow therapeutic range. |
| Dilantin administration | PO with meals to decrease GI distress, IM not recommended (painful, erratic absorption, crystallizes causing necrosis, NEVER Sub q. Highly alkaline |
| Dilantin IV admin. | IV not greater than 50mg/min (elderly 5-10mg/min) b/c dysrhytmias, CV collapse, dropped BP. |
| Dilantin Action | inhibits N+ channels, suppresses action potentials, inhibits spread of seizure activity in motor cortex. |
| OD/ Toxic SEs of Dilantin | double or blurred vision, N, V, ataxia, slurred speech, CV collapse, CNS depression, confusion, hallucinations, sleepy |
| SE of Dilantin | rash (D/C drug), hirutism, constipation, drowsy, ginigcal hyperplasia, folic acid deficiency, hyperglycemia, dicolors urine (pink to red-brown) |
| What if a female is on BC? (Dilantin | She needs to use another form of BC other than OC or increase the OC dosage |
| Effects of Dilantin | Decreases effect of warfarin (blood thinner), ETOH increases durg metabolism |
| Teaching with Dilantin | reduce drug gradually, metabolized by liver, excreated in urine (alkaline urine enhances excretion) |
| What is Dilantin frequently combined with? | Phenobarb |
| Barbiturates aka | Phenobarbital, prototype |
| What is a barbituate? | a long acting, widely used, oldest, cheap, AED with few SEs |
| Barbiturates action | potentiates effect of GABA. TR: 15-45 |
| What are barbiturates used for? | generalized, tonic/clonic, febrile in infant, alternate for status ep, sedative/ sleep induction |
| Why would you not give barbiturates to school age children? | Intellectual decline |
| SE of barbiturates | drowsiness, lethary, dizziness, resp depression, broncospasm, dependency with L-T use, N, V, folate deficiencies, male impotence |
| Adverse SE of barbiturates | neurotoxicity, hematologic depression |
| NI with barbiturates | patent airway, resuscitatibe equipment, safety--sedative/hypnotic effects, routine CBC, use another form of BC other than OCs |
| Barbiturates with children | can cause birth defects, paradoxical response is irritability/hyperactivity |
| Valproic Acid aka | Depakene, Depakote |
| What is Valproic Acid's action? | Blocks sodium channels, suppresses calcium influx, and increaess GABA which has an inhibitory effect on synapses |
| What is Valproic Acid used for? | treat absence, myoclonic, tonic/clonic. TR: 40-100 (lower = seizure, higher = toxic) |
| SEs of valproic acid | N, V, indigestion, prolongs bleeding time, possible fatal hepatoxicity--watch for decreased appetite, malaise, abd pain, jaundice |
| What is valproic acid also used for? | bipolar disorder and prophylaxis of migraine HA |
| Contraindications of valproic acid | pregnant-->birth defects (NTD) |
| Carbamazapines aka | Tegretol |
| Tegretol's action | delays neuronal discharge around seizure foci by acting on sodium channels |
| What is tegretol used for? | generalized, tonic/clonic, simple and complex partial in both children (over 5) and adults. Not for absence. #1 drug for partial. Bipolar disorder, trigeminal, and glossopharyngeal neuralgias |
| What is tegretol similar to? | Dilantin, but with fewer SE (GI upset, dry mouth) |
| NIs with tegretol | Blood counts initially and periodically, check for hematologic toxicity (bone marrow depression, aplastic anemias) |
| what are S&S of blood abnormalities with tegretol | fever, sore throat, pallor, weakness, infection, easy bruising, petechiae |
| SE with tegretol | CHF: crackles, water retention, dependent edema, daily weight---rashes, photosensitivity, necrosis, Stevens-Johnson syndrome |
| Ethosuximide aka | Zarontin |
| What is Zarontin used for? | Drug of choice for absence seizures in children and adults (Celontin, Milontin) |
| Contraindications for Zarontin | yellow dye #5 allergy. Take with meals! |
| Action of Zarontin | depresses nerve transmission in motor cortex, raises seizure threshold |
| SE with Zarontin | N, V, drowsy, blood dyscrasis, discolors urine |
| Primidone aka | Mysoline |
| What is Primidone used for? | all major seizure disorders except absence. Nearly identical in structure to phenobarbital |
| Golden rule with primidone | Rule with another AED (phenytoin, carbamazepine) but NEVER with phenobarbital |
| Adverse effects with Primidone | sedation, ataxia, dizziness, confusion in the elderly, paradoxical hyperexcitability in children |
| Serious SE with primidone | psychosis, leuropenia, thrombocytopenia, systemic lupus erytematosus |
| What are benzodiazepines useful for? | As adjunctive and in Status Epx |
| Action of benzodiazepines | increase availability of inhibitory neurotransmitter GABA to brain neurons |
| Diazepam | Valium: restricted to acute tx of status ep and tonic/clonic. Parenteral, short acting, give repeatedly. 10mg: admin. 2mg/min |
| Clonazepam | Klonopin: only one in class used for L-T tx. Long acting, used for absence, atonic, myoclonic |
| Lorazepam | Ativan: status ep. IV-prolonged effect up to 24 hrs. Not faster than 2mg/min |
| what to check for with lorazepam? | physical dependence, check baseline VS, decreases HR, RR, BP, shorter acting. TAPPER OFF |
Created by:
Keller_KI
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